Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

 Can someone have post traumatic stress disorder and mild traumatic brain injury at the same time from the same event?  Some experts say no while others say yes.

Approximately 7.7 million Americans suffer from PTSD, according to recent population-based survey research. The most common causes of PTSD in the civilian sector are motor vehicle crashes and assaults (including domestic violence and rape), with women approximately
twice as likely as men to suffer from PTSD.

Surveys of military personnel returning from deployments to Iraq and Afghanistan find prevalence rates of PTSD ranging from 8% to 16%; it is likely that these rates are underestimates, given the many barriers to reporting mental health problems in the military . Approximately 15% of
these veterans seeking care at Veterans Administration hospitals in the United States have been given a diagnosis of PTSD.

One train of thought says that in order to have post traumatic stress disorder you must remember the traumatic event.  Indeed it is the very memory of the event that causes the post traumatic stress.  Yet others opine that mild traumatic brain injury must involve some loss of consciousness and therefore memory of the event is missing.  Hence you can not have mild traumatic brain injury and post traumatic stress disorder.  However the fact of realizing what happened when revived leaves the post traumatic stress question wide open for discussion.

An estimated 1.5 million brain injuries occur every year in the United States, and over 5 million Americans (2% of the population) live with disabilities resulting from TBI. In the civilian sector, the leading causes of TBI are falls, motor vehicle crashes, struck-by-or-against events, and assaults . Interestingly, motor vehicle crashes and assaults are also two of the most common causes of PTSD in the U.S. civilian population, highlighting the overlap in exposures to TBI- and PTSD-causative events.

In the U.S. military, TBI is the most common type of physical injury sustained by combatants in Afghanistan and Iraq, and explosion or blast injury is the most common cause. In a 2006 survey of more than 2,500 recently returned army infantry soldiers, 5% reported injuries with loss of consciousness during a yearlong deployment to Iraq, and 10% reported injuries with altered mental status. A recent RAND report suggested even higher rates of probable TBI in a 2007 telephone survey of almost 2,000 previously deployed service personnel. A similarly high rate (23%) of clinician-confirmed TBI history in a U.S. Army brigade combat team with at least one deployment corroborates these findings.

 It is important clinically to recognize that both disorders are associated with higher rates of other psychological health problems, including depression, substance abuse, and suicidal behavior in both civilian and military populations . Furthermore, the presence of these comorbid conditions may have an impact on conventional treatments, lending additional impetus to the need to understand these interactions more completely.

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 Depression in traumatic brain injury cases is a classic symptom. Traumatic brain injury is associated with an increase in the relative risk of developing a variety of psychiatric
disorders, particularly depression and cognitive impairment.

This relationship is best understood in the context of both the neuropathophysiology and the typical profile of regional brain injury associated with biomechanical trauma. The disturbance of brain function from MTBI is related more to dysfunction of brain metabolism rather than to structural injury or damage. The current understanding of the underlying pathology of MTBI involves a paradigm shift away from a focus on anatomic damage to an emphasis on neuronal dysfunction involving a complex cascade of ionic, metabolic and physiologic events. Clinical signs and symptoms of MTBI such as poor memory, speed of processing, fatigue, and dizziness result from this underlying neurometabolic cascade.

The relationship is further understood as the psychosocial sequelae that often follow the injury and their attendant effects on social, vocational, and family functioning. Thus, in many ways TBI
is a prototypical neuropsychiatric disorder.

There remains much that is incompletely understood about neuropsychiatric and functional outcome after TBI. Individuals may have disparate long-term outcomes after seemingly similar injuries. Probable contributors to this variance include preinjury host factors, injury-specific
biomechanics, and genetic factors.  Further investigation of these matters is needed to improve our ability to understand, identify, and more effectively treat those individuals at risk for poor outcomes following mild TBI.

Currently, a multidimensional approach is critical to the assessment and treatment of the neuropsychiatric sequelae of mild TBI. The most important initial step is accurate diagnosis, which can be challenging in cases of mild TBI. A combination of psychotherapeutic and
pharmacologic interventions can alleviate many symptoms, and improved quality of life for persons with TBI and their families can be achieved.

Psychiatrists, armed with a neuropsychiatric approach to mild TBI, are critical members of the health care team attending to persons with mild TBI and have an important role in the
management of this significant public health problem.

I typically involve a psychiatrist in the treatment team, along with a neurologist, neuropsychologist, neuroradiologist, and others in my cases.

