Focus On Neurology And Psychiatry

[Read the Article] Agitation is common in patients with dementia and can contribute to distress for patients and caregivers and an increased risk of institutionalization. Nonpharmacological interventions are recommended as first-line therapy, but many patients fail to respond, and medications are often needed. Currently available medications don't work very well and can have serious side effects. A new study tested a combination of two existing medications, dextromethorphan hydrobromide and quinidine sulfate, to see if this would help control agitation in patients with Alzheimer's dementia. Researchers from the Cleveland Clinic recruited 220 patients with Alzheimer's dementia and agitation. During a preliminary 10 week trial, participants were randomly assigned to receive either the dextromethorphan- quinidine combination or a placebo. Results showed that patients receiving the combination medication demonstrated fewer episodes of agitation compared to patients who received the placebo. When agitation did oc

[Read the Article] About 42 percent of the general U.S. population has low vitamin D levels. In addition to promoting calcium and bone health, vitamin D may also affect the brain and cognitive function. A new study by JAMA Neurology looked at the association between baseline vitamin D levels and the rate of cognitive decline in a group of ethnically diverse older adults. A researcher from Rutgers University, along with colleagues from the University of California Davis, studied 382 older adults with an average age of 75. Among the group, 61 percent of participants were women, 41 percent white, about 30 percent were African American and 25 percent were Hispanic. At study enrollment, about 18 percent had dementia, 33 percent had mild cognitive impairment and half were cognitively normal. Vitamin D levels and cognitive function were measured at baseline. Cognitive function was also followed in 318 of the participants for an average of 5 years. Researchers found:- About 60 percent of the group, regardless of thei

[Read the Article] Some evidence suggests that physical activity can help slow cognitive decline. A new study evaluated whether a program of moderate physical activity would result in better cognitive function, lower risk of dementia, or both, for older adults compared with a health education program.Researchers from Wake Forest School of Medicine, Winston-Salem, North Carolina evaluated more than 1,600 sedentary adults, between the ages of 70 and 89, and randomly assigned them to either physical activity or a health education program. The participants were monitored for 24 months, during which their cognitive function was measured using a variety of clinical tests.Results found that both groups preserved their cognitive function over the two year study period. Although there was no difference between the groups, the outcomes still prove notable, since steady decline in cognitive function would generally be expected within this age group. [Watch more videos of The JAMA Report] JAMA Report videos provided pur

[Read the Article] Posttraumatic stress disorder (PTSD) affects twenty-three percent of veterans returning home from deployments in Afghanistan and Iraq. Left untreated, PTSD is associated with high rates of other disorders, disabilities, and poor quality of life. A new study evaluated a different approach to managing PTSD related symptoms, a mindfulness-based stress reduction therapy.Researchers at the Minneapolis Veterans Affairs Health Care System randomly assigned 116 veterans with PTSD to receive nine sessions of mindfulness-based stress reduction therapy, which teaches participants to be present in the moment in a nonjudgmental, accepting manner. The others attended group therapy, primarily focusing on current life problems. The veterans were monitored before, during and after treatment.Results found that among veterans with PTSD, mindfulness-based stress reduction therapy, compared to group therapy, resulted in a greater decrease in PTSD symptom severity. [Watch more videos of The JAMA Report] JAMA Re

[Read the Article] Each year, nearly 800,000 Americans experience a stroke, and for survivors, cognitive decline including memory and thinking speed, is a major cause of disability. Many patients experience these declines immediately after a stroke, but a new study examined whether cognitive decline continues several years after the initial stroke.Researchers from the University of Michigan Medical School, Ann Arbor examined changes in cognitive function in more than 23,000 individuals who were 45 years of age or older. All participants were free of cognitive impairment at the start of the study. Memory and other measures of cognitive function were recorded at the beginning and at regular intervals throughout a six year follow up period. 515 participants experienced a stroke during the study, the rest remained stroke free.Results found that stroke survivors had a faster rate of cognitive decline after stroke compared with the pre-stroke rate. Stroke was associated with an early decline in cognitive function a

Host: Maurice Pickard, MD Renowned trauma expert Dr. Bessel van der Kolk has spent over three decades working with trauma survivors. In his book, The Body Keeps the Score, Dr. van der Kolk adds to modern understandings of traumatic stress, revealing how it literally rearranges the brain’s wiring—specifically areas dedicated to pleasure, engagement, control, and trust. He discusses how these areas can be reactivated through innovative treatments including neurofeedback, mindfulness techniques, play, yoga, and other therapies.

