Abolish TV

Here are 10 reasons, feel free to ad more in the comment section:

1. You watch other people work.
2. Guaranteed brainwashing.
3. Faster death by sitting all those extra hours on your butt.
4. (Mainstream) TV is like yesterday’s newspaper. No original thought, mostly regurgitated online content.
5. Negative bias towards murder, horror, filth and every other display of based human behavior.
6. TV aims for your amygdala. Why would you want to constantly fear-activate this part of your brain?
7. TV polarizes. What happened to rational thinking? I forgot, that’s boring…
8. People who don’t stop preaching are annoying at best, dangerous at worst. TV is a preacher’s monologue. It kills the dialogue of human communication.
9. You will waste money.
10. Video killed the radio star - TV killed your family life and entire communities. 

Abolish TV from your life.

Your iPhone Is A Weapon Of Mass Distraction

Multi tasking is dead. 

Actually, it was never alive, dead on arrival so to speak...
Single tasking is all you ever needed.
So how do we focus when we are glued to our "devices":

Glad you've asked.
Rule Your Devices. Stop Being Your Devices' B*&ch.
See, your phone can be very helpful when you use it as a tool instead of letting it become the single most destructive weapon of mass distraction (WMD).
The following step will help you return to being a productive and mindful human. In addition, you will live a longer and happier life. I have an iPhone and the following steps are written for iPhone users but I bet Androids can figure out the same steps on their platform.
Lastly, what you find here works for me. I trust that you can adapt it to your situation. That said, err on the side of less.

Here's the most important step: Turn off notifications.
Notifications fake importance by coming across urgent. But not everything that is urgent is important. Notifications are disruptive, they have taken me and will take you away from the goals we fave. Have you every been working in a flow state? Good. Know that notifications will kick you out of it. Repeat after me: "I Am the Ruler of My Phone." 

To do this, open Settings > Notifications. Now go through every app listed and turn off all notification:

• For most apps, you can safely switch off "Allow Notifications". 
• If you need to leave notifications on, minimize their detrimental effect:
• Switch off sounds
• Switch off badges - those annoying white numbers with a red background in the upper right hand corner of the app indicating that a new message, email, voicemail, or notification is waiting.
• For really important notifications, you can allow alerts in the Notification Center.

I will repeat myself here: Turn all badges off. Except a for a very few apps, turn all notifications off as well. 

• Only a few apps can have notifications on, for example:
• Your calendar app should have notifications on.
• Google Maps should have notifications on
• The phone app should have notifications on.
• Leave notifications on for delivery or transportation apps (Grubhub, Seamless, Uber, Lyft). Even for those apps: No badges allowed!
• For text message, leave banners on and turn badges off. You will see most of your text messages on your home screen when they come in. You don't need the badge for text messages, it will just give you FOMO.

And Now to Social Media: Facebook, Twitter, Instagram... Hide them all. 

• Open a folder, they all go in there. Name the folder "Dilly Dally".
• The most addictive apps go on the 2nd screen of the folder. If you keep them on the first screen, they are still sirens calls luring you in. 
• Ideally, most apps are on the 2nd screen and  the first screen only shows a couple. 
• If you really want to push the limits: Delete your "Dilly Dally" social media apps. LinkedIn is okay.

All Messaging Apps Need to Get Out Of Your Face As Well. 

• All mail maps, the Messages App, WhatsApp go into another folder an on the second screen within the folder. Again, NO BADGES. If important, they can alert you via banner. 

Thou Shalt Not Steal

Have you every wondered why all these apps prompt you to rate them and write a review?
They want good ratings to get more customers and more sales. Stop giving them reviews! 

• To get out of this, go to Settings > Apple ID > iTunes & App Stores > In-App Ratings & Reviews

How to Catch Butterflies - On Thinking Original Thoughts

Spongebob SquarePants 

I haven't spent much time evaluating SpongeBob properly - I doubt he would make it through a full session. From what I can tell, he's not the most psychologically minded creation. It's a mystery to me how he's catching butterflies at the bottom of the Bikini Atoll. Maybe the radioactive fallout has created not only Spongebob SquarePants but also deep-sea butterflies. 

