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Health disparities in Alzheimer’s Disease

Yulin Chu, N.P.

Racial Disparity in AD
Per U.S. Department of Health and Human Services (HHS) (2013) reports, some populations are unequally burdened by Alzheimer’s disease (AD), including racial and ethnic minorities. According to Alzheimer’s Association (AA) reports, the likelihood of developing AD and other dementias is overall at two times more likely for African Americans and about 1.5 times more likely for Hispanics than whites (U.S. Medicine, 2010).

In the past decade, many studies in the U. S. reported the similar results.  Hispanics had an earlier age of onset (Alzheimer symptoms may strike Latinos almost seven years before white Americans) and greater severity of Alzheimer’s symptoms at their initial evaluation.

Propranolol: A possible therapeutic option in PTSD?

Manasa Enja, M.D., Suneela Cherlopalle, M.D., Murali K. Kolikonda, M.D., Steven Lippmann, M.D.

People with posttraumatic stress disorder (PTSD) repeatedly re-experience the agony of past emotionally upsetting circumstances. PTSD is characterized by hypervigilance, intrusive thoughts, sleep disturbance, and avoidance behavior towards reminders of past trauma. These symptoms often lead to social, occupational, and/or interpersonal dysfunction.

Catecholamines in PTSD
Epinephrine and norepinephrine are the primary catecholamines secreted in response to stress.

New concerns about caffeine products

Gurpreet Singh, M.D., Pramod Kayathi, M.D., Vivek C. Shah, M.D., Steven Lippmann, M.D.

Caffeine is a naturally occurring psychoactive substance found in many different plants. It is a powerful stimulant, marketed as a dietary supplement, and occurs in beverages such as coffee, tea, cola, energy drinks or pills, and chocolate products, etc.  Unlike some other psychoactive drugs, caffeine is legal and unregulated. About  80% of American adults ingest caffeinated products at an average intake of approximately 200mg per day (1).  Caffeine utilization at under 500mg is commonly considered to be safe, and there is documented safety at 300mg or below per day (2).

Treatment options in obstructive sleep apnea

Vivek C. Shah, M.D., Gurpreet Singh, M.D., Pramod Kayathi, M.D., Steven Lippmann, M.D.

Obstructive sleep apnea
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder involving a decrease or a temporary halt in airflow despite an effort to breathe. It occurs during sleep with pharyngeal muscle relaxation, resulting in soft tissue collapse, blocking the upper airway. This results in partial reductions (hypopneas) and/or complete pauses (apneas) in breathing, that last at least 10 seconds. Most apneas continue for up to 30 seconds, but may persist for one minute or longer. This leads to reductions in blood oxygen saturation, with oxygen levels falling as much as 40% or more in severe cases. Most people with OSA snore loudly and frequently, with periods of silence when airflow is compromised; they then emit loud chocking, snorting, or gasping sounds as the airway reopens.

A meeting of the World Federation of Biological Psychiatry Task Force on Men’s Mental Health

Leo Sher, M.D.

The members of the World Federation of Biological Psychiatry (WFSBP) Task Force on Men’s Mental Health met in Madrid, Spain in September 2014 to discuss the research and clinical directions in the field of Men’s Mental Health. Leo Sher, M.D. (USA), Zoltan Rihmer, M.D., Ph.D. D.Sc. (Hungary), Javier Didia-Attas, M.D. (Argentina), Jose de Leon, M.D. (USA), Shih-Ku Lin, M.D. (Taiwan), Carlos Roncero, M.D. (Spain), and Nestor Szerman, M.D. (Spain) participated in the meeting.


Forensic psychiatric assessments: ethical issues

Leo Sher, M.D.

Forensic psychiatric evaluations fundamentally differ from routine provision of clinical care, despite significant overlap in how they are performed (1-9). The opinion generated by the interview could be helpful, harmful, or neutral to the person being evaluated. These points distinguish a clinical psychiatric interview from a forensic evaluation.

A proposal has been made for an ethical framework of forensic psychiatry, which considered that its practice was acceptable if it fulfilled two criteria: truth-telling (honesty) and respect for persons, which means respect for the right of the people evaluated by a forensic psychiatrist to be informed of the implications of the assessment before entering into the process (3).

Dr. Robertas Bunevicius: a pioneer of DSM in Lithuania

Juste Buneviciute

Dr. Robertas Bunevicius was always inquisitive and uncertain truths attracted his attention. While studying at Kaunas University of Medicine in late 1970’s he had difficulty connecting Freudian philosophy with a Soviet definition of “sluggish schizophrenia.”  Even though both schools of thought had similarities: both systems erased a line between psychiatric disorder and health. According to Freud, we all have crazy thoughts and temptations, and it is normal; however, under the Soviet definition of “sluggish schizophrenia” we could put any originally thinking person and make him a psychiatric patient. In the Soviet Union, the diagnosis of “sluggish schizophrenia” was often used for political purposes to isolate dissenters or “radicals” not willing to accept occupation by placing them in mental health hospitals.

Can you differentiate decisional capacity from competence?

Gurpreet Singh, M.D., Vivek C. Shah, M.D., Murali K. Kolikonda, M.D., Steven Lippmann, M.D.

When determining a patient’s right and ability to accept or to refuse treatment, understanding decisional capacity and competence is important. Do you know the difference? When can your patient agree to or decline a recommended treatment? What should you do when your patient is not capable to make medical decisions?

Decisional capacity and competence requires that the patient is at or above the age of majority. This is the age at which a person is legally considered an adult and usually begins on one’s 18th birthday. However; this definition may vary from state-to-state.