Joseph Kim, MD, MPH – Brain Blogger http://brainblogger.com Health and Science Blog Covering Brain Topics Wed, 30 May 2018 15:00:03 +0000 en-US hourly 1 https://wordpress.org/?v=4.9.6 Bruxism and the Brain http://brainblogger.com/2009/10/28/bruxism-and-the-brain/ http://brainblogger.com/2009/10/28/bruxism-and-the-brain/#comments Wed, 28 Oct 2009 12:00:34 +0000 http://brainblogger.com/?p=2856 Do you grind your teeth at night? Bruxism is the technical term for teeth grinding or teeth clenching that usually occurs in sleep. Bruxism may lead to jaw pain, shoulder pain, ear ache, and all sorts of other physical ailments.

Have you ever wondered why some people grind their teeth at night? Some people clench their jaw and grind their teeth during the day, but nocturnal or night-time bruxism is what I’m referring to right now. I know many people who grind their teeth in their sleep and they have to wear night guards to protect the enamel on their teeth. There are many theories behind nocturnal bruxism, but I doubt that anyone really knows why people grind their teeth. There may be a host of different reasons why certain people struggle with bruxism. Allow me to share my thoughts on some of the major theories behind unexplained bruxism.

Anger: There are many who think that people who have suppressed anger release their anger at night by grinding their feet. Does it make sense that people would clench and grind their teeth if they were trying to release their suppressed anger? Is the brain releasing anger by clenching teeth? Perhaps it is a natural reaction that cannot be controlled unless the anger someone gets eliminated. I wonder if some people have a chronic level of anger that never goes away. If anger is building up and growing, then it could take many years before the anger goes away. Maybe if some people are not in touch with their feelings, then they may not realize how much anger they have building up inside of themselves. It’s important for people to be connected with their feelings so that they can recognize their feelings and deal with them appropriately. Otherwise, suppressed emotions may express themselves in unusual ways.

Anxiety: Anxiety comes in various forms. For some, it is generalized anxiety disorder (GAD). Others may have a combination of anxiety and depression. Anxiety may be suppressed or hidden in others. So, is bruxism a way the brain releases some of the tension caused by anxiety? Is it possible that the brain tries to escape anxiety by gnashing teeth? If my theory is correct, then people who receive treatment for their anxiety should have less bruxism. Does this happen?

Stress: Everyone experiences stress, but everyone doesn’t struggle with nocturnal bruxism. If some people live with a constant level of stress due to work or family problems, could this lead to bruxism? If people actively practice relaxation techniques, could this lead to a reduction in bruxism?

Mental trauma: Some people may encounter some type of severe mental trauma in their life. As a result, they may have Post-Traumatic Stress Disorder (PTSD). This type of mental trauma may manifest itself in different types of bodily symptoms ranging from headaches, body aches, and other types of ailments. At night, could this also be expressed through bruxism? Is it possible that the brain tries to escape this mental trauma by clenching the jaw?

In the future, perhaps we’ll understand what causes bruxism and discover a cure. Until that day arrives, we can only consider various theories offered by clinicians and researchers.

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The Adoption of Health IT http://brainblogger.com/2009/04/23/the-adoption-of-health-it/ http://brainblogger.com/2009/04/23/the-adoption-of-health-it/#respond Thu, 23 Apr 2009 16:03:06 +0000 http://brainblogger.com/?p=2644 Health and Healthcare CategoryDr. David Blumenthal is the newly appointed National Coordinator for Health Information Technology. You may have seen his name as the director of the Institute for Health Policy at the Massachusetts General Hospital (also known as “Mass General”) and Partners Healthcare System which is part of the Harvard hospital system. It’s too bad for Harvard. They’re losing a brilliant healthcare executive, but it’s for the greater good if he serves the nation. As the National Coordinator for Health IT, Dr. Blumenthal will be pushing for electronic health record (EHR) adoption in the United States.