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 Traumatic Brain Injury has significant and distinct psychiatric effects.  The following is a brief discussion of what those effects can be:

• Loss of consciousness - Can be either brief or protracted. On recovery of consciousness, patients develop confusion, agitation, disorientation and delirium.

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Educating lawyers to better represent their clients.

I returned last week from a seven day convention. The 2011 American Association of Justice Convention in New York City.  The annual event consisted of solid educational seminars put on by the brightest and most successful lawyers across the country and in Canada.

On Saturday, the Interstate Trucking Litigation Group sponsored an all day presentation by excellent experts in law and trucking.  The rules that affect litigation and legislative changes were discussed.  The group hopes to back higher insurance mandates for trucking companies and more regulation under the North American Free Trade Agreement (NAFTA) to deal with Mexico's influx of trucks on American roads near the borders.

I am on the executive board of the Traumatic Brain Injury Litigation Group, and the all day seminar featuring traumatic brain injury issues on Sunday was terrific.  

An article I wrote with Dr. Howard Friedman entitled Bearing Witness was featured in the Traumatic Brain Injury Litigation Group Newsletter.

I attended many board meetings and group meetings in which I participate such as the Inadequate Security Litigation Group, Motorcycle Litigation Group, and Products Liability Group.

I also got to visit with old and new friends from around the country who practice law, consult, offer needed legal services and more.  Of note was my dinner with Louis Siracusano, Dan Buttafuco, Ken Goldblatt and his lovely wife, Antonio Romanucci.  Many others were there too.

I also dined with Dorothy Clay Sims, and David Ball.  I had the pleasure of bringing to-go boxes of gourmet Italian food from Patsy's, in Manhattan, to two homeless men Dorothy and I found on the street.  Dorothy Clay Sims, had just received the verdict for her client Casey Anthony the day before in Florida.

I also enjoyed a meal on Arthur Avenue with the folks from the Trucking Litigation Group on Monday Night.  This group never fails to have over the top dinners with great company and food.

And of course a visit to Central Park was a must-do.  I am originally from Long Island, NY and I poke fun at myself for never having been to the Statute of Liberty.  I always took it for granted.  Maybe someday with the kids.  But I had not been to Central Park in the summer in years.  It was beautiful.

The next meeting is in Phoenix in February, a little closer to my home in Las Vegas, and I am already looking forward to a great time.

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 The Brain On Trial

Is Criminal behavior regulated by “free will?” Is free will something that is actually free at all? Neuroscientist, David Eagleman[1], recently published an article in The Atlantic, July/August 2011, The Brain on Trial.[2] He describes how the foundations of our criminal-justice system are beginning to crumble, and proposes a new way forward for law and order.

My interest in theological, philosophical, psychological and biological explanations ranging from the reason for suffering in this world and free will versus fate/destiny was discussed in my blog a few years back.

Can I freely choose to not eat chocolate cake? Can I freely invoke my long term understanding of the cake’s short term benefits versus its long term costs to overpower my short term understanding of my desire to eat it? Clearly the obesity crisis in our country and others would say ‘sometimes, but not most.’ Certainly eating chocolate cake is not a crime. But let’s apply the same ideas to crime and recidivism.

Neuroscientist, Wolf Singer argued that crime itself should be taken as evidence of brain abnormality, even if no abnormality can be found, and criminals treated as incapable of having acted otherwise.[3]

Conversely, at an Ethics and Public Policy Conference on Neuroscience and the Human Spirit,[4]  the question was asked: "Do . . . scientific advances challenge the first principles that the majority of our citizens believe provide the very foundation upon which our civilization rests—free will and the capacity to make moral choices? . . . Does [the] growing understanding of genetic and environmental influences on human behavior leave any room for free will?"

The conclusion advanced “accepting a compatibilist, naturalistic view of freedom and morality will unify our self-understanding. Since moral mechanisms have a clear social function that science can help us to understand and improve, no longer will morality have to seek shelter from science. We may not be free in the exceptional, ultimate sense we once supposed, but we are more than compensated by the pragmatic benefits that flow from recognizing our complete inclusion in the causal order. The "human spirit"—our dignity, freedom, and power—is not threatened by science, only shown its true home in the natural world.”

