ADHD or attention deficit hyperactivity disorder is similar to AADD but research has shown that one third of the adults affected with AADD do not show any hyperactive behavior. Thus, the medical community has taken to using the AADD term instead.

In the brain of patients with AADD, executive function is impaired. This is the function that governs a person’s ability to monitor their own behavior by organizing and planning. This disorder affects approximately 2 to 4% of adults.

AADD patients are often the types seen by others as not thinking before they speak or act. They are sometimes referred to as a Type A personality or an always on the go individual. While they may seem to be driven, it is noted that they are rarely focused on one task long enough to see it to completion. In a recent study, three different groups of AADD patients all scored much lower than non-AADD adults on a dual memory and simultaneous capacity test, demonstrating their inability to concentrate in such situations. While this may seems like a small step, this recognition helps prove AADD to be a real concern.

As mentioned, treatment options vary depending on the severity of symptoms. For some AADD patients the symptoms are bad enough that medications along with social therapy are prescribed. Some of the more popular prescription medications are Ritalin, Adderall or Vyvanse. Ritalin is the most commonly known medication and is used in the treatment of ADD in children with some success. Adderall is a psychostimulant and Vyvanse (also used for children) is a stimulant as well.

It may seem strange that stimulants are prescribed for a disorder that sometimes causes hyperactivity but they are effective in many cases. This is thought to be accomplished by coaxing the brain to manufacture more serotonin. Increased serotonin has been shown to have a calming effect. This not only treats the hyperactive symptoms but may allow an adult to focus on their tasks at hand and see them to completion.

As recognition of AADD grows, more studies may lead to new treatments and an increased awareness of the disorder.

Reference

Dige, N., Maahr, E., Backenroth-Ohsako, G. (2008). Memory Tests in Subgroups of Adult Attention Deficit Hyperactivity Disorder Reveals Simultaneous Capacity Deficit. International Journal of Neuroscience, 118(4), 569-591. DOI: 10.1080/00207450701239384

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Part of me really emphasizes with the pediatricians and other health officials who urge vaccination compliance. Until I had children I didn’t realize how imposing the word is… v-a-c-c-i-n-a-t-i-o-n-s. In fact I clearly remember my best friend, lying on her hospital bed, a few hours after giving birth, asking me whether her newborn son should get one vaccination or another.

I don’t remember the exact words I uttered 6 years ago but I’m sure they were along the lines of,

Well of course. If they say he should get it there has to be a reason.

But now, well, I’m just not so ready to jump the gun.

In fact, when I recently took my son in for a well-child visit I felt intense pressure to give the go-ahead on his vaccinations. Since he was sick at his prior “well-check” visit and unable to receive vaccinations, he was a few months behind schedule and it was time to get him back on track.

But I said no. Well, no to most of the vaccinations.

No vaccinations? I felt as though I were wearing a scarlet A on my chest representing anything from Anti-vaccination movement to A clearly misinformed individual to A bad mother.

And then, I read this. The article points out that researches have loosely identified two groups of people who choose not to have their children vaccinated with the MMR. One group of parents, one that refuses all vaccinations, are considered radical. This group is basically beyond hope; regardless of any information they receive they will most likely say no to the MMR. The other group of parents are those that opt out of particular vaccinations or choose to have their children vaccinated with “single antigen vaccines” (one vaccine for measles, one for mumps, one for rubella instead of the combined shot, etc.). These parents fit in the reformist category and may be able to be persuaded to vaccinate according to the government’s schedule.

Now, if you haven’t guessed, the authors of this article are pro-vaccination. And you may think that I’m anti-vaccination but I won’t claim that title. I think that certain vaccinations have their time and their place; I don’t inherently think they are wrong. In fact, my child is about 85% vaccinated already. I’m open to looking at any and all research on the subject and my mind is not inflexible on the matter. But I definitely fit in the reformist group… although I think that title is a little, um, shall I say condescending. I’m not quite sure I need to be reformed.

When I visited my doctor and asked her a basic question about the amount of thimerosal in the shot my child was going to receive she laughed it away. Thimerosal in shots today, no way. All that mumbo jumbo about thimerosal in shots — propaganda. The funny thing about her response was that if she had only sat down and talked to me about realistic concerns I had, she would have done more good than trying to blow off the “alternative health propaganda” out there. Does she think that government sponsored vaccination information is void of propaganda?

It’s easy to take information from supposedly wiser sources than ourselves and run with it, so to speak. And there are times when that’s the only thing we can do. But when it comes to injecting our children with a HUGE number of vaccines, I don’t think that sitting silently on the sidelines is the best route to take. I’m not saying that vaccinations are wrong, I’m just asking questions:

Why is this the right way to proceed?

What long term studies have been done regarding the long-term effects of these vaccinations? (And don’t just talk about a reduction in polio or mumps… what about other problematic childhood epidemics we’ve seen crop up?)

Why does the government recommend this particular schedule? How do they know that this is safe considering the brain developments during this time?

And possibly most importantly,

Can you discuss anti-vaccination issues with me without acting like I’m dumb, naive, or insane?

