Random Acts Of Coolness

Posted on Posted in Continuing Education, Homestudy, Psychology, Seminars, Webinars

by Mary O’Brien, M.D.

I live in Myrtle Beach, South Carolina.  In the dead of winter, I’m grateful for that.  Right now (during mid-summer), however, it’s the dead of “awful.”  The temperature has been in the mid to high nineties for several weeks, and I suspect there may be lower humidity in a steam shower.  For that added touch, traffic is terrible.  Tourists are tripping over one another, and everyone is cranky.  I’ve thought about moving to Alaska.

Yesterday, on the way home from the grocery store, I drove by a utility crew digging a huge ditch.  For a split second, I caught the glance of a very large, burly man crawling out of a hole.  He was covered with dirt and sweat.  I thought he was about to collapse.  In a heartbeat, the “do something” physician-part of me began to debate with the shy, introverted, aging woman part of me:

“This man is on the verge of heat exhaustion.  I should stop and offer help.  But with what?   A trunk full of cereal, paper towels, and cat food?  It’s really none of my business.  This is their job.  Besides, it’s probably not safe to pull over. Blah, blah, blah…”  Perhaps you know the routine.  I can debate myself for hours.

A mile down the road, I turned into my driveway — still conflicted.  Then it dawned on me. “I am an idiot.  This is not a difficult decision.”  I dumped my groceries in the kitchen and grabbed what I could from the fridge:  bottles of water; Coke; lemonade; and Hawaiian Punch.  I know, I know — I have the taste buds of a ten-year old.  Then, I raided my stash of ice cream bars from the freezer and headed back out.  As I pulled up to the work site and got out, the crew looked baffled.  I suspect the crew thought some fussy woman was about to start complaining about the mess or the congestion.  It happens.

I explained I had driven by ten minutes earlier and was worried about them.  When I pulled out the cold drinks and ice cream bars, their jaws dropped.  They still looked as if they were about to fall over, but this time it was from shock.  By the way, I’m not the only one with the taste buds of a ten-year old.

If you’re ever in a similar situation and you feel conflicted, choose the “random act of coolness.”  You’ll feel better about everything all day long.

Little Charlie

Posted on Posted in Brain Science, Continuing Education, Pain, Psychology

By Mary O’Brien, M.D.

Do you know what “Mitochondrial Deficiency Syndrome” is?  Most people don’t.  Unfortunately, that doesn’t stop them from weighing in on the case of little Charlie Gard.  Charlie is an 11-month old baby with a rare and devastating genetic disorder that precludes normal functioning of mitochondria.  Mitochondria are intracellular organelles that generate ATP (adenosine triphosphate).  In essence, ATP represents energy at the cellular level.  Without ATP, cells, especially brain and muscle cells, cannot function.  The most sensitive and vulnerable cells in the body are those of the cerebral cortex.  Little Charlie cannot see or hear or move or swallow or vocalize or think.  No one can know with absolute certainty, but he probably cannot “feel” anything at this point.  The word tragic is utterly inadequate.

The global media frenzy surrounding this heartbreaking situation is revealing and deeply disturbing.  Controversy sells, and unfortunately, the less people know, the more adamant and emotional they often become.  Those of us who have dealt with life and death situations for decades can help by elevating the level of conversation.  Some timeless principles are useful:

  • Embrace humility.  Never be afraid to say “I don’t know enough about this situation to have a well-informed opinion.” That would be refreshing.
  • Exercise the intellectual discipline to learn the facts involved.  In medicine, every patient is unique.  Arguments for or against life support or experimental treatments are pointless absent actual knowledge.
  • Resist the temptation to become emotional.  Unbridled emotions cause far more problems than they solve.  Try to be the voice of reason.
  • Try not to confuse or conflate the issues.  People in nearly every media outlet have tried to make the case about socialized medicine, cost control, parental rights, the British court system, the European Union, or theology.  The case of Charles Gard is about medical ethics.
  • Focus on principles, not personalities.  There is a colossal difference between saving life and prolonging death.  Remember, there is never a moral imperative to render futile care.

Primum non nocere.  (First, do no harm.)  There’s a reason that Solomon prayed for wisdom.

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Obsessive-Compulsive Disorder

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Barbara Sternberg, Ph.D.

