MCN | Medical Consultants Network

The Power of a Second Look

Home / MCNTalk / Tag: brain

Viewing items tagged:

brain

A Preview of “Life, Animated” by Ron Suskind

This Sunday’s New York Times Magazine published an except of Life, Animated: A Story of Sidekicks, Heroes, and Autism, by Ron Suskind, a Pulitzer-Prize winning journalist with the Wall Street Journal. And father of Owen, who at age 3 was diagnosed with regressive autism.

The excerpt is beautifully written and moving, and provides a candid, eloquent glimpse into the twenty-year struggle of one family to communicate — through Disney characters, movies, and their themes — with their son. Well worth the read, as are the on-line comments.

Secret to Winning a Nobel Prize? Eat More Chocolate!

The 2013 Nobel prizes were awarded in October, but as this is the time of year when many of us are surrounded by treats — holiday gifts and celebration goodies — we thought we’d ease a little guilt on holiday consumption and maybe add a little perspective to common New Year’s resolutions.

Why would the sweet treat be linked to winning the most prestigious intellectual award, you ask? In the New England Journal of Medicine, Dr. Franz H. Messerli, a cardiologist at St. Luke’s–Roosevelt Hospital in New York City, writes that cocoa contains flavanols, plant-based compounds that previous studies have linked to the slowing or reversing of age-related cognitive decline. (You can also get flavonols in green tea, red wine and some fruits.) Read more…
Read

Release of the DSM-V

The American Psychiatric Association unveiled this past week the fifth edition of its handbook of diagnoses, the D.S.M-V (Diagnostic and Statistical Manual of Mental Disorders, Fifth edition), after 14 years in the making.

This article in The New York Times neatly summarizes a major, on-going discussion over the publication. Per the author,

The media will trumpet the release of the new D.S.M., but practicing psychiatrists will largely regard it as a nonevent. Unfortunately, the same cannot be said for other institutions — insurance companies, state and government agencies, and even the courts — which will continue to imbue the D.S.M. with a precision and an authority it does not have.

Psychiatrists tend to treat according to symptoms. However, the manual carries a fair amount of clout with the rest of society: They are the passports to insurance coverage, the keys to special educational and behavioral services in school and the tickets to disability benefits. Sometimes a diagnosis of a condition like autism, A.D.H.D. or conduct disorder is necessary for students to qualify for special therapies. And diagnoses also figure in disability determination.

As noted, the D.S.M. is an imperfect guide to predicting what treatments will benefit patients most — a reality tied to the fact that psychiatric diagnoses are based on clinical appearances that tend to cluster, not on the mechanism behind the illness, as is the case with, say, bacterial pneumonia.

There are definitely changes in the D.S.M.-V over the fourth edition, and as the article notes much of this this will most likely change as researchers learn more about genetics, brain circuitry and cognitive data to fashion better guides to what to prescribe for patients, and in terms of what new compounds to develop. Read more…

How to Deal with Illness & Death

In a recent Wall Street Journal article, “A Better Journey to the Final Exit,” reviews three books that address interesting issues regarding illness and death.

While these two subjects are often painfully uncomfortable topics of discussion, three authors confront specific issues that may help prepare us for the “final exit”.

The first book, “Happier Endings,” by Erica Brown proposes that even joy and inspiration can come from death. She shares stories of how other cultures deal with death through rituals or spiritual traditions in order to prepare and accept death’s inevitability.

Another book, “In the Kingdom of the Sick,” sheds light on the social history of chronic illness in America. Laurie Edwards, a science writer who suffers from chronic illnesses herself, seeks to bridge a communication gap—between society and the chronically ill.

After extensive research, the book questions whether stress, depression and anxiety (fueled by purported medical information on the Internet) create psychosomatic patients who merely believe they have certain illnesses or whether their ” stress and depression might result from the isolation and anxiety of having legitimate symptoms dismissed. If patients felt more supported and doctors “less besieged” in their first encounters in the doctor’s office, Ms. Edward says, physician-patient collaboration could narrow the gulf between patient and healer.” Read More…

The last book, Letty Cottin Pogrebin’s “How to Be a Friend to a Friend Who’s Sick,” is a guide to bedside manner for friends and family. She explains that while most family and friends mean no harm when trying to console or talk to loved one who is ill, many commit major bedside manner faux pas out of discomfort.