The reason Spongebob SquarePants entered my mind is that I thought about how to become more aware of my own thoughts, especially those fast, not automatic but high-speed cognitions that easily go unnoticed. That is what Daniel Kahneman describes as system 1, I propose SpongeBob only operates there. 

How to catch your own thoughts, let alone the thoughts of my patients? 

Is it like catching butterflies, armed with a huge net, you frolic in your thoughts and bring that's how you become aware of them? For sure, one of the exasperating but depending on the situation saving traits of our thoughts is that they are rather elusive. It's probably not as tricky as catching the Higgs Boson but difficult nevertheless. The constant urgent and unimportant, meaningless noise from our beloved "devices" has made it even more difficult to catch our thoughts.

That's an issue of modernity - that everything tries to catch our attention, because attention is a most precious commodity.

Not trying to catch your thoughts and not engaging in deep, effortful and focussed thinking we keep us shallow and reactive to whims of whatever and whoever succeeds in grasping our attention, chipping away from our ability to understand ourselves and our place in this reality.

And if that wasn't enough, our emotions interrupt our thinking as well. One of those emotions is anxiety, which often puts a quick stop to original thoughts. Thoughts that easily trigger anxiety are everything that is ad odds with what we think people around us do and should think about us. Thoughts that are forerunners of realizing that some decisions have led to unfortunate consequences. Thoughts at odds with current commitments and habits. We might not want to catch every thought. How about the ones that bring loss, failure and disappointment into our awareness? Very few things in our life elicit thoughts and emotions with the same emotional value, that is all good or all bad. With most people, events, even ourselves, we are ambivalent as there is light and shadow, qualities we cherish and qualities we abhor. 

So, catching butterflies seems to be a trivial pursuit compared to catching our thoughts. "What was I thinking?" is one of the crucial questions to ask repeatedly but to sit in silence and to simply think harder would we the equivalent to swing the net more furiously through the air when catching butterflies - probably not the best strategy. Our mind does not do too well when all we allow a mind to do is thinking and it can do a terrific job in keeping cognitions that might elicit negative emotions such as anxiety in the depths away from the conscious "surface". 

But we can help our mind, the trick is to lower its guard with benign distraction and solitude. That could be a journey alone, a train or bus ride. Or we could go alone to a cafe, take a walk in the park or the countryside, sit next to a stream or the ocean. A few things help us here: For once, distance allows our mind to be more willing entertaining challenging ideas. When outside walking, we do that automatically while we have to also take notice of what's going on around us. This might be enough "distraction" for our emotions to guard towards the outer world and allow original thoughts to slip unnoticed.

When I was a child, I took long walks with my best friend around the small town in Germany I grew up in. I realize now why that was so helpful for our development as independent thinkers. 

I suggest you take a walk now. 

Friendship Is Founded On the Possibility of Mutual Destruction

To be a good friend is more than to be polite, thoughtful and compassionate. Friendship requires taking the risk of giving our friend something that they could use against us. We do that, so friends feel safe giving us something in return, that we could use against them. It is peculiar that the real possibility of mutual destruction should build the trust our friendships grounds on. 

Pillen Gegen die Traurigkeit

Eines Abends setzte sich ein alter Mann zu mir und erzählte:

"Weißt Du, mein Sohn, irgendwann einmal, kurz nach diesem gewaltigen

"You know, my son, at some point in the future, just after this gigantic last bang, when the

Allerletzten Knall wenn's auf der Erde nur mehr große, nackte Steine gibt

Mit einer fettigen, schwarzen Rußschicht bedeckt, wird ein großes, weißes

Strahlendes Raumschiff landen. Irgendwo zwischen dem ehemaligen Los Angeles

Und dem verdampften Schwarzen Meer. Und diese fremden, hochgewachsenen Wesen

Werden Pillen an Bord haben, die sie uns Menschen als Geschenk überreicht hätten

So wie man immer, wenn man irgendwelche Wilde besucht, ihnen kleine Geschenke überreicht

Pillen gegen die Traurigkeit hätten sie uns geschenkt, wenn wir noch dagewesen wären