In his lengthy article, David Eagleman sets out court dramas of those recently brought to trial. Judges and juries compare, as they instruct and are instructed, to weigh their analysis against a “reasonable person” standard. Many times, we all engage in the blame game by asserting, “Well I would not have done that.” However that may be missing the point according to Eagleman. “Changes in the balance of brain chemistry, even small ones, can also cause large and unexpected changes in behavior [:]” Addictive personalities and gambling; Pedophiles and the desire to look at children. Also included are not just unacceptable behaviors but, as mentioned earlier, compulsive eating, excessive alcohol consumption, and hypersexuality, to name a few.

“The lesson from all these stories is the same: human behavior cannot be separated from human biology….Perhaps not everyone is equally “free” to make socially appropriate choices.” Do we really have free will to choose or is that really an illusion? Eagleman states “Many of us like to believe that all adults possess the same capacity to make sound choices. It’s a charitable idea, but demonstrably wrong. People’s brains are vastly different.”

Starting at birth we are the product of our parent’s genes. “When it comes to nature and nurture, the important point is that we choose neither one. We are each constructed from a genetic blueprint, and then born into a world of circumstance that we cannot control in our most-formative years….The unique patterns of neurobiology inside each of our heads cannot qualify as choices; these are the cards we are dealt.”

Turing to the legal system and courts, the standard applied assumes we are ‘practical reasoners’ which, in turn, presumes beings with free will. Eagleman uses the example of those inflicted with Tourette’s syndrome, who suffer from doing things they do not will to do: sticking out her tongue, voicing inappropriate language and others. The point is that a Tourette’s patient’s free will cannot over ride her sense of “free won’t.” Similarly, high-level behaviors can take place in the absence of free will.

“Historically, clinicians and lawyers have agreed on an intuitive distinction between neurological disorders (“brain problems”) and psychiatric disorders (“mind problems”). The two ends of the spectrum have been those whose brain injuries (e.g. Parkinson’s) who cannot help some of their behavior, while most others are simply thought of as freely choosing actors.

Therefore, prisons have, according to Eagleman, become de-facto mental-health-care institutions. Incarceration does little to rehabilitate those with mental illness and increases cases of recidivism.   Courts around the country and in Nevada have begun mental-health courts and drug courts based on better understanding of the problems of recidivism. 

Eagleman proposes a new approach. He posits the understanding that the brain “operates like a team of rivals, with different neural populations competing to control the single output channel of behavior.” Something he terms the ‘prefontal-workout.’ Essentially he is trying to defeat the short term brain circuits to overcome bad behavior. It is similar to bio-feedback of the 1970s. So when we see that delicious piece of chocolate cake, we can overcome the choice to eat it, which is essentially against our will. More importantly when one is faced with a socially unacceptable behavior, can he invoke a system to squelch the urge and make a better choice?

Eagleman concludes by saying that “neuroscience is beginning to touch on questions that were once only in the domain of philosophers and psychologists, questions about how people make decisions and the degree to which those decisions are truly ‘free.’ These are not idle questions. Ultimately, they will shape the future of legal theory and create a more biologically informed jurisprudence.”

David Eagleman’s article is available on The Atlantic's site and in print.

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Las Vegas Traumatic Brain Injury Law Blog

When you have depression, it's more than feeling sad. Intense feelings of sadness and other symptoms, like losing interest in things you enjoy, may last for a while. Depression is a medical illness - a condition - not a sign of weakness. And it's treatable.

If you're depressed, it might not be easy to figure out why. In most cases, depression doesn't have a single cause. Instead, it results from a mix of things -- your genes, events in your past, your current circumstances, and other risk factors.

In cases I handle depression is typically associated with brain injury.  There is organic-based depression which is a result of insult to the brain itself and the chemical processes.  Other depression, more psychological, can be serious as well.  When one of my clients learns of their limitations, due to injury, and the process of trying to overcome them, depression becomes a factor.  Both types are compensable but different in how they are proved.