Occurring in men and women with comparable frequency, obsessive-compulsive disorder (OCD) affects about 2.2 million Americans 18 years or age and older — one percent of the adult population of the United States.  Initial symptoms usually manifest themselves in childhood, adolescence, or early adulthood, and median symptom onset is 19 years of age.  One third of adults with OCD experience their first symptoms as children.

 OCD is characterized by repetitive, intrusive, unwanted, and disturbing thoughts known as obsessions and by the performance of rituals known as compulsions — in an urgent attempt to control the anxiety that the obsessions generate.

Fear of social embarrassment, for example, could prompt someone with OCD to comb his or her hair so compulsively that the individual becomes unable to look away from the mirror.  Thoughts of engaging in violence, bringing harm to loved ones, and having a persistent preoccupation with performing distasteful sexual acts or violating one’s religious beliefs are common obsessions.  Common rituals include repeated hand-washing, counting, or touching objects (especially in a particular sequence).

People who have OCD may be preoccupied with order and symmetry, have trouble discarding things, and accumulate or hoard things they don’t need.  Healthy people perform such rituals as repeatedly making sure the stove is off before leaving the house.  People with OCD perform rituals that distress them, interfere with daily life, and provide no more than a temporary respite from their obsession-induced anxiety.  Most people who have OCD are eventually enslaved by their own compulsions. 

Research indicates that OCD may be a familial disorder.  Many adults who have OCD recognize the futility of their actions, but children and some adults who have OCD are unaware that their behavior is unusual.  The course of OCD can vary.  Symptoms may emerge and disappear, ease or intensify, or prevent the individual from carrying out his or her responsibilities.  Many people with OCD try to control their disorder by avoiding circumstances that trigger their obsessions or by self-medicating with alcohol or drugs.

 

What is a Mild Brain Injury?

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By Michael Howard, Ph.D.

The Mild Traumatic Brain Injury (MTBI) Working Group of the CDC (Center for Disease Control) in Atlanta has defined MTBI as an injury to the head resulting from blunt trauma or acceleration or deceleration forces with one or more of the following conditions:

  • transient confusion, disorientation, or impaired consciousness.
  • dysfunction of memory around the time of injury.
  • loss of consciousness lasting less than 30 minutes.

Mild traumatic brain injury is also called concussion.  Traumatic brain injury results when the neurons inside the brain are damaged from acceleration-deceleration forces during impact.  When the head is struck or moved violently, the gel-like brain is rapidly displaced or concussed back and forth within the skull.  The brain is distorted in shape and the fragile, thread-like neuron cells inside the brain can be stretched, torn, or traumatized by the mechanical forces.

Typically, the long axon of the neuron is most susceptible to injury.  The phenomenon is called axonal shearing.  This type of traumatic injury can result in the neuron’s death or temporary loss of function.  When, by head trauma, a number of neurons is disabled in such a manner, disruption or alteration of brain functions can occur.  This is the major mechanism behind MTBI.

Traumatic brain injury can result in the skull being broken or fractured (penetrating head injury) or the skull remaining intact (closed head injury).  In MTBI, closed-head injuries are by far the most common.  It is not necessary for the head to be physically struck to result in mild traumatic brain injury.  Violent back-and-forth movement of the head, called whiplash, can also result in neuronal damage.  The MTBI that is due to proximity to a blast explosion that many soldiers and others in Iraq have sustained is another example of an MTBI occurring without the head being physically struck.

WHAT ARE THE SYMPTOMS OF A MILD BRAIN INJURY?

It is common for individuals to have immediate symptoms of brain impairment after a mild traumatic brain injury.  These symptoms can be physical, cognitive, and behavioral in nature and can occur in any combination. They typically last up to a few weeks.  Although there is no “typical” MTBI patient, headaches, dizziness, insomnia, and intermittent confusion are commonly seen in the first days or weeks after the injury.  These symptoms are most severe immediately after the injury.

Over the few days or weeks following the injury, the symptoms should diminish in number and intensity.  Whether or not an individual will have symptoms persisting beyond the first few weeks or months is very difficult to predict and may depend on a number of factors, including the presence of co-existing conditions like depression, anxiety, chronic pain, prior head traumas, or involvement in personal-injury litigation.