Stell Dir vor, mein Sohn", sagte der alte Mann ganz traurig

"wunderbare, kleine Pillen gegen die Traurigkeit

Und diese fremden, hochgewachsenen Wesen werden ihr Raumschiff verlassen

Sie werden sich umsehen und sofort wissen, daß hier vor kurzem ein gewaltiger

Ein allerletzter Knall war. Und dann werden sie sich kopfschüttelnd zwischen die großen

Nackten Steine setzen und schwer durchatmen

Und jeder von ihnen wird schnell eine Pille gegen die Traurigkeit schlucken

Einer von ihnen wird sogar mit dem Finger in die fettige

Schwarze Rußschicht an einem großen, nackten Stein schreiben:

Wir hätten so gerne gewußt, wie Du bist!

Wie Du aussiehst! Wie Du sprichst! Mensch!

Und dann plötzlich wird einer von ihnen was rufen, er wird rufen

Daß er was gefunden hat. Und das wird ein alter, verbeulter

Kleiner Filmprojektor sein mit einem eingespannten Film

"Ja, warum nicht", sagte der alte Mann. Und sie werden sich freuen

Die hochgewachsenen fremden Wesen

Sie werden warten, bis es dunkel ist und den Film auf ihr strahlendes

Weißes Raumschiff projizieren. Und sie werden sehr staunen

Denn sie werden einen Micky Maus-Film sehen. Einen Micky Maus-Film

Mit Donald Duck, Kater Carlo und Goofy

Und diese fremden, hochgewachsenen Wesen werden in ihr Raumschiffsteigen und sagen

Sie waren lustig, diese Menschen. Sie haben lustig ausgesehen

Sie haben lustig gesprochen

Wir hätten unsere Pillen gegen die Traurigkeit völlig umsonst überreicht."

How Much Sugar Can I eat? Defining Low Carb

I am a sugar addict in early remission. 

What is helped me to increasingly lower my sugar intake and now comfortably stay in ketosis for several weeks has been the increasing insight into the negative effects on (refined) sugar) on human health and wellbeing and the personal experience of how sugar affects me.

From what I can tell, our Western diet is characterized by a high carbohydrates intake. The differences between my diet in Germany when I grew up and the so called Standard American Diet (SAD - nomen est omen) are probably marginal. Both had high carb contents, the use of high fructose corn syrup was probably higher in the US but Germany has been catching up over the past decades. 

There are numerous lines of evidence (=published, peer controlled, large scale studies, including randomized clinical trials) that demonstrate the plethora of positive effects of lowering your overall carb intake. I shall post more about that in the future. 

For now, it's probably good to start with definitions - to clarify, what I mean by low carb and how far you would have to cut your carb intake to be considered being on a low carb diet. 

A good point to start is a review by Feinman et al. It's a review and for those interested RTWT (read the whole thing). Feinman looked at carbohydrate restriction as a first approach in diabetes management. For that matter, they define diets by their carbohydrate content:

• High carb: Over 45% of the total caloric intake comes from carbs

• Moderate carb: 26-45% of the total caloric intake comes from carbs 

• Low carb: Less than 26% derived from carbs. That's less than130 grams of carbs/day

• Very low carbohydrate ketogenic diet (VLCKD): Less than10% of calories (20-50 grams of carbs) 

What do I do with that information:

The average American today derives about 50% of calories from carbohydrates. The SAD is a high carb diet and that's what's driving the obesity epidemic. Sadly, the American Diabetes Association still recommends a high carb diet (sic!)

Moderate carb intake (26-45%) is the upper limit for living a healthy life in the author's opinion. Interestingly, that is also what average Americans ate before a few decades ago. Just have a look at TV footage from the 60s or 70s (moderate carb intake) and compare that to what you see on TV today (high carb intake). Notice the difference? 

