The Brain Science Podcast  can be accessed at www.brainsciencepodcast.com.  Each episode takes on a new and challenging aspect of the human brain.  This podcast is not only about brain damage, but other brain matters such as memory, plasticity, mapping, philosophy and many others.  It is designed for general audiences.

Each episode Dr. Campbell features a new book she has reviewed and usually conducts an interview with the author.  It is really great.  She will preview upcoming texts at the end of an episode.  So, if you are like me, you can get the book, read it, and then be more engaged in the interview with the author.

You can tell that she really puts a lot of effort and time into creating the podcast just by listening in.  She has over 80 podcasts dating back from 2006.  She challenges listeners to go back and listen to each one.  Now that I have an iPhone I am doing just that.  The information is amazing.

She also encourages listeners to offer criticism, advice or general discussion about the brain.  Her email is docartemis@gmail.com.  You can subscribe fore free through iTunes, or other podcast services.  Check it out.   

We all know that brain cells do not regenerate once damaged.  Broken bones heal, and soft tissue injury rebuilds.  But the brain, holding the precious cargo of neurons, dendrites and axons, has traditionally been unreceptive to healing in terms of cell structure. 

The promise of stem cell research held up the hope that unspecialized cells could become neurons if introduced into the brain or spinal cord.  The problem has been political more than medical.  George Bush, in a State of the Union address condemned stem cell research based on religious grounds.

Now science is getting center stage on stem cells.  The Journal of Neurotrauma published a study.  Researchers at the University of Texas Medical Branch at Galveston conducted experiments with both laboratory rats and an apparatus that enabled them to simulate the impact of trauma on human neurons, and they identified key molecular mechanisms by which implanted human neural stem cells -- stem cells that are in the process of developing into neurons but have not yet taken their final form -- aid recovery from traumatic axonal injury.

A significant component of traumatic brain injury, traumatic axonal injury involves damage to axons and dendrites, the filaments that extend out from the bodies of the neurons. The damage continues after the initial trauma, since the axons and dendrites respond to injury by withdrawing back to the bodies of the neurons.

I will surely follow these discoveries as it has significant meaning for curing or lessening the adverse effects of traumatic brain injury.  

This is the final post in my series on Post Traumatic Stress Disorder.  Last week we looked at Treatment for Post-Traumatic Stress Disorder.  Today we will look at how the disorder and litigation relate.

In law, trauma which produces post-traumatic stress disorder is referred to as a tort. For many years only physical injury related to a trauma could form the basis of a lawsuit since it was observable and quantifiable. As the behavioral sciences gained ground, the concept of “traumatic neurosis” emerged and by the 1940s, testimony relevant to this psychiatric syndrome was accepted in many courts. By 1980, post-traumatic stress disorder found its way in the Diagnostic and Statistical Manual – the DSM – and the condition became a source of monetary damages to one so inflicted.

 The legal cause of action for emotional distress and psychiatric disorder including post-traumatic stress is readily accepted by courts for the person involved in the physical trauma. However the only time one not involved in the physical trauma can recover for emotional distress or post-traumatic stress disorder is if they were within the “zone of danger.” Please refer to my previous post.

 The Zone of Danger Rule - The Zone of Danger Rule, applied in almost every jurisdiction, allows a plaintiff to recover for emotional distress caused by a defendant’s negligent conduct if the plaintiff was in a location where the defendant’s conduct could have caused physical harm to the plaintiff.

 The theory supporting this doctrine is that the likely truth of a claim of emotional distress is increased if the person making the claim came close to suffering physical harm from the conduct that caused the person’s emotional distress.

 Predisposition to PTSD is frequently contested. Whether a person’s personality type gave way to PTSD where others with other personality types would have avoided the disorder is bandied about in trials. The question of predisposition has puzzled doctors over the years. Not all soldiers in the same battle, passengers in the same automobile accident, or workers exposed to the same industrial calamity develop PTSD. A dispute often arises in my practice over how a driver or passenger in the same car crash could develop PTSD while the other does not. Why certain individuals are vulnerable to PTSD must have something to do with heredity (genetics), environmental factors (family upbringing) together with the nature and impact of the trauma.

 Since my legal practice is significantly defined by the many traumatic brain injury cases I handle and have handled over many years, I come in contact with the PTSD diagnosis quite frequently. It is my experience that the condition is typically disputed and attempts are made to relate any psychiatric injury claims to predisposing factors.

 Today we are continuing our discussion of post-traumatic stress disorder by identifying treatments options.

Post-traumatic stress disorder consists of a spectrum of pathologic symptoms and behaviors involving the environment, the brain, and psychosocial influences. The environment is both cause and effect as the trauma from the environment initiates the disorder and leaves its imprint as an aftermath. The brain interacts with the trauma to produce symptoms of intense fear, dissociative flashback episodes, and physiological reactivity upon exposure to cues that resemble the traumatic event. Because of the constellation of symptoms typical of PTSD, the conceptualization of symptoms and pathologic behaviors related to the environment, the brain and psychosocial factors allows the clinician to select biologic, cognitive-behavior, psychosocial and environmental modalities to formulate a comprehensive treatment plan. (C.B. Scrignar)

The Mayo Clinic describes treatments.