ChartIn a recent edition of the New England Journal of Medicine, Dr. Blumenthal discusses some of the challenges that different stakeholders will face with the adoption of health IT. The American Recovery and Reinvestment Act of 2009 will drive health IT or HITECH adoption. For many years, different groups have been pushing physicians to use EHRs. Only a small percentage of doctors have adopted change. The rest have resisted change. They have chosen to continue with paper charts and hand-written or dictated records. There are so many inefficiencies when you compare paper records to electronic records. Plus, EHRs may reduce medical errors if they are used properly.

President Obama is now using both the carrot and the stick to incentivize and penalize physicians. The incentives will be driven by Medicare and even Medicaid (for those physicians who still accept Medicaid). Will this increase EHR adoption? I’m sure that it will. However, there are still many challenges ahead for all the stakeholders involved.

So we have President Obama pushing for increased use of EHRs. Actor Dennis Quaid is a strong advocate of health IT and believes that EMRs in the hospital setting may reduce medical errors like improper dosing of blood thinners like heparin. Quaid even started something called the Quaid Foundation to raise the standard in medical care and reduce medical errors. Compute-based hospital records can produce automatic alerts and warnings that can remind clinicians that orders may be incorrect. The use of health IT may also significantly improve mental health providers who often try to coordinate care among multiple different healthcare professionals.

As consumers embrace electronic personal health records, there is an opportunity for healthcare professionals to engage patients and maximize the potential that health IT has to offer. We will certainly see some significant changes in the healthcare system over the next several years. My hope is that it improves the care of mental illness among patients who have mild, moderate, and severe mental illnesses.

References

Blumenthal, D. (2009). Stimulating the Adoption of Health Information Technology New England Journal of Medicine, 360 (15), 1477-1479 DOI: 10.1056/NEJMp0901592

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Emotions and the Brain http://brainblogger.com/2009/04/08/emotions-and-the-brain/ http://brainblogger.com/2009/04/08/emotions-and-the-brain/#comments Wed, 08 Apr 2009 12:40:04 +0000 http://brainblogger.com/?p=2606 Opinion CategoryI’ve recently started to think about emotions. I’m not a very emotional person. I guess I’m just like many other men. I admit that I’m stereotyping here so I hope you don’t mind. However, I often wonder why men and women tend to differ so much when it comes to our emotions. There are so many stereotypes and many of them seem to be true most of the time.

Do emotions come from our brains, our hearts, or from some other organ? Does it come from hormones and other chemicals circulating in our bloodstream? Perhaps that’s why people blame emotional flare-ups on variations on hormone levels. However, we all know that our brain ultimately controls our words and actions. How we react to our emotional flares are determined by our cognitive processes occurring in our brain.

BoxMen (or the stereotypical man) can easily compartmentalize their emotions and place them into a box. Those boxes may never get opened for many years. Although some people may do this subconsciously, others do it consciously and intentionally. Certain people don’t want to feel specific emotions. They hide from them and they use any type of rationalization (yes, from the brain again) to tell themselves that they don’t need to be emotional. Others feel that they are stronger if they don’t display emotions. Much of this is culturally rooted since young boys may grow up conditioned and trained not to display their emotions. In some cultures, the display of emotions may be a sign of weakness. In certain cultures, men are expected to be so stoic that they forget how to connect with their emotions. They become so detached and removed that they ultimately lack emotions. In the East Asian culture, men tend to be very unemotional. Many remain detached even from their families. Maybe that’s why they can disown their children for seemingly menial things and be unemotionally affected.

We must not forget that we also have psychiatric conditions where people don’t display emotions. Or, they may display inappropriate emotions. I think that people who have antisocial personality disorder are classic examples of individuals who may be so disconnected from emotions like guilt that they rarely (or never) display remorse for their wrongful actions. It’s actually quite frightening when you think about it. Some people have no conscience and they are able to do some horrific things and be totally unaffected emotionally.

So have you ever wondered why we have emotions? Do animals also have emotions? Some would argue that animals feel love, sadness, anger, and other emotions. Others may think that animals are unable to feel as many emotions as people and they only react to instincts. I think emotions help us from killing ourselves. How would you know to run from a roaring lion in the middle of the jungle if you didn’t experience fear? Emotions ultimately help us maintain social order if we’re connected with them and use them appropriately. So are you an emotional person? Or are you emotionally detached?