Low and very low carb (VLCKD) diets offer is where weight loss and maintenance of a healthy body weight and composition become simple and sustainable. On this diet, your carbohydrate intake is less than 130 grams today for the low carb diet and between 20-50 grams today for the very low carb diet (ketogenic diet). That's not a lot of carbs by today's standard. A coke and chips - I'm not even adding the sandwich that would go well with that - will get you certainly get you above 50 grams. You will need determination to stay on a low carb intake if you've lived high sugar life before. It does not necessarily have to be a very low carb diet (keto) but when your carb intake is that low, your body will start to produce ketones by burning fat and both body and mind will run well on it. Your energy levels will be more even keel and your mind is less perturbed by the spikes of insulin and glucose levels observed on the high carb diet because carbohydrate restriction will keep your insulin levels low. If you want to lose weight, go very low carb (keto), I would even recommend fasting. You can fast for a long time, a very long time if you stay on top of your hydration and minerals and vitamins. Angus did. His body was running on ketones. Nothing wrong with that. In fact, lowering your carb intake will increase your health if you're on the SAD. If you want to change that, here's all the diet you need:

H2O

Realism 101 - Expect Screw Ups

Every day, I expect life to screw up my plans.

That's not a very optimistic way of looking at it, but it has helped me to manage my unrealistic expectations. What it does is leaving more space for the unforeseen, unknown and error. That space is needed. Not leaving it accounted for 40% of self-inflicted dis-stress and dis-ease over the past years. The remaining 60% were caring too much what others think about me. And that's a story for another day...

Every day, life will screw up my plans

In Jiu Jitsu, you will likely have a plan how to submit your sparring partner.
And he will have his.
Therefore, he will try to screw up your plans. Has to. You are doing the same.
Now you can try and muscle it through and and waste a lot of energy or you can observe and look for your opening elsewhere. You will likely not find it where you thought you would, but it it could well be the opportunity you needed to succeed and submit.

Every day, life will screw up my plans.
Leave room for the unforeseen, unknown and error.
That is life, better live with it.

Problem Solving Algorithm

I find myself making the same mistakes. I assume this is not only my problem, more likely an almost universal human trait. People who ask me for help almost always want help for a repetitive problem that has caused enough cumulative grief and pain to be addressed now.

Of course, we could have thought about more efficient strategies, such as solving the problem, after it occurred first. That would have been a much better timepoint and if you prefer, I will let you dwell in masochistic hindsight for another minute.

The Best Time to Address a Problem is Right After We become Aware of It and Before It Happens Again... the Next Best Time to Change It Is Now.

This should help shortcutting the frustration we derive from the "would have, should have" of thinking about problems by thinking about as repetitive failures to "fix" them. 

Now is the next best time when you learn to operate guided by your principles rather than your goals. 

Now talking about a problem repeatedly in therapy will be fine as long as it leads to 

1.) a better understanding of what the problem is and 

2.) to problem solving  by devising a strategy next

So, the basic algorithm to solve repetitive problems is:

define > strategize > implement  > monitor

Define the problem, strategy a way to solve it, implement the strategy with concrete steps and monitor implementation until you have formed a routine that helps establish different, more helpful behavior. Fine tuning of strategy, implementation and routine happens along the way, because nothing we devise will immediately fit like a glove.

Working on problems with this approach will be in particular helpful to people with ADHD or bipolar disorder. Therefore, this is relevant of several of my patients and if you're one of them, I encourage you to give it a try or bring your ideas and feedback to our next appointment to work on it collaboratively.

Benefits Of Stucture & Routine For Children

                               Picture found here

Structure can create stability, safety and orientation to your life, the life of your children and your family as a whole. Children feel safer with structure because it makes life predictable and they know what is coming next. Routines are a way to add structure to your days. 

You can create routines by following 4 steps:

1. Identify the routine
2. Explain the routine
3. Stick to the routine
4. Use consequences

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To identify the routine, think about what part of your day could use more structure. Recurring events where structure is needed and routines are helpful could be mealtime, going to bed, even a clean-up or getting out of the house routine. Identify the routine, the activities that need to happen and their order.

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You will have to explain the routine well, so your child knows what is expected and will happen: What, when and where. A chart illustrating the individual steps with space to check steps or the whole routine off as a feedback helps your child and yourself to be consistent and to establish the routine.

ad 3.

