Brain and Spine Injury Law Blog : Brain and Spine Injury Lawyer & Attorney : Tim Titolo Law Office : Personal Injury & Wrongful Death : Car, Truck, and Motorcycle Accident: Las Vegas, Nevada

 We are almost through August and more than half way through Summer 2010. Parents, children and kids are preparing for the return to school in the next couple of weeks. In Nevada, public schools start August 30.

Meanwhile Nevada, and particularly Las Vegas, continues to muddle through the recession which for Southern Nevada has been a novel experience. The unemployment rate is close to 15% as I write.  The city many thought was immune from economic storms has seen itself hardest hit. Hopefully things will improve.

We face a heated election where the Tea Party candidate, Sharon Angle, accuses Democrat incumbent, Harry Reid, for the current state of plummeted home values while Reid criticizes Angle for not making job creation a part of her job!

The Station Casino’s recent resurface from Bankruptcy with owners, Frank and Lorenzo Fertitta, manning the helm, may be a boost. Of course some creditors had to write off $4,000,000,000 – four billion dollars! But maybe the massive adjustment will re establish the local casino group and have a positive impact on Las Vegas. 

Today’s report of the M Resort, opening just over a year ago, being put up for sale may result in an interesting bid; especially if Boyd gets back into the picture. Boyd’s recent failed effort to take over Station properties may be a prelude to an M resort bid.  Although my sources tell me that Station may make a bid to buy M resort now that they have shaken off 4 billion in debt.

I am reporting on 2 separate topics relating to Brain and Spine Injury issues. First is a look at the Cleveland Clinic’s Las Vegas Lou Ruvo Center. Second is the recent revelation concerning veterans. 

Lou Ruvo Brain Center

Nevada, and specifically Las Vegas, may be on its way to becoming the "go-to" place in the country for Brain Health.  The Cleveland Clinic Lou Ruvo Center for Brain Health (CCLRCBH) provides state-of-the-art care for cognitive disorders and for the family members of those who suffer from them.

 For persons with mild cognitive impairment such as early stage dementia and Alzheimer’s disease, the center offers the most up-to-date and technologically advanced diagnostic imaging services, including 3-Tesla MR, performed by one of the leading neuroimaging academic centers in the world. The CCLRCBH also offers a multimodal treatment program for persons with mild cognitive disorders, including physical exercise, cognitive rehabilitation, and cognitive enhancing medications.

Recently named to head up the Center, leading researcher and neurologist Jeffery L. Cummings, MD, will be the Director of the Cleveland Clinic Lou Ruvo Center for Brain Health.

Prior to joining Cleveland Clinic, Dr. Cummings was the director of the Mary S. Easton Center for Alzheimer’s Disease Research and a professor of Neurology and Psychiatry and Biobehavioral Sciences at David Geffen School of Medicine at UCLA.

He is past president of the Behavioral Neurology Society and of the American Neuropsychiatric Association. Dr. Cummings has authored or edited 30 books and published more than 600 peer-reviewed papers.
 

Misdiagnosis Hurt U.S. Soldiers

We now know that during the height of the Iraq war, the Army routinely misdiagnosed hundreds of soldiers with “personality disorder.” In doing this, the Army was categorizing veterans being dismissed from duty, with a pre-existing condition. Pre existing conditions are not covered by the military health care for veterans.

Leaving wounded veterans ineligible for military health care and with a stigma attached to mental weakness, advocates for veterans, congress and the public actively pushed for re-evaluation of veterans conditions. The Nation, published an article exposing the practice and caused the Defense Department to change its policy. 

All soldiers diagnosed with Personality disorder prior to 2008 are being re-evaluated. Before 2008, over 1000 soldiers were dismissed based on personality disorder. In 2009 only 260 were dismissed for personality disorder.   By 2008, 14,000 soldiers were diagnosed with brain injury or post traumatic stress disorder.   The number of personality disorder cases dropped 75%. Watch this You Tube video.

The significance for those men and women that serve the country in the military is staggering. Could you imagine sacrificing life and limb only to have the U.S. government tell you that you suffered a pre-existing personality disorder? Why, you might ask, did the Army, for example, not make that determination until after my sacrifice of life and limb? How convenient for the Army to take advantage of the sacrifice and not pay the veteran when they can no longer make the sacrifice.