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Relying on a Peripheral Brain http://brainblogger.com/2009/03/09/relying-on-a-peripheral-brain/ http://brainblogger.com/2009/03/09/relying-on-a-peripheral-brain/#respond Mon, 09 Mar 2009 14:51:52 +0000 http://brainblogger.com/?p=2520 Opinion CategoryIn the old days, medical students used to walk around with pockets bursting at the seams. Why? Because they were carrying around hand-written notes, cards, and mini textbooks to help them remember all the information they were trying to learn. Many people have described the medical school experience as “drinking out of a fire hydrant.” The volume of information is so great that our limited brains quickly get saturated with information and we’re unable to retain any more data.

When medical students would transition from the classroom environment to the clinical setting, they often relied on a pocket-sized notebook that they often called their “peripheral brain.” Some may have called that book their “second brain,” while others may have referred to it as their “ectopic brain.” Here’s a slight tangent: the word ectopic is defined as something that is in the wrong place. You’re probably familiar with the phrase “ectopic pregnancy” which is used when the developing embryo/fetus is not in the correct place (uterus) and is developing in the wrong place (e.g., in the fallopian tubes).

GadgetsThe medical student’s peripheral brain often lasts for several years because many students carry this book into post-graduate medical training (also called internship and residency). This book often gets very personalized with a wealth of hand-written notes, formulas, and other medical pearls.

Perhaps you think that I’m speaking of the stone ages when I speak of a paper book. Granted, the electronic PDA (personal digital assistant) and the smartphone have revolutionized the concept of a peripheral brain. Having access to the Internet on your handheld device is like having a gigantic book in your pocket. In the pre-PDA era, students had a finite amount of content they could carry in their pockets. Now, the sky is the limit because of revolutionary technology and increasing capabilities of micro computers (also known as ultra-mobile PCs or UMPCs).

So, you may not be a medical student, but do you rely on a peripheral brain? I think many of us have become utterly dependent on one but we may not realize it until we accidentally leave it at home. Then, when we’re somewhere and we suddenly realize that we don’t remember someone’s phone number, we are hopelessly lost! Technology continues to increase our efficiencies, but it also makes us more and more dependent on our peripheral brains. If you rely on a GPS (global positioning system) for directions as you’re driving, then you’re relying on a peripheral brain. If you keep all your phone numbers on your mobile phone, then that phone has become your peripheral brain. If you heavily use a PDA or smartphone and you keep a wealth of important information on that, then you’ve got an electronic peripheral brain in your pocket.

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Migraines and Nerve Stimulation http://brainblogger.com/2009/02/28/migraines-and-nerve-stimulation/ http://brainblogger.com/2009/02/28/migraines-and-nerve-stimulation/#comments Sat, 28 Feb 2009 17:03:32 +0000 http://brainblogger.com/?p=2405 Neuroscience and Neurology CategoryNerve stimulation therapy is used to treat many different types of disorders, including back pain, epilepsy, depression, and headaches. Some recent clinical findings were presented at the 2009 American Academy of Pain Medicine (AAPM) annual meeting held in Honolulu, Hawaii. Wouldn’t you love to go to Hawaii for a medical meeting?

The research was on the use of occipital nerve stimulation for refractory migraines. Vagus nerve stimulation has been used very successfully to treat epilepsy. A stimulator gets implanted under the skin (similar to a pacemaker) and then electric impulses are sent up the vagus nerve in the neck. You won’t be getting through airport security smoothly if you have one of these devices implanted in you. Of course, the bulge under your skin should be a clue that you have a medical device implanted in your body.

So what about occipital nerve stimulation?