The following are causes of depression commonly encountered:

• Biology. While we still don't know exactly what happens in the brain when people become depressed, studies show that certain parts of the brain don't seem to be working normally. Depression might also be affected by changes in the levels of certain chemicals in the brain, called neurotransmitters.
• Genetics. Researchers know that if depression runs in your family, you have a higher chance of becoming depressed.
• Gender. Studies show that women are about twice as likely as men to become depressed. No one's sure why. The hormonal changes that women go through at different times of their lives may be a factor.
• Age. People who are elderly are at higher risk of depression. That can be compounded by other factors -- living alone and having a lack of social support.
• Health conditions. Permanent Conditions such as cancer, heart disease, thyroid problems, chronic pain, and many others increase your risk of becoming depressed.
• Trauma and grief. Trauma, such as violence or physical or emotional abuse -- even if it's early in life or more recent -- can trigger depression. So can grief after the death of a friend or loved one.  Job changes, moving into a new home and other life changes can also contribute to depression.
• Changes and stressful events. It's not surprising that people might become depressed during stressful times -- such as during a divorce or while caring for a sick relative. Yet not as well known is that even positive changes -- like getting married or starting a new job -- can trigger depression.
• Medications and substances. We all take some medication at some point in our lives.  Many of us take medication more or less for life.  Many prescription drugs can cause symptoms of depression. Alcohol or substance abuse is common in depressed people. It often makes their condition worse.

Brain Injury

Depression is typically associated with brain injury.  Feeling like there is nothing you can do to make you like you were before the brain injury brings on emotional and organic depression.

Post Traumatic Stress Disorder  

People with post-traumatic stress disorder (PTSD) often re–live the traumatic event in flashbacks, memories or nightmares. Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD - post traumatic stress disorder - include violent personal assaults, natural or human-caused disasters, auto accidents, falls, assaults, or military combat.

Other symptoms of post traumatic stress disorder include irritability, anger outbursts, intense guilt, and avoidance of thinking or talking about the traumatic ordeal. In a National Institute of Mental Health (NIMH)–funded study, researchers found that more than 40 percent of people with PTSD also had depression at one-month and four-month intervals after the traumatic event.

Talk to your doctor or traumatic brain injury lawyer if you have depression you suspect was caused by trauma and injury. Getting treatment is critical to recovery.

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The Attention Deficit Disorder Association has announced the launch of its new website.  For those of us who have or know someone who has Attention Deficit Disorder, this website can provide useful information.  Sometime called Hyperactivity, ADD is experienced by virtually everyone at one time or another in their lives.  But a strict diagnosis arises when the behavior affects multiple areas of a person's life.

The Mayo Clinic defines Attention Deficit Disorder as:

Signs and symptoms include:

• Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
• Often has trouble sustaining attention during tasks or play
• Seems not to listen even when spoken to directly
• Has difficulty following through on instructions and often fails to finish schoolwork, chores or other tasks
• Often has problems organizing tasks or activities
• Avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
• Frequently loses needed items, such as books, pencils, toys or tools
• Can be easily distracted
• Often forgetful

Signs and symptoms of hyperactive and impulsive behavior may include:

• Fidgets or squirms frequently
• Often leaves his or her seat in the classroom or in other situations when remaining seated is expected
• Often runs or climbs excessively when it's not appropriate or, if an adolescent, might constantly feel restless
• Frequently has difficulty playing quietly
• Always seems on the go
• Talks excessively
• Blurts out the answers before questions have been completely asked
• Frequently has difficulty waiting for his or her turn
• Often interrupts or intrudes on others' conversations or games

Brain Changes

While the exact cause of ADHD remains a mystery, it increasingly appears that structural changes in the brain are linked to the disorder. Here are several factors that may play a role in developing ADHD:

• Altered brain function and anatomy. Brain scans have revealed important differences in the structure and brain activity of people with ADHD. For example, people with ADHD appear to have less activity in the area of the brain that controls attention than people who don't have ADHD.
• Inherited traits. ADHD can run in families.
• Maternal smoking, drug use and exposure to toxins. Pregnant women who smoke, drink alcohol or use drugs are at increased risk of having children with ADHD. Likewise, women exposed to environmental poisons during pregnancy — such as polychlorinated biphenyls (PCBs) — may be more likely to have children with symptoms of ADHD.
• Childhood exposure to environmental toxins. Preschool children exposed to certain toxins are at increased risk of developmental and behavioral problems. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behavior and to a short attention span

Check out the new website.  Click here to view a state by state and city by city Adult AD/HD Support Group list.

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 Depression is something that can be related to brain activity.  It is frequently associated with traumatic brain injury as a sign, symptom or consequence.

The frequency of depression can also be affected by external situations.  Recent data reveals that depression for Men due to Social and Economic Environment is prevalent.  Emory University School of Medicine experts write in the  British Journal of Psychiatry about the tendency.