We now know about PTSD as it relates to war, something the Vietnam veterans did not benefit from. We also know, unlike Vietnam, that more soldiers stay alive after blast and concussion trauma due to the enhanced protective gear.

I really hope that the U.S. will be proactive in caring for its military. I think we should all support brain injury groups like the Brain Injury Association of America who are on the front lines, so to speak, in getting legislation for brain injured survivors.

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A recent study was funded by the National Institute of Mental Health entitled "Stigma Experience Among Adolescents Taking Psychiatric Medications."  This breaks open the issue of stigma in patients treated for mental illness as it applies to teenagers.

Teenagers reimagine the way people think about adolescents. No longer society's scourge and scapegoat, the teenager emerges from David Bainbridge's fascinating study as an awe-inspiring natural phenomenon that evokes reverence and wonder. Bainbridge, an anatomist, suggests that the second decade is the most important in the human lifecycle. In lively prose, he explains the science behind the changes that occur both on the surface of the teenage body and deep within the teenage brain, from lanky limbs and bad skin to falling in love, sleeping till noon, and the irresistible allure of sex, drugs, and rock‘n’roll. Observed through a scientific lens, these bizarre biological transformations and behavioral anomalies snap into focus, as not only a beautifully choreographed sequence of steps on the path to adulthood, but also as a key evolutionary factor in the success of the species.

Teenagers have their own special place in the study of development and brain science. 

The study evaluated boys and girls between the ages of 12 and 17 who are taking medications. Researchers found that at least 90 percent of the study's participants reported experiencing some form of stigma. It has led to shame, secrecy and limiting social interactions.

While the stigma associated with wounded veterans, soldiers and adults is relatively known, this data suggests young people are burdened as well.  Individuals, young and old, with mental illnesses suffer from public and self-stigmas. The researchers were concerned about how the youth internalized the public discrimination, or stereotyping of their illnesses, and if these stigmas experienced at a young age might impact the individuals as adults.

1 in 6 adults and almost 1 in 10 children suffer from a diagnosable mental illness. Yet, for many, the stigma associated with the illness, can be as great a challenge as the disease itself. This is where the misconceptions stop. This is where bias comes to an end.

Here are some interesting Fact versus Fiction data I found on the internet. 

FICTION: People with a mental illness are often violent.

 FACT: Actually, the vast majority of people with mental health conditions are no more violent than anyone else. People with mental illness are much more likely to be the victims of crime.

 FICTION: Mental illness is a sign of weakness.

 FACT: A mental illness is not caused by personal weakness—nor can it be cured by positive thinking or willpower - proper treatment is needed.

 FICTION: Only military personnel who have been in combat can suffer from PTSD.

 FACT: While PTSD is prevalent in men and women who have seen combat, experiencing or witnessing a traumatic event can trigger PTSD, including violent personal assaults such as rape or robbery, natural or human-caused disasters, or accidents.

 FICTION: People with a mental illness will never get better.

 FACT: For some people, a mental illness may be a lifelong condition, like diabetes. But as with diabetes, proper treatment enables many people with a mental illness to lead fulfilling and productive lives.

 FICTION: Children don’t suffer from mental illness.

 FACT: Millions of children are affected by depression, anxiety and other mental illnesses. As a matter of fact, 1 in 10 children suffer from a diagnosable mental illness. Getting treatment is essential.

 FICTION: “Mental illness can’t affect me!”

 FACT: Mental illness can affect anyone. While some illnesses have a genetic risk, mental illness can affect people of all ages, races and income levels, whether or not there is a family history. 

I also ran across a cool blog on Facebook called bringchange2mind. Check it out.
 

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Dealing with Brain Injury symptoms and consequences quite frequently, I am exposed to the contention that Depression is the culprit when it comes to the subjectivity of pain.  Subjective pain is that which is rated according to the one complaining, not the observer.  Objective pain is that which can be observed independent of the one complaining.

Brain Injured Victims are often accused of malingering pain symptoms as a result of being depressed.  And the depression is dismissed as a personality flaw or pre-existing a brain injury.