Now, you will need to follow the routine, this is difficult for your child when it’s about chores or stopping playtime or going to bed. This can also be challenging for the parent when being tired and irritable after a long day gets in the way. Think about your routines as the beta versions of software. Your kids will test the software (= the routine). That’s what kids do. It’s your job you ask yourself if you need to adapt the routine to your life so it continues to “fit” well and make your life easier. What that means is that good routines and helpful structure allow you to be present and engaged in your life without giving you a sense of monotony or being constricting. Form follow function. Routines are there to help you and not mindlessly performed.

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If establishing routines for your family, you will have to remind your child what happens if he does not follow the routine. For example: “If you don’t clean up after playtime, there will be no dessert after dinner.” Even better, use much praise (positive reinforcement) to help strengthen routines. If you need to change a routine, let yourself, child or family know about it and explain what will happen instead. You will need to fine tune or even change or suspend routines depending on what is going on in your life. Too much structure will cause rigidity and stop life from moving along. With not enough structure, especially family life easily disintegrates into the chaos that prevents life from developing in a meaningful way.

Treating Autism With Drugs

Pharmacological Treatments for Behavioral Symptoms Associated with Autism Spectrum Disorders (ASD)

This is a summary of a 2012 review paper by Doyle and McDougle. Of course, the pharmacological treatments should only follow AFTER behavioral interventions have been tried consistently and repeatedly without sufficient success and if the problem at hand is actually getting in the way of the patient’s daily functioning.

I am now always through with this review and will finish this post over the next days. This will include the information from newer reviews published after 2012. 

While I am a psychiatrist, this is not intended to replace a psychiatric consultation or discussion of medication with your psychiatrist. 

I have been supervising NP students while on call at NYP-Brooklyn Methodist Hospital and instead of repeating myself, I will post important professional information on my blog for my students to review.

With that said:

Tl;dr: 

• Behavioral Symptoms in ASD are repetitive and stereotyped behaviors, irritability & aggression, hyperactivity & inattention, and social impairment.
• Antispychotic drugs (APD) are the most efficacious drugs for the treatment of irritability & aggression in ASD, and maybe useful for the tx of other sxs as well.
• Psychostimulants demonstrate some benefit for the tx of hyperactivity & inattention in patients with ASD BUT are less officiations and associated with more adverse effects compared with patients receiving them for ADHD.
• SSRIs are less efficacious and 
• D-cycloserine and memantine appear helpful in the tx of social impairment, HOWEVER, the evidence for this is still limited.

In-depth:

Autism Spectrum Disorders (ASDs) is a widely used term, most commonly referring to disorders such as Autism, Asperger’s (disorder) and Pervasive Developmental
Disorder (PDD). 

A few definitions are in place:

1. Autism:
1. Characterized by 
1. Impaired reciprocal social interaction
2. Aberrant language development
3. Repetitive, stereotyped behaviors, interests or activities.
4. Delay/dysfunction of social interaction, language or symbolic/imaginative play must be present before age 3.
2. Asperger’s disorder requires impairment in social interaction and a pattern of restricted & stereotyped behavior but differs in that language and cognitive development are preserved (“weird but smart”, think Sheldon Cooper).
3. PDD-NOS (Pervasive Developmental Disorder Not Otherwise Specified) is diagnosed when there is a
1. Severe and pervasive social impairment
2. Abnormal communication or stereotyped behavior 
3. But the criteria for Autism or Asperger’s disorder are NOT met.
4. Other rare pervasive developmental disorders include
1. Rett’s disorder
2. Childhood Disintegrative Disorder

Side note here: You might notice that the diagnostic criteria for Autism and PDD sound quite similar. In fact, do not assume that people use the terms above as defined above. Many doctors use PDD as a way to not diagnose autism and to avoid the word. This might be done to avoid stigma. However, by narrowing autism to only the most severe cases, the definition is narrowed without scientific evidence and diagnosis terms lose their value. In my clinical practice, I try to use the term Autism Spectrum Disorder and explain to my patients and parents that Autism exists on a spectrum of symptoms and severity. I find this clearer and less stigmatizing because most people can conceptualize that human traits and behaviors are seldom qualitative (“yes/no” or “on/off”) but rather quantitative.