I actually find it ironic that asking questions about vaccinations seems to be shunned. Since when did it become wrong to ask, to discuss, to question your paediatrician about the well-being of your child? Especially in this day and age when there are many hidden “factors” that influence various entities, including our government. We don’t simply shrug off rising gas costs and politely say,

Well, if they say it’s so high, there has to be a *legitimate* reason.

In an article titled, MMR controversy has left parents emotionally scarred, study finds, the author discusses the impact that research — which showed a connection between the MMR and complications — has had on parents of autistic children. (Note: since being published many of these findings have been unsubstantiated.) The article points out that many parents:

… felt anger towards health visitors and GPs, who they felt did not appreciate their anxiety when making the decision on whether to allow subsequent children to be given the MMR vaccine… (Kmietowicz, 2007, p. 715)

The article goes on to say that some of the parents felt as though their doctors were being “inflexible” and “dismissive” regarding their concerns regarding the vaccination.

Come on people. The days of patients blindly following doctor’s directions are over. After all, how many times do we hear that we are ultimately in charge of our own health?

If someone wants to convert me from my “reformist” viewpoints, acknowledging my questions and concerns as valid is the first step. After all, I do realize that propaganda does exist… but at least I acknowledge that it’s present on both sides of the debate.

References

McIntyre, P., Leask, J. (2008). Improving uptake of MMR vaccine. BMJ, 336(7647), 729-730. DOI: 10.1136/bmj.39503.508484.80

Kmietowicz, Z. (2007). MMR controversy has left parents emotionally scarred, study finds. BMJ, 334(7596), 715-715. DOI: 10.1136/bmj.39174.371493.DB

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To be better informed, and more effective, people are also looking at how we are affected by the groups we belong to that are treated unequally and subjected to various kinds of stress and discrimination. This is called intersectionality, because it refers to intersecting statuses. To understand it, just imagine if Hurricane Katrina had flooded a wealthy area such as Beverly Hills. If you think the largely white and connected inhabitants would have gotten more respect and not been treated like dangerous refugees when they tried to escape across a bridge into a nearby community (turned back at gun point by the authorities), I think you would be right.

Of course, intersectionality can be more subtle, and even show up as discrimination within minority groups. A friend of mine with fibromyalgia who suffered from a great deal of disabling pain was attending a disabilities conference. She was insulted by someone in a wheel chair, as if her disability was not valid somehow. A woman in the deaf community began a lesbian relationship and suffered rejection and verbal attacks, and even being spat upon, because of attitudes toward homosexuality in her particular community. Wikipedia has a nice entry on intersectionality if you’d like to learn more.

Let’s take this to the third, final, perspective for this piece. Consider how poor education, cognitive difficulties (that can be caused by the higher levels of contaminants and drug exposure in poorer communities), post traumatic stress disorder (that can be caused by exposure to heightened levels of violence in poorer communities), and unremitting stress (that can be caused by trying to survive in an area with low employment, gang activity, getting into and out of jail, and poverty), and violent enculturation (that occurs in communities that are without good economies and educational resources for extended periods of time, and that have substantial numbers of people who have been in prison) contribute to domestic violence and other violent and criminal behavior.

Think about how the gutting of social programs (that have been shown to actually be an investment because they recoup their costs many times over when done right) contributes to sickness and disease, poverty, violence, drug addiction, crime, and the ability of organized crime and gangs to build power. Think about how the power of global corporations is used to influence the public through media controlled by those corporations (think Fox News and Rupert Murdoch, for example), and through elections that require massive funding, and through political parties that have had many decades to become funded, incested, and orchestrated by those corporate interests (think, “Impeachment is off the table” per the democrats in the U.S.).

Connect the gutting of social programs with the corporate coup taking place in the U.S. What we see is a boil of social problems taking place in populations that are used, abused, and discarded in whatever way suits the powerful interests at the helm. This would just be paranoia, if it weren’t for the extensive documentation of these trends people like Noam Chomsky and Howard Zinn, and reporting by people like Amy Goodman of Democracy Now.

If I had started this entry by saying that unbridled corporate power causes domestic violence, I might have just sounded simple minded. But do I sound like I’m letting perpetrators of DV off the hook? I can only say that anyone who is unwilling to look at all the factors that contribute to DV is insular, stuck in the past, and being simple minded.

Part of the solution to DV is a political one. Part of the solution is restoring democracy in the U.S. Would a national strike be therapeutic? It was for the horrible conditions of child labor in America. I think it would be for many of today’s ills as well.

The VoteStrike.org site has information about the rationale of strikes, and is helping to coordinate a national strike on 9/11/09.

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Parkinson’s disease develops as the result of nerve cell damage or death in the midbrain. The cells that are impaired are responsible for the production of dopamine, this neurotransmitter aids in the transmission of signals from the midbrain to the corpus striatum. The proper transmission of these signals is needed for coordinated movement. Currently, treatment options for Parkinson’s include medications such as L-dopa to treat individual symptoms like stiffness and tremors. There is also an entire class of L-dopa derivatives that perform similar functions and are more efficiently converted into dopamine in the body. Unfortunately, the L-dopa derivatives cause more negative side effects than the traditional L-dopa drugs. In addition, each Parkinson’s case is unique to the patient and the severity of symptoms often varies considerably from patient to patient so treatment must be tailored to each individual.