Well this is the what came first argument: the chicken or the egg.  Certainly there is medical support for the statistics of depressed patients being more likely to report subjective pain symptoms.  Also there are statistics supporting the evidence that pain leads to depression.

It is difficult to weed out the two but that difficulty is not justification to dismiss complaints of pain due to depression or depression being the true source of pain.

 When it comes to pain, the two competing schools of thought are that it's either "all in your head" or "all in your body". A new study led by University of Oxford researchers indicates that, instead, pain is an amalgam of the two.  Dr. Chantal Berna and colleagues used brain imaging to see how healthy volunteers responded to pain while feeling low.

 The article is "Induction of Depressed Mood Disrupts Emotion Regulation Neurocircuitry and Enhances Pain Unpleasantness" by Chantal Berna, et al. Berna, is affiliated with The Centre for Functional Magnetic Resonance Imaging of the Brain, Department of Clinical Neurology and Nuffield Department of Anaesthetics, University of Oxford, Oxford, United Kingdom.

The article appeared in Biological Psychiatry, Volume 67, Issue 11 (June 1, 2010), published by Elsevier.  The authors' disclosures of financial and conflicts of interests are available in the article.
 

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A selection of useful mental health website links and resources. Please note that Titolo Law Office is not responsible for the content on any of these external websites.

• Internet Mental Health
  Information on the most common mental disorders, medications and recovery stories.
  http://www.mentalhealth.com/

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• Intervoice
  Information for people who hear voices (auditory hallucinations), their family and friends
  http://www.intervoiceonline.org

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• Mental Health Foundation
  A detailed A-Z database of mental health disorders - their symptoms, causes and treatments
  http://www.mentalhealth.org.uk

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• PSYweb
  Information on Anxiety, Depression and Schizophrenia - including online tests.
  http://psyweb.com/

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• The Mental Health Research Association: NARSAD
  Organisation supporting research into the causes, better treatments and cures for severe mental illnesses. Information available for Schizophrenia, Depression, Bipolar Disorder and Anxiety.
  http://www.narsad.org

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New Evidence that prevention will not cure Alzheimer's.  Here is some news that will turn your head around.  Just when you thought you might be doing everything right, you find out you might be wrong.  This reminds me of how much cigarette smoking is condoned Europe.  If you have ever been on an elevator in Italy or France you can not help but notice (and ingest) second hand smoke from the habitual smokers.  Now why is that?  Did Woody Allen's prediction in Sleeper come true?  Are cigarettes really good for you!?  And now the following.

An independent panel of experts meeting in the US concluded there is no evidence that you can prevent or slow down Alzheimer's, a progressive and fatal brain disease, even if you keep yourself active with exercise, social interaction, brain puzzles, or take fish oil, other supplements, or medication.  That is exactly the opposite of what we have been told.

The National Institutes of Health determined that the value of these strategies for delaying the onset and/or reducing the severity of decline or disease hasn't been demonstrated in rigorous studies.  Interestingly, the panel's assessment of the available evidence revealed that progress to understand how the onset of these conditions might be delayed or prevented is limited by inconsistent definitions of what constitutes Alzheimer's disease and cognitive decline. Other factors include incomplete understanding of the natural history of the disease and limited understanding of the aging process in general. The panel recommended that the research community and clinicians collaborate to develop, test, and uniformly adopt objective measures of baseline cognitive function and changes over time.
 

Alzheimer's Disease and Cognitive Decline, Structured Abstract. April 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/alzcogtp.htm actually concludes:

The current research on the list of putative risk or protective factors is largely inadequate to confidently assess their association with AD or cognitive decline. Further research that addresses the limitations of existing studies is needed prior to be able to make recommendations on interventions.

 But the initial ramifications may make us all rethink taking up smoking!  If you have not seen it, watch Woody Allen explain it in this short video.

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What is Inteligent Design and What is Random?  I recently came across a statement by Wasserman and Blumberg in the May-June issue of American Scientist that I want to share.

Do not take this too seriously...or do.

Although evolutionists and creationists strongly disagree about the role that intelligent design plays in the origins of bodies and brains, they curiously agree about the role that intelligent design plays in the origins of human inventiveness. However, both camps would do well to focus less on perceived foresight and purpose and more on the actual origins of behavior.

