Helpful Topics
Online / Tele-health Sessions
Mar 24, 2020
To continue providing services to our patients during COVID-19 crisis, our providers will be using Doxy.me for HIPAA-compliant video-chat sessions, which insurance will cover. You will need a desktop or laptop computer, tablet or cell phone with a good internet connection. The link for Dr. Miller is: Kevin Miller, MD
Coronavirus (COVID-19)
Kevin Miller MD
Mar 22, 2020
This dangerous virus is easily spread, and carriers may not even know that they've been exposed. To reduce the chance that our offices could add to the spread, we are moving all regular appointments online. The online service we are using is HIPAA-compliant, and no recordings will be made of sessions, either by us or by the service. To make use of this technology, you will need a good internet connection and a device with a camera and microphone, such as a desktop, laptop, tablet or cell phone. We will provide the link when we contact you to confirm your appointment.
Some resources to track the virus:
Johns Hopkins University CSSE (updated continuously)
CDC (Center for Disease Control) (updated M-F only)
St. Louis Post-Dispatch - Missouri information by county
HIMS Psychiatrist
Mar 10, 2020
A HIMS Psychiatrist is a psychiatrist trained by the Federal Aviation Administration (FAA) to evaluate airmen (pilots, student pilots, air traffic controllers, and others) for medical certification based on aviation standards. When questions about alcohol or drug use might affect medical certification (for example, a history of DUIs, drug arrests, or drug use), the FAA will usually request a HIMS psychiatric evaluation to help determine if formal involvement in a HIMS program is needed.
Although not related to the need for HIMS programs and questions of addictions, HIMS trained psychiatrists also perform psychiatric evaluations in accordance with aviation standards for airmen with a history of other psychiatric diagnoses (for example, ADHD, depression, anxiety, PTSD, OCD) or a history of treatment with certain medications (such as antidepressants, antianxiety medications, stimulants, mood stabilizers, pain medications), to help the FAA determine if they qualify for medical certification, or if additional steps will help them qualify.
Consulting a HIMS psychiatrist early in the medical certification process can avoid a lot of back-and-forth with the FAA and save substantial time in the certification process. Dr. Miller has been a HIMS psychiatrist since 2014.
What If I Have No Insurance?
Aug 26, 2013
Some of our providers will work at a reduced rate with people who are financially unable to pay but this is determined on a case-by-case basis, and none of our providers is obligated to accept a reduced fee.
Every county in Missouri has a state-subsidized Community Mental Health Center offering sliding scale and free mental health services. Click here to find the services in your county. Also funded by the State of Missouri is Behavioral Health Response, providing 24-hour emergency mental health assistance.
In St. Louis County, the county run and subsidized medical cllinics have, in the past, teamed up with the university medical schools to provide psychiatric services. Location and contact information for the three county health clinics can be found here. Call first to make sure those services are still offered.
If you are a past client of the Department of Health's Family Mental Health Service, or a resident of Saint Louis County, you can contact the Family Mental Health Collaborative at (314) 993-1000.
A more extensive list of mental health services and resources can be found at the Mental Health America of Eastern Missouri's website.
Dreams and Dream Interpretation
Oct 21, 2012
Dreaming is a normal part of sleep, occurring about every ninety minutes whether you remember your dreams or not. They last about as long as they seem to last. Despite years of research, the function and importance of dreaming are not well understood. Some medications can dramatically suppress dreaming, yet no daytime consequences have been identified.
Some dreams feel like they're actually happening, others like a story is being told. Some people dream in color, some in black and white. Some dreams are pleasant, very creative, or simply fantastic, while others are traumatic. Much of the detail of a dream evaporates from your conscious mind within seconds after awakening. If you're serious about working with your dreams, keep a pad by your bed so you can write down the dream in detail as soon as you wake.
For centuries, people have attributed special meanings to their dreams: foretelling the future, exposing a hidden truth. Some schools of dream interpretation asign specific meanings to objects in dreams, regardless of the person's life events: a dog representing security and/or faithfulness; a snake representing sexuality. Some books claim to be encyclopedic guides to dream symbols.
Sigmund Freud's major contribution to dream interpretation was having the dreamer "free associate" to dream elements -- simply saying whatever came into their mind about things in their dreams. Recurring dreams are a common sign of an emotional struggle. Psychotherapy with an experienced counselor or therapist can help you understand your dreams, and maybe improve your sleep! Call for an appointment with any of our therapists for help with troubling dreams.
Divorce
Oct 07, 2012
Even the best divorces involve changes that can be emotionally challenging: loneliness, financial fears, new routines with children and the functioning of the household. Unfortunately, most divorces aren't among the best, with one side choosing divorce before the other, catching the other by surprise. This can stir up intense feelings in what may have already been a difficult relationship -- feelings such as betrayal, abandonment, lonliness, and fears about the future. As the process proceeds, the couple may become increasingly embattled, helpless, angry, and even malicious. Fears of loss, and betrayal through affairs and aggressive behavior, can leave both sides feeling alone, worried for the health of their children, and, if they're not careful, resentful and bitter. The strain of divorce can also worsen a pre-existing mental health problem, such as anxiety, depression, or addiction.