MigraineAccording to the presentation by Joel Saper, M.D., of the Michigan Head Pain and Neurological Institute in Ann Arbor, occipital nerve stimulation may be a promising option for patients with intractable chronic migraine headaches. According to his study, 39% of patients had relief when they received nerve stimulation while 0% of patients had relief when they took standard medications. This device is currently still investigational, so don’t expect to get in line right away if you have chronic intractable migraines. The FDA has to approve it before it becomes publicly available. Adverse reactions reported in this study included lead migration (where the implanted lead moved around) and worsened headaches. This device was tested in 68 patients, so that’s a small study. You may be wondering how the leads moved around. Well, try to imagine a long wire going up from your stomach area, up your back, and to the bottom of your head. That’s essentially the way this device is implanted. The stimulator device goes somewhere in your belly and the long electrical leads are carefully placed up your back and they end up next to the occipital nerve which is near the bottom of your skull. Doesn’t sound too fun, does it? Then again, the implantation of medical devices is not something you’d want to have done to you unless you really needed it.

Would you be willing to have a battery-powered implanted device to treat your migraines? Or do triptans and other medications work for your headaches?

Commonly used migraine drugs include triptans such as Sumatriptan (Imitrex), Zolmitriptan (Zomig), Naratriptan (Amerge), Rizatriptan (Maxalt), Almotriptan (Axert), and Frovatriptan (Frova). They come as tablets, nasal sprays, and injections. Most people find that they work really well, but they can have some serious drug-drug interactions and they shouldn’t be used in patients with certain risk factors.

As technology allows device makers to develop implantable nerve stimulators and other devices, the management of difficult conditions like migraines may improve. It may be difficult to really understand how that may impact your life unless you’re the one with chronic intractable migraines and nothing ever works for you. Migraines can be extremely debilitating and if you’re the one who’s suffering all the time, then you may be willing to have a battery-powered electrical device implanted in your belly with wires going up your back and ending near the bottom of your skull. If you don’t think you can tolerate that, then let’s hope that better medications and non-invasive strategies will improve.

References

Saper J, et al. Occipital nerve stimulation (ONS) for treatment of intractable migraine headache: 3-month results from the ONSTIM feasibility study. American Academy of Pain Medicine. 2009; Abstract 155.

B. Burns, L. Watkins, P. J. Goadsby (2009). Treatment of intractable chronic cluster headache by occipital nerve stimulation in 14 patients Neurology, 72 (4), 341-345 DOI: 10.1212/01.wnl.0000341279.17344.c9

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Bias and the Brain http://brainblogger.com/2009/02/09/bias-and-the-brain/ http://brainblogger.com/2009/02/09/bias-and-the-brain/#comments Mon, 09 Feb 2009 19:01:19 +0000 http://brainblogger.com/?p=2367 Opinion CategoryThere has recently been a lot of discussion revolving around bias and medical education. Many people are asking the question, “What level of bias is appropriate?” Is it possible to educate students and clinicians without and be completely free of bias? After all, we’re only human. Or, do we do our best to identify and address bias in a way that is fair, objective, and evidence-based? As we try to rid ourselves of bias, we can’t help but to discover that our brains are naturally biased. We all know this, but we can’t help ourselves since we’re all human. Others are asking, “Is all bias bad?” Is there an appropriate level of bias that is good, acceptable, and appropriate? The sad reality is that we’ve all seen examples of bad or inappropriate bias in the medical field. The bad apples are rotting the bunch, but I don’t think that the entire basket has been lost yet.

To start this discussion, let’s clarify our definition of bias. How do you define bias? Well, Google defines bias as:

influence in an unfair way; a partiality that prevents objective consideration of an issue or situation.

The National Institute on Aging defines bias as:

A point of view or preference which prevents impartial judgment in the way in which a measurement, assessment, procedure, or analysis is carried out or reported.

This brings me to an interesting discussion on the topic of good or appropriate bias versus bad or inappropriate bias. Does appropriate bias exist in health education? If a certain drug or treatment is considered to be far better than all the others in a specific class, then doesn’t that constitute bias? After all, should all drugs be considered equal when they really aren’t? Then how do we free ourselves of bias? But what if all the evidence points to the superiority of a specific agent? That drug is biased as the best because all the evidence points that way. Is such a situation impossible?

Inappropriate bias should never be tolerated. As defined, that type of bias is inappropriate. Healthcare professionals should always be objective about the available levels of evidence when making clinical decisions. The practice of evidence-based medicine has been emphasized greatly and clinicians need to be familiar with the evidence behind specific therapies. Many doctors practice medicine based on their own experience and not based on the clinical evidence. As a result, they may become very biased in what they prescribe or how they treat a certain disorder.

