Brenda Walker, MA – Brain Blogger Health and Science Blog Covering Brain Topics Wed, 30 May 2018 15:00:03 +0000 en-US hourly 1 Medical Marijuana – A Magic Bullet for Treating PTSD? Sat, 07 Dec 2013 12:00:52 +0000 A new battle has been waged on Capitol Hill surrounding the much-debated legalization of medical marijuana. As research continues solidifying the positive effects of using cannabis to treat certain clinical symptoms, some research is focusing on the possible effects it may have on treating Post Traumatic Stress Disorder (PTSD).

Since the 1990s, organizations including the Multidisciplinary Association for Psychedelic Studies (MAPS) have attempted to further the development of research protocols surrounding the use of medical marijuana.

It was not until March 2011 that the National Cancer Institute acknowledged the viability of using marijuana in various treatment protocols. MAPS has continued its work to initiate further research and legislation requiring the National Institute on Drug Abuse and the Drug Enforcement Administration to loosen its reins and allow scientific organizations to grow their own cannabis for research purposes.

Viable research continues to evidence the positive impact medical marijuana has had on the lives of those suffering from cancer, glaucoma, multiple sclerosis, and other symptomatic disorders and diseases. It is also widely recognized that some individuals suffering from PTSD already use recreational drugs, including the illegal use of marijuana, to offset symptoms of the disorder. A 2012 case study focusing on a male patient with a variety of PTSD symptoms, severe in nature, revealed some symptoms were significantly reduced “by smoking cannabis resin.”

Further studies have focused on the molecular etiology of PTSD in reference to elevated brain cannabinoid CB1 receptors, along with endocannabinoid signaling systems. Research implies that the increased CB1 receptor-mediated anandamide signaling may play a role in some PTSD symptoms. As such, this research may provide evidence-based opportunities for drug therapies by utilizing a neurobiological model as presented in positron emission tomography studies.

The field of psychiatric medicine recognizes the distinct commonality of specific symptoms associated with PTSD, including severe flashbacks as well as uncontrollable panic attacks. How and why do memories of traumatic events affect the biological nature of the brain with such intensity? Evidence continues to support the theory that the endocannabinoid system holds primary influence over the regulation of memory and emotional behavior. Therefore it is reasoned that the evidence-based research focusing on the affects that THC and medical marijuana have had in other case studies may provide the same results with some symptoms exhibited in patients suffering from the PTSD.

Many social and political barriers continue to plague the future of not only the research of possible treatment options for medical marijuana, but also the legalization and use of its byproducts. It is difficult for society to erase the visual memories of soldiers smoking marijuana depicted through media sources throughout the Vietnam War. Vivid memories of young “hippie-garbed” individuals dancing in the rain while listening to rock-and-roll music and smoking “reefer” often wash over the eyes of many Americans who struggle with the concept of legalizing medical marijuana. Many politicians recognize the possible fall-out that may occur in supporting the legalization of medical marijuana, along with the difficulties involved in management of the sale and use of a perceived controlled substance.

There is no cut and dried solution to overcoming the possible negative implications of complete legalization of a product, such as marijuana, for medical purposes. Many government agencies are cautious of approving less restrictive regulations surrounding prescribed treatments using cannabis.

Yet, the number of individuals suffering from PTSD continues to grow. Many of these people maintain an active search for treatments that provide even the slightest bit of relief from often debilitating symptoms. The addition of military personnel suffering from PTSD is likely to lend greater support for continued research and legalization of medical marijuana as a viable treatment option.


Akirav I. (2013). Targeting the endocannaabinoid system to treat haunting traumatic memories. Frontiers in Behavioral Neuroscience 7: 124. PMCID: PMC3776936

Neumeister A, Normandin MD, Pietrzak RH, Piomelli D, Zheng MQ, Gujarro-Anton A, Potenza MN, Bailey CR, Lin SF, Najafzadeh S, Ropchan J, Henry S, Corsi-Travali S, Carson RE, & Huang Y (2013). Elevated brain cannabinoid CB1 receptor availability in post-traumatic stress disorder: a positron emission tomography study. Molecular psychiatry, 18 (9), 1034-40. PMID: 23670490

Passie T, Emrich HM, Karst M, Brandt SD, & Halpern JH (2012). Mitigation of post-traumatic stress symptoms by Cannabis resin: a review of the clinical and neurobiological evidence. Drug testing and analysis, 4 (7-8), 649-59 PMID: 22736575

Image via Yarygin / Shutterstock.

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Are Guns in the Hands of the Mentally Ill Really the Problem? Mon, 25 Nov 2013 12:00:52 +0000 In an effort to appear pro-active in pushing for stronger gun control legislation, some opponents to stricter gun laws, as well as some political leaders, have turned the spotlight on mental illness as a primary concern surrounding mass shootings. But is this focus misplaced?

On April 20, 1999, as news stations across the country broke through regularly scheduled programs, shots continued to ring out at Columbine High School in Colorado. Still reeling from the devastating consequences of this mass shooting, exactly one month later, the echo of gunfire was heard, this time at Heritage High School in Georgia.