Contemporary evolutionists such as Richard Dawkins should move beyond the arcane argument over where to draw the line between things that "really are designed" and "things that only appear to be designed." By doing so, Wasserman and Blumber note, we will better appreciate the actual forces that unite the processes of change across both evolutionary and developmental timescales.
And that I like:  appreciating the actual forces that unite the processes of change across both evolutionary and developmental timescales.  Is your language science?  Is it theology or philosophy?  Do you call it God, Jesus, Mohammad, or simply "the force?"  I believe something is there, what ever you want to call it.

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In a new book titled "Religion and Psychiatry: Beyond Boundaries," the author considers why and how, when and where religion (and spirituality) are at stake in the life of psychiatric patients.  The interface between psychiatry and religion is explored at different levels, varying from daily clinical practice to conceptual fieldwork.

Religion is one subject that many people around the world feel extremely passionate about, either feeling strongly in their belief of a certain religion, or being against religions generally or specifically. Other people do not engage with religion at all. These choices represent a part of who we are, and as such it is essential for psychiatrists to understand and be able to relate to their patients' decisions and beliefs in this area.

Religion and Psychiatry is recommended reading for residents in psychiatry, postgraduates in theology, psychology and psychology of religion, researchers in psychiatric epidemiology and trans-cultural psychiatry, as well as professionals in theology, psychiatry and psychology of religion.

Religion (and spirituality) is very much alive and shapes the cultural values and aspirations of psychiatrist and patient alike, as does the choice of not identifying with a particular faith.  Patients bring their beliefs and convictions into the doctor-patient relationship.  The challenge for mental health professionals, whatever their own world view, is to develop and refine their vocabularies such that they truly understand what is communicated to them by their patients.

"The boundary between religious belief and the practice of psychiatry is becoming increasingly porous," say the editors in the Preface to Religion and Psychiatry: Beyond Boundaries. "No longer can psychiatrists in a multi-faith, multi-cultural globalized world hide behind the dismissal of religious belief as pathological, or behind a biomedical scientism, as they are more frequently confronted by distressed patients for whom religious belief may determine their choice of symptoms and their compliance with treatment."

Published on behalf of the World Psychiatric Association, Religion and Psychiatry: Beyond Boundaries, addresses the impact that religion and spirituality have on shaping cultural values, as well as the choice of not identifying with a particular faith. With this book, Peter Verhagen and colleagues provide a framework to understand the importance of these factors in mental well-being, and how to develop and refine their vocabularies to ensure they truly understand what their patients are telling them.

This is the first time that so many psychiatrists, psychologists, and theologians from all parts of the world and from so many different religious and spiritual backgrounds have worked together to produce a book addressing these important issues.

The book discusses what religious traditions can learn from each other to assist the patient, as well as the neurological basis of religious experiences. It describes training programmes that successfully incorporate aspects of religion and demonstrates how different religious and spiritual traditions can be brought together to improve psychiatric training and daily practice.

In the Foreword to Religion and Psychiatry Mario Maj, President of the World Psychiatric Association, states "The WPA welcomes this comprehensive and multifaceted volume, produced by one of its most active Scientific Sectors, hoping that the effort will continue to clarify the issue and stimulate further reflection and research."
 

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Have religious leaders and prophets, been able to tap into something science has not?  A recent grant will finance a study on the science of free will.  Are we predestined to live the blueprint of life already created for each of us?  Do we control our own destiny?  Or is it something beyond our comprehension?  Is our free will and control of destiny something foreordained toward a result that we will inevitably reach?

Since the beginning of time, philosophers, scientists and theologians have sought to find out whether human beings have free will or whether other forces are at work to control our actions, decisions and choices.

Now, Florida State University philosopher Alfred Mele has been awarded a $4.4 million grant from the John Templeton Foundation to get to the bottom of this question for the ages. Mele, the William H. and Lucyle Werkmeister Professor of Philosophy, will oversee a four-year project to improve understanding of free will in philosophy, religion and science. 

The primary purpose of the project is to improve understanding of free will in three spheres: science (especially neuroscience and social psychology); philosophy; and theology.  The project's website can be accessed here.