National clinical practice guidelines are written by leading experts in the field as they evaluate the evidence that support the use of specific agents. Many guidelines refer to specific drugs as the “agent of choice” for specific situations. Are these guidelines biased? Some people may think that the clinician authors are being biased when in reality they are being as objective (as humanly possible) with the available amount of clinical evidence. Newer guidelines publish the levels of evidence and indicate the strength of the evidence (the highest levels represent the most robust forms of clinical studies).

Recent revisions to the PhRMA code have now taken into effect. Gone are the days of pens, notepads, soap dispensers, and other pharma-labeled freebies. Supply of such items will soon start dwindling in doctor’s offices and you may have a hard time finding a pen to sign your signature. Will the removal of such small items eliminate bias in the healthcare profession? What does the evidence suggest?

Since doctors and other healthcare professionals are human, we are all prone to bias. Our brains are all biased. What we learn during medical school is taught by faculty who are biased. What we hear from our peers and colleagues is always biased. Can we, as healthcare professionals, distinguish good versus bad bias? Can we judge what is appropriate and inappropriate? I certainly hope we can learn to so that we can do what is best for our patients.

These are just my opinions and I openly admit that I’m naturally biased since I’m human.

References

Pharmaceutical Research and Manufacturers of America. Code on Interactions with Healthcare Professionals.

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Smoking Behavior and the Transtheoretical Model of the Stages of Change http://brainblogger.com/2009/01/25/smoking-behavior-and-the-transtheoretical-model-of-the-stages-of-change/ http://brainblogger.com/2009/01/25/smoking-behavior-and-the-transtheoretical-model-of-the-stages-of-change/#comments Sun, 25 Jan 2009 16:13:01 +0000 http://brainblogger.com/?p=2298 BioPsychoSocial Health CategoryWelcome to the New Year. Have you made any resolutions for 2009? Have you ever wondered what motivates people to change their behavior? There are some who are always seeking self-improvement. Others may feel content and they may see no reason to change certain habits or behaviors. Do you have any New Year’s resolutions that you plan to keep this year? 

The famous transtheoretical model (TTM) of behavior change is often used to guide clinicians who are trying to promote smoking cessation. Smokers often need help in order to quit successfully. It can be very difficult to overcome a long-time habit or addiction if you do not have the proper guidance from a professional. When the TTM is applied in the setting of smoking cessation, the goal is to move a patient from one stage to the next stage. This is a gradual progression that takes time and people usually don’t jump through several stages at one time.

SmokedThe stages of change within the TTM are:

Precontemplation: At this stage the person is not even thinking about the behavior change. The person may be unaware of the need for change, or the person may be in denial. He or she has not personally considered making a change in lifestyle or behavior. In the case of smoking, the person has no thoughts of quitting. He or she has never considered quitting and has never thought about the harmful effects of smoking. There is no motivation to quit since the person has never seriously entertained the thought.

Contempation: Once a person reaches contemplation, he or she begins to seriously consider the pros/cons associated with the change. The person may do some research and may learn more about the aspects of the behavior change. The individual may ask certain questions and read some books about successful quitting techniques. Eventually, he or she considers actually making the change. Many smokers are in this stage because they hear about the health hazards associated with smoking and they begin to wonder whether they should try quitting. They don’t have any set plans to quit, but they consider what their life might be life if they were to quit.

Preparation: At this stage, the person begins to make plans and prepares for the necessary change. Most of this is mental and psychological preparation, but there may be some lifestyle changes that also take place as the person begins to prepare for action. For smokers, this may involve a mental preparation of quitting. They may plan ahead by setting a quit date and marking it on the calendar. They may also tell others about their quit date so that they have some accountability from others.

Action: This is where the individual implements the change in behavior. This is when the quit date arrives and the smoker stops smoking. If the action stage occurs and the behavior change isn’t maintained, then people fall back into a previous stage. Some people give up while others get motivated to prepare and plan for another quit date. Others are able to maintain their behavior change for a while, but then they may relapse and have to go through the stages of change again.