A study published recently in the journal Glia discusses an exciting discovery of “radial glia-like cells” that lead to the production of dopaminergic neurons in the midbrain. These are the neurons typically affected by Parkinson’s disease. Glial cells nourish, protect, and support neurons. Researchers hope that this discovery may lead to a scientific method that would allow them to artificially reproduce dopaminergic neurons. The transplantation of healthy radial glia-like cells into the brain of Parkinson’s patients may lead to the regeneration of dopaminergic neurons that were damaged or destroyed.

Another study recently published in Nature Medicine showed that in some patients the progression of Parkinson’s disease can affect transplanted dopaminergic neurons that were grafted into an individual’s brain up to one decade earlier. As previously stated, each Parkinson’s case is unique. Some patients may continue to respond positively to the dopaminergic neuron grafts after prolonged periods of time while in other patients the disease will begin to affect the transplanted cells after one decade. Despite this discovery, the benefits of dopaminergic neuron transplantation are quite evident. After a successful transplantation patients usually experience reduced rigidity and an increase in the speed at which they can move. Researchers hope that figuring out why transplanted neurons can be affected in Parkinson’s patients will identify the mechanism of the disease. A better understanding of how this disease develops can lead to treatments that slow or prevent the progression of symptoms.

In conclusion, the contradictory results from these two studies suggest that more research regarding the development and progression of this disease needs to be the focus of treatment. More specifically, discovering how the disease can affect healthy transplanted neurons that were cultured in a clinical setting will undoubtedly lead to the control and prevention of this disease. These types of discoveries may also lead to a better quality of life for Parkinson’s patients.

References

Bonilla, S., Hall, A.C., Pinto, L., Attardo, A., Gotz, M., Huttner, W.B., Arenas, E. (2008). Identification of midbrain floor plate radial glia-like cells as dopaminergic progenitors. Glia, 56(8), 809-820. DOI: 10.1002/glia.20654

Li, J., Englund, E., Holton, J.L., Soulet, D., Hagell, P., Lees, A.J., Lashley, T., Quinn, N.P., Rehncrona, S., Bjorklund, A., Widner, H., Revesz, T., Lindvall, O., Brundin, P. (2008). Lewy bodies in grafted neurons in subjects with Parkinson’s disease suggest host-to-graft disease propagation. Nature Medicine, 14(5), 501-503. DOI: 10.1038/nm1746

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There isn’t any proof that stimulant medications have caused heart attacks or stroke, but the AHA wants physicians to evaluate for heart disease. There is the theoretical possibility that structural heart conditions that normally would go undetected, could cause a vulnerability to stimulants. If a structural problem shows up, the child may still be able to take the medications, but would require monitoring.

Some of you are wondering why anyone in their right mind would consider medications when this kind of concern exists. Even if you are well-informed, and not affected by alarmists who compare stimulants to cocaine and meth, you might wonder. For many parents and mental health workers, the answer lies in the problems that children with ADD have that can profoundly affect their development. But, you might argue, look at the successful people who also happen to have ADD. Alas, comes the response, those examples don’t erase what we detect in research. There is even some evidence that children with ADD who received stimulant medication have been less likely to abuse drugs later in life. Presumably, this is because they have had richer developmental experiences and feel less marginalized.

So am I an apologist for Big Pharma? No; I understand that it is a difficult decision in an unpredictable world. But I also know that in speaking with scores of people with ADD over about two years, many have said that they were quite thankful that their parents put them on meds. Many who were not on meds as children said they wished they had been, because they were aware of the connection between their difficulties and the academic, employment, or social problems that they had, or were having.

To really understand this issue, one must delve into a number of topics, such as the kinds of adaptations that work for people with ADD, the similarities between ADD and other conditions, such as deafness, that create a sense of community, the state of research and enlightened opinion on various treatments and supplements for ADD, and issues of identity. Among the most important is the nature of developmental windows, and what is lost when they are not navigated successfully.

Reference

Vetter, V.L., Elia, J., Erickson, C., Berger, S., Blum, N., Uzark, K., Webb, C.L. (2008). Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Stimulant Drugs: A Scientific Statement From the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing. Circulation, 117(18), 2407-2423. DOI: 10.1161/CIRCULATIONAHA.107.189473

Further Reading

Best Supplements for ADD are described at ADD Supplements vs. Medication, a page I maintain, based on what people tell me.

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Vytorin is a combination pill for high cholesterol and contains Merck’s Zocor, which is now generic, and Schering’s Zetia, which works differently than Zocor — one of many statin drugs. Both Vytorin and Zetia are co-promoted by Merck and Schering. Several years ago, an outcomes study was initiated to prove superiority of Vytorin over Zocor as a single therapy. The clinical trial was named the ENHANCE Trial.