"Dubbed by some the 'Mancession', the economic downturn has hit men particularly hard because of its disproportionate effect on traditional male industries such as construction and manufacturing. Research has shown that roughly 75% of jobs lost in the United States since the beginning of the recession in 2007 were held by men. There is little reason to believe that traditional male jobs will return in significant numbers with economic recovery.

 Neuroscientists at Cold Spring Harbor Laboratory (CSHL), Brookhaven National Laboratory (BNL) and UC San Diego (UCSD) have collected evidence suggesting that a previously overlooked portion of the brain could be a prime locus of human depression. An upcoming article in the journal Nature will contain the findings.

 "It covers an area only about 1-2 mm across." So far only two brain imaging studies have implicated the LHb in depression because of the difficulty in resolving it using existing technologies such as PET and fMRI.

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I have learned that people who pray and meditate actually lower stress and brain function.  I have yet to make meditation a daily part of my life, but recent studies may change my routine. 

 In a study that will appear in the January 30 issue of Psychiatry Research: Neuroimaging, Participant-reported reductions in stress were correlated with decreased grey-matter density in the amygdala, which is known to play an important role in anxiety and stress.

Previous studies found structural differences between the brains of experienced mediation practitioners and individuals with no history of meditation, observing thickening of the cerebral cortex in areas associated with attention and emotional integration. But those investigations could not document that those differences were actually produced by meditation.

 Meditation group participants reported spending an average of 27 minutes each day practicing mindfulness exercises, and their responses to a mindfulness questionnaire indicated significant improvements compared with pre-participation responses.

So lets start changing our brains by meditating.  If anyone can share a personal experience where meditation has noticeably changed stress or anxiety please let me know.

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Overcoming Loneliness After Traumatic Brain Injury

Common Signs of Loneliness

Traumatic Brain Injury may have physical and medical components. However, it can also change the way you feel about yourself and those around you. This is especially true in cases of mild and moderate brain injury. People often view you as “healed” or “well” and do not relate your change in feelings to a traumatic event. Understanding how brain injury has affected the way you feel and act is an important first step. Next you can learn how to improve old relationships, develop new relationships, and feel better about life.

Do you hear yourself saying…

• "Nobody cares about me.”
• “Why won’t my boyfriend return my calls.”
• “Seems like no one wants to talk to me.”
• “Everyone avoids me.”
• ”I just do not feel like going out.”
  

Are you saying or doing things that cause other people to be uncomfortable? Are you pushing others away by…

• focusing on what is wrong with your life and the world?
• not listening when others speak, interrupting, or talking too much?
• talking about yourself only?
• asking people very personal questions?
• hurting other people’s feelings?
• not going out

Common Feelings After Brain Injury

You may feel very lonely even around family and friends. Loneliness is a normal experience for most people at one time or another. It is when we feel disconnected and feel like something is missing in our lives. After a traumatic brain injury, those feelings can be intensified. Understanding how brain injury has affected the way you feel and act is an important first step.

The following are common feelings experienced by victims of traumatic brain injury…

• Difficulty communicating or relating to others
• Fear of Rejection
• Irritability
• Fatigue
• Anxiety
• Frustration relating to inability to drive or work

Additionally, some survivors find that they lose contact with friends and co-workers because they do not see them as much, especially if they have not returned to work or school.

Ways to Overcome Loneliness

These simple steps will help you overcome loneliness…

●Identify and develop interests in hobbies and activities you can do alone

Being alone and loneliness do not have to be the same. Find some alone time and use it to do things you enjoy like drawing, crafts, gardening, crossword puzzles, reading, listening to or playing music, researching your family tree, writing in a journal or any number of thousands of things. A side benefit is that you will more interesting to talk with since you have positive things to talk about.

●Exercise

We all know that exercise is the great healer. It will increase your strength and help you feel better about yourself. Consider joining a gym, health club, YMCA or YWCA, a mall walker’s club or other physical activity.

●Reduce television time

●Smile more

Greeting people with a smile will likely result in getting one in return which makes the moment positive. Eye contact says you are confident. It makes people like to be around you.

●Eat healthy and eliminate alcohol

Along with exercise, this self improvement suggestion will add energy to your regime. Buy a good diet book and commit to its program.

●Take your medication

Never stop taking prescribed medication if you do not like the way it makes you feel. Everyone has a unique reaction to different medicine. Advise you doctor and she will suggest alternate medicine for you to try until you find one that works best for you.