I previously posted in this blog about the new revelations of free will.  In fact, in 2008, Professor John-Dylan Haynes and colleagues at the Max Planck Institute in Germany reported findings of an extraordinary experiment which seems to show that 'free will' -- the most cherished tenet of humanity, which decrees that Man has total control of his own actions -- may, in fact, be little more than an illusion.

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My ongoing investigation into the Diagnostic and Statistical Manual, anticipated 2013 release, reveals the following sources:

NPR: "Doctors use the DSM to diagnose patients, and insurance companies use it to decide on reimbursement, so it's incredibly important in the profession of psychiatry."

NPR reports on a change for children currently being diagnosed with bipolar disorder (also known as manic-depression): "The condition will be called temper dysregulation disorder, and it will be seen as a brain or biological dysfunction, but not as a necessarily lifelong condition like bipolar. ... By adding this new entry, the American Psychiatric Association is trying to use the considerable institutional power of the DSM to curb use of the pediatric bipolar label" (Spiegel, 2/10).

The Associated Press: The American Psychiatric Association "is seeking feedback via the Internet from both psychiatrists and the general public about whether the changes will be helpful before finalizing them. ... Sure to generate debate, the draft also proposes diagnosing people as being at high risk of developing some serious mental disorders -- such as dementia or schizophrenia -- based on early symptoms, even though there's no way to know who will worsen into full-blown illness" (Neergaard, 2/10).

USA Today reports on efforts to classify illness like autism as broader illnesses rather than a specific subtype: "DSM-5 proposes replacing diagnoses for autism, Asperger's, childhood disintegrative and pervasive developmental disorders with a single diagnosis, 'autism spectrum disorders,' based on deficits in social interaction and communication and the presence of repetitive behaviors and interests" (Rubin, 2/9).

To follow my other posts on proposed changes to DSM see http://brainandspine.titololawoffice.com/2010/02/articles/brain-injury-news/revising-the-diagnostic-and-statistical-manual/

http://brainandspine.titololawoffice.com/2010/02/articles/brain-injury-news/revising-the-diagnostic-and-statistical-manual/

http://brainandspine.titololawoffice.com/2010/02/articles/brain-injury-news/revising-the-diagnostic-and-statistical-manual/

http://brainandspine.titololawoffice.com/2010/02/articles/brain-injury-news/revising-the-diagnostic-and-statistical-manual/

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All to often people who suffer from disease are unable to get care due to insurance company limitations and policies, lack of insurance or finances to cover expenses.  Sometimes folks are left with Social Security Benefit applications for their care.

In its effort to improve and expedite the disability determination process, the Social Security Administration (SSA) has announced that it will add early-onset Alzheimer's disease to its Compassionate Allowances Initiative. The initiative identifies debilitating diseases and medical conditions that meet the SSA's disability standards for Social Security Disability Income (SSDI) or Supplemental Security Income (SSI). 

Social Security is launching this expedited decision process with a total of 50 conditions.  Over time, more diseases and conditions will be added.  A list of the first 50 impairments -- 25 rare diseases and 25 cancers -- can be found at www.socialsecurity.gov/compassionateallowances.

This recent development will lead to increased care more quickly for those who could not otherwise afford it.

Since 2003, the Alzheimer's Association has been advocating on behalf of individuals with early-onset Alzheimer's as they navigate the Social Security disability determinations process and welcomes the SSA's decision. Until now, individuals with early-onset Alzheimer's disease have faced a myriad of challenges when applying for SSDI or SSI, including a long decision process, initial denials, and multiple appeals.

Today's decision will simplify and streamline the SSDI/SSI application process and decrease the wait time for benefits, which for some has lasted as long as three years. There are currently an estimated 5.3 million Americans with Alzheimer's disease. Although the majority of Alzheimer cases are individuals age 65 and older, a significant number of people under age 65 are also affected by this fatal disease and have few financial options other than the Social Security disability program. 

This good news comes at a time when politics has brought the issue of universal health care to a stand still.  It always intrigues me that certain folks think the "right" to choose a doctor, hence stumping public/social or universal health care, exists.  While, at the same time, those folks shun the idea that anyone has a "right" to not be subject to Rendition based on suspicion, or the "right" of due process.

What ever your reflection on the matter, the recent Compassionate Allowances Initiative moves us in the right direction.
 