After several years passed, the trial sponsors faced disappointment which was first brought to the attention of Schering in March of 2007, however, the results existed since the spring of 2006, I believe. The disappointment is that Vytorin lacked anticipated benefit over Zocor. Since about 1 million scripts were written for both Vytorin and Zetia in 2007, combined with what I believe was about $5 billion in revenue for these two drugs, this was a problem — perhaps for Schering in particular, since over half of their profits and earnings were from these drugs.

Being the responsible corporations both companies are, of course, alterations occurred after such events. The trial sponsors delayed the release of the trial results for secrecy reasons, it has been speculated. Although the trial results existed, they were not disclosed at the time of their discovery. After several months of possessing the results that were only known to the manufacturers, they created or implemented some atrocious tactics to improve the trial’s unimpressive results. At the end of 2007, the companies changed the primary endpoint of the trial, which is what the results were measured upon during its course. Since their deliberate concealment was clearly wrong, in response to those who asked if trial manipulation was occurring, Schering stated that continued data analysis from the trial was the etiology for the delay.

With clinical trials, case report forms are used to record data and are created in a manner where further analysis is unnecessary, as such forms are quite clear and not subject to interpretation. So at the end of 2007, both Merck and Schering got the attention of relevant government officials who contacted both companies regarding this ENHANCE Trial. An investigation began into the activities of both companies at that point. It became a catalyst for the ENHANCE Trial results to be finally released in the beginning of 2008, which caught the attention of major media organizations.

In the spring of 2008, a very large cardiology meeting was held, where the audience was told to stick with statins due to this trial’s lack of outcomes for Vytorin. Furthermore, a cardiologist at this meeting also suggested that a moratorium occur with the utilization of Vytorin, since statins are much less expensive, and are highly regarded since they have been available for a couple decades already. Of course and as expected, Merck and Schering were not pleased, nor were they surprised at the review of Vytorin at this particular meeting. The following month after this cardiology meeting, Schering’s earnings dropped by 48%.

Now, these cholesterol drugs promoted by Merck and Schering, Zetia and Vytorin, were aggressively marketed in a number of ways including investing what I believe to be about $200 million in 2007 for direct-to-consumer ads for these products. To add, and soon after the medications were launched, representatives from both companies made inferences to doctors about outcomes regarding cholesterol-plaque accumulation and how Vytorin was superior in that area, which, of course, this ENHANCE Trial proved it is in fact not whatsoever. It did not matter, apparently, to both Merck and Schering that such a claim is entirely void of proof, which is not unique to any pharma rep, in my opinion. Yet what is known now is that these companies performed junk science with their deliberate manipulation of this ENHANCE Trial. Last year, Zetia and Vytorin had about 20% of the cholesterol lowering market. It does not seem that there will be an increase of this percentage anytime soon.

Worst of all is the harm caused to both doctors and patients. The ENHANCE Trial concerned and confused both of these participants in the health care system. Furthermore, it’s likely they were devastated by being so clearly misled by the marketing of both Merck and Schering regarding the false benefits of Vytorin.

This whole situation is another example of the corruption of the scientific method by placing profits over the well-being of patients. Most were shocked by Merck behaving in such a way in particular because of what use to be their excellent reputation as an ethical pharmaceutical company. And this alone shows the progression and infiltration of such damaging corruption that desperately needs to be stopped and corrected for the sake of others.

Don’t just say something. Have something to say — to the right people, with conviction, and with others who share your views.

Waste no more time arguing what a good man should be. Be one.
— Marcus Aurelius

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I don’t have a gun in the office, nor am I a card-carrying NRA member. I don’t challenge those who feel they have a right to bear arms. I personally feel that if there were fewer guns around people would be safer. However, I understand that people need to have protection and they have this right.

I’m curious to know what my readers think. After all, running a medical office is really running a small business. Don’t small business owners, particularly retail store owners, have a right to protect their stores? Are doctors any different from other business owners?

If I were a patient, I think it would be kind of scary to know that my doctor who I am seeing has a gun in his office. I think it would be scary not because of the gun itself, but because of the fact that the environment could actually warrant firearms.

It’s kind of like going to the Emergency Room and seeing all of the metal detectors and all of the bullet proof glass around that is all scratched up. It makes you think twice about your surroundings and take a closer look at the people in the waiting room before you sit down. There is a reason why there is bullet proof glass in the ER waiting room — because shootings have actually occurred there!

I have yet to read an article about a physician shooting or killing a patient who was assaulting him in his office. I hope I don’t ever hear such news. But if doctors are starting to keep firearms then this is bound to happen.

I’m curious to hear what people think. Would you not see a doctor if you knew he had a gun in his office? Do you feel that physicians are similar to the Red Cross and that they should be neutral and conflict avoiding?

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The British Medical Journal article mentioned above attempts to answer timely questions regarding doctors and extreme Islamic ideology and actions. When it became public knowledge that several doctors were alleged leaders of the 2007 attempted bombings in London and Glasgow, it shocked many. Muslim terrorists are nothing new; Muslim terrorists who are also medical doctors, well, that’s a whole new story.