Since this time, the violence has continued in what appears to be a cancer spreading across the United States, the effects of which have gun control advocates and civil rights advocates at odds with each other. As legislators struggle to find a cure to this malevolent disease, managing gun control laws in relation to individuals suffering from mental illness has quickly becoming a focal point of the debate.

Over a decade after the Columbine shooting, Americans were faced with the loss of more lives in the mass shooting at Virginia Tech on April 16, 2007. The tragedy resulted in the deaths of 32 students and faculty members along with 17 non-lethal injuries. Gun violence would continue through the years with little progress made in controlling this vicious cycle, until America was once again slammed in the face with another mass shooting on a school campus. This was not just any school, but an elementary school. On December 14, 2012, the quiet town of Newton, Connecticut would lose 20 children and six adults in what some speculate as an avoidable tragedy.

The general rhetoric of the NRA and other political supporters holding the line against stricter gun legislation lobby that the real issue is keeping guns out of the hands of the mentally ill. Yet, there is evidence that suggests this line of thought is inaccurate. Studies reveal that individuals with severe mental illnesses, a small percentage in overall comparison, perpetrate approximately one in 20 violent crimes.

It is not as though American political leaders have never passed legislation in an attempt to control the availability of guns to the mentally ill. Congress passed the Gun Control Act in 1968, making it illegal for individuals that had been committed, involuntarily, to a mental hospital or that had been determined mentally “defective” (a term commonly used during that time) to purchase a gun.

Later, legislation via the 1994 Brady Violence Prevention Act, extended the 1968 Gun Control Act exclusionary clauses regarding mental illness (along with initially the same verbiage), and added provisions to include a waiting period to purchase a handgun in hope of better ensuring proper background checks of potential buyers.

The insinuation that placing stronger reporting mandates on mental health clinicians alone will drastically reduce the number of violent acts committed using a gun, is simply unsubstantiated. Also, the totality of legislation, such as the New York Secure Ammunition and Firearms Enforcement Act of 2013, focuses on past, current, and future individuals seeking mental health services. The law mandates mental health professionals to report patients that may potentially harm others as well as themselves.

The outcome of such action could prove to be less of a deterrent to gun violence and more harmful to individuals with mental illnesses. It has the potential of leading to wrongful identification of potentially violent patients and a systematic response whereby individuals who need mental health services withdraw from treatment or forego treatment out of fear of being reported as mentally unstable. Further, it simply violates doctor-patient’s confidentiality as well as the overall privacy of patients.

Many gun rights advocates and political leaders often quote the Second Amendment to the Constitution as evidence supporting the right to bear arms. Yet, there seems to be little concern by the same individuals regarding breaching patient confidentiality also afforded to individuals, including psychiatric patients, provided under the protection of the Health Information Portability and Accountability Act (HIPAA). Still, the push for more stringent gun control legislation focusing on individuals with mental health illnesses is one that is supported by both advocates of gun rights and gun control.

As the battle continues to ensue over protecting the rights of gun owners and protecting the health and safety of innocent citizens, there is little doubt that something must be done to reduce the overwhelming statistics relating to gun violence. Most professionals within the mental health field support continued efforts to effectively reduce the risks of gun violence at the hands of a severely mentally ill individual. It is through this support that the mental health community believes more doors will open providing greater opportunities in the funding and treatment of individuals suffering from many forms of mental illness.


Fazel S, & Grann M (2006). The population impact of severe mental illness on violent crime. The American journal of psychiatry, 163 (8), 1397-403 PMID: 16877653

Friedman, R (17 December, 2012). In Gun Debate, a Misguided Focus on Mental Illness. The New York Times.

Swanson J (2013). Mental illness and new gun law reforms: the promise and peril of crisis-driven policy. JAMA : the journal of the American Medical Association, 309 (12), 1233-4 PMID: 23392291

Webster, D. and Vernick, J. (2013). Reducing Gun Violence in America: Informing Policy with Evidence and Analysis. Baltimore, Maryland: The Johns Hopkins University Press, 2013. ISBN 10: 1-4214-1110-5.

Image via Sandra Matic / Shutterstock.

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Following the Bouncing Affordable Care Ball Mon, 07 Oct 2013 15:01:56 +0000 Even before the passing of the Patient Protection and Affordable Care Act (PPACA), more commonly referred to as the Affordable Care Act (ACA), the bill was surrounded by argument, anger, disenchantment, and all out refusal to comply. The bill was also surrounded by as much support, honor, and celebration. Yet, many Americans, health professionals, and general population alike, are as confused today as to its inevitable outcome, as they were before the ACA was passed.

Since the enactment of the ACA in March 2010, there have been approximately 40 attempts to overturn the piece of legislation. One of the most recent attempts came in September 2013, as Republican Party members vowed, once again, to retaliate with a government shutdown. This constant battling between political parties has led to approximately seven bills within the Act to either be repealed completely or altered in some manner.

In its initial stages, the ACA promised hope in providing quality healthcare to every citizen in the United States. This included psychiatric care, a component in many health insurance policies that is included more as an afterthought than a viable program within the policy. Efforts were made to streamline ICD and CPT diagnostic and billing codes, as well as increase Medicare Advantage payments to insurers by 2014. Yet the battle continues surrounding whether to increase or decrease these payments.