Psychotherapy can help people remain "centered" -- on their feet, emotionally -- as they go through challenging times. Making decisions that are clear and rational but protective and emotionally sustaining can ease a difficult divorce, benefitting you, the divorce process, and involved children. All of our providers have had experience working with people going through divorce. If you're feeling emotionally challenged by marital struggles, a divorce or separation, or the aftermath of a divorce, our providers can help you find ways to cope better and function more effectively. Call now! You don't have to do this alone.
Schizophrenia
Kevin Miller MD
Sep 20, 2012
Schizophrenia is one of the best known but least understood psychiatric disorders. It's an often devastating neurological illness that is managed by psychiatrists and other mental health professionals because of it's signs and symptoms, which can include auditory hallucinations ("voices"), visual hallucinations, and paranoid thinking -- believing someone is out to do the person harm. The first episode of illness in a person is usually the most dramatic, typically occurring between mid-teens and 25 years of age. Onset is over several months, with a gradual deterioration in functioning and self-care. Death by accident, suicide, and other violent means is more common in people with schizophrenia than in the general population. Addictions are, too.
Paranoid thinking and hallucinations are frightening to the sufferer, and hospitalization is often sought, either by the patient or those concerned for them. With prompt use of medication, relief can occur quickly but full normal functioning may not return, or may take a long time.
The causes of schizophrenia are unknown. It's clear that some families have an increased genetic susceptibility to the disease but environmental factors are thought to be very important because many family members will not be affected, there is a seasonal pattern to onset, and early treatment may limit the extent of the illness. Oddly, regular marijuana use is associated with an earlier age of onset and more severe course for the illness.
A mental health professional can help you decide if someone's symptoms represent schizophrenia or one of the other illnesses that can be confused with it, and help guide you to an appropriate treatment plan.
Panic Disorder
Kevin Miller MD
Aug 26, 2012
Panic attacks are relatively common, with a large number of people experiencing at least one panic attack sometime in their life. Onset is usually sudden, lasting from several minutes to an hour, with intense symptoms such as feeling short of breath, racing or pounding heart, sweating, shaking, or a sense that something terrible is about to happen. Because the symptoms can include chest pain, fear of a heart attack and a trip to the emergency room are common. Attacks can occur after a clear trigger or without warning for no identifiable reason -- during calm times, stressful times, or even in the middle of the night. The victim may feel exhausted afterwards, yet live in fear of the next attack.
If someone has enough panic attacks in a month without identifiable cause, they may meet criteria for panic disorder. More panic attacks means more time worrying about the next one, more time avoiding things that are reminders of past attacks, and less time engaging in usual activities. The risk of suicide in panic sufferers is similar to the risk in depression.
Treatment of panic disorder involves psychotherapy, medication, or both. Cognitive-behavioral therapy is the best studied and most commonly recommended form of psychotherapy for panic disorder. Commonly used medications include several medications originally approved as antidepressants but which have since been shown to work for panic disorder -- such as sertraline and paroxetine -- and the benzodiazepines -- such as diazepam, lorazepam, alprazolam, and clonazepam. Your mental health provider can help establish the diagnosis, rule out other explanations for your symptoms, and devise a treatment plan that works for you.
OxyContin, Heroin and Tragic Teen Deaths
Jul 03, 2012
With many drugs of abuse, too much can mean you either get sleepy or fade out -- alcohol, sleeping pills, solvents, or marijuana -- or you become psychotic -- the paranoia of cocaine, the psychosis of psychedelics. In the first case, you fall asleep, in the last you end up on a psychiatric unit.
OxyContin and heroin are a completely different story. Both are members of the opiate family, named for the family's origin in the opium plant. They work by blocking opiate receptors in the brain and spinal cord. For pain relief, that's a good thing. But opiates also control breathing: too much effect and you stop breathing. This does not mean you get short of breath! When the opiate effect is too strong, your desire to breath just stops. In just a few minutes, lack of oxygen starts to kill cells in your brain and your heart, organs that will not recover. On the street, there's no quality control, and you have no way of knowing how strong heroin will be.
In the 1960's, the War on Drugs was mostly about heroin. With the rise of cocaine, and especially crack, demand moved to those drugs, and the War became focused on them, with heroin moving to the sidelines for decades. Young people coming upon it for the first time in the last few years had no idea what they were dealing with. Now we had an epidemic of fatal heroin overdoses in teenagers.
Posttraumatic Stress Disorder (PTSD)
Kevin Miller MD
May 20, 2012
An emotionally traumatic event is one that is very frightening or overwhelming, where you're afraid you or someone else will be seriously hurt or killed, or you have witnessed someone being seriously hurt or killed. Examples of events that may be traumatic are unexpected deaths, motor vehicle accidents, fires, natural disasters, combat situations, frightening medical diagnoses, treatments or conditions, childhood physical or sexual abuse, robberies and assaults, and rape.