Children and adults “on the spectrum” often have behavioral symptoms associated with their condition:

• Repetitive and stereotyped behaviors
• Stereotyped motor mannerisms such as hand-flapping, clapping, rocking, spinning, inflexible adherence to nonfunctional routines or rituals (the latter might look like OCD sxs).
• Irritability and aggression
• Severe tamper outbursts and/or impulsive aggression towards self and others (occurs in 30% of children and adolescents with ASDs)
• Hyperactivity and inattention
• 40-60% of children dx with ASDs also meet criteria for ADHD.
• Common in ASDs but ASD dx excludes concurrent ADHD dx.
• Social Impairment
• Lack of social or emotional reciprocity
• Impaired gestures used to regulate social interaction

Doyle and McDougle reviewed the literature about pharmacological interventions to treat these disorders. The most common meds used in behavioral sxs associated with ASDs are 

• SRIs (Serotonin Reuptake Inhibitors)
• Antipsychotics (APDs)
• ADHD meds

Overall: 

1. SRIs are LESS efficacious  and more poorly tolerated in children with ASDs compared with adults.
2. APDs are the most efficacious drugs for the treatment of irritability but useful for the tx of other sxs, too.
3. Psychostimulants demonstrate some benefit for the tx of hyperactivity and inattention. They are less efficacious and have MORE adverse affect when given to patients with ASDs compared to their use in patients with ADHD.
4. Other meds that MAY be helpful for various sxs include
1. Mirtazipine
2. Atomoxetine
3. Alpha-2 agonists
4. D-cycloserine
5. Memantine

SRIS and other meds affecting serotonin neurotransmission

Serotonin abnormalities have been implicated in ASD for >50yrs. Therefore, studies have looked into the effectiveness of SRIs in ASDs. Results have been MIXED, SRIs appear to work better in adults than children with ASDs and have less side effects when used in adults as well.

1. Clomipramine has been shown to be efficacious for the tx of repetitive behaviors and stereotypes in some individuals with ASDs, and may be helpful with aggression and hyperactivity. HOWEVER, many children and adolescents have adverse effects. 
1. The dose range across various studies ranged from 75 to 250mg/day, sometimes in divided doses.
2. Adverse effects from minor to significant included
1. Sleep disturbance
2. Dry mouth
3. Constipation
4. Fatigue/lethargy
5. Dystonia
6. Depression
7. Behavioral problems
2. Fluvoxamine is minimally effective and poorly tolerated in children and adolescents with ASDs ALTHOUGH it has been found to be officiations in the management of repetitive and maladaptive behaviors and aggression in some adults with autism.
3. Fluoxetine has not been found to be effective in the treatment of repetitive behaviors in children. Again it has been proven to be more effective in adolescents and adults with autism with adolescents having more side effects from it. The dose range for fluoxetine in adult studies was 20-80mg/day.
4. Sertraline is moderately effective and relatively well-tolerated in the management of repetitive behavior and aggression in adults with ASD. There is only minimal data in children. Adults tolerated 25-200mg/day. Discontinuation occurred 2/2 increased anxiety or agitation, worsening of self-picking or non-complicance. The most common adverse effects were weight gain and anxiety or agitation.
5. Citalopram limited efficacy for children and adolescents and higher associations with side effects. Not sufficient data base for adults with ASDs.
6. Esicalopram does not have enough data to draw conclusions.
7. Venlafaxine is a combined serotonin and norepinephrine reuptake inhibitor (SNRI). Studies are limited and small and found that it is somewhat effective in children, adolescents and adults.
8. Trazodone, a heterocyclic AD, has not been sufficiently studied.
9. Mirtazapine, a tetracyclic AD, which antagonizes both alpha-2 adrenergic and serotonergic receptors, is somewhat effective in managing some symptoms associated with autism, including inappropriate sexual behaviors.