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I came across a new website directed at assisting with mental illness. Step Up on Second.

Step Up on Second announces the launch of its newly enhanced Web 2.0 site. Step Up on Second is a California non-profit organization providing support services for adults affected by severe and persistent mental illness, and young adults experiencing the initial symptoms of a mental illness and their families.

The interactive site provides resources for loved ones, clients, and family members in search of an organization that can provide help, hope, and a home to individuals affected by mental illness.

Step Up on Second provides help through comprehensive, integrated clinical programs for relapse prevention; hope through the embrace of community, opportunities for inclusion, advocacy, and empowerment; and permanent supportive home units for stability achieving self-determined goals.

Recently Actress Glenn Close posted on their blog.

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 Daniel responds to my post on Understanding Depression at http://brainandspine.titololawoffice.com/2009/11/articles/psychiartric-psychological-iss/understanding-depression/

I appreciate the support because depression almost always results in traumatic brain injury cases I handle.  Not to mention the clinical nature of the disorder in non-traumatic brain injury cases.

Thanks for this interesting article. I think it is very important to talk about this topic, because it becomes more and more up to date. Lots of people are adversely affected by depression without knowing it. And this is very dangerous because of the consequences of not treating this suffering.

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Reader Carol Brown wrote me recently from her nursing perspective.  I am afraid there are more phobias than I anticipated.  (wait - that fear is a phobia and probably has a name too!)  Carol writes about phobias that nurses are not privy to in their training but confront in practice. 

If you are into phobias or are worried you have some (which worry may be sign of phobia) read Carol's article by clicking

http://www.nursingdegreeguide.org/2010/100-weird-phobias-that-really-exist/comment-page-1/#comment-5607

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Recall the recent post I made raising the issue of whether antidepressants were properly relied on by patients and physicians.  That post can be accessed here. http://brainandspine.titololawoffice.com/2009/12/articles/psychiartric-psychological-iss/antidepressant-may-change-personality/

 A new study appears in the December issue of The Annals of Pharmacotherapy.  (Published Online, November 24, 2009. www.theannals.com, DOI 10.1345/aph.1M326) Suicidal adolescents who were prescribed an antidepressant medication during inpatient psychiatric hospital treatment were 85 percent less likely than others to be readmitted within a month after discharge.

The results provide additional evidence that antidepressants may play a key role in helping improve the mental health of suicidal youth. Cynthia Fontanella, co-author of the study and assistant professor of social work at Ohio State University, points out that the the findings are especially important now, because antidepressant use dropped in 2003 after the Food and Drug Administration issued a black box warning that some antidepressants may increase the risk of suicidal behavior for pediatric patients. A black-box warning is the most serious type of warning in prescription drug labeling.

Despite considerable recent attention and wide-scale interventionsby regulatory authorities that have changed drug usage patterns,the possible relationship between psychotropic pharmacotherapy and suicidal behavior among children and adolescents remainsunclear. Confounding by diagnosis adds to confusion in the interpretationof the relationship between antidepressant use and suicidal behavior among young people. Cynthia Fontanella's recent research suggests that antidepressants may be protective against early readmission after hospitalization for suicide attempts or ideation, but that psychotropic polypharmacy (although common) may be associated with increased risk of rehospitalization.There remains an urgent need for high-quality, ongoing research into these clinical dilemmas.

Once again, I invite your input and thoughts on this issue by posting a comment.
 

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The American Psychiatric Association revised the timeline for publishing the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, moving the anticipated release date to May 2013.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States. It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems).

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) has been designed for use across clinical settings (inpatient, outpatient, partial hospital, consultation-liaison, clinic, private practice, and primary care), with community populations. It can be used by a wide range of health and mental health professionals, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors. It is also a necessary tool for collecting and communicating accurate public health statistics.

Diagnostic criteria provide a common language for clinical communication and their use has been shown to increase diagnostic agreement between clinicians.   It is important to understand that the appropriate use of the diagnostic criteria requires clinical training and that they cannot be simply applied in a cookbook fashion.