Alzheimer’s Disease

Posted on Posted in Brain Science, Continuing Education, Elder Care, Seminars

constant-63613_640By Dr. Mary O’Brien, MD

Alzheimer’s disease is one of the most dreaded health conditions of our time. There is no cure, and current treatments don’t slow down the disease; they can only alleviate symptoms. As well as avoiding Alzheimer’s disease and age-related cognitive decline, many people want to stay as sharp as possible as they age, and, if possible, delay age-related cognitive decline. Yet are there truly preventive strategies to stave off of Alzheimer’s disease or cognitive problems associated with aging?

While there’s no definitive evidence about what can prevent or reduce the risk of Alzheimer’s disease or dementia, scientific studies have offered clues about strategies that might slow down or prevent cognitive decline. The good news is that research on the prevention and treatment of Alzheimer’s disease—which currently affect about 5.3 million Americans—is now a high priority.

In late 2015, the U.S. Congress approved the largest increase to date in federal spending for Alzheimer’s disease research and care-giver support in the 2016 federal budget—a $350 million increase over 2015. The increase in federal spending came in response to reports and studies documenting the needs and opportunities that lie ahead for Alzheimer’s disease research. By 2050, Medicare spending on Alzheimer’s disease is expected to quadruple to $589 billion annually, but one treatment delaying the onset of the disease could save Medicare $345 billion in the first 10 years of its use, according to a report from the Alzheimer’s Association.

Over the past 30 years, many advances have been made in understanding Alzheimer’s disease and dementia. We now understand the biology of Alzheimer’s disease as never before. The brains of people with Alzheimer’s disease are filled with amyloid plaques—composed of deposits of a toxic protein fragment called beta-amyloid. The brains of Alzheimer’s disease patients also have an abundance of neurofibrillary tangles or abnormal collections of twisted protein threads found inside nerve cells, composed chiefly of a protein called tau.  In Alzheimer’s disease, the amyloid plaques and neurofibrillary tangles damage the brain’s neurons, interfering with their ability to function and communicate with one another. As a result, Alzheimer’s disease causes the brain to shrink and atrophy.

Scientists are now emphasizing research on the development of Alzheimer’s disease and on the symptoms and signs of early Alzheimer’s disease, which is termed mild cognitive impairment. The hope is that learning more about mild cognitive impairment can help identify patients at increased risk for the disease and for disease progression.

The symptoms of mild Alzheimer’s disease include:

  • Memory loss and confusion about once familiar things or places.
  • Difficulty accomplishing daily tasks, especially handling money and paying bills.
  • Poor judgment that leads to bad decisions.
  • Mood and personality changes, such as increased anxiety and aggression.

The symptoms of moderate Alzheimer’s are more serious, and include:

  • Increasing memory loss and confusion, and shortened attention span.
  • Irritability and Inappropriate outbursts of anger.
  • Difficulty with language (in reading and writing) and difficulty in working with numbers.
  • Trouble recognizing friends and family members.
  • Difficulty organizing, planning, and thinking logically.
  • Restlessness, agitation, anxiety, tearfulness, and wandering.
  • Repetitive movements and statements and sometimes muscle twitches.
  • Paranoia, delusions, and hallucinations.
  • Loss of control over impulses.

Age and genetics are the strongest risk factors for dementia and Alzheimer’s disease. However, other risk factors have been linked to Alzheimer’s disease. Research has shown that people with heart disease, stroke, and high blood pressure may be more likely to develop Alzheimer’s disease and to have more severe diseases.  Studies also show that patients with metabolic syndrome, Type 2 diabetes, and sleep apnea are at increased risk for mild cognitive impairment and Alzheimer’s disease. Whether or not successful treatment of hypertension, heart disease, diabetes and sleep apnea can affect cognitive decline is open to question, but is under study. One large trial funded by the National Institutes of Health (NIH) has compared intensive glucose-lowering treatment with standard treatment for Type 2 diabetes, but there were no significant differences between the two groups.

Hormones such as estrogen and progesterone also have effects on the brain. Yet studies on whether menopausal hormone therapy is protective against cognitive decline or Alzheimer’s disease have been conflicting.  Research is continuing on estrogen and progesterone as well as other hormonal therapies that could be preventive, including testosterone, growth hormone-releasing hormone and DHEA (dehydroepiandrosterone).