Still, many hold out hope that the ACA will indeed, provide expansion and improved care to the most vulnerable people in the country. As there is a higher prevalence of mental illness among individuals in lower income brackets, expanded coverage should greatly improve medical outcomes for these individuals. The ACA is set to expand eligibility for Medicaid as well as provide federally subsidized health insurance benefits for those living up to 138% of the federal poverty line.

The Department of Veteran Affairs is well aware of the growing need to provide not only medical care but also consistent mental health services to its growing number of veterans and service members. Enhanced medical services are provided to veterans through the VA healthcare system. These services are provided for up to five years after discharge from active duty. Although many veterans are still eligible for services, active duty personnel are considered first priority, leaving many veterans seeking treatment outside VA centers or going without treatment.

The ACA is designed to expand coverage through Medicaid for veterans who are uninsured. Reports indicate that approximately half of the 1.3 million veterans that are uninsured will be eligible for Medicaid expanded coverage along with an addition 40% that will qualify for subsidized coverage due to the ACA.

Proponents of the ACA suffered somewhat of a loss in the delaying of the mandated employer provided health insurance. Originally set to roll out in 2014, employers were given another year to make necessary preparations in offering and providing health insurance options to full-time employees if the business had 50 or more full-time employees on its payroll. Currently, the mandate is set to take effect in 2015, leaving many employees who thought they would be provided health insurance through their employer, scrambling to make other arrangements.

There is some relief provided through the Health Insurance Marketplace — scheduled to roll out October 1, 2013. The website provided by offers information relating to locating each individual state’s health insurance marketplace/exchange, health insurance options, information for businesses, and how to make the program work the best for each individual. In the coming months, this website will prove to be a much-needed resource as more individuals struggle to meet and comply with the health insurance mandate resulting from the enactment of the ACA and the fall out of the continued dissention among political parties.


Chretien JP, & Chretien KC (2013). Coming home from war. Journal of general internal medicine, 28 (7), 953-6 PMID: 23435767

Golberstein E, & Busch SH (2013). Two steps forward, one step back? Implications of the Supreme Court’s health reform ruling for individuals with mental illness. JAMA psychiatry (Chicago, Ill.), 70 (6), 567-8 PMID: 23553230

American Psychology Association, (2013). Current Procedural Terminology (CPT) Code Changes for 2013: The Basics.

Image via A Katz / Shutterstock.

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Taking Out the Trash Sat, 28 Sep 2013 11:00:21 +0000 Taking out the trash is definitely a priority if you would like your home to smell clean and fresh. Although you may have to pinch your nose when you are throwing those sweaty gym socks in the laundry, you still manage to flush the dingy particles from the cloth in order to preserve the integrity of the socks. What you may not be aware of is that your brain may require a similar process to remain healthy.

With an aging population almost bursting at the seams, understanding the brain’s reaction to certain stimulation and lack of stimulation has become increasingly more important. The impact of neurodegenerative disorders affecting the population has sparked more profound research in tracking, mapping, and deciphering when, where, and how messages are carried throughout the brain’s intricate network.

Dr. Leonard Guarente has spent years researching genes related to the longevity of life. He is also responsible for discovering the longevity-boosting properties in SIRT1, an enzyme responsible for altering the proteins that contribute to cellular regulation, as in longevity and reaction to certain stressors. It appears that SIRT1 not only has properties that fight diseases associated with aging, but also assists in controlling the circadian rhythms in the human body. This supports the theory of the connection between sleep and the aging process.

Interestingly, studies continue to evidence the neuronal damage that can be caused by the clustering of toxic proteins in the brain. It appears the primary culprit of this action is associated with misfolded protein in plaques and neuronal inclusions. A number of unconnected diseases, including cancer, diabetes, and transmissible spongiform encephalopathies (TSEs) or prion diseases, have the pathological characteristic of deposits left by aggregated, misfolded protein.

The abnormally shaped or misfolded proteins may be responsible for killing and damaging other brain cells near where they accumulate. It is believed that in normal circumstances, brain cells recognize the mutated proteins and ‘trash them’ through the proteostasis process. This in turn controls the quality and levels of protein in the brain.

A study conducted by the University of California and Duke University using the huntingtin protein, evidenced that the rate of proteostasis may be the key to understanding, and perhaps overcoming, the neuronal damage caused by these misfolded proteins. The research indicates that the mean lifetime of the protein in a set of striatal neurons ranged from three to four fold. This would indicate that although the proteins may be the same, cells might process some slower than others.

The discovery sparked yet another test requiring the activation of the Nrf2 protein that regulates protein processing. The result indicated that the neuron had a longer life span and the huntingtin mean lifetime was shorter. The research also indicated that the cortical neurons recognized and disposed of the mutant proteins more effectively than the striatal neurons.

As striatal neurons are more susceptible to cell death than cortical neurons, this information is crucial to furthering the studies of neuronal damage associated with misfolded proteins. The discovery, as it relates to the impact these toxic and damaged proteins have in causing neurodegeneration, may be a direct result of their obstruction of the proteostasis process.