Host: Brian P. McDonough, MD, FAAFP Dr. McDonough welcomes Dr. Donald Frei, neuroradiologist and Director of Neurointerventional Surgery at Radiology Imaging Associates in Denver, CO. Dr. Frei is working towards establishing state-of-the-art diagnosis and management strategies in treating patients with acute stroke. His procedural specialties include acute catheter directed stroke intervention, angioplasty/stent revascularization of cerebrovascular stenosis and minimally invasive treatment of cerebral aneurysms and arteriovenous malformations.

Guest: Tatjana Rundek, MD, PhD Host: Maurice Pickard, MD Hundreds of millions of people may have insulin resistance worldwide. What is the connection between insulin resistance and the risk of ischemic stroke? Dr. Tatjana Rundek, associate professor of neurology and director of the clinical translational research division in the department of neurology of the Miller School of Medicine at the University of Miami, Florida, discusses her research on the risk of developing ischemic stroke among non-diabetic patients with insulin resistance with host Dr. Maurice Pickard. How can lipid-lowering medications help reduce the risk of stroke for non-diabetic patients with insulin resistance, and are any other medications on the horizon for these patients?    

Guest: Guy Diamond, PhD Host: Maurice Pickard, MD Depression is one of the most common mental health conditions in the US, affecting 4-6% of adolescents. Suicide is also a significant issue in this age group, and is the the third leading cause of death among adolescents. How effective are the various types of psychotherapy and medications typically used to treat adolescent depression, and how is a newer form of therapy, attachment-based family therapy, aimed at engaging this patient population more effectively? Dr. Guy Diamond, director of the Center for Family Intervention Science at the Children's Hospital of Philadelphia, and associate professor of psychology at Penn Medicine, joins host Dr. Maurice Pickard to discuss the theory behind attachment-based family therapy, which is intended to address the patient's environment and stressors that may be contributing to their depression. When might attachment-based family therapy be more beneficial than enhanced usual care (including cognitive-be

Guest: William Thies, PhD Host: Bruce Japsen Some 5 million Americans have Alzheimer's disease, with more cases sure to develop as the baby boomer generation ages. New potential discoveries are on the horizon. But, as Dr. William Thies, chief medical and scientific officer for the national office of the Alzheimer's Association, tells host Bruce Japsen, significant challenges and obstacles also lie ahead for these potential ground-breaking discoveries.

Guest: Darrel Regier, MD Host: Bruce Japsen It's been over 15 years since the publication of the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The DSM-V is due to be published in May 2013, and for the first time, the American Psychiatric Association invited input from the wider medical community and the general public. Anyone could go to the website, view the draft criteria alongside DSM-IV criteria, as well as the rationale behind the proposed changes, and add their comments, through April 20, 2010. Dr. Darrel Regier, executive director of the American Psychiatric Institute for Research and Education and director, division of research, at the American Psychiatric Association, tells host Bruce Japsen about what's due to change in the Manual, and the ramifications for research, treatment, payment, and — ultimately — outcomes.

Guest: Mary Solanto, PhD Host: Vatsal Thakkar, MD How can cognitive behavioral therapy help alleviate symptoms of ADHD patients, as well as other symptoms of comorbid anxiety or depression in these patients? Is cognitive behavioral therapy more effective than other types of group or individual counseling for these patients? Dr. Mary Solanto, associate professor of psychiatry and director of the ADHD Center at the Mount Sinai School of Medicine, describes some of the benefits ADHD patients may receive from this non-pharmacologic approach to treatment. Dr. Vatsal Thakkar hosts.

Guest: Randy Blakely, PhD Host: Vatsal Thakkar, MD Dopamine is an important neurotransmitter in the cortex, essential to movement and activity control, as well as attention and executive function, tying this transporter to ADHD. How are scientists finding the genetic markers that may be transmitted to those with ADHD, and how does this help scientists understand more about the disorder? Dr. Randy Blakely, director of the Center for Molecular Neuroscience at the Silvio O. Conte Center for Neuroscience Research and the Alan D. Bass Professor of Pharmacology and Psychiatry at the Vanderbilt University School of Medicine, describes a genetic mutation that causes the dopamine transporter to run backwards, and how this discovery is helping scientists understand the mechanisms of ADHD. Dr. Vatsal Thakkar hosts.