Many studies have also investigated whether vitamins and dietary supplements can protect against cognitive decline and Alzheimer’s disease. Epidemiological and laboratory studies have suggested that antioxidants from food and supplements can lower the risk of Alzheimer’s disease by preventing oxidative damage from free radicals. Vitamin E, vitamin C, B vitamins, and coenzyme Q10 have been tested as treatments to slow down or prevent Alzheimer’s disease, but none have proved effective. Researchers are also investigating the effect of resveratrol—a compound found in red grapes and red wine.

Research has also revealed that healthy habits can have an important influence on the risk for Alzheimer’s disease and cognitive decline. Studies show that exercise can stimulate the brain and help to make new neuronal connections within the brain that are vital to healthy cognition. Daily aerobic exercise, for instance, can enhance recall and executive function. Research has also found that a diet rich in vegetables is associated with a reduced risk for cognitive decline, and a Mediterranean diet significantly lowers the risk for mild cognitive impairment and Alzheimer’s disease.

Keeping your mind active throughout life may also reduce the risk of Alzheimer’s disease. Large observational and epidemiological studies have associated cognitive health with the maintenance of social relationships at work, volunteering or by living with someone. Mentally stimulating activities such as reading books and magazines, playing game and going to lectures may also keep the mind sharp. Recent large studies have found that people who spend a lot of time in intellectually stimulating activities are significantly less likely to be diagnosed with Alzheimer’s disease.

For healthy people, formal cognitive training sessions also seems to have benefits for the brain. Studies on memory, reasoning, and processing speed training—all aimed at improving mental skills—show that this training can improve cognitive skills for up to 10 years. Other studies are now investigating whether the combination of exercise and cognitive training can delay or prevent age-related cognitive problems.

  1. National Institute on Aging. Alzheimer’s Disease: Unraveling the mystery. nia.nih.gov/
  2. National Institute on Aging. Alzheimer’s Disease Progress Report: Intensifying the Research Effort. nia.nih.gov
  3. Preventing Alzheimer’s Disease: What Do We Know? nia.nih.gov
  4. Alzheimer’s Association. Historic Alzheimer’s funding increase signed into law, answering Alzheimer’s Association call for action. alz.org

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Exploring Parkinson’s Disease

Posted on Posted in Brain Science, Continuing Education, Elder Care, Homestudy

parkinsonBy  James Coggin, M.D.

Every movement of the body requires communication among the central nervous system—especially the brain and spinal cord—and the nerves and muscles. Movement occurs when specialized clusters of neurons in and around the brain stem, called basal ganglia, release neurotransmitters, chiefly dopamine. When there is insufficient formation and action of this neurotransmitter, degenerative disorders can occur, impairing one’s motor skills, speech, and many non-motor skills as well.

Parkinson’s disease (PD) is a chronic, progressive, and degenerative neurological disorder characterized by a loss of dopamine-producing neurons in the substantia nigra (Latin for “black substance”), a small region in the brain stem. The brain stem connects the spinal cord to the brain  and is comprised of the medulla oblongata (myelencephalon), pons (metencephalon), and mid-brain (mesencephalon). Parkinson’s disease or “primary parkinsonism,” results from a neurodegenerative process without any secondary systemic cause. Patients typically experience muscle rigidity, tremors, bradykinesia (slowing of movement), and ataxia (poor balance).

The symptoms of Parkinson’s disease, as well as possible therapies, were discussed in the Ayurveda, the system of medicine that has been practiced in India since 5000 BC, and Nei Jing, the first Chinese medical textbook, published 2,500 years ago. Descriptions of symptoms and treatment of PD date back to medieval times, most notably by Averroes.

Researchers estimate that between 500,000 and one million Americans have Parkinson’s disease, making it one of the most common neurodegenerative disorders in the U.S., second only to Alzheimer’s disease. These statistics are not precise, however, because Parkinson’s is frequently misdiagnosed. The disease occurs in one of two forms:  idiopathic (or sporadic) or — rarely — familial. Most forms of PD are idiopathic  while secondary cases can result from drugs, head trauma, and other medical disorders. Some forms have a genetic or familial basis.