In essence, when the brain is cluttered with damaged proteins, it affects the processes of the healthy brain cells. It would be much like attempting to dispose of the kitchen garbage when the can is over-filled. As you are carrying out the trashcan, it can brush against clean objects on the way out the door. Now the disposal process will take longer. The trash will still be out of the house but the process has affected other areas in the kitchen. As is the case of an overfilled trash can, it seems that the inability of the brain to dispose of damaged proteins can cause neurodegenerative diseases.


Taylor, J. P., Hardy, J., & Fischbeck, K. (2002). Toxic proteins in neurodegenerative disease. Science, 296(5575), 1991-1995. doi: 10.1126/science.1067122

Tsvetkov AS, Arrasate M, Barmada S, Ando DM, Sharma P, Shaby BA, & Finkbeiner S (2013). Proteostasis of polyglutamine varies among neurons and predicts neurodegeneration. Nature chemical biology, 9 (9), 586-92 PMID: 23873212

Image via Martin Kemp / Shutterstock.

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Fireworks – Not Always a Cause For Celebration Sun, 22 Sep 2013 21:31:41 +0000 Fireworks displays are a way of expressing and sharing in the celebration of independence or bringing in the New Year. Yet, as the rest of us watch the skies for the next light show, it is a time that causes great despair for some, which seems to go largely unnoticed.

In the distance, fireworks paint the sky like an artist’s canvas, with beautiful and vibrant colors, in celebration of another annual event. The smell of rockets as they shoot through the air spreads throughout the neighborhood. The intensity and excitement of the crowd grows with the anticipation of each cycle of fiery lights as children jump to their feet, pointing to the elaborate displays.

Yet, just across the way, a man cowers in the corner of his room, his hands clasped deliberately over his ears, his legs drawn tightly to his body, tears streaming down his face. Around the corner, a woman hides herself away in her home, radio blaring to drown out the loud sounds she associates with times of the past, not yet forgotten. Her children wonder why she never comes when the neighbors take them to see the beautiful light show.

We may love and enjoy these celebratory events and yearn for more, but an entire segment of society suffers silently, looking forward to the coming week where reminders of past traumas no longer ring through the air. Such is the life for some who suffer from the effects of Post Traumatic Stress Disorder (PTSD).

Studies continue to evidence a direct link between cognitive memories of traumatic events and the sights, sounds, and smells of everyday life. Since 1980, PTSD has been recognized as a diagnosable psychiatric disorder. Prior to this time, the term “shell shock” was frequently used to describe the physical and emotional anomaly associated with the reactions of individuals who had seen and suffered traumatic episodes. Still, it took the fall-out of the Vietnam War for the disorder to become something more than what some believed to be a passing phase that soldiers experienced, or an attempt to “side-step” returning to the battlefield.

Steps continue to be taken to broaden the scope of the diagnosis and treatment of PTSD to reach beyond the sole focus on military soldiers. The fifth edition of the American Psychological Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders shifts the spotlight of diagnosis to include triggers of actual events to include those also suffered by civilians.

The field of neuroimaging continues to make great strides in studies that relate to the impact of how the brain reacts to PTSD. Studies have found that neurobiological changes in individuals who suffer from PTSD (compared to those who do not) are notably detected in three specific areas of the brain. These three areas include the amygdala, the medial frontal cortex, and the hippocampus, with the over-reaction of trauma-related stimuli presented in the amygdala. It is believed that the medial frontal cortex and the hippocampus may be responsible for the brain’s inability to minimize the extreme warning signs of stimulation and anxiety that are created in the amygdala in reaction to memories of traumatic events. Together, these responses characterize the signature symptoms of PTSD, such as flashbacks and over-reaction to the startle response.

Some might say it is curious that there has been little consideration in legislation to control and minimize the amount of fireworks and the location of such displays. Only taking into account almost 257,000 Iraq and Afghanistan veterans that received care from 2002-2012 for PTSD, and not the totality of individuals suffering from PTSD during that time, there is sufficient reason to promote the consideration for legislation to control when, where, how much, and for how long these celebratory displays are allowed.

Firework displays are, after all, often intended to be a celebration of freedom and of new beginnings. There should therefore offer a level of consideration for, at the very least, the military personnel struggling with this debilitating disorder, if not for the totality of the social segment of those suffering from PTSD across the country.


Kupfer DJ, Kuhl EA, & Regier DA (2013). DSM-5–the future arrived. JAMA : the journal of the American Medical Association, 309 (16), 1691-2 PMID: 23440257

Nutt DJ, & Malizia AL (2004). Structural and functional brain changes in posttraumatic stress disorder. The Journal of clinical psychiatry, 65 Suppl 1, 11-7 PMID: 14728092

Phillips, A. & Walker, C. (eds) (1969, March 13-14). Proceedings of a Workshop on Mass Burns. National Academy of Science. Accession: AD0689495.

American Psychological Association (2000). Diagnostic & Statistical Manual of Mental Disorders, 4th edition, Text Revision, ISBN: 978-0890420256.

Department of Veteran Affairs, Office of Public Health: Post-Deployment Health Group (2012). Report on VA facility specific Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) veterans coded with potential PTSD-revised cumulative from 1st quarter of 2002 through 3rd quarter of 2012 (October 2, 2001-June 30, 2012.