Floating around, gathering followers are a number of explanations that attempt to explain why the more extremist views of Islam are being endorsed by some Muslim doctors throughout the world. Some of these have merit but the report published by the Centre for Islamic Pluralism brings to light a cultural element that may, at least partially, explain this disturbing trend. This is where the connection between the historical Catholic Church and the operations of current Muslim culture come into play.

In the past, the Catholic Church was not just a religion — it was a government. The entire religion of a country could be, and was, dictated by the ruler. More times than not, this meant that Catholicism was the mandated religion. The fact that there was corruption within the church ranks than is not surprising or abnormal. After all, political power seems to be almost synonymous with personal or government corruption… as we are all witness to on an all-too-regular basis.

Although the extent of this religious-political conflict of interest seems almost bizarre by today’s standards, at the time, this was normal, the way society operated. And to understand why extremist Muslim doctors are an important part of the fundamental movement, we need to grasp the fact that their society still operates on a principal not unlike the one mentioned above.

In many traditional Muslim cultures, they welcome this conflict of interest. Just as the Catholic Church was once known as much for its’ political actions as it was for its’ religious doctrine, many Muslim doctors today are regarded both as medical adviser and religious leader. Sometimes, in fact, their professional clout gives them more religious stature than someone known only for their religious authority.

So the question as to why a percentage of Muslim doctors are following suite of extremists such as the Muslim Brotherhood, the Saudi Wahhabis, and the Pakistani jihadists , isn’t an easy one to answer. But, a closer look at the traditional culture, the one that espouses extremists views helps:

• Muslim doctors are professionals and are thereby leaders.
• Muslim doctors are considered to be medical and, somewhat loosely speaking, spiritual practitioners.
• Spreading Islamic laws to patients is considered a duty of doctors.

Along with these cultural beliefs, the study shows that some traditional Muslim professionals, including doctors, are quite open to using a fundamentalist interpretation of Islam to solve problems. Because of the influence these professionals have, simply by the title they hold and the education they have, they are considered a key element in influencing others to take on embrace radical extremist views. These “others” that they are expected to reach are people who, like the majority of Muslims, believe in a “mainstream Islam,” the Islam that can easily co-exist with other major religions.

Just as Catholicism is more beneficial as a religion instead of a governing body; many may feel that a medical doctor would do better to stick to treating physical aliments instead of attempting to recruit others through the status they have attained. But, as all of humankind has learned since 9-11, cultural differences are not always as simple as they first may seem. It’s important to remember that many, if not most, Muslim professionals find this cultural pattern as disturbing as anyone outside of the Muslim community does: a conflict of interest that takes advantage of the title M.D.

References

Al-Alawi, I., Schwartz, S. (2008). Radical Muslim doctors and what they mean for the NHS. BMJ, 336(7648), 834-834. DOI: 10.1136/bmj.39282.655035.4E

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If you were left out in this round, just leave a comment with your blog entry. Don’t worry, we’ll format it to match the blog carnival (or even include it in the main post).

Remember, we review the latest blogs related to drugs — medicinal, recreational, interactional, personal, professional, or any other aspects. You can check our Drugs and Pharmacology archive for all editions.

For future editions, please remember to submit your blog entries using the online submission form. We will do our best to review and include your entry! Enjoy your readings…

RN Central reports 25 Tips to Help Protect Yourself from Medical Errors:

There are few people who haven’t heard the horror stories about patients who have gone in for a simple medical procedure and ended up with legs amputated or undergoing unnecessary surgical procedures. While these cases are few and far between, millions of medical errors are made each year that can leave patients with infections and additional injuries, many of which can be life threatening.

Toxic World Blog reports Smog and Premature Death - Science Has Linked Them, The White House Denies It:

If the White House wants to look any dumber, I honestly cannot see how after reading a report on MSNBC.com about the link between the ozone in smog and premature deaths. The National Academy of Sciences review of the data clearly shows that people are dying because of effects of short-term exposure to pollution.

Caffeine Addiction reports on the Health Effects Of Caffeine:

Too much caffeine can lead to cardiovascular problems.
When you consume caffeine your blood pressure and heart rate will rise. Additionally, over time, an overuse of caffeine can lead to heart disease.

Teen Drug Abuse blogs reports on Myths About Marijuana:

Sure, it can’t directly kill you – but that doesn’t mean that pot is risk-free. Regular marijuana use has been shown to be associated with long-term problems, including poor academic performance, memory loss and lung cancer. To a developing brain, like those of teenagers, marijuana can be especially toxic — using pot can lead to panic attacks, depression and other mental health problems, not to mention increased anxiety.

Health Chaos reports Here we go again; more drugs:

I was dismayed to read and see all the news about blood pressure and cholesterol reducing drugs this week. I really believe that my previous internist received her MD by watching the drug ads on television.

Food Matters reports Are Drugs Killing You?:

Modern Medicine is now the third leading cause of death in America! Most of us don’t know how many people are actually dying at the hand of the very system that is supposed to save us. What is even more astonishing is that the information about these travesties is completely hidden and not talked about.