Medications
Several types of medications can help symptoms of post-traumatic stress disorder improve.

•  Antipsychotics. In some cases, you may be prescribed a short course of antipsychotics to relieve severe anxiety and related problems, such as difficulty sleeping or emotional outbursts.
• Antidepressants. These medications can help symptoms of both depression and anxiety. They can also help improve sleep problems and improve your concentration. The selective serotonin reuptake inhibitor (SSRI) medications sertraline (Zoloft) and paroxetine (Paxil) are FDA-approved for the treatment of PTSD.
• Anti-anxiety medications. These drugs also can improve feelings of anxiety and stress.
• Prazosin. If your symptoms include insomnia or recurrent nightmares, a drug called prazosin (Minipress) may help. Prazosin, which has been used for years in the treatment of hypertension, also blocks the brain's response to an adrenaline-like brain chemical called norepinephrine. Although this drug is not specifically approved for the treatment of PTSD, prazosin may reduce or suppress nightmares in many people with PTSD.

Psychotherapy
Several types of therapy may be used to treat both children and adults with post-traumatic stress disorder. You may try more than one, or combine types, before finding the right fit for you. You may also try individual therapy, group therapy or both. Group therapy can offer a way to connect to others going through similar experiences.

Some types of therapy used in PTSD treatment include:

• Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck — for example, negative or inaccurate ways of perceiving normal situations.

In PTSD treatment, cognitive therapy often is used along with a behavioral therapy called exposure therapy.

• Exposure therapy. This behavioral therapy technique helps you safely face the very thing that you find frightening, so that you can learn to cope with it effectively. A new approach to exposure therapy uses "virtual reality" programs that allow you to re-enter the setting in which you experienced trauma — for example, a "Virtual Iraq" program.
• Eye movement desensitization and reprocessing (EMDR). This type of therapy combines exposure therapy with a series of guided eye movements that help you process traumatic memories.

All these approaches can help you gain control of lasting fear after a traumatic event. The type of therapy that may be best depends on a number of factors that a PTSD sufferer and a health care professional can discuss.

As identified above, Medications and psychotherapy also can help you with other problems related to traumatic experience, such as depression, anxiety. Many PTSD sufferers engage in “self-medication” with alcohol or substance abuse. Therapy and treatment can help curb the burden of PTSD.

Next week we will look at special issues germane to litigation and post-traumatic stress disorder.

 II.               What are the Types of Trauma that Causes of Post-Traumatic Stress Disorder?

Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a terrifying event. Symptoms may include flashbacks, nightmares and severe anxiety, as well as uncontrollable thoughts about the event.

According to http://www.medicinenet.com/posttraumatic_stress_disorder  

 Virtually any trauma, defined as an event that is life-threatening or that severely compromises the physical or emotional well-being of an individual or causes intense fear, may cause PTSD. Such events often include either experiencing or witnessing a severe accident or physical injury, receiving a life-threatening medical diagnosis, being the victim of kidnapping or torture, exposure to war combat or to a natural disaster, exposure to other disaster (for example, plane crash) or terrorist attack, being the victim of rape, mugging, robbery, or assault, enduring physical, sexual, emotional, or other forms of abuse, as well as involvement in civil conflict. Although the diagnosis of PTSD currently requires that the sufferer has a history of experiencing a traumatic event as defined here, people may develop PTSD in reaction to events that may not qualify as traumatic but can be devastating life events like divorce or unemployment.

It is an interesting observation that the traditional “Trauma Principle” discussed in my last post has been broadened to include trauma where the “zone of danger” is no longer requisite. In my experiences, I am most exposed, as a consumer rights attorney, to those individuals who suffer traumatic events that injure either themselves or someone with them. The following is a summary of such common events and others that can cause PTSD.

•       Vehicular Trauma

There is no denying that a vehicle weighing several thousand pounds can cause injury, trauma and even death. That is typical in cases of car “accidents.” But consider for a moment, big rig trucks carrying heavy loads of cargo or hazardous materials. Think of train wrecks and airplane crashes. As I state on my website, before there were trains, planes and automobiles, we simply did not travel or crash in the manner we see quite frequently today.

•       Industrial Trauma

Industrial settings – factories, oil refineries, construction sites, and other blue collar work places – have a high potential for accidents. Work related trauma could well be any trauma that is sustained while at work or on the job. Sometimes trauma can be very job specific like falling off scaffolding. Other times it could be like any other; a truck crash while hauling dirt. The point is trauma related to the job can result in PTSD.

•       Criminal Assaults

Statistics of criminal assault are staggering. When a person is attacked, beaten or hit, a trauma occurs. In cases of of negligent security, one can see how criminals and trespassers could gain access to apartments, hotels and other public sites and commit crimes that include injury to the victim.

•       Sexual Assaults

Sexual assault is defined as any sort of sexual activity between two or more people in which one of the people is involved against his or her will.