Another important aspect of the DSM diagnostic system is that the diagnoses are described strictly in terms of patterns of symptoms that tend to cluster together.  These symptoms can be observed by the clinician or reported by the patient or family members.  Because it focuses on manifest symptoms clinicians from widely differing theoretical orientations can therefore use the DSM.  Since the causes of most mental disorders are subject to ongoing scientific inquiry, the DSM avoids incorporating competing theories in its diagnostic definitions.  This feature has been an important element in the widespread clinical acceptance of the DSM, and has allowed a wide scope of research investigation.  

This is also an important limitation of the DSM system.   Patients sharing the same diagnostic label do not necessarily have disturbances that share the same etiology nor would they necessarily respond to the same treatment.   It is therefore critical to understand that the diagnostic terms and categories in the DSM represent only current knowledge about how symptoms cluster together.   

I find that the DSM has been too general in situations involving my clients and too specific and exclusionary in other situations.  I, and experts I consuted, fully expect that, over the coming decades, the DSM system will be radically reorganized as the etiologies of mental disorders become better understood.

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So is your boss paying you enough?  Do you want a raise or better working conditions?  What motivates employees to perform?

People paid by the hour exhibit a stronger relationship between income and happiness, according to a study published in the current issue of Personality and Social Psychology Bulletin (PSPB), the official journal of the Society for Personality and Social Psychology. 

The Society for Personality and Social Psychology (SPSP) is an academic society for personality and social psychologists with over 4500 members worldwide. SPSP serves as Division 8 of the American Psychological Association and publishes the journals Personality and Social Psychology Bulletin and Personality and Social Psychology Review and the biannual newsletter, Dialogue. It also co-publishes the journal Social and Personality and Psychology Science.

Researchers explored the relationship between income and happiness by focusing on the organizational arrangements that make the connection between time and money. They found that the way in which an employee is paid is tied to their feeling of happiness.

The researchers theorize that hourly wage-earners focus more attention on their pay than those who earn a salary.

A UK survey of managers across health and social care found that nearly two thirds (62 per cent) of them believe that Christmas parties are important in helping improve employee engagement. The survey comes in the wake of a government report that blames UK business leaders for low levels of staff engagement.
 

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Have you ever considered the claims by celebrities, like Tom Cruise, or health care professionals that decry the impact of anti-psychotics and anti-depression medicine?  Have we come to rely on Prozac, Paxil and the laundry list of "feel good" medication to overcome what generations of folks have dealt with without them?  Or, is there a benefit reaped by those on the medication?  Do doctors overprescribe?  I am interested to know what you think.  Drop me a comment. 

The December issue of Archives of General Psychiatry, one of the JAMA/Archives journals,  reports Individuals taking a medication to treat depression may experience changes in their personality separate from the alleviation of depressive symptoms.

Two personality traits, neuroticism and extraversion, have been related to depression risk, according to background information in the article. Individuals who are neurotic tend to experience negative emotions and emotional instability, whereas extraversion refers not only to socially outgoing behavior but also to dominance and a tendency to experience positive emotions. Both traits have been linked to the brain's serotonin system, which is also targeted by the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Read More Arch Gen Psychiatry.2009;66[12]:1322-1330.  Drop me a comment on your take on this issue.

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The American Psychological Association notes that Holiday stress is a leading cause of financial stress for Americans.   National unemployment levels push into double digits for the first time in decades, the American Psychological Association's (APA) newest Stress in America survey finds that Americans continue to cite financial concerns as leading sources of stress.

Approximately seven in ten Americans report that money is a significant source of stress (71 percent), according to APA's 2009 Stress in America survey, with similarly high percentages reporting stress resulting from work (69 percent) and the economy (63 percent). More than half of adults (55 percent) also cited family responsibilities as a significant source of stress in their lives.

APA suggests the following strategies to manage holiday stress and enjoy the season:

1. Take time for yourself. Taking care of yourself helps you to take better care of others in your life. Go for a long walk or take time out to read or listen to your favorite music. By slowing down you will actually have more energy to accomplish your goals.

2. Volunteer. Many charitable organizations face new challenges as a result of the ongoing economic downturn. Find a local charity, such as a soup kitchen or a shelter, where you and your family can volunteer together. Helping others who are less fortunate can put hardships in perspective and can build stronger family relationships.

3. Set realistic expectations. No holiday celebration is perfect; view inevitable missteps as opportunities to demonstrate flexibility and resilience. Create a realistic budget and remind your children that the holidays aren't about expensive gifts.