Image via Noppasin / Shutterstock.

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And the Beat Goes On Wed, 07 Aug 2013 11:00:36 +0000 It has been said that music feeds the soul. It is also said that music is a universal language, understood by all. Music serves a number of purposes ranging from communication to simple enjoyment. Not only that, but research also suggests that music can play an important role in deterring and minimizing the affects of age-related cognitive dysfunctions.

Decades of research has implied a direct correlation between the development of neural pathways associated with not only hearing and feeling the sound and rhythm of music, but also the process of learning to play musical instruments.

Scientific research implies that brain development begins as early as the third week from conception and continues well into an adult’s twenties. The human brain is far more plastic during early development than in later life. So how might music relate to the development of the brain and cognitive neural responses of older adults?

Although there is little evidence to suggest that a fetus truly reacts to the sound of music, there appears to be a correlation between learning to play a musical instrument such as the piano and the development of spatial recognition perception in young children. The enhancement of neural connectivity associated with hand and eye coordination as a child learns to play an instrument suggests that musical training can have a long-term effect on the ability to process and understand the meaning and exchange of words.

Neurological deficiencies associated with the aging process describe a litany of disorders ranging from short-term memory loss to the slow decay of response time. Evidence suggests that the aging process reduces inhibitory neurotransmitter levels and dampens neural processing. Yet, further evidence reveals a link between previous musical training during childhood and a reduction in the degenerative neural processes associated with aging.

One particular study suggests that the nervous system is essentially changed in those individuals who had received early childhood training in music (for at least three years duration), and that these neural alterations continued into adulthood even if the training was discontinued (a minimum of seven years later).

Given this link, it could be that time reaction delays can be reversed through neural auditory training processes. A recent study theorized that cognitive training through auditory processes could re-establish — to some extent — age-related insufficiencies in temporal dispensation in the brain. And in turn, the associated plasticity of the brain could serve to encourage enhanced perception and cognitive abilities.

The study’s findings found that even short-term training induced neural plasticity in older adults in fundamental aspects of biological auditory processing. The results demonstrated that declines in neural temporal precision, normally associated with the aging processes found in older adults, were to some extent reversed. Improvements were also noted in short-term memory, processing speed, and sensitivity of speech.

Efforts such as these to understand the brain’s response to reduced inhibitory neurotransmitter levels and a reduction in neural processing as it relates to age-related dysfunction has led to research the possible role that music can and does play in slowing and possibly reducing these outcomes. It may be that music feeds a lot more than just the soul.


Anderson S, Parbery-Clark A, White-Schwoch T, & Kraus N (2012). Aging affects neural precision of speech encoding. The Journal of neuroscience : the official journal of the Society for Neuroscience, 32 (41), 14156-64 PMID: 23055485

Anderson S, White-Schwoch T, Parbery-Clark A, & Kraus N (2013). Reversal of age-related neural timing delays with training. Proceedings of the National Academy of Sciences of the United States of America, 110 (11), 4357-62 PMID: 23401541

Pujol J, Vendrell P, Junqué C, Martí-Vilalta JL, & Capdevila A (1993). When does human brain development end? Evidence of corpus callosum growth up to adulthood. Annals of neurology, 34 (1), 71-5 PMID: 8517683

Skoe E, & Kraus N (2012). A little goes a long way: how the adult brain is shaped by musical training in childhood. The Journal of neuroscience : the official journal of the Society for Neuroscience, 32 (34), 11507-10 PMID: 22915097

Image via Rick Lord / Shutterstock.

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Big Changes for Diagnosing PTSD Sat, 22 Jun 2013 11:00:13 +0000 The effects of post traumatic stress disorder (PTSD) can dismantle the lives of not only those who suffer from this illness, but also those of family and friends. The federal government, the Department of Veteran Affairs, and professionals within the psychiatric field are working diligently to provide alternatives in treatment for victims suffering from PTSD and their families.

From the soldier on the battlefield, to the victim of a violent crime, PTSD knows no ethnic, gender, racial, or social boundaries. This vicious disorder can take a soldier, fighting for the freedom of others, to living homeless on the streets. It can take a loving mother, caring for her family, to the streets of her city, seeking drugs or simply unable to leave her house at all. The uncertainty of child’s future who has suffered from long-term violence remains a threat to a growing society. This disorder affects its victims both physically and mentally, leaving many wondering if there will ever be a time when it will not control its victim’s life.

As men, women, and children across the world struggle to overcome the fall-out of PTSD, nations work to reach a better understanding of its triggers in hopes of treatments that are more successful in managing its affects.  This can only be accomplished through continuous funding of research grants and programs specific to the nature of brain disorders.

People respond to traumatic events differently. The process of “fight or flight” is one that has yet to reveal itself in such a manner as to determine who is likely to fight and who is likely to flee under any given set of circumstances. Studies have revealed that brain functions can be significantly altered when a person is faced with extreme fear, terror, or trauma. It is through discoveries such as this, that many scientists believe that brain mapping may provide greater insight into how PTSD affects its victims.