Maintenance: This is where one maintains the changed behavior and incorporates the new behavior as a way of life. Some people do not include this as a stage of change since at this point the person has already made the change. However, since people often revert back to original behaviors, this maintenance stage is a necessary step for many. Most smokers who quit for the first time relapse at some point. Hence, it often takes many efforts to get smokers to quit permanently.

Have you been wondering about making some type of lifestyle behavior change in your life? Perhaps you are a smoker and you find yourself in the contemplation stage. Where do you find yourself? As the New Year begins, consider what types of changes you need to make in your own life. Talk with your doctor about health habits that may need to change, such as smoking.

References

P AVEYARD, L MASSEY, A PARSONS, S MANASEKI, C GRIFFIN (2008). The effect of Transtheoretical Model based interventions on smoking cessation Social Science & Medicine DOI: 10.1016/j.socscimed.2008.10.036

Christopher J. Armitage, Madelynne A. Arden (2008). How useful are the stages of change for targeting interventions? Randomized test of a brief intervention to reduce smoking. Health Psychology, 27 (6), 789-798 DOI: 10.1037/0278-6133.27.6.789

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Recent Drug Warnings About Suicide http://brainblogger.com/2009/01/06/recent-drug-warnings-about-suicide/ http://brainblogger.com/2009/01/06/recent-drug-warnings-about-suicide/#comments Tue, 06 Jan 2009 14:24:42 +0000 http://brainblogger.com/?p=2257 Psychiatry and Psychology CategoryDuring the holiday season, I was reminded of the old myth that suicide rates increase over the holidays. This medical myth has been debunked numerous times and it was one of the topics covered in a recent BMJ story about medical myths. For many years, people believed this myth because they felt that the depression worsens when depressed patients see other happy and celebrating with friends and family. Plus, in many areas, the winter seasons may lead to more rain, cloudy weather, and gloomy days for people who may be susceptible to seasonal affective disorder (SAD). So how about suicide? How often do depressed patients commit suicide? And what prompts depressed individuals to the verge of suicide? This is a very complex topic that has no simple explanation.

PillsA few years ago, the FDA added suicide warnings to common anti-depressants. This included drugs like:

  • Prozac (fluoxetine),
  • Zoloft (sertraline),
  • Paxil (paroxetine),
  • Luvox (fluvoxamine),
  • Celexa (citalopram),
  • Lexapro (escitalopram),
  • Wellbutrin (bupropion),
  • Effexor (venlafaxine),
  • Serzone (nefazodone), and
  • Remeron (mirtazapine).

This is a very long list of extremely common medications. When this happened, people asked, “Why do anti-depressants increase the risk of suicide?” Many different theories emerged, but this did not stop clinicians from prescribing these common agents for patients suffering from depression or anxiety. This warning was also considered very ironic since severely depressed patients are the ones who may commit suicide, yet they are the ones who need to be treated with anti-depressants. So how do you treat suicidal patients if the treatment may increase the risk of suicide? Many people wondered whether the drugs really increased suicide, or if the increased suicide was simply an association without causation. This matter still seems to be quite controversial among healthcare professionals. If you’re going to treat patients who are very suicidal with any type of drug, there is a high chance that some of them may still commit suicide.

More recently, the FDA added suicide warnings to anti-epileptic drugs. These agents are used to treat patients with seizure disorders (epilepsy). They are also used to treat certain types of nerve-related pain, also called neuropathy. Anti-epileptic agents are often used to treat certain migraines. Not sure which drugs fall into this class? Maybe you’ve heard of some of these:

  • Tegretol (carbamazepine),
  • Klonopin (clonazepam),
  • Depakote (divalproex),
  • Depakene (valproic acid),
  • Zarontin (ethosuximide),
  • Peganone (ethotoin),
  • Felbatol (felbamate),
  • Neurontin (gabapentin),
  • Lamictal (lamotrigine),
  • Vimpat (lacosamide),
  • Keppra (levetiracetam),
  • Mesantoin (mephenytoin),
  • Celontin (methsuximide),
  • Trileptal (oxcarbazepine),
  • Dilantin (phenytoin),
  • Lyrica (pregabalin),
  • Mysoline (primidone),
  • Gabitril (tiagabine),
  • Topamax (topiramate),
  • Tridione (trimethadione), and
  • Zonegran (zonisamide).

