Marks Psychiatry

Mark McDonough PhD, who specializes in brain injuries spoke at an international conference on combat stress and discussed the impact of brain injuries on troops. He concluded that traumatic brain injury may be the “signature injury” of the Iraq war. The Kelvar helmets help prevent penetrating head wounds, but don’t adequately protect an individual from a closed head injury.

Unfortunately brain trauma that affects the white matter of the brain difficult to spot on a CT scan. So a soldier can be close to a blast, survive it without losing any limbs, may get a quick scan of his head, and assume everything is okay because he doesn’t have any visible injuries.

This is important because soldiers with traumatic brain injuries could have slower reaction times, be subject to confusion or be more suggestible to leading questions. Dr. McDonough reported they could also be more easily implanted with false memories. All of these negative consequences of a traumatic brain injury could pose a security risk if these soldiers were returned to combat.

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We used to believe that we were born with all of the new brain cells we would have for life. Once we reached adulthood, we can’t learn any more new tricks. Actually it’s not quite that way, but in general neural stem cells (undifferentiated brain cells, like fetal brain cells) were thought to only exist in fetal or neonatal brain. This is why brain injury to an adult has such a devastating affect.

But, new research conducted by Fred Gage PhD of the Salk Institute shows that neural stem cells exist in the adult brain and they can multiply, differentiate and join the rest of the mature brain cells. This process, called neurogenesis (think nerve beginning or nerve birth) can happen throughout our lives.

Aging slows neurogenesis, but Dr. Gage has also found that physical activity enhances the process. Chronic stress suppresses neurogenesis temporarily, possibly for months.

These findings have tremendous implications for finding ways to promote growth of damaged brain and spinal cord cells.

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WalMart’s SEO Lee Scott has developed his own solution to healthcare reform with the arrival of RediClinic inside Walmart Store.  Now you can shop and have your bronchitis treated all in one trip 7 days a week.  The service is designed to reach the uninsured as their services are low cost.  For example, a visit for an active condition (as opposed to well-check or routine physical) is $59.  They will often have coupons on their Website for $10 off.  Labwork is also inexpensive.

Unfortunately, they do not provide mental health services and I guess I shouldn’t be surprised as mental health care is often seen as a non-standard part of health care.  Another reason for this is the clinic is staffed by nurse practitioners with doctors available for backup.  Nurse practitioners trained in general medicine usually have little exposure to psychiatry.  But I would have thought they would have some services available for uncomplicated mood disorders such as depression and anxiety since these disorders are often being treated by primary care physicians.

Perhaps they may expand their services to include mental health checks.  But for now, they have begun to offer some benefit in the mental health arena by including a number of psychiatric medications in their $4 prescription drug plan.  For those who don’t know about this, you can take your prescription for certain medications to Walmart and get a one month’s supply for $4.  Target has a similar plan.  Check out Walmart $4 Drugs or Target $4 Drugs for a complete list, however just a few of the andtidepressants included are generic Prozac, Paxil, Trazadone, Celexa and Elavil.

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A study lead by Dr. Karen H. Seal of University of California, San Francisco found that 25% of the 100,000 veterans returning from Iraq and Afghanistan as of November 2005 were diagnosed with a mental disorder. This study was published in the Archives of Internal Medicine (2007:167 pp 476-82). The most common diagnosis was Post-Traumatic Stress Disorder (PTSD) which accounted for more than half of the veterans.

Of the roughly 25,000 vets diagnosed with a mental disorder, 44% had one diagnosis, 29% had two and 27% had three or more. Younger veterans ages 18-24 were found to be at higher risk of being diagnosed with a mental disorder. It was suggested this group was at higher risk because they were likely to be of lower rank and have more combat exposure.

These are disturbing statistics. Unfortunately the publication of research is often way behind real time as you can see with this article that was published in March 2007 and includes veterans returning home as of November 2005. Who knows what that number has grown to today, 18 months later? It is especially concerning that there are thousands with three or more mental disorders.

It is not uncommon for someone to have more than one diagnosis, as some disorders can beget others. PTSD and depression would be a good example. PTSD is an anxiety disorder that alone does not produce depressive symptoms. But individuals can subsequently develop depression or have had pre-existing depression and thus end up with two separate diagnoses if they later develop an anxiety disorder such as PTSD.

The study concluded by emphasizing the need for early screening and intervention to prevent these veterans from developing chronic mental illnesses, especially the younger population of veterans.

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The FDA issued a warning about buying medication online. The agency tested several medications including Ambien, Xanax, Lexapro and Ativan and determined they were contaminated with the drug Haldol. Haldol is an antipsychotic medication that can cause a number of side effects, but most notably muscle stiffness or other movement disorders.

In fact, the FDA statement noted instances of people who received emergency care for symptoms such as muscle stiffness and trouble breathing after taking the medication they bought online.

If you have purchased medication online, you can compare your pills to photos provided by the FDA at their site FDA Drug Warning Photos. According to the FDA, the packages were postmarked from Greece, but they still have been unable to determine their origin.

In March, the FDA recalled a dietary supplement that could be purchased over the internet because it was found to contain Cialis - the medication to help with erectile dysfunction.

What the take away message? Be very cautios when purchasing medications online. Most legitimate operations will require a prescription and have a pharmacist available for questions. Visit the FDA Buying Guide for more information.

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