It was in 1980 that the American Psychiatric Association (APA) first released a classification of PTSD in its third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Today, the APA’s fifth edition of the DSM, entitled the DSM-5, has been considered long overdue. The highly controversial document was set for release at the 2013 annual APA meeting in mid-May. Evidence suggests that the new DSM-5 contains many revisions for diagnostic criteria requirements within the psychiatric field, including those for PTSD. One of the biggest changes the newly released document holds for the diagnosis and treatment of PTSD is its change in classification from “anxiety disorders” to “trauma and stressor-related disorders.”

This new classification of PTSD in the DSM-5 serves to provide a more defined look at the triggers associated with PTSD. These triggers have been listed to include actual experiences or threat of death, sexual assaults, or serious injury. The individual must have had direct experience to the traumatic event or witnessed the event. Additionally, the individual may have learned of a traumatic event that happened to a close friend or family member or is repeatedly exposed to extreme or violent traumatic events that are not part of any media related encounters. 

In essence, the DSM-5 is centered more on the behavioral symptoms in association with PTSD, expanding the previous three diagnostic clusters to four specific diagnostic clusters. These four diagnostic clusters include avoidance, arousal, re-experiencing, and negative cognitions and moods. Additional changes within the DSM-5 associated with PTSD include two subtypes for PTSD Preschool and PTSD Dissociative.

The proposed Brain Research through Advancing Innovative Neurotechnologies (BRAIN) initiative supports the concept of brain mapping as a means to diagnose, treat, and possibly reverse the affects of PTSD. Millions of children and adults suffer from the affects of PTSD. Evidence suggests that over seven million adults in the United States suffer from PTSD each year. As these numbers continue to rise, both government and mental health professionals diligently pursue avenues to control this growing epidemic. 

It took decades for the health field to incorporate a diagnostic protocol for PTSD despite evidence that the disorder was affecting a countless number of people. Realizing that PTSD is not a disorder associated only with individuals who have served in the military forces, the opportunity to further develop brain mapping research is critical to serving all individuals suffering from this debilitating disorder.


Kessler, R. (2005). Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders in the National Comorbidity Survey Replication Archives of General Psychiatry, 62 (6) DOI: 10.1001/archpsyc.62.6.617

Kupfer, D. (2013). DSM-5—The Future ArrivedDSM-5—The Future Arrived JAMA DOI: 10.1001/jama.2013.2298

American Psychological Association (June 2009). Treatment of Posttraumatic Stress Disorder in Special Populations: A Cognitive Restructuring Program.

Trimble, M.D. (1985). Post-Traumatic Stress Disorder: history of a concept. In trauma and its wake: The study and treatment of Post-Traumatic Stress Disorder (ed. C.R. Figley), pp. 5-14. New York: Brunner/Mazel.

Image via Suzanne Tucker / Shutterstock.

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Change on the Horizon for Psychiatric Medicine Wed, 19 Jun 2013 11:00:23 +0000 Fear and uncertainty has plagued the implementation of the Affordable Care Act (ACA) since its inception. There have been wins and losses on both sides, and medical professionals across the country have had growing concerns that the continued battle amongst political parties would increase the gap between quality care and reimbursements. Recent events indicate more changes directly related to psychiatric medicine are on the horizon.

One of the greatest victories for both the insurance industry and health providers has been achieved with the announcement that the Obama administration has moved to increase Medicare Advantage payments to insurers by 3.3 percent for 2014. This falls on the heels of the Administration’s initial endeavor to cut those same reimbursements by 2.2 percent in 2014. Meanwhile, the field of psychiatric medicine remains vulnerable to new changes implemented through the ACA, such as the recently released ICD-10 and CPT code modifications.

The mandated ICD-10 and CPT code changes has only proven to further increase the problematic issues the public faces in finding, receiving, and paying for mental health services. A 2008 survey conducted by the AMA evidenced that of the psychologists consulted, 33% of their clients paid for their services out of pocket, leaving 67% of service payments made through billing insurance companies. It should be noted that most of these were claims filed with programs funded by federal, state, and local governments.

The ACA has taken measures to try and serve the needs of U.S. citizens who require assistance and treatment from mental health professionals. Mandates are now in place requiring insurance carriers to include comprehensive options for mental healthcare within each health insurance plan. This should result in a large reduction in the growing number of individuals who forgo necessary mental health treatment due to financial constraints.

And yet a major issue remains enticing more private practice mental health professionals to accept both public and private health insurance. In an effort to provide mental health professionals with a better understanding of the ICD-10 and CPT code changes, the APA released a series of documents summarizing major CPT code changes that directly affect the field of psychiatric medicine. Here is a brief summary of these documents (important links to these changes can be found in the references):