The sexual activity involved in an assault can include many different experiences. Women can be the victims of unwanted touching, grabbing, oral sex, anal sex, sexual penetration with an object, and/or sexual intercourse.

•       Child Sex Abuse
•       Terrorism

Veterans, like other people, respond to traumatic events in a number of ways. They may feel concern, anger, fear, and helplessness. These are all normal responses to an abnormal event. Research shows, though, that people who have been through traumas in the past may be even more likely than others to be affected by new events such as terror attacks and war.

•       Torture
•       The Holocaust
•       War Trauma

Now that the war in Iraq is over, the return of military personnel will reveal the residual injury of war, PTSD. The signature injury has already been well recognized by the military and government. Getting care will be the next challenge.

Experts think PTSD occurs:

§ In about 11-20% of Veterans of the Iraq and Afghanistan wars (Operations Iraqi and Enduring Freedom), or in 11-20 Veterans out of 100.

§ In as many as 10% of Gulf War (Desert Storm) Veterans, or in 10 Veterans out of 100.

§ In about 30% of Vietnam Veterans, or about 30 out of 100 Vietnam Veterans.

•       Natural or Man-Made Disasters

Every year, millions of people are affected by both human-caused and natural disasters. Disasters may be explosions, earthquakes, floods, hurricanes, tornados, or fires. In a disaster, you face the danger of death or physical injury. You may also lose your home, possessions, and community. Such stressors place you at risk for emotional and physical health problems.

Trauma producing post-traumatic stress disorder – PTSD – comes in many shapes and sizes and not in a one size fits all. As an attorney whose practice is defined by the significant cases of traumatic brain injury handled over the years, I am often disappointed at how difficult it is to convince insurance companies, defense lawyers and defense experts of the relation of trauma to a diagnosis of post-traumatic stress disorder – PTSD.

Next week we will continue our discussion of post-traumatic stress disorder. We will look at the treatments used to manage it and will look at the nuances PTSD brings to litigation.

During the month of February, I will do a short series of posts on Post-Traumatic Stress Disorder.  Starting today and for the next 3 Tuesdays in February we will look at what PTSD is, the types of causes of PTSD, treatment plans, and. finally, litigation issues.

I.               What is Post Traumatic Stress Disorder?

The National Institutes of Mental Health defines Post Traumatic Stress Disorder, also known as PTSD, as “an anxiety disorder that some people get after seeing or living through a dangerous event.” It is natural to feel afraid when faced with danger. The fear or “fight or flight” response triggers split second changes in the body to prepare to defend against the danger or to avoid it. The reaction is designed to protect a person from harm. However in people with post-traumatic stress disorder, PTSD, the reaction is changed or damaged. These folks feel stressed or frightened even when they are no longer in danger.

Some of the classic characteristics of post-traumatic stress disorder include:

•  Nervousness
•  Preoccupation with the trauma
•  Pain or physical discomfort
• Sleeplessness and nightmares
• Flashbacks and intrusive thoughts
• Deterioration of performance
• Phobia
• Personality change
• Unprovoked outbursts

A concept, known as the “Traumatic Principle,” helps to sort out those victims of trauma more likely to develop PTSD. Important elements of serious trauma include:

•        Vulnerability

Predisposition recognizes the role of genetics, family upbringing, and other risk factors in the diagnosis of PTSD.

•        Environmental Stimulus

This refers to any traumatic event coming from outside of the individual.

•       Realistic Threat

This means that by observable and obvious standards, the environmental event has the capacity to produce physical injury or death.

•       Perception by Five Senses

Here is the acknowledgment that neurobiological components exist from the traumatic event.

•       Cognitive Awareness

Perception involves cognitive awareness and the nervous system.

•       Activation of the Sympathetic Nervous System

This is the most obvious neurobiological indication of intense fear, helplessness, or horror.

•       Zone of Danger

This concept, somewhat controversial among experts, holds that before PTSD can develop, the victim must be present at the traumatic scene and experience, witness, or be confronted with a dangerous situation that can be actual or threatened death or serious injury.

A compilation of these factors results in the Traumatic Principle which C.B. Scignar, M.D. describes as:

Any environmental stimulus which poses a realistic threat  to life or limb, if perceived by one, or more likely a combination of the five sensory pathways to the brain, if cognitively interpreted as dangerous (a serious threat to life or physical integrity to self or others), and followed by intense stimulation of the sympathetic nervous system, whether it produces a physical injury or not, can be regarded as a traumatic event which can precipitate PTSD in a vulnerable individual who is in the zone of danger.

Anyone, according to the National Institutes of Mental Health, can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events. In contrast to Dr. Scignar, the National Institutes of Mental Health endorses that not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or is harmed. For instance, the sudden, unexpected death of a loved one can also cause PTSD.

In the posts to follow this month we will examine the types of trauma, treatment and some of the issues in litigation that are affected by post-traumatic stress disorder. 

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.

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.

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

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.

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.

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.

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.

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.

 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.

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.

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.

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.

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.

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.