Posttraumatic Stress Disorder (PTSD) does not always occur after a traumatic event, and different people can have the same experience with only some developing PTSD. Some people are biologically at greater risk for PTSD, and people are more likely to develop PTSD when they've experienced trauma before, especially in childhood. About five percent of Americans will experience PTSD at some point in their life.
Symptoms of PTSD can begin right away or be delayed as long as years. Symptoms may include impaired concentration, loss of sleep, loss of interest in familiar activities and irritability; nightmares, flashbacks (experiencing parts of the event happening over and over) or intrusive memories of the traumatic event; being easily startled and hypervigilant for threats; emotional numbing and difficultly experiencing closeness to others; and increased physical and emotional arousal when reminded of the trauma, or avoidance of reminders. Such reminders, or triggers, can include television shows, movies, visiting the trauma location, talking about the event, hearing about similar experiences, hearing a sound or being exposed to a smell or a sight that is a reminder of the trauma, or just a certain time of year or day of the year. Arousal may appear as elevated heart rate, shortness of breath, sweating, shaking, stomach upset, and feelings of fear, shock, anger, sadness, helplessnes, and being alone.
Some people will experience PTSD symptoms for a short time after a traumatic event but then the symptoms go away on their own. In others, symptoms can continue indefinitely. If enough symptoms continue for more than a month, treatment is indicated. Treatment options include various forms of talking therapies, meditation, EEG brain wave training, and medication. Specific techniques used in talking therpy that can be very powerful and very helpful are hypnosis and EMDR (Eye Movement Dissociation and Reprocessing). Effective treatment often requires more than one treatment option.
One of our mental health providers can help you decide if you have Posttraumatic Stress Disorder and get your treatment started.
Anger and Irritability
May 20, 2012
Anger is a normal emotion -- you were born with the ability to feel and express anger. It can protect you and those you care about. "Irritable" means you tend to get angry easily, in reaction to simple annoyances or minor threats. If you get angry too easily, or your anger leads to aggressive behavior, it can damage relationships, cause you emotional, physical or legal harm, and can result in violence or injury to others.
Problems with anger or irritability may exist on their own or may be a sign of a psychiatric disorder or mental health condition, such as depression, Bipolar Disorder, an anxiety disorder, Attention Deficit-Hyperactivity Disorder, or intoxication with or withdrawal from alcohol or others substances. They can also happen in response to some medications and medical conditions.
No matter what triggers your anger, help is available. A mental health expert can help you identify psychiatric disorders that may be causing or worsening your irritability, guide you through appropriate treatment for it, help you develop more effective coping strategies to deal with your feelings of anger, whatever the cause.
Depression
Kevin Miller MD
May 18, 2012
Depression, sometimes referred to as "clinical depression" or Major Depression, is a disorder of the brain and mind that can impair social, school and work functioning, causes a substantial amount of suffering and disability, and can result in death due to suicide or to failure to care for one's needs or health. It's estimated to affect more than one in five people during their lifetime, and many more through how it affects families and relationships.
Common symptoms of depression include disturbed sleep and appetite, impaired concentration and memory, feeling worthless or guilty, and loss of energy, motivation, and interest in things. Depressed people often lose the capacity to enjoy life. Hopeless feelings and thoughts of suicide may be present.
Some people have one episode of depression in their life time, some have many episodes, and they can start as early as childhood. Some episodes will respond to psychotherapy (talking therapy), some to medication, and some require both. Other treatments, such as electroconvulsive therapy, are still available for the most severe forms of depression.
A mental health professional can help you diagnose depression, select a treatment, and start you on the path to feeling well and enjoying life.
Bipolar Disorder
May 14, 2012
Bipolar Disorder, also called manic-depressive illness, is a disorder of mood and functioning. It involves episodes of significant mood swings, with weeks-to-months spent depressed (see entry for depression) and days-to-weeks spent in a phase of elevated or irritable mood. There may be long periods between these episodes, sometimes a decade or longer, or episodes may happen as often as several times each year. Bipolar Disorder affects less than five percent of the population during their lifetime.
The periods of elevated or irritable mood in Bipolar Disorder involve other symptoms such as loss of need for food or sleep, excessive energy and activity, rapid speech, jumping quickly from one activity to the next, enhanced or inflated self-esteem, and increased involvement in pleasure-seeking or risky behaviors, such as driving faster, spending too much money, increased libido, and impaired social judgment. If the episode is severe enough to interfere in a person's life, it's usually called a manic episode. If it's distinct but doesn't cause major difficult for someone, it's probably a hypomanic episode.
Bipolar Disorder can be confused with other conditions that can affect mood, such as drug and alcohol problems, medical disorders, anxiety syndromes, and attention deficit-hyperactivity disorder. A mental health professional can help diagnose bipolar disorder, help you understand the effects it has on your life, and help you recognize barriers to effectuve treatment. Medication is a crucial part of effective treatment for Bipolar Disorder and must be prescribed by a physician. Psychiatrists are specially trained in the medication treatment of this disorder.