In her recent essay, “What to Say to a Friend Who’s Ill,” she provides a detailed account of  inappropriate things people say to their ill friends out of nervousness and discomfort. She also provides a list of the “10 Commandments for Conversing with a Sick Friend” :

1. Rejoice at their good news. Don’t minimize their bad news.

2. Treat your sick friends as you always did—but never forget their changed circumstance.

3. Avoid self-referential comments.

4. Don’t assume, verify.

5. Get the facts straight before you open your mouth

6. Help your sick friend feel useful.

7. Don’t infantilize the patient.

8. Think twice before giving advice. .

9. Let patients who are terminally ill set the conversational agenda.

10. Don’t pressure them to practice ‘positive thinking.’

Read More…

Should the head of the NRA be restricted from owning guns?

By Brian L. Grant MD
If a sign of mental illness is delusional thinking and being out of touch with reality, Wayne LaPierre may qualify. His ongoing rants suggesting that there exists some sort of mental health database that if consulted, would screen out murderers, is absurd.

Mr. LaPierre, please show us what you refer to. Also, please demonstrate how many — if any— of those thousands of killers who used firearms were in this non-existent database?

I hope you are not suggesting that an individual who seeks counseling or psychotherapy from a psychiatrist or psychologist, or antidepressants from their primary care doctor should be entered in a registry restricting their current firearm rights?

To do so would fly in the face of logic, privacy, and have zero impact on the problem of gun deaths. There is no linkage between seeking mental health care and dangerousness, and any such registration would only serve to deter individuals from addressing issues that might then go untreated.

Any mental health professional possessing appropriate humility knows that their record of predicting dangerousness is little better than the general public.

The public depiction of some of the recent mass killers certainly describe strange individuals, who before their act are not unlike those that one might find in large numbers in any high school class, software, Star Trek, or dare I say, Psychiatry convention. Hindsight bias, where something suddenly becomes obvious after the fact, is simple but misguided.

The proximate cause of gun deaths are guns and bullets. Killers armed with less lethality may be less dangerous toward others and themselves.

Do we collectively as a society have the political will and common sense to at least confine our arguments to reality?

Read More at:  The Economist: “Why the NRA keeps Talking about Mental Illness, Rather than Guns.”

Troubles in Psychiatry

By Brian L. Grant MD

Years ago, long before I had decided to become a psychiatrist, I read the work of psychiatrist Thomas Szasz, MD. He was critical of the concept of mental illness and the role that psychiatry plays in society.

His provocative writings continue to challenge, but did not deter me from becoming a psychiatrist. The idea of understanding human motivation and behavior in what may be the most holistic specialty in medicine appealed greatly and I have learned a great deal over the years and hopefully helped a few patients along the way. 

In my years in psychiatry, I have witnessed the movement from a specialty with a foundation in the mind and a focus on psychotherapy as a significant treatment modality, to one where medications reign and therapy has been devalued by many.

Most disturbing to me has been a clear distortion of the profession, driven by overdiagnosis and the labeling of psychopathology attributed to many normal conditions of life — including distractibility being labeled as attention deficit disorder (ADD), and sadness upon the death of a loved one being labeled as bereavement disorder. Many more examples can be found in the culture by looking at those diagnoses that have increased many fold, such as autism, post-traumatic stress disorder, and bipolar disorder in children.

My critique is not meant to apply to a particular individual who deserves individual assessment, but rather the significant trends that are taking place that should cause concern for anyone in distress seeking help and those whose job it is to help.

Of course human suffering exists and significant mental disorders including schizophrenia and major depression are real and deserve careful assessment and effective treatment. Likewise other diagnoses should be scrutinized for individual patients as well as being examined in the aggregate.

Marcia Angell, MD, former editor of the New England Journal of Medicine and one of the thought leaders in American medicine has written incisive reviews of several books:

Her  review, published in two parts in the New York Review of Books in 2011, was followed by an exchange with some notable psychiatrists who responded to her critiques and her response to them.

I was disheartened and disturbed upon reading her reviews. Not because I disagreed, but because at its core, her critiques ring true and should disturb anyone in society who cares about mental health and expects those engaged in research and treatment in the field to approach their work with intellectual rigor and integrity.

The party line in current psychiatry has diverted from one of thoughtful inquiry and reflection to an unwarranted certainty, callous overdiagnosis of a significant double-digit percentage of the population as mentally ill, and a willingness to prescribe very strong drugs in, at times, a glib and excessive manner, based upon bad science, dubious statistics, and a minimization of significant side effects and potential habituation.

Angell’s review, while not short, is worth reading and passing on, especially to those who deserve to have their beliefs challenged on the nature, extent of, and treatment of mental disorders.

Will the NFL Brain Injury Lawsuits Change the Game?

With the Super Bowl a receding memory, we are reminded about the physical nature of football in this Business Week article.

Many players and their families believe that football has been a source of permanent brain damage resulting from multiple head injuries in the course of play for some. A former Princeton quarterback in the 50s, Gene Locks, and a group of allied plaintiffs’ lawyers are taking up the cause and the league is on the defensive.

