April 25, 2008, 12:40 pm

Mental Health and Brain Injury Issues for Returning Vets: Astonishing Numbers

The RAND Institute issued a comprehensive study of mental health issues and brain injury problems experienced by Iraq and Afghanistan veterans. According to the study nearly 20% of the returning veterans (300,000 soldiers) report symptoms of PTSD or major depression. Slightly more than half have received treatment. The study also revealed that 19% report a possible brain injury and 7% report a probable brain injury with PTSD or major depression. The study noted that many service members do not seek treatment due to concerns with the recognition of psychological problems being a blemish on their careers. For those who seek treatment, the RANDS researchers consider the treatment to be "minimally adequate". Terri Taniellan, the RAND project co-leader, called the problem "a major health crisis facing the men and women who have served in Iraq and Afghanistan". The RAND project targeted three areas: to identify psychological and cognitive injuries among those who have served; to develop economic modeling to study the costs associated with providing treatment, lost productivity and suicide; and to assess the availability of existing treatment and the barriers to access. Lisa Jaycox, a RAND study co-leader, referred to untreated PTSD and depression as "a cascading set of consequences". The RAND study estimated that the two year cost of PTSD and depression post-deployment ranged from $6,000 to $25,000 per case. The societal cost was between $4 billion to $6.2 billion.

The RAND study identified 320,000 service members who may have received a traumatic brain injury during deployment. This includes the range from concussive injuries through severe and catastrophic injuries. Only 43% were ever evaluated by a physician for their injury. The one year costs associated with a Mild Brain Injury were $32,000 per case. The moderate to severe injuries ranged from $268,000 to $408,000 per case over the one year period. The one year societal impact for  2700  brain injury cases identified to date range from $591 million to $910 million. These numbers will increase significantly as more individuals are evaluated and deemed to have a brain injury. Over the course of the next fifty years, the societal costs for brain injury involving service members will be enormous.

The newly created Defense Center for Excellence for Psychological Health and Traumatic Brain Injury has a herculean task over the next few years. It can truly become a center of excellence with adequate funding, trained personnel and an agenda directed towards identifying problems and providing treatment.The needs of the returning service members with psychological and brain injury related problems requires a call to action in the newly organized Center. 

The RAND report is entitled: Invisible Wounds of War:Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery" and may be found at rand.org.

Link to this post

April 22, 2008, 11:24 am

Stroke Patients Under Neurologists’ Care Have Better Outcomes

Medpage Today’s John Gever reports that individual’s suffering from stroke fair better if their primary care physician is a neurologist, stating they “were less likely to die or need a second hospitalization.”

While the study showed no significant differences in mortality rates while in the hospital, it did show that neurologists tend to keep patients in the hospital for a longer period than other physicians. Gever wrote “Neurologist-treated stroke patients had a 14% lower rate of 30-day mortality and a 7% lower rate of 30-day readmission, according to a review of Medicare records reported by Judith Lichtman, Ph.D., M.P.H., of Yale, at the American Academy of Neurology meeting.”

According to the article, “It’s possible that [the patients cared for by other specialists] may be more complex cases, maybe they had other acute events that were going on at the same time. That we haven’t been able to look at very closely,” Dr. Lichtman said.

Click here to read the full article in MedPage Today

Link to this post

April 21, 2008, 5:05 pm

Hello world!

Welcome to WordPress. This is your first post. Edit or delete it, then start blogging!

Link to this post

, 7:51 am

Progressive Inflammatory Neuropathy Syndrome

Two dozen Midwestern pork plant workers have suffered from “mysterious neurological symptoms”. The workers were exposed to aerosolized pig brains, which appears to have caused an autoimmune reaction. This is not a localized event. The story, published in Med Page Today, reports that 18 workers in Minnesota, 5 in Indiana, and 1 in Nebraska have exhibited symptoms of leg pains, sensory disturbances, weakness and fatigue. Daniel Lachance, M.D. of the Mayo Clinic in Rochester, Minnesota led the clinical investigation into the outbreak; he believes the symptoms are induced by exposure to “something in to porcine brain tissue” which causes an immune reaction resulting in neural inflammation. Dr. Lachance continues to work on this investigation with the collaboration of officials at the CDC and the state health department.

Click here to read the full story in MedPage Today

Link to this post

, 6:30 am

The Brain Injury Association of Iowa says Thankyou

Proof that advocacy works. In a recent Blog, I shared that BIA Iowa was asking for residents of Iowa to contact their state representatives to gather support for sufficient allocation of funds for survivors of brain injury. On that note I received the following email on Friday, showing that the voices of Iowa’s constituents were heard:

You DID it!

Brain Injury Advocates made their voices heard and the Iowa Senate today responded by allocating dollars equitably to the Medicaid waiver waiting lists. More to follow….