LiveSmarter reports 30 Environmentally Friendly (and effective) Alternatives to Traditional Medicines and Procedures:

While the benefits of advanced medical treatments help patients combat painful, scary and even deadly diseases, they often release toxic contaminants into the atmosphere and may disrupt the natural processes of a patient’s body.

Parenting Squad reports Are Autism and Vaccinations Linked?:

From my research, most of the medial industry seems to believe that there is not a relationship…which does not exactly surprise me. The reasoning behind this is that the age most children get vaccinated, is the same age children regress in their development if they have autism (between 1 and 2 years of age).

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While it has long been known that GAD can affect someone physically, new research is pointing to potential causes for GAD. Reported in Archives of Internal Medicine, researchers are studying the effects of some conditions such as thyroid disease, arthritis, migraine and respiratory disease and their connection to the onset of GAD. They approached this study knowing that physical illness often leads to depression. They wanted to find out if physical illness may cause GAD or other anxiety disorders.

They studied more than 4,000 adults for two years for signs of the GAD mind/body connection. They included all anxiety disorders such as agoraphobia, obsessive-compulsive disorder and panic disorder. Their results thus far show an increased rate of anxiety disorders in patients suffering from physical conditions. They are trying to figure out how and why the connection exists. One thought is that when a person is suffering a physical illness they are faced with increased worry and anxiety, triggering the development GAD.

I would go one step further to say that it seems like the brain gets “stuck” in the worry and anxiety mode, and maybe it can’t get out of it due to the existing stress on the body caused by the illness. It would be interesting to see if GAD patients without illness triggers can recover from their GAD more easily.

It is the hope of researchers that these studies will have the same effect on the medical community as the depression/physical illness studies. As more was learned about depression and physical illness, more doctors watched for the signs in their patients and made treatments available. There may come a day when physical illness automatically leads to a mental health evaluation to help patients circumvent depression and anxiety.

Some doctors may begin to screen for GAD and prescribe antidepressant or anti-anxiety medication for conditions shown most likely to induce depression or anxiety disorders. In some cases this may be handled in a proactive manner if a patient is already an anxious or depressive person.

Reference

Sareen, J., Jacobi, F., Cox, B.J., Belik, S., Clara, I., Stein, M.B. (2006). Disability and Poor Quality of Life Associated With Comorbid Anxiety Disorders and Physical Conditions. Archives of Internal Medicine, 166(19), 2109-2116. DOI: 10.1001/archinte.166.19.2109

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Research on domestic violence and cognitive problems largely centers around executive function that is known to be managed in the frontal cortex of the brain. Footballs have no frontal cortex at all, and will hit anyone. But you knew that.

One of the key aspects of executive function deficits is impulsivity. However, as with all neat categories that we are learning vast amounts of information about, impulsivity is a multidimensional construct. Neuropsychological testing does not do a lot to help us assess impulsivity, especially in our efforts to prevent violence. The best way to assess it, is to look at the person’s behavior in real-life situations. For therapists, social programs, and physicians, that means that it is folly to think that you have assessed a person suspected of domestic violence by talking to them, in so far as impulsivity is concerned. Getting collateral information (talking to family members, looking at arrest record and other background information) is essential. There is even a study that is encouraging for assessing impulsivity in clinical settings for some people.

A key question about impulsivity is how much the problem is a matter of impaired restraint, as opposed to how much the strength of the impulse is the problem. Is it the intensity of the drive to act, or is it a poor ability to exercise “free won’t” by resisting an urge (a failure of inhibitory control). Or is it both? In one study of violent offenders, time pressure reduced inhibition of errors, supporting the idea of frontal cortical deficits because the violent offenders in the test only performed poorly under time pressure conditions in which they had less ability to exercise conscious control. This suggests that inhibitory control may play a larger role. It suggests that batterers don’t need to be more emotionally aroused prior to being violent so much as that many are impaired in exercising control.

The study of suicide is an allied area, because it is a violent act and can be associated with violence against others in various ways. A recent study showed executive dyscontrol in actively suicidal people. The researchers believed that there was a state-dependent component. This is a subject for another post, but dissociation and triggers of behavior and emotion are very important here. In this study, impaired decision making was the strongest feature. Suicidal ideation without a strong impulse to act, says the article, was more likely to have rigid thinking behind it. However, both (thinkers and those at higher risk) had higher levels of aggression.

We need to look at every angle on how to improve treatment and sentencing, because the rates of recidivism are high. This is especially true for people with criminal lifestyles. Those who were prone to using weapons in violence, who engaged in other crimes, and who used drugs were very likely to batter, abuse drugs, or engage in other criminal activity over ten years following arraignment (when the study began). The first year, rates were roughly half of the full duration. This dynamic gives the impression that arrests, programs, restraining orders, and other measures are more effective than they actually are, because many studies do not look beyond a year.