Antipsychotics

1. Haloperidol has been demonstrated to be efficacious in the short- and longterm tx of sxs associated with autism. 
1. In adults, haloperidol is superior to clomipramine in the management of irritability.
2. Studies in children have shown that haloperidol is superior to placebo in reducing stereotypes and social withdrawal and maladaptive behavior.
3. Higher IQ is more predictive of a greater symptom reduction and there was a greater reduction of sxs when the severity of illness was greater.
4. Adverse effects include
1. Dose-related sedation
2. Rarely dyskinesias
3. Long-term dyskinesias are not found to be a problem during short-term tx.
4. Found efficacious in long-term tx (>6mt) with greatest response for irritability, labile and angry affect and uncooperativeness. 
5. HOWEVER, 34% of subjects developed dyskinesias in one long-term study.
6. Risk factors for dyskinesia are
1. Female sex
2. Treatment length
3. Higher doses
7. Haloperidol appears to be more effective compared to fluphenzine.
8. HOWEVER, haloperidol has been less effective than risperidone in the short- and longterm tx of behavioral sxs, impulsivity, and impaired language skills and social relations. 
9. Haldol is COMPARABLE to olanzapine in sxs reduction in children.
5. The effective dose range in studies was between 0.5 and 4mg/day.
2. Clozapine carries an INCREASED risk of agranulocytosis and lowers the seizure threshold. That said, the few studies do suggest good tolerability and effective management of severe aggression & irritability. The dose range in the few studies that exist were between 200-475mg/day.
3. Risperidone is efficacious in the tx of irritability in children, adolescents and adults with ASD, as demonstrated in a number of studies. A combination of risperidone and parent management training was found to reduce irritability, stereotypic behavior, hyperactivity even better than mono therapy with risperidone alone. 
1. Dose ranges for risperidone ranged from 0.5 to 3.5mg/day in studies. 
2. Adverse effects included:
1. Increased appetite
2. Weight gain
3. Fatigue
4. Somnolence
5. Drowsiness
6. Dizziness
7. Anxiety
8. Hypersalivation
9. URIs
10. Rhinitis
11. Transient dyskinesia occurred in 15% of one study
4. Olanzapine is moderately efficacious in children with ASD and has demonstrated some effectiveness in adults.
1. Adverse effects included:
1. Increased appetite
2. Weight gain
3. Sedation
2. Doses ranged from 2.5-20mg/day
5. Quetiapine has been minimally effective in individuals with ASDs.
1. Adverse effects included weight gain, sedation, behavioral activation, akathisia, probably seizures
2. Dosages ranged from 25-800mg/day.
6. Ziprsidone is moderately effective in individuals with ASDs
1. Doses ranged from 10-160mg per day.
2. Most common adverse event being transient sedation.
7. Aripiprazole appears to be effective in children, adolescents and adults with ASDs but studies are limited.
1. Dosages ranged from 2.5-15mg/day. 
2. Adverse events included:
1. Sedation
2. Hypersalivation
3. Aggression
4. Weight increase
5. EPS-like tremor, hyperactivity, akathisia, dyskinesia
8. Paliperidone appears to be effective for children, adolescents and adults with ASDs, although studies are limited.
1. Dosages ranged from 5-12mg/day. 
2. The only noted adverse effect in the few studies was increased appetite

Treatment of hyperactivity and inattention

1. Methylphenidate (MPH) is a psychostimulant and moderately efficacious in the tx of hyperactivity in children with ASD. Its use is usually limited by side effects in children and adolescents with ASD.
1. Dosages ranged from 7.5mg-50mg/day in studies, sometimes divided and often dosed by weight (0.3-0.6mg/kg/day). Dosages for preschool children were between 5-20mg/day.
2. Atomoxetine is a selective norepinephrine reuptake inhibitor

Treating ADHD

"ADHD is like forcing a fish to climb a tree for years on end, and when it inexplicably fails to do so, diagnose it with tree climbing disorder and prescribe tree climbing pills."

I didn't come up with it but there's truth in it.

12 Stupid Things that Mess Up Recovery

Stupid Thing # 1: Believing that Addiction to One Substance is the Only Problem
Stupid Thing # 2: Believing Sobriety will Fix Everything
Stupid Thing # 3: Pursue Sobriety with Less Energy Than Pursuing Addiction
Stupid Thing # 4: Being Selectively Honest
Stupid Thing # 5: Feeling Special and Unique
Stupid Thing # 6: Not Making Amends
Stupid Thing # 7: Using the Program to Try to Become Perfect
Stupid Thing # 8: Confusing Self-Concern with Selfishness
Stupid Thing # 9: Playing Futile Self-Improvement Games
Stupid Thing # 10: Not Getting Help for Relationship Troubles
Stupid Thing # 11: Believing the Life Should Be Easy
Stupid Thing # 12: Using the Program to Handle Everything

Pace Yourself to Take the Edge of Anxiety

Paced Breathing

This is an adaptation from a breathing technique taught be the military. What works for soldiers in combat can work for civilians in Brooklyn's urban jungle as well... 