Thank You!
Brain Injury Association of Iowa

Link to this post

April 18, 2008, 9:44 am

Caffeine May Protect Blood-Brain Barriers from Cholesterol Damage

A recent study published in the Journal of Neuroinflammation has found that a single cup of coffee a day can cause a more intact blood-brain barrier. Authored by Jonathan D. Geiger, Ph.D., of the University of North Dakota and colleagues, the study was conducted over a 12 week period and compared the effects of caffeine in a cholesterol enriched diet verse a standard diet when administered to rabbits.

After the 12 week period, the authors examined the olfactory bulb (chosen because of its known dysfunction in Alzheimer’s patients and its intact blood-brain barrier) for evidence of leakage. It was determined that the cholesterol-enriched diet of the rabbits increased IgG and fibrinogen extravasations, while having no effect on rabbits with a controlled diet.

“High levels of cholesterol are a risk factor for Alzheimer’s disease, perhaps by compromising the protective nature of the blood-brain barrier, “said Dr. Geiger. “For the first time we have shown that chronic ingestion of caffeine protects the blood-brain barrier from cholesterol-induced leakage.”

Click here to read the full article

Link to this post

, 8:53 am

Constraint Induced Therapy Increases Gray Matter

The University of Alabama developed Constraint Induced (CI) Therapy has been shown to produce structural brain changes, as well as increased gray matter. Constraint Induced Therapy requires intense practice of an activity over a relatively short period of consecutive days. Newswise (2008) reports:

The efficacy of CI therapy as a rehabilitation technique for stroke patients has been well documented. Taub and other researchers worldwide have seen remarkable clinical changes in patients, such as dramatically improved use of an affected arm or leg. They also have observed functional changes in the brain, such as increased blood flow or an increase in excitability of brain cells. The new study confirms what Taub and his colleagues have long suspected….that the brain also has the ability to remodel itself structurally.

Lynne Gauthier, a graduate student working in Taub’s lab, took MRI images of 16 stroke patients who received CI therapy and 20 controls who received a comparison therapy.

Gauthier used a sophisticated analysis technique known as voxel-based morphometry (VBM) to measure the amount of gray matter in the outer layers of the brain and the hippocampus, a structure deep in the brain involved in learning and memory. The CI therapy group showed an increase in the amount of gray matter in areas of the brain responsible for motor skills while the comparison group had no increase. The gray matter increase corresponded to a similar increase in the ability of the patients to use the affected arm for activities of daily living in the home situation.

“Interestingly, the patients who demonstrated the greatest improvement in use of the affected arm also showed the greatest increase in the amount of gray matter,” Gauthier said.

Click here to read the full article

Click here to read A Placebo-Controlled Trial of Constraint-Induced Movement Therapy for Upper Extremity After Stroke

Click here to read Constraint-Induced Therapy of Chronic Aphasia After Stroke

Link to this post

April 16, 2008, 1:30 pm

New Brain Injury Treatment Device on the Horizon?

Austin 8 News reports that a new medical device could improve brain injury treatment. The device created by PhotoThera is called NeuroThera and is currently undergoing clinical trials. The device is operated by a train clinician, and is used to stimulate the inactive mitochondria in brain cells via high-intensity infrared laser. The theory is that the mitochondria (the powerhouse of the cell) will be stimulated and when it starts working the rest of the cell will have energy and can resume functioning.

Click here to read the full story in News 8 Austin

Click here to go to PhotoThera’s website

Link to this post

April 15, 2008, 10:51 am

Do Some Drugs Increase the Risk for Suicide?

According to a recent article published in The New York Times, the debate over the potential suicidal side effects of drugs like Prozac, Paxil and anti-epileptics is still going on. Part of the problem is that, “the act itself is so rare – 1 in 10,000- that a series of drug trials cannot pickup enough cases to allow for adequate analysis” (Carey, 2008). There have been suggestions that the use of suicide markers may be beneficial in ferreting out which drugs may increase the risk of suicidality, as well as requiring drug manufacturers to track suicidal symptoms in their studies. Adding to the complexity of the issue is that suicide is a private affair – some will confide that they are having suicidal thoughts, others keep it to themselves; some will actually attempt suicide, others will not. Carey (2008) found another way to potentially tackle the problem:

In a paper in The Journal of the American Medical Association last year, the psychiatrists Dr. Donald Klein of Columbia University and Dr. Charles O’Brien of the University of Pennsylvania argued that the best way to study the risk of rare side effects was to establish large, linked databases of patients, including medical records and prescription histories. Such a system could be created in the United States in a short time, they wrote, but “the possibility has received almost no public discussion or legislative attention.”

Carey, B. (2008, February 10). Making sense of the great suicide debate. New York Times. Retrieved April 15, 2008, from http://www.nytimes.com/2008/02/10/weekinreview/10carey.html?emc=eta1

To Read the full article in the New York Times click here

Link to this post

, 10:19 am

Perception and Reality: Cultural Considerations

A study published in the March 2008 issue of the Journal of Personality and Social Psychology by Dr. Masuda and his colleagues addresses the issues of cultural differences in perception. The study highlights the differences between a person-centric bias which we see in the United States from a group-centric bias seen in Japan. To read a brief summary of this interesting study click here for a link to a synopsis of the study from the New York Times.

Link to this post