●Do not let challenges overwhelm you

This is easier than it sounds. Meditation helps produce certain brain activity that becomes a familiar and accessible place during times of stress. Do not let your depression overwhelm you. Talk to your doctor if you feel the need.

 For more information on services in your areas, contact your state mental health agency. You can find a psychologist in your area at www.apa.org; a licensed social worker at www.naswdc.org; or a local psychiatrist at www.psych.org.

●Do something for others without expecting something in return

The whole “pay it forward” mentality is a good place to begin. Carry someone’s groceries, walk their dog, visit a nursing home.

●Ask others for help when you need it

Victims often lack insight. Therefore they fail to appreciate that others who may want to help simply do not know what they can do. Tell them. You will be surprised at the response.

●Understand that to meet new people you have to be around other people

●Keep an open mind

It is hard for most people to try new things. But commit yourself to doing that at least once each week. Find community events in your local paper. It may be hard at first but if you put in the effort you will be pleasantly rewarded.

You can find support groups by contacting the Brain Injury Association of America at www.BIAA.org. You can attend community events like theater productions, music productions, art shows, book clubs, sport events, political meetings, adult education, Rotary Clubs www.rotary.org, Lions club International www.lionsclubs.org, Kiwanis International www.kiwanis.org, Soup kitchens, day care centers, nursing homes and animal shelters, to name a few.

●Make a list of things you would like to do

It is true that by writing goals down you are more likely to achieve them.

●Adopt a pet

For information on adopting a pet you can visit your local Humane Society at www.hsus.org or the American Society for the Prevention of Cruelty to Animals at www.aspca.org.

●Write, email or call family and friends

●Volunteer

You can support religious groups, schools, hospitals, and libraries that need volunteer work. You can find such organizations and others in your local newspaper. You can also research at www.volunteermatch.org.

●Join a church

●Learn about brain injury

Go to www.biaa.org or www.nabis.org to learn about traumatic brain injury and related issues.

●Limit the time you spend on the computer and the internet

Plan on developing and interacting personally rather than in virtual terms like chat rooms and the internet provide.

Building Strong Relationships

            Consider these ideas to build strong relationships…

            ●Learn to like who you are

We have all heard this before, “if you can’t like yourself, how can you like someone else?” Well start liking yourself. You are a good person and worthy of good friends.

            ●If you believe that others will like you they are more likely to

A Positive attitude about yourself will rub off on those around you.

            ●Write down your goals about making new and keeping new friends

It is true that by writing goals down you are more likely to achieve them.

            ●Make new friends

Resolve to not be afraid. Accept the invitation to the party, dinner, movie or whatever the opportunity provides. View meeting new people as an opportunity. Think about the possibilities of new things that can be had through making new and exciting friends.

            ●Take care of your physical appearance

Co0mmonly, when people become discouraged about themselves it shows in how they care for their outward appearance. Do not neglect yourself.

            ●Allow friendships to build slowly

Remember good friends are hard to find. Do not become discouraged if everyone you reach out to does not become more than an acquaintance.

            ●Try to listen more and talk less

Be a good listener. Hear the conversation, do not completely occupy it.

            ●Ask questions

A good way to show you are listening is to ask questions about what is being said.

            ●Show interest in what is being said

Participate in the conversation by occasionally nodding or making other sounds indicating you understand what is being said such as “Uh huh.”

            ●Remove distractions

It is difficult for anyone to focus on a speaker all the time. Trying to do so with extraneous noise like a T.V. or radio just makes it more difficult.

            ●Be a good friend that others will like to be around

Similar to people liking you for who you are, you should accept people for who they are. This may not make them a friend, but it will make you more pleasant to be around.

            ●Communicate positively

Some Traumatic brain injury survivors stay very negative about things. You need to focus and tell others about good things in your life or the world around you.

            ●Understand that relationships have good and bad moments

            ●Fight fair

Conflict is likely in any relationship. Be aware of that. Be ready and willing to forgive others as well as to be forgiven.

            ●Be polite, considerate and kind

Language can be sharper than the sword. Be very careful when you disagree to do so politely, respectfully and with a vision that the disagreement does not mean the end of the friendship.

            ●Think of others as much as you think about yourself

Thinking about others is a skill. The more you practice the better at it you become.

            ●Think about what you say before you say it

Along with being polite and respectful of what others have to say, be careful in what you say to others. Brain Injury makes people naturally less patient which can lead to unintended outbursts. Again practice makes perfect.