4. Remember what's important. Commercialism can overshadow the true sentiment of the holiday season. When your holiday expense list is running longer than your monthly budget, scale back. Remind yourself that family, friends and the relationships in our lives are what matter most.

5. Seek support. Talk about stress related to the holidays with your friends and family. Getting things out in the open can help you navigate your feelings and work toward a solution. If you continue to feel overwhelmed, consider talking with a professional such as a psychologist to help you develop coping strategies and better manage your stress. A psychologist has the skills and professional training to help people learn to manage stress and cope more effectively with life problems, using techniques based on best available research and their clinical skills and experience, and taking into account an individual's unique values, goals and circumstances. Psychologists have doctoral degrees and are licensed by the state in which they practice. They receive one of the highest levels of education of all health care professionals, spending an average of seven years in education and training after they receive their undergraduate degrees.

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A new finding appears in Psychosomatics, the official journal of the Academy of Psychosomatic Medicine which publishes peer-reviewed research and clinical experiences in the practice of psychosomatic medicine/consultation-liaison psychiatry.

Poynter B, et al. Sex differences in the prevalence of post-stroke depression: a systematic review. Psychosomatics 50(6), 2009, find:

Depression occurs in as many as one-third of patients after a stroke, and women are at somewhat higher risk, according to a large new review of studies. Post-stroke depression is associated with greater disability, reduced quality of life and an increased risk of death.

The systematic review appears in the November-December issue of the journal Psychosomatics.
 

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Americans do not believe they know much about depression , but are highly aware of the risks of not receiving care, according to a survey released today by the National Alliance on Mental Illness (NAMI).

See full survey results at http://www.nami.org/depression.

The survey provides a "three dimensional" measurement of responses from members of the general public who do not know anyone with depression, caregivers of adults diagnosed with depression and adults actually living with the illness.

- Seventy-one percent of the public sample said they are not familiar with depression, but 68 percent or more know specific consequences that can come from not receiving treatment-including suicide (84 percent).

- Sixty-two percent believe they know some symptoms of depression, but 39 percent said they do not know many or any at all.

- One major finding: almost 50 percent of caregivers who responded had been diagnosed with depression themselves, but only about 25 percent said they were engaged in treatment.

- Almost 60 percent of people living with depression reported that they rely on their primary care physicians rather than mental health professionals for treatment. Medication and "talk therapy" are primary treatments-if a person can get them-but other options are helpful.

- Fifteen percent of people living with depression use animal therapy with 54 percent finding it to be "extremely" or "quite a bit" helpful. Those using prayer and physical exercise also ranked them high in helpfulness (47 percent and 40 percent respectively).

- When people living with depression discontinue medication or talk therapy, cost is a common reason, but other significant factors include a desire "to make it on my own," whether they believe the treatment is actually working and in the case of medication, side effects.

"The survey reveals gaps and guideposts on roads to recovery," said NAMI Executive Director Michael J. Fitzpatrick. "It tells what has been found helpful in treating depression. It can help caregivers better anticipate stress that will confront them. It reflects issues that need to be part of ongoing health care reform."
 

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The British Journal of Psychiatry,  available online, published findings that good diet contributes to less depression.

A new study led by researchers in the UK found that an overall healthy "whole food" diet comprising a high proportion of fruits, vegetables and fish, protected middle aged people against depression compared to a processed food diet containing a high proportion of high fat dairy food, processed meat, fried food, refined grains and sugar-laden desserts.

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Women come in first again!  This time it's officially scientific:

Women are better than men at distinguishing between emotions, especially fear and disgust, according to a new study published in the online version of the journal Neuropsychologia....

While women have long been thought to outperform men in neuropsychological tests, until now, these findings were inconsistent. To obtain more conclusive evidence, the Université de Montréal researchers did not use photographs to analyze the reaction of subjects. Instead, the scientists hired actors and actresses to simulate fear and disgust. "Facial movements have been shown to play an important role in the perception of an emotion's intensity as well as stimulate different parts of the brain used in the treatment of such information," says Collignon, who also works as a researcher at the Université catholique de Louvain's Institute of Neuroscience in Belgium.

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