You may have also heard of suicide risks associated with the popular smoking cessation drug Chantix (varenicline).  In February 2008, the FDA issued a public health advisory about the risks of suicide associated with Chantix.

So what’s next? Will more psychotropic medications get a suicide black box warning? What about non-psychotropic medications? If the suicide warning gets added to so many different medications, then people may start ignoring the warning if it’s everywhere. How often do people read the Surgeon General’s warning on cigarette packs? That warning is ubiquitous. However, is it effective? Do people actually pay attention to that warning, or do they ignore it since they’ve seen it so many times?

How are healthcare professionals supposed to prescribe drugs that have a suicide black box warning? How are patients supposed to react to such warnings? This is a very confusing topic right now, and I’m eager to see what happens in the next few years as the FDA evaluates suicide association with other drugs.

References

R. C Vreeman, A. E Carroll (2007). Medical myths BMJ, 335 (7633), 1288-1289 DOI: 10.1136/bmj.39420.420370.25

FDA Public Health Advisory. Worsening Depression and Suicidality in Patients Being Treated With Antidepressant. FDA News. March 22, 2004.

FDA Issues Public Health Advisory on Chantix. FDA News. Feb 1, 2008.

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Personal Health Records and Mental Health http://brainblogger.com/2008/12/15/personal-health-records-and-mental-health/ http://brainblogger.com/2008/12/15/personal-health-records-and-mental-health/#comments Mon, 15 Dec 2008 14:09:01 +0000 http://brainblogger.com/?p=2081 Health and Healthcare CategoryPersonal health records or PHRs are becoming more and more popular these days as health information technology capabilities become more wide-spread. Look at Google Health as one example. The federal government has picked Google Health as one of four components of a Medicare pilot program in Arizona. The other three companies were HealthTrio, NoMoreClipboard.com, and PassportMD. Should all our health information be uploaded to the internet? What types of implications does such a PHR have on public health, disease management, and individual privacy?

First, on the population health level, I think that the use of PHRs will improve public health because of the availability of data to healthcare professionals. I have witnessed so many instances where a “John Doe” or a “Jane Doe” ends up in the emergency room with no identification and the doctors are playing guessing games to figure out what might be wrong with an individual who remains unresponsive. Did the person overdose on a drug? Is the person intoxicated? Did the person try to commit suicide? Did this individual have a stroke and pass out? These individuals are given generic names (like John Doe and Jane Doe) while social workers work to identify these people. Sometimes they are homeless individuals who lack ID. Some are people who got intoxicated, lost consciousness, and also lost their ID. Others have some type of mental illness and may be psychotic or actively hallucinating. Without identification, these individuals may claim to be anyone. Providing healthcare professionals to valuable patient data will only improve public health in this country.

RecordsOn the disease management side of things, PHRs will help with medication tracking. So often, patients are prescribed different drugs from different providers. The primary care provider may write for one drug, and then the psychiatrist may change that drug or add another. Patients can often get confused about their medications unless they have them written down in a place where all their doctors can see the list. A PHR can allow this to happen. Electronic health records used in hospitals and physician offices have tremendously made an impact in public health and disease management. Doctors now have automated reminders that are popping up for their patients. Their computers may remind them of dangerous drug interactions and other potential adverse effects of prescribed medications. These are the types of tools that were missing twenty years ago. Patients often have access to the same type of resources if they are using an intelligent PHR system that can alert them to drug-related side effects and warnings.

Finally, privacy remains a very important piece of the PHR puzzle. If your health data is on the internet, could someone gain access to it? Could someone even change it? These are some of the common questions that get asked these days. These are certainly legitimate questions and as information technology improves and security measures increase, people should have less to fear about. The government feels confident enough to award these four major companies access to Medicare patient data, so we know that someone feels OK with electronic PHRs.