Here's how four-count paced breathing works:

1. Inhale through your nose, expanding your stomach for a count of four — one, two, three, four.
2. Hold that breath in for a count of four — one, two, three, four.
3. Slowly exhale through your mouth, contracting your stomach for a count of four — one, two, three, four.
4. Hold the empty breath for a count of four — one, two, three, four.

A few pointers to make this work well:

• Abdominal breathing: check you’re doing it by placing one palm of your hand on your belly and one on your chest. The one on your belly is the one that should rise and fall with your breathing.
• Pacing: you can gently tap with your index finger. As you go on breather, tap slower to get to a slow, paced breathing.
• 5-10 min is a good time, for practice or for any situation where slow diaphragmatic (belly) breathing is advantageous. Start with twice a day, use an anchor to make sure you do practice daily. An anchor could be after waking up while still lying in bed and after you go to bed before going to sleep. 
• Try it with the idea that it will help you to "embrace" the anxiety. It's to take the edge of and keep it manageable. It is not about controlling the anxiety pushing it away. 

Theoretical Background:

• What this breathing does is activating the “relaxation response”. In contrast to the fight-or-flight response, the relaxation response the body moves from a state of physiological arousal - e.g. increased heart rate and blood pressure, decreased blood flow to the extremities, slowed digestive function, increase release of adrenaline and cortisol - to a physiological state of relaxation, where the functions above return to “normal”. 
• Chronic stress leads to a chronic activation of the the fight-or-flight response. A panic attack is a false alarm. It’s your body going into fight-or-flight mode without any “real” danger - and for most of us, that doesn’t feel good at all. By activating the relaxation response, you help your body got out of this state and return to a calm, “no-threat” state. Herbert Benson is a Harvard physician who coined the term “relaxation response” for the observations he made when he was studying people who practice meditation in the 70s. 

100 Years of Solitude - The Big 5 Habits to live 100 years

1. Smoke-free - that includes vaping
2. Modest alcohol consumption:  Don't drink every day and not more than 2 drinks
3. Stay lean; Your height / your waist size > 2
4. Healthy diet:  Avoid highly processed food
5. Regular exercise - preferably HIIT and resistance exercise.

People who practiced all 5 of these live to around the age of 90 (Li, Yanping, et al. "Impact of healthy lifestyle factors on life expectancies in the US population." Circulation 138.4 (2018): 345-355).

Healthy Habits Help Healthy Sleep

These steps will improve your sleep: 

1. ONLY go to bed when you are sleepy. If you are not sleepy at bedtime, do something else: You can read a book, listen to soft music, browse through a magazine or a comic. Anything that is relaxing, but not stimulating, to take your mind off of worries about sleep. This will relax your body and distract your mind. 
2. If you are NOT asleep after 20 minutes, get out of bed. Find something else to do that will make you feel relaxed. Do this in another room. Your bed is where you sleep or have sex. It is not a place to go when you are bored. Once you feel sleepy again, go back to bed. 
3. Use rituals that help you relax each night before bed.  For example, meditate, take an evening walk, take a bath, a light snack, a few minutes of reading. 
4. Get up at the same time every morning. Even on weekends/holidays do not stray away from this for more than 1 hour. 
5. Get a full night’s sleep on a regular basis. Enough sleep means that you feel well-rested nearly every day.
6. Do NOT take naps. If you must, keep it short: Less than 1 hour and never after 3pm.
7. Keep a regular schedule. Regular times for meals, medications, chores, and other activities help keep the inner body clock running smoothly. 
8. NO reading, writing, eating, watching TV, talking on the phone, etc. in bed. Again, your bed is ONLY for sleep and sex.