References

Votruba, K.L., Rapport, L.J., Vangel, S.J., Hanks, R.A., Lequerica, A., Whitman, R.D., Langenecker, S. (2008). Impulsivity and Traumatic Brain Injury. Journal of Head Trauma Rehabilitation, 23(2), 65-73. DOI: 10.1097/01.HTR.0000314525.93381.69

CHEN, C., MUGGLETON, N., JUAN, C., TZENG, O., HUNG, D. (2008). Time pressure leads to inhibitory control deficits in impulsive violent offenders. Behavioural Brain Research, 187(2), 483-488. DOI: 10.1016/j.bbr.2007.10.011

Westheide, J., Quednow, B.B., Kuhn, K., Hoppe, C., Cooper-Mahkorn, D., Hawellek, B., Eichler, P., Maier, W., Wagner, M. (2008). Executive performance of depressed suicide attempters: the role of suicidal ideation. European Archives of Psychiatry and Clinical Neuroscience DOI: 10.1007/s00406-008-0811-1

Klein, A.R., Tobin, T. (2008). A Longitudinal Study of Arrested Batterers, 1995-2005: Career Criminals. Violence Against Women, 14(2), 136-157. DOI: 10.1177/1077801207312396

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• Welcome back to the GNIF Brain Blogger!

If you were left out in this round, just leave a comment with your blog entry. Don’t worry, we’ll format it to match the blog carnival (or even include it in the main post).

Remember, we review the latest blogs related to the brain and mind that go beyond the basic sciences into a more human and multidimensional perspective. You can check our Brain Blogging archive for all editions.

For future editions, please remember to submit your blog entries using the online submission form. We will do our best to review and include your entry! Enjoy your readings…

Mental Health Disorders

Dr. Deb reports on Into The Wild ~ A Study of Schizophrenia?:

What struck me was that this was NOT a story of an idealistic visionary but rather a young man with Schizophrenia.

Providentia reports on The Beast Within:

A similar case was brought to trial in 1603 involving a mentally disturbed (and possibly intellectually challenged) boy named Jean Grenier. Following reports of animal attacks on children in Gascony, France, Grenier confessed to all of the attacks and claimed to have eaten some of the children involved.

Coping, Therapy, and Treatment

Live Beyond Stress and Illness reports on Deep Breathing for the Health of it:

In all my years of working with clients in the health and wellness field, rarely do I run across someone challenged by stress and illness that is conscious of their breathing habits let alone conscious of the true benefits deep breathing can offer them.

Dr Shock reports on Computer Based Psychotherapy:

Patients often improve more with computer based cognitive-behavioral psychotherapy than with conditions such as waiting list control or care as usual, says a recent review. This is coupled with an over 50% cut in usual therapist time.

Blog Motivation reports on 9 Effective Ways To Get Out Of A Rut:

Routines have their purpose. Many people like them, as they give us some comfort and security. However, sometimes it gets too comfortable and thus lead to a lack of action. Which is what the rut is all about.

Drugs and Toxins

Caffeine Addiction reports on the Health Effects Of Caffeine:

Since caffeine stimulates stress hormones, this can lead to increased anxiety, insomnia, and tension. If you are like most people, increasing the amount of stress and anxiety in your life is not a good thing. There is enough of that to go around already!

A Girl Smiles reports on Going off SSRI’s:

I’ve been on 10-20mg of Lexapro for at least 2 years now. I’ve tried going off before with rather bad results. This time I’m going to make it. Other than my sister, I’m not telling my family. My mom would freak out and accuse me of being depressed even when I was not.

Genetic Conditions and Diseases

Lumosity Brain Health reports on the Genetic Component of Alzheimer’s Disease:

Researchers examined families in which both parents have Alzheimer’s, and found that their children ended up with the disease 42% of the time.

Mind, Soul, and Body reports That which we pass on, when flawed:

Becoming the parent of a child with a genetic disease is a harrowing experience. This is likely more true today than it has ever been. We are hardwired to want the best for our children. Discovering they have a life altering condition pulls the rug right out from under parents.

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The authors concluded that these results mean happiness could be the result of these specific personality traits, and that depression was brought about by the opposing traits of introversion, disagreeability and neuroticism. While this is a potentially correct conclusion, it seems that the opposite could also be true — depression is an inheritable trait, which leads to certain personality traits that occur in response to this depressed mood.

Many studies have linked certain personality traits to depression. But whether the underlying cause is these traits or depression itself remains to be determined. Alternatively, it may be that both personality traits and depressive tendencies are genetically inherited, but they are inherited together in a predictable pattern, i.e. genes for depressive mood and introversion travel together.

Anyone who has been depressed can vouch for the fact that, when things get bad, you do not want to socialize, you do not feel agreeable or open, and you are not very conscientious about yourself or those around you. So it seems plausible that these traits are as much a product of the depression as they are its underlying cause.

The truth probably lies somewhere in between. Personality traits are not always inherited, and environmental factors clearly also play a role in the development of personality development. Environmental factors are also important in the development of depression — but we still cannot explain why some individuals become depressed but others do not in response to the same stressful event. Underlying genetic susceptibility to depression and other mood disorders clearly exists, and likely interacts with life events and personal habits in a complex fashion to ultimately determine our personality and our mood. But the idea that our personality traits are genetically determined and are the major determinate of mood disorders is still just a theory.