References

Medicare Selects Four Companies Where Beneficiaries Can Maintain Their Own Personal Health Records Medicare Press Release, November 12, 2008.

J. Myers, T. R. Frieden, K. M. Bherwani, K. J. Henning (2008). Ethics in Public Health Research: Privacy and Public Health at Risk: Public Health Confidentiality in the Digital Age American Journal of Public Health, 98 (5), 793-801 DOI: 10.2105/AJPH.2006.107706

Alexander S. Young, Edmund Chaney, Rebecca Shoai, Laura Bonner, Amy N. Cohen, Brad Doebbeling, David Dorr, Mary K. Goldstein, Eve Kerr, Paul Nichol, Ruth Perrin (2007). Information Technology to Support Improved Care For Chronic Illness Journal of General Internal Medicine, 22 (S3), 425-430 DOI: 10.1007/s11606-007-0303-4

Victor Strecher (2007). Internet Methods for Delivering Behavioral and Health-Related Interventions (eHealth) Annual Review of Clinical Psychology, 3 (1), 53-76 DOI: 10.1146/annurev.clinpsy.3.022806.091428

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Psychiatric Conditions and Alcohol Abuse in the College-Aged http://brainblogger.com/2008/12/06/psychiatric-conditions-and-alcohol-abuse-in-the-college-aged/ http://brainblogger.com/2008/12/06/psychiatric-conditions-and-alcohol-abuse-in-the-college-aged/#comments Sat, 06 Dec 2008 14:00:55 +0000 http://brainblogger.com/?p=2007 I always find epidemiological studies very interesting because they can give you a snapshot of the prevalence of certain conditions. Have you ever wondered about the prevalence of psychiatric conditions and alcohol use disorders among college students? This is a topic that has been studied extensively by many different research groups.

Recently, an article was published about this topic by a group of researchers from the National Institutes of Health (NIH) and it caught my attention. According to a series of over 40,0000 interviews conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), almost half of college-aged individuals had a psychiatric disorder in the past year. What was very interesting about this survey was that college students had a greater risk of alcohol use disorder compared to non-college students in the same age group.

AlcoholDoes this mean that you’re likely to run into life-long alcohol problems by going to college? Well, not necessarily. Let’s see why. If you read the study that was published in the Archives of General Psychiatry, you’ll find that when the authors adjusted that risk by taking into account factors such as background sociodemographics, the risk for alcohol misuse between the college and non-college groups was roughly the same. However, college students were significantly less likely to have a diagnosis of drug use disorder or nicotine dependence. We all know that college students are surrounded by enormous peer pressure and parties. In fact, fatalities from alcohol intoxication are not too uncommon. Why aren’t college students seeking help if they have alcohol use disorders? Many of them probably fail to recognize the severity of the problem.

So what’s the bottom line? The conclusion of this paper reads:

Psychiatric disorders, particularly alcohol use disorders, are common in the college-aged population.

Most people probably already know this, so what did this paper tell us? We all know that many college students misuse alcohol and drugs. This often leads to life-long dependence problems and other serious mental health disorders. These researchers noted that many college students are not seeking professional help for their mental health problems. Treatment rates for alcohol misuse remain low and this underscores the need for public health initiatives aimed at both college students and their non-college-attending peers. People need to be reminded that no one is immune from the dangers of drugs, tobacco, or alcohol. The social stigmas associated with substance use may prevent people from seeking professional help, so this remains yet another barrier for people.

Alcohol misuse remains a significant public health problem in this country. There is tremendous need for interventions aimed at reducing alcohol abuse, especially in the college-aged population. The authors of this paper note that skills-based interventions, motivational interviewing, and personalized normative feedback are all effective ways to reduce drinking in college students.

Reference

C. Blanco, M. Okuda, C. Wright, D. S. Hasin, B. F. Grant, S.-M. Liu, M. Olfson (2008). Mental Health of College Students and Their Non-College-Attending Peers: Results From the National Epidemiologic Study on Alcohol and Related Conditions Archives of General Psychiatry, 65 (12), 1429-1437 DOI: 10.1001/archpsyc.65.12.1429

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