            ●Prepare yourself to work at building relationships

Building relationships takes time. Be ready and do not give up. Give it time. Accept that it may not have the same priority for the other person that it does at this moment for you.

I hope these basic tips will help you or a loved one cope better and ultimately overcome the tedium and strain of loneliness.

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New research supported in part by grants from the National Institute of Aging, part of the federal government's National Institutes of Health, and the U.S. Department of Defense, brings hope to the understanding and treatment of Alzheimer's Disease.

Reported in the Sept. 2 issue of the journal Nature,  the problem in Alzheimer's disease,  is beta-amyloid, a protein that accumulates in the brain and causes nerve cells to weaken and die.

Alzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, and eventually even the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear after age 60.

Alzheimer’s disease is the most common cause of dementia among older people. Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—to such an extent that it interferes with a person’s daily life and activities. Estimates vary, but experts suggest that as many as 5.1 million Americans may have Alzheimer’s.

Drugs designed to eliminate plaques made of beta-amyloid have a fatal problem: they need to enter the brain and remove the plaques without attacking healthy brain cells.  Scientists have learned an enormous amount about how beta-amyloid plaques are formed and the toxic effects that these structures as well as the earlier forms of beta-amyloid have on neurons and synapses. These findings have opened up new avenues of investigation and new possibilities for therapeutic targets. New research from the laboratory of Nobel Prize winner Paul Greengard, however, suggests that treatments modeled on the blockbuster cancer drug Gleevec could be the solution. 

Gleevec has the unique ability to bind to a protein that triggers the production of beta-amyloid plaques. The new research from Greengard's lab shows that this protein, called gamma-secretase activating protein (GSAP), dramatically and selectively increases the production of beta-amyloid peptide, which makes up the senile plaques found in the brains of most people with Alzheimer's. 

We are still far from shouting "success" and "cure" but we are inching closer.  Scientists are conducting studies to learn more about plaques, and other features of Alzheimer’s disease. They can now visualize plaques by imaging the brains of living individuals. They are also exploring the very earliest steps in the disease process. Findings from these studies will help them understand the causes of Alzheimer’s.

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What attracts men to women?  What do women want in men?  A psychology professor in Rochester, New York, has some interesting ideas.  Study results show that the color red worn by men increases their chances with most women.  Similarly, a man's station in life registers high on the aphrodisiac scale.  And of course romance.

But before you agree or disagree, know that the Journal of Experimental Psychology: General published an article supporting those findings.  And not just among human test subjects.

"In many nonhuman species of vertebrates, females are attracted to red on male conspecifics. Red is also a signal of male status in many nonhuman vertebrate species, and females show a mating preference for high-status males," says Dr. Elliot Andrew.

And women like their men macho.  Being metrosexual ranks more of a turn off for women then the traditional rugged look.  In Psychology of Men and Masculinity, modesty in men is seen as the less likely to cause attraction.  The article is entitled When men break the gender rules: Status incongruity and backlash against modest men.

And the results for men? "Heterosexual women bear the brunt of narcissistic heterosexual men's hostility, while heterosexual men, gay men and lesbian women provoke a softer reaction," according to psychologist Dr. Scott Keiller from Kent State University in Sex Roles: A Journal of Research.  Sex Roles is an interdisciplinary behavioral science journal offering a feminist perspective.

Another piece of information in the universe to think about.

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What do preschoolers, psychology and statistics have in common?  Well a new study published in Psychological Science, a journal of the Association for Psychological Science, finds that children figure out another person's preferences by using a topic you'd think they don't encounter until college: statistics.

Before exposure to the bell shaped curve or standard deviation, the preshcooler has entered the realm of statistical analysis.

Children are natural psychologists. By the time they’re in preschool, they understand that other people have desires, preferences, beliefs, and emotions.

The Squirrel puppet experiments reveals that children are able to distinguish which toys make others happy.  A child picks a blue flower from a container of red circles and blue flowers when the child is conditioned to understand the squirrel likes to play with blue flowers.  Four and Five year olds make this determination in the study.  The conditioning is achieved by the child watching a puppet show where the squirrel is given a blue flower and enjoys playing with it.

Of course, statistical information isn’t the only way children learn about the preferences of other people. Emotion and verbalization are also important.

Read the full article and test results.

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 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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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.

Read more here.

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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.

 Read More Here.

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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.

Read More.

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