While Locks and other lawyers say they have no interest in putting the NFL out of business, they will represent more than 4,000 former players and their wives who accuse the $9.5 billion-a-year business of covering up life-altering brain injuries.

A protracted battle could provide the plaintiffs’ lawyers with an opportunity to reveal sordid details about a period during which they allege the NFL intentionally obfuscated evidence of the long-term brain damage suffered by its willing gladiators.

If this is true, and if the ugly particulars are played out in depositions, internal documents, and court testimony, such a legacy could alienate fans already uneasy about the suicides of former players such as Dave Duerson, Andre Waters, and Junior Seau, all of whom suffered from neurodegenerative brain disease linked to concussions.  Read More…

The outcome is far from decided and will be determined in part by public opinion, the courts, and hopefully additional meaningful scientific studies.

The Difference: Looking Healthy vs. Being Healthy

Every January, millions of people resolve to change their habits of years past in hope of making better choices for the new year.

And while vowing to become debt-free, to quit smoking, or to be more organized rank among top resolutions, statistics show that the No. 1 goal for millions of Americans is to lose weight.

After reading the New York Times article “Our Absurd Fear of Fat,” the author addresses our nation’s obesity epidemic and poses an argument about a key issue: What truly makes someone healthy?

The author proposes that our nation’s definition of “normal” or “healthy” weight may not be supported by medical literature. He states that a study by Katherine M. Flegal and her associates at the C.D.C and the National Institutes of Health, found that:

“All adults categorized as overweight and most of those categorized as obese have a lower mortality risk than so-called normal-weight individuals…The study found a 6 percent decrease in mortality risk among people classified as overweight and a 5 percent decrease in people classified as Grade 1 obese, the lowest level (most of the obese fall in this category).

This means that average-height women — 5 feet 4 inches — who weigh between 108 and 145 pounds have a higher mortality risk than average-height women who weigh between 146 and 203 pounds. For average-height men — 5 feet 10 inches — those who weigh between 129 and 174 pounds have a higher mortality risk than those who weigh between 175 and 243 pounds.”

With so many mixed messages about what “healthy” looks like or entails, it is often difficult to create a realistic goal about our weight. On one hand, we are trying to reverse our nations obesity epidemic, while on the other, we are also trying to combat our nation’s unhealthy obsession to be overly thin.

We invite our readers to comment on what they think about this article and share resolutions that have helped kick-start the new year in good health.

Risks and “Dangers” of Marijuana Legalization?

Overall evidence for dangers of marijuana do not support continued criminalization.

Steadily it appears that its use will be permitted, though there remains a disconnect between state laws liberalizing possession and growing, vs. federal standards that at least as written, continue to criminalize use and distribution.

As the matter evolves, we should not be naïve to the potential risk of users abusing and developing an addiction to marijuana and its potential impact on cognition, and youth, especially when not used in “moderation.”

A New York Times article, “Legalizing of Marijuana Raises Health Concerns,” states:

“While marijuana can be addictive, scientists generally agree that fewer than 10 percent of marijuana smokers become dependent on the drug, compared with 15 percent for alcohol, 23 percent for heroin and 32 percent for tobacco.

Marijuana does contain carcinogens, including tar and other toxins similar to those found in tobacco, but people generally do not smoke marijuana in the same amounts as cigarettes. Still, legalization takes health consumers into murky territory. Even though marijuana is the most commonly used illegal drug in the United States, questions about its health effects remain.”

Sounds like the same risks, more or less, of many other legal substances, consumed in excess or misused, including alcohol, prescription drugs, and/or firearms. Whether society should outlaw substances and products that can be used with little risk or high damage is a question that is increasingly being answered at the ballot box.

How to Recognize Pseudo and Junk Science

Scientific illiteracy abounds, including and especially in medicine.

This succinct Forbes article, “10 Questions to Distinguish Real From Fake Science,” helps identify bogus enterprises and claims.

Consider these guidelines during your next bout of insomnia when you find yourself watching infomercials or the next time a vaccine denier spouts their dangerous rhetoric. Or perhaps the next time you are asked to review or pay for an unsubstantiated treatment course based upon absent scientific evidence and clear self-interests.

Below are the top-10 questions you should ask yourself before buying into the latest miracle weight-loss pill, anti-again cream, or magical bracelets that will set your world in balance.

  1.  What is the source?
  2. What is the agenda?
  3. What kind of language does it use?
  4. Does it involve testimonials?
  5. Are there claims of exclusivity?
  6. Is there mention of a conspiracy of any kind?
  7. Does the claim involve multiple unassociated disorders?
  8. Is there a money trail or a passionate belief involved?
  9. Were real scientific processes involved?
  10. Is there expertise?