A number of environmental factors has been linked to an increased incidence of Parkinson’s disease. These include:

  • exposure to heavy metals and pesticides.
  • living in a rural area within an industrialized country.
  • exposure to jet fuel.
  • drinking well water.
  • not smoking cigarettes.

The elderly are particularly affected. Parkinson’s is the second-most common neurodegenerative disease of the elderly, and about one percent of Americans over age 65 has been diagnosed with PD. While the average age of onset is about 60 years, the disorder does occur in younger people. In fact, five to 10 percent of cases are diagnosed before age 40. People with early-onset Parkinson’s discover initial symptoms between the ages of 21 and 40. The first symptom in juvenile-onset disease occurs before the age of 20.

People of all ethnic origins can develop Parkinson’s disease although it is slightly more prevalent in Caucasians than in Asians or African-Americans in the United States.

Parkinson’s occurs with slightly greater frequency in men than in women. About 15 percent of sufferers have a first-degree relative who also has the disease although there is typically no clear path of inheritance. Researchers suggest that most cases arise from a combination of factors, including genetic susceptibility, exposure to certain toxins, and aging.

You can learn more about Parkinson’s disease by reading our Parkinson’s Disease & ALS

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Statistics on Bullying

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology

cyber-bullying-122156_640Bullying is not only a serious problem, it is deceptively complex. As a result, it is not easy to understand bullying problems or to determine how to respond to them. It is important to address bullying because it is pervasive and accompanied by detrimental and often subtle effects that linger after the episodes end. The dynamics of bullying go beyond the children, youth, or adults who bully or are bullied. Individual features, family and peer interactions, and cultural considerations all contribute to bullying. Making the situation more complex are new forms of bullying such as cyberbullying, which has unique implications for prevention and intervention.

Common in the schoolyard and in the workplace for decades, bullying has been a predictable, “accepted,” usually undiscussed although painful, part of childhood, youth, and adulthood. It has been said that bullying is “the most prevalent form of low-level violence in schools today.” Until very recently, bullying has been tolerated in Western society, and school-based bullying was considered a “normal” part of childhood that had a possibly good outcome through “character-building.” Although some people still see it that way, possibly because of how pervasive bullying is in the school context, bullying has recently been recognized as a public health problem that needs to be addressed.

But it has taken acts of extreme violence in which bullying appeared to be a factor for this phenomenon really to become part of the public agenda. For example, after the April 1999 Columbine killings, it was learned that one of many factors that may have contributed to the killing spree by Eric Harris and Dylan Klebold was their chronic victimization by popular school athletes. Of course, this was a special case of extreme violence that doesn’t occur in the vast majority of schools. Still, Columbine was described by certain students, teachers, and parents as a place where bullying was tolerated.


Prevalence of Bullying

  •  In 2009, about 28 percent of 12- to 18-year-old students reported having been bullied at school during the school year and 6 percent reported having been cyberbullied.
  • High school students are more likely to be cyberbullied than middle school students
  •  Of all students who reported being cyberbullied in 2009, about 3 percent reported being subjected to harassing text messages (4 percent of girls and 2 percent of boys).
  •  20 percent of female and 13 percent of male students reported being the subject of adverse rumors in 2009
  • 10 percent of male and 8 percent of female students reported being pushed, shoved, tripped or spit upon
  • 6 percent of female and 4 percent of male students reported being deliberately excluded from activities

Other statistics:

  • 19 percent of students reported having been made fun of
  • 16 percent were the subject of negative rumors
  • 9 percent reported being pushed
  •  6 percent reported being threatened
  •  5 percent reported being excluded
  •  4 percent reported being forced to do things they didn’t want to do
  • 3 percent reported having their property destroyed
  •  Boys are 1.7 times as likely to bully as girls
  •  Boys are also 2.5 times as likely as girls to bully as well as be bullied
  •  Boys are typically bullied by boys, while girls are typically bullied by both boys and girls
  • 20 percent of girls and 25 percent of boys reported that they had either bullied, been bullied, or both two to three times a month or more

Learn all about bullying in our homestudy course, The Psychology of Bullying.   Check out all of our courses by clicking below.

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