  • Document 90862 has been deleted in one of the biggest CPT code changes. It has been replaced with the appropriate 99xxx series E/M code, which requires more documentation, even up to 11 separate elements. The 90862 code paid lower than a 99214 E/M code for Moderate Complexity.
  • Replace 90801 (Initial Psychiatric Evaluation) with:
    • 90791 (and 90785 report with interactive complexity when appropriate): Psychiatric diagnostic evaluation without medical services.
    • 90792 (and 90785 report with interactive complexity when appropriate): Psychiatric diagnostic evaluation with medical services. New patient E/M codes can be used instead of 90792.
  • Replace 90802 (interactive diagnostic initial evaluation) with:
    • 90791 and 98785 report with interactive complexity
    • 90792 and 98785 report with interactive complexity
  • Replace 90804, 90816, 90806, 90816, 90808, 90821 to be used in all settings (in relationship to time with patient and or family) with:
    • 90832: 30 minutes psychotherapy
    • 90834: 45 minutes psychotherapy
    • 90837: 60 minutes psychotherapy
    • Report with interactive complexity and 90785 when appropriate in all three cases
  • Replace 90810, 90823, 90812, 90826, 90814, 90828 to be used in all settings (in relationship to time with patient and or family) with:
    • 90832: 30 minutes psychotherapy
    • 90834: 45 minutes psychotherapy
    • 90837: 60 minutes psychotherapy
    • Report with interactive complexity and 90785
  • Replace 90805-90809, 90817-90822 Psychotherapy & Evaluation Management (E/M) with:
    • Proper E/M code (not chosen based on time) and 90833 add-on code for psychotherapy 30 minutes
    • Proper E/M code (not chosen based on time) and 90836 add-on code for psychotherapy 45 minutes
    • Proper E/M code (note chosen based on time) and 90838 add-on code for psychotherapy 60 minutes
    • Report with interactive complexity and 90785 when appropriate and/or required
  • New Psychotherapy for crisis 90839 and 90840
  • Replace 90857 Interactive group Psychotherapy with:
    • Group psychotherapy 90853 and report with interactive complexity 90785
  • These CPT code modifications present major changes that will directly affect the fields of psychiatry and psychotherapy. This is the first time in almost two decades that CPT code changes have been directed specifically to psychotherapy services. Although some professionals may find it tedious and difficult to make the change, the overall compatibility of the codes and processes will link to those already used by primary care physicians, as well as other service providers.


    American Psychiatric Association, Current Procedural Terminology (CPT) Code Changes for 2013: The Basics.

    American Psychological Association, Insurance Module, 2008 APA Survey of Health Service Providers, (2009, August).

    Kaiser Health News, Medicare Boosts Rather Than Cuts Payments To Advantage Plans, (2013, April 2).

    Image via Krivosheev Vitaly / Shutterstock.

    ]]> 2 Medicare Reimbursement – What’s the Latest? Sun, 17 Mar 2013 11:00:45 +0000 Even with the continued political debate over the economics of the Affordable Care Act (ACA), there remains an even more dominating concern. Great concern remains for the actual viability of the overall Act as it applies to providing access to quality care to all US citizens; more specifically, the continued debate over Medicare reimbursement rates.

    The mandate to ensure the availability to quality care while also containing and reducing the cost of healthcare in the United States remains an illusion to those entities tasked with this accomplishment. Nevertheless, since the passage of the ACA, there have been both macro and micro level changes within the industry specific to Medicare reimbursements.

    Primary macro-level changes that have affected the healthcare delivery system can be noted in cost containment reforms to reduce Medicare and Medicaid spending through restructuring payment reimbursements. This has led to a surge in the implementation of Accountable Care Organizations (ACOs) and the Patient Centered Care Models. It is believed that ACOs are the greatest hope for the much needed and desired delivery system reform.

    Operational changes affected by administrative simplification initiatives have taken a critical role in the fiscal solvency, directly affecting the revenue streams for providers and clinicians. Many are facing long and unexplained delays in reimbursements for their clients who are Medicare beneficiaries. The implementation of the HIPAA Version 5010’s deadline initially set for January 1, 2012, has come and gone, leaving practices that were unsuccessful in fully implementing the change faced with extreme delays in reimbursements. The Centers for Medicare and Medicaid Services (CMS) provided a PDF updated document addressing some of the concerns linked to the delayed reimbursements on March 2, 2012. The implementation deadline was then pushed to June of 2012. News on the front indicates that CMS has initiated a program with Emdeon to research the viability of implementing the HIPAA Transaction Version 6020.

    Another area of great concern within the healthcare community is the implementation of the ICD-10 codes, along with the consistent HIPAA transactions updates. The push for greater access to information by creating wide-spread HIT systems has created a lack of cohesion within transferring systems. Looming implementation deadlines add to an already stressful environment for practicing clinicians who are struggling financially as a result of the delayed reimbursements from Medicare.

    In February 2013, with CMS struggling to overcome a growing level of negative response from practicing clinicians regarding the overall Medicare program, the agency announced continued implementation changes provided through the ACA. These efforts include a proposal to update the 2014 rate-book to mirror the most current Fee-For-Service (FFS) costs, alignment restructuring changes of Medicare Advantage (MA) benchmarks with Medicare FFS costs, and basing some of the MA payment on the quality of the plan. In addition, CMS has proposed a 1.5% increase above the 2013 MA plan payment for 2014, resulting in a 4.91% total adjustment.

    Most likely, the continued efforts by health care professionals and organizations to express the ongoing discontent among clinicians regarding the overall state of the Medicare program, served as a catalyst for CMS’ 2013 legislative proposals, which included much needed provider payment incentives. With approximately 92% of Medicare beneficiaries enrolled in the voluntary Medicare Part B program, this should relate to a greater volume of pay-outs for provider incentives in effecting higher levels of quality care. As Medicare Part B assists in covering mental health services primarily provided outside of a hospital setting, this translates into greater opportunity for mental health clinicians who enroll as Medicare providers to offer their services.