Guest: Richard Rubin, MD Host: Vatsal Thakkar, MD Although stimulant medications are often used to treat ADHD patients, there are patients for whom non-stimulants might also be a viable option. What are the advantages to each type of medication? Dr. Richard Rubin, clinical associate professor at the University of Vermont College of Medicine and adjunct associate professor of child psychiatry at Dartmouth Medical College, joins host Dr. Vatsal Thakkar to discuss medication options for treating patients with ADHD.

Guest: Ralph Sacco, MD Host: Shira Johnson, MD Over 700,000 Americans have a new or recurrent stroke each year. Dr Ralph Sacco, professor and chairman of neurology at the University of Miami's Miller School of Medicine, discusses the leading research on treatment in the 'golden hour' after a stroke occurs. He reviews why thrombolytics have led the way after a dry infarct, but why your patients may need additional care only available in a comprehensive stroke center. As chief of neurology at Jackson Memorial Hospital in Miami and a leading researcher, Dr. Sacco joins host Dr Shira Johnson to talk about the state of the art in care after a CVA.

Guest: Ira Chasnoff, MD Host: Jennifer Shu, MD Over the past few decades, there has been grave concern that prenatal exposure to cocaine would result in a population of children with physical, mental and emotional problems. Many of these infants have been carefully studied as they progress toward adolescence and beyond, and data suggests the impact on their development may not be as dramatic as we once thought. Dr. Ira Chasnoff, professor of clinical pediatrics at the University of Illinois College of Medicine and president of the Children's Research Triangle in Chicago, joins host Dr. Jennifer Shu to explore the shift in our thinking about the long-term effects of prenatal exposure to cocaine.

Guest: James McGaugh, PhD Host: Michael Greenberg, MD How can beta-blockers influence the formation of memories? Can beta-blockers erase memories entirely, or do these medications only affect the way or degree to which a memory is imprinted? Dr. James McGaugh, founding director of the Center for Neurobiology and Memory at the University of California, Irvine, explains the way beta-blockers can be used to treat post-traumatic stress disorder. What are the ethical concerns about pharmacologically manipulating our anxieties or stresses? Dr. Michael Greenberg hosts.

Guest: Richard A. Friedman, MD Host: Cathleen Margolin, PhD The continued growth of the Internet, and its increasing pervasiveness in our lives, has many of us considering how we might incorporate Web-based avenues of communication in our practice. The ease and convenience of e-mail, for example, is tempting, but could also open up a Pandora's box. Does e-mail inherently pose new challenges that may not be an issue with phone dialogue or in-person discussion? Dr. Richard Friedman, professor of clinical psychiatry at Weill Cornell Medical College and a regular contributor to the New York Times, shares his experience with e-mail in his practice and a few tips for those who use or are contemplating Web communication for their practice. Dr. Cathleen Margolin hosts.

Guest: Matthew A. Menza, MD Host: Larry Kaskel, MD Could tricyclic antidepressants be more effective at treating depression in patients with Parkinson's disease? They have been used since the 1950s for treatment of depression, but in recent years, selective serotonin reuptake inhibitors (SSRIs) have become the predominant form of therapy. New research is suggesting that SSRIs may not be the best antidepressant option for our patients with Parkinson's. The lead author of this research, Dr. Matthew Menza, professor of psychiatry and neurology, and interim chair of psychiatry at the Robert Wood Johnson Medical School, speaks with host Dr. Larry Kaskel about the potential implications of his study on how we care for our Parkinson's patients who are also suffering from depression. Dr. Menza also explores a few other relevant issues: the reticence, among many of those with Parkinson's, to speak with their physician about depression, and the concurrent reluctance, among many in the medical community, to recog

Guest: Matthew B. Stern, MD Host: Jennifer Shu, MD Medication and physical therapy have been mainstay treatments for controlling neurologic symptoms associated with Parkinson's disease. One strategy for mitigating the characteristic tremors, rigidity and slow movement has focused on deep brain stimulation (DBS). What are the risks and benefits of this surgical intervention, when is it indicated, and how does it compare with medical treatment for Parkinson's? Host Dr. Jennifer Shu welcomes Dr. Matthew Stern, the Parker Family Professor of Neurology and director of the Parkinson's Disease and Movement Disorders Center at the University of Pennsylvania School of Medicine, to explore DBS and its indication for your patients with Parkinson's disease. Dr. Stern also offers his view on the question of whether DBS could eventually be considered for treatment much earlier in the disease's progression, or potentially as a first-line therapy for patients with Parkinson's.