Reference

Weiss, A., Bates, T.C., Luciano, M. (2008). Happiness Is a Personal(ity) Thing: The Genetics of Personality and Well-Being in a Representative Sample. Psychological Science, 19(3), 205-210. DOI: 10.1111/j.1467-9280.2008.02068.x

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Thus, the shortage of physicians will increase as more doctors are needed to take care of our aging population.

One person’s analysis of some data shows that one key reason compounding this shortage is the changing demographic of the physician workforce. Currently, women make up an increasing part of the medical school populace, with most schools over half women. It is argued that the data show that women physicians:

• have less longevity than their male counterparts,
• take more time off for maternity and family matters, and
• work less hours and take less overnight call.

Now I am not going to argue any of these points because I am not in the business of making enemies. However, I think those general points can be applied to the younger and newer generations of physicians, physicians-in-training, and medical students. Younger doctors are not working as long or hard as older physicians did. This is largely due to lifestyle considerations and well as work-hour restrictions in training.

Time are changing and the next generation of physicians are not going to stay up all night and take call at any hour of the day to maintain the physician-patient relationship.

Do female physicians work less than their male counterparts? Do they take less call? Do they get pregnant and leave the workforce for longer than male doctors? Maybe. Maybe not.

The point is that this is not necessarily a phenomenon of women, but of a new generation of physicians who demand sanity , mental and physical health in their own lives. After all, shouldn’t physicians take care of themselves the way they expect their patients to?

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Brand new research [2] from a study of over 77,000 people has shown that higher than recommended doses of Vitamin E can lead to a “significant” increase in the risk of developing lung cancer, irrespective of whether they smoked or not. The strength of the findings was somewhat unexpected — a 7% rise in lung cancer for every extra 100 mg of Vitamin E taken daily for 10 years. With an average daily Vitamin E supplement of 400 mg, this could mean a 28% excess risk for someone to develop lung cancer taking just one pill a day.

An important question is: do we need Vitamin E supplementation at all on top of an average diet? The UK Food Standard Agency website estimates daily dietary requirements of Vitamin E to be just 4 mg for men and 3 mg for women. It also mentions that not enough is known about the side-effects of high-dose vitamin E supplements, and that 540 mg or less a day is “unlikely” to be harmful. This new study could change all that.

While the protective effects of Vitamin E against heart disease and many forms of cancer are acknowledged, dietary deficiency is rare today [3]. This is mainly related to the fact that vitamin E intake in modern diets is mainly dependent on polyunsaturated fatty acids, and with diets rich in vegetable oils and green leafy vegetables, the amount of daily vitamin E intake could well exceed 20-40 mg — just a tablespoon of sunflower oil has 6 mg, while wheatgerm oil has 20 mg or so.

Do we actually need any extra vitamin E supplements if we can make up for our daily requirement through diet? An editorial from the American Journal of Clinical Nutrition in 2006 [4] concluded that intervention studies did not support a beneficial effect of antioxidant supplements, and there was a growing body of evidence that with anti-oxidant vitamins, “just enough” was more than adequate. About 15 mg per day of Vitamin E was enough to provide us with maximum protection against chronic disease, according to the journal.

The debate about Vitamin E supplementation as a potential cause of premature death is however not new. In 2004, the Times [5] reported the results from a John Hopkins study [6] that pooled the result of 19 studies on vitamin E supplementation worldwide. The study found that doses of 400 international units (IU) of Vitamin E, “often the equivalent of a single capsule were associated with a 10% increased risk of death.” Ominously, the study found that many people were taking as much as 400-800 mg of Vitamin E a day. Even the Lancet had earlier estimated that out of a million people taking Vitamin E supplements, 9,000 were expected to die premature deaths.

The question therefore is not “if,” but rather “how much.” Supplementation can increase the intake of Vitamin E by up to a hundred times of that of daily requirements, and as the latest study shows, the increase in risk of lung cancer can also be substantial. Dietary adjustment can well increase our intake of Vitamin E to well above our recommended daily allowances. The question therefore remains: is it at all justifiable to use “killer” doses of a supplement that has no demonstrable benefits at all above its physiological limits?

References

1. Wellcome Trust. Anti-ageing treatments.

2. Byers, T. (2007). Nutrition and Lung Cancer: Lessons from the Differing Effects of Foods and Supplements. American Journal of Respiratory and Critical Care Medicine, 177(5), 470-471. DOI: 10.1164/rccm.200711-1681ED

3. British Nutrition Foundation. (2004). Vitamins.

4. Traber, M.G. (2006). How much vitamin E? … Just enough! American Journal of Clinical Nutrition, 84(5), 959-960.

5. Lister, S. (2004). The vitamin boost that could cause early death. TimesOnline.

6. MILLER, E., PASTORBARRIUSO, R., DALAL, D., RIEMERSMA, R., APPEL, L., GUALLAR, E. (2005). Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality. ACC Current Journal Review, 14(5), 17-17. DOI: 10.1016/j.accreview.2005.04.017

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