Posts in Articles
STAT, "Preventing PTSD: calling Dr. Tetris?"

“Preventive psychiatry, a forgotten chapter in the history of mental health, is trying to make a comeback. One area in which it is being explored is post-traumatic stress disorder. This condition represents an excellent opportunity for prevention because of the so-called golden hours: the period between experiencing a traumatic event and the onset of PTSD. It represents a window of opportunity for medical intervention to set the brain on a path toward recovery…”

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ArticlesNick Courage
KevinMD.com, "When the doctor becomes the victim"

“Working with the mentally ill requires a unique form of bravery. One must be willing to wade into the intimate and dark recesses of people’s psyches in order to help them even when it gets messy. I knew the man’s psychiatrist to be a professional, intelligent and sensitive doctor. My hunch was this: The patient’s marriage break-up was so impossible for him to accept that he needed someone else to bear the brunt of his shame and rage…”

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ArticlesNick Courage
Psychology Today, "Aziz Ansari, 100 French Women, 'Witch Hunts' and Backlash: What #MeToo must learn from the science of sexual harassment"

“Last Fall, when news cycles filled with sexual harassment scandals from the worlds of Hollywood, media and politics something surreal happened.  For the first time that I can recall, conversations about sexual trauma were overflowing well beyond the narrow confines of my clinic room. They were showing up in conversations with friends at dinner, with family members both young and old, social media streams and the table of contents of prestigious medical journals…”

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ArticlesNick Courage
Psychiatric News, "How a VA Facility Integrates Primary and Mental Health Care"

“In 2007, the Veterans Affairs (VA) health system started an initiative to integrate primary care with mental health services and developed PC-MHI programs nationwide. Along with integration of care, the goals were to improve access to mental health care, provide high-quality mental health care, enhance treatment adherence, promote an accepting atmosphere for patients, and reserve mental health specialty settings for treatment of more severe mental illness. In fact, to “develop a collaborative care model for mental health disorders that elevates mental health care to the same level of urgency/intervention as medical health care” is a goal embedded in the VA’s 2004 Mental Health Strategic Plan…”

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ArticlesNick Courage
Hektoen International (A Journal of Medical Humanities), "Sectioned"

“In 1999, during my residency in Liverpool, England, I had the experience of observing a supervising psychiatrist make a home visit to a severely mentally ill patient and arrange for her involuntary hospitalization, a process referred to in England as sectioning1. I was greatly impressed at the time with the skill, clinical acumen, empathy, and sensitivity involved in carrying out such a decision…”

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ArticlesNick Courage
Hektoen International (A Journal of Medical Humanities), "The aftermath of trauma"

“I try to stay in this moment: Dave, my patient, is telling me about his Saturday trip to the mall. His cheeks are slightly red with the heat of jubilation, and his voice is louder than usual, propelled by a mixture of excitement and disbelief. In the drafty space of my tiny office, he spills the details of his expedition: he had navigated the flow of human traffic from JC Penney to Sears and from Old Navy to the men’s bathroom without becoming drenched in sweat—some flutters in his chest of course, but no more heart-thumping panic. Instead of reflexive rage and verbal threats, the accidental brushing of shoulders or treading on toes he had tolerated with a no-worries attitude. His brain had not translated the hustle and bustle of a holiday crowd as danger; a man wearing a backpack did not imply a suicide bomber; and unattended shopping bags were no longer harbingers of death. The fused aroma of fresh-baked pizza, cinnamon pretzels, and salty French fries wafting from the food court was, once again, enticing. The thwack of our high five that marks the end of this session—this sound I try to retain…”

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ArticlesNick Courage
PLOS Blogs, "Do Daily PTSD-Induced Emotional Triggers Increase Risk for Coronary Heart Disease?"

“Recent research, published in the June edition of the Journal of the American College of Cardiology, presented findings which appeared to support what many of us, who spend our days treating those living with PTSD, long suspected: a fascinating correlation between the health of the mind/brain and its direct impact on one’s physical wellbeing…”

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ArticlesNick Courage
KevinMD.com, "Violence against women is a serious public health problem"

“The reality is that for millions and millions of women, all over the world, violence is an everyday part of their lives. Rape, battery and other forms of sexual and domestic violence are such a common part of the lives of women that they cannot be viewed as unusual or outside what one might consider an ordinary experience. Such acts are more likely to be perpetrated by someone known to the woman. An example of one of the most common forms of violence against women worldwide is intimate partner violence (IPV), i.e. physical, psychological or sexual abuse of women perpetrated by their intimate partners.”

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ArticlesNick Courage
PLOS Blogs, "Hearing Voices: PTSD and Auditory Hallucinations"

“One of the greatest benefits of being affiliated with a major university is the opportunities that often arise to engage in interdisciplinary collaboration.  I was invited, by Composer and researcher Jonathan Berger, to present at the seventh annual Music and Brain Symposium, which was held earlier this month at Stanford University.  Jonathan is the Denning Family Provostial Professor in Music at Stanford, and is co-director of the Stanford Institute for Creativity and the Arts (SICA) and The Center for Computer Research in Music and Acoustics (CCRMA)…”

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ArticlesNick Courage
PLOS Blogs, "The Complexities of Diagnosing Posttraumatic Stress Disorder (PTSD)"

“When I was in medical school, senior physicians would frequently usher a group of us students into a patient’s room so we might hear them tell the story of their illness.  It seemed that the more classic the story was for a particular illness the more intense was their ushering.  We would huddle around the patient’s bed all of us transfixed by the doctor interviewing the patient. I remember hanging on the patient’s every last word and, simultaneously, shifting through the textbook data stored in my brain in search of a diagnostic match.  When done, the senior doctor would turn around and challenge us to diagnose what ailed the patient and we would respond with a flurry of answers. I still remember the thrill of solving the puzzle, of making a ‘textbook diagnosis’…”

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ArticlesNick Courage
Canadian Medical Association Journal, "Self-Disclosure"

“Mr. Hussein’s story in his own language was infused with colour. After the death of his wife, he had moved to America to be with his son. Life in Pakistan was a struggle, so he was relieved to live here in comfort. But recently, while his son and daughter-in-law were at work, he found himself feeling depressed. He was not accustomed to the quiet of the suburbs and missed the familiar hustle and bustle of Karachi. His family was caring, but he felt like a burden. His jet-black eyes clouded over with tears as he admitted he had experienced thoughts of suicide and stopped taking his blood pressure pills…”

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ArticlesNick Courage