    As the political debate continues over the ACA, many practicing clinicians remain focused on issues regarding the Medicare program. CMS recognizes the need to ensure cooperation within the health care industry to ensure greater access to quality care for all US citizens as mandated under the ACA. As such, this should continue to effect both macro and micro level changes within the health care industry specific to Medicare reimbursements.


    Leibenluft RF (2011). ACOs and the enforcement of fraud, abuse, and antitrust laws. The New England journal of medicine, 364 (2), 99-101 PMID: 21175308

    U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, (2013, February 15). Details for Rate Year: 2014.

    U.S. Department of Health and Human Services, Centers for Medicare and
    Medicaid Services, (2012, March 4). Medicare Advantage Rates and Statistics.

    U.S. Department of Health and Human Services, Centers for Medicare and
    Medicaid Services, (2012, June). Medicare and Your Mental Health Benefits.

    U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, (2012, March 7). Version 5010 and D.0 & 3.0.

    U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, (2013). Fiscal 2013 Budget in Brief: Strengthening Health and Opportunity for All Americans.

    Image via S_L / Shutterstock.

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    Legislative Changes in Research Tue, 05 Mar 2013 12:00:59 +0000 Many changes in the overall scope of research and development have come to pass since the initial implementation of the Patient Protection and Affordable Care Act (ACA). Although the majority of conversation regarding the ACA is centered around the health insurance mandate, for many in the field of medicine, the impact of this act is much more far reaching than has previously been discussed. The ACA has provided a greater platform for funding research and development programs, as well as promoting positive changes in providing greater access to these findings.

    The medical community continues to maintain a high profile in discussion that will further impact the roll-out of the ACA. In particular, the American Academy of Neurology (AAN), has created its own resources to assist members in discovering alternative payment methods, as well as engaging in incentive programs that assist in avoiding payment penalties. Through the efforts of the AAN and other health care agencies and professionals, not only can the interests of the general public be preserved, but also the professional and business interests of those medical entities will remain intact.

    The issue of access to research and technology has once again reared its inquisitive head in an effort to spark greater continuity within the research community. On February 14, 2013, the Fair Access to Science and Technology Research (FASTR) was introduced to Congress as H.R. 708 and S. 350. Supported by both the American Library Association (ALA) and The Scholarly Publishing and Academic Resources Coalition (SPARC), the bill is designed to provide a platform for greater sharing of publicly funded research articles. It is believed that by opening access to these findings, a higher level of productivity in science and technology research, as well as a higher level of academic achievement can be attained.

    Since the passage of the ACA on March 23, 2010, The Agency for Healthcare Research and Quality (AHRQ) continues to remain vigilant in its efforts to clarify challenges faced within the healthcare industry. Most recently, the European Federation of Neurological Societies released new guidelines for the diagnosis and management of Alzheimer’s disease, which has been included in the AHRQ data base. Primary issues addressed include providing an evidenced-based, peer-reviewed statement of guidance for practice to psychiatrists, geriatricians, and clinical neurologists, as well as qualified physician specialists charged with the care of patients with Alzheimer’s Disease.

    The ACA also includes several provisions to direct discretionary spending toward specific components that increase the production and productivity of high-risk disease management, such as Alzheimer’s Disease and Parkinson’s Disease. The ACA increased discretionary spending on a number of fronts, opening the door to greater research possibilities. Section 10409 of the ACA allocated approximately $10 million in 2012, with an additional $50 million requested in 2013 for biomedical research. Under Section 10409 these changes reflect the establishment of a Cures Acceleration Network (CAN) program, overseen by the Office of the NIH which will award cooperative agreements, contracts, and/or grants to support the development of treatments for conditions and/or diseases that may be considered uncommon, and where market incentives are deficient. Eligible recipients include both private and public participants, research institutions, biotechnology companies, pharmaceutical companies, research institutions, higher education institutions, medical centers, patient advocacy organizations, academic research institutions, and disease advocacy organizations.

    The NIH continues to reach out to the medical community in an effort to provide much needed funding for research and development. Both the government and the private sector recognize the continued need for progressive and consistent tools for advancement in chronic disease management. Although primary focus remains centered on the health insurance mandate, the stage has been set to increase both funding and transparency in biomedical research and development.


    American Academy of Neurology (2013), The Patient Protection and Affordable Care Act Largely Ruled Constitutional: Now What?.

    American Library Association (2013)., The Fair Access to Science and Technology Research (FASTR).

    Redhead, C., Colello, K., Heisler, E., Lister, S., Sara, A. (2012, October 1). Discretionary Spending in the Patient Protection and Affordable Care Act (ACA). Congressional Research Services (R41390).

    U.S. Department of health and Human Services, Agency for Healthcare Research and Quality (n.d.). National Guidelines Clearing House: EFNS guidelines for the diagnosis and management of Alzheimer’s disease.

    Image via Mesut Dogan / Shutterstock.

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