January 23, 2010

Saturday, January 23, 2010
The term concussion originates from the Latin concutera, which means to shake violently or the Latin concussus, which refers to the action of striking together. It is the most common type of traumatic brain injury. The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), and minor head trauma and concussion are often used interchangeably.

The American Academy of Neurology Guidelines ranks the severity of a concussion into 3 grades:

Grade I - Confusion, symptoms last < 15 minutes, no loss of consciousness

Grade II - Symptoms last > 15 minutes, no loss of consciousness

Grade III - Loss of consciousness

Concussion Symptoms:
  • Headache
  • Dizziness
  • Vomiting
  • Nausea
  • Lack of motor coordination
  • Difficulty balancing
  • Light sensitivity
  • Seeing bright lights
  • Blurred vision
  • Double vision
  • Tinnitus
  • Convulsions
  • Confusion
  • Disorientation
  • Difficulty focusing attention
  • Loss of consciousness
  • Post-traumatic amnesia
  • Confusion
  • Slurred or incoherent speech
  • Changes in sleeping patterns
  • Difficulty with reasoning, concentrating, and performing everyday activities
  • Crankiness
  • Loss of interest in favorite activities or items
  • Tearfulness
  • Displays of emotion that are inappropriate to the situation
**Common symptoms in children include restlessness, lethargy, and irritability.

Typically symptoms will go away without treatment. Roughly 1% of treated concussions require surgery for a brain injury. Most often plenty of rest is prescribed with a gradual return to normal activities at a pace that does not cause symptoms to worsen.

Medications may be prescribed to treat symptoms associated with the concussion, such as sleep problems and depression. Analgesics such as ibuprofen can be taken for headaches that frequently occur after a concussion, but acetaminophen is preferred to minimize the risk for complications, such as intracranial hemorrhage. Individuals are advised not to drink alcohol or take drugs that have not been approved by a doctor as they may interfere with the healing process.

Observation to monitor for worsening condition is an important part of treatment. Unconsciousness or altered mental status, convulsions, severe, persistent headache, extremity weakness, vomiting, or new bleeding or deafness in either or both ears suggests that another visit to the doctor is needed. No conclusive evidence suggests that it is necessary to wake a patient up every few hours or not.

Symptoms usually go away entirely within three weeks, though they may persist, or complications may occur. Although the mortality rate is almost zero, repeated concussions can cause cumulative brain damage such as dementia pugilistica or severe complications such as second-impact syndrome.

Certain factors may lengthen recovery time, such as longer periods of amnesia or loss of consciousness, substance abuse, clinical depression, poor health or additional injuries sustained and life stress. For unknown reasons, having had one concussion significantly increases a person's risk of having another. Having previously sustained a concussion has been found to be a strong factor increasing the likelihood of a concussion in the future. The prognosis is likely to differ between adults and children; however little research has been done on concussion in the pediatric population. Concern exists that severe concussions could interfere with brain development in children.

A 2009 study published in Brain found that individuals with a history of concussions might demonstrate a decline in both physical and mental performance for longer than 30 years. Compared to their peers with no history of brain trauma, victims of concussion exhibited the following effects:

    • A decrease in episodic memory (times, places, associated emotions, and other contextual knowledge)
    • A decrease in response inhibition
    • Delayed P3a/P3b waves recorded via EEG
    • An increase in the cortical silence period
    • Reduced muscle speed otherwise known as bradykinesia (slow movement)
In recent news, Canadian researchers suggest that the term concussion is scraped from medical terminology as doctors and parents quite often underestimate the severity of these types of injuries.

“Carol DeMatteo, an occupational therapist and associate clinical professor in the School of Rehabilitation Science at McMaster University in Hamilton, Ont., says children diagnosed with concussions are treated differently from kids with other mild brain injuries.” These children are often sent home from the hospital and returned to school much sooner than those treated for mild brain injuries.

The term mild brain injury takes on a more negative connotation that concussion, which tends to suggests that the prognosis is obviously good. Concussion should not be taken as lightly as evidence suggests people who have experience multiple concussions risk neurological damage or even Alzheimer's disease and other dementias.

Natasha Richardson’s tragic death is a perfect example of what might happen when brain injuries are not taken seriously enough. On 16 March 2009, Richardson sustained a head injury when she fell while taking a skiing lesson at the Mont Tremblant Resort in Quebec. The injury was followed by a lucid interval, when she appeared to be fine as she was able to talk and act normally. Paramedics were told they were not needed. She returned to her hotel room and about three hours later was taken to a local hospital in Sainte-Agathe-des-Monts after complaining of a headache. About 7 hours following her fall, she was transferred by ambulance to Hôpital du Sacré-Cœur, in Montreal, in critical condition. The following day she was flown to Lenox Hill Hospital in New York City, where she died on 18 March. An autopsy conducted by the New York City Medical Examiners Office on 19 March revealed the cause of death was an "epidural hematoma due to blunt impact to the head", and her death was ruled an accident. There is a lot of controversy surrounding her death as many believe it could have been prevented with proper medical care.

If the term "mild traumatic brain injury" replaced "concussion", it would help people understand that this type of injury is serious and that it is an injury to the brain, not just the head. It could also save lives and prevent more serious complications later in life.

'Concussion' underplays severity of injury: doctors
Natasha Richardson

© www.mentalhealthblog.com

January 8, 2010

Friday, January 08, 2010
“The Women's Health Initiative (WHI) of the National Institutes of Health followed more than 160,000 postmenopausal U.S. women for up to 15 years, examining risk factors for and potential preventive measures against cardiovascular disease, cancer and osteoporosis.”

The researchers collected data from 136,000 participants that were not taking antidepressant medications when they first began the study. It was noted during their first follow up between one and three years later that roughly 5,500 of those women had begun taking antidepressants. “The research team compared that group's subsequent history of cardiovascular disease with that of participants who had not started taking antidepressants.”

Results showed that the women taking antidepressants had a small, but statistically significant increased risk of stroke and/or death compared to participants declaring that they were not taking antidepressants.

Lead author, Jordan W. Smoller, MD, ScD, of the Massachusetts General Hospital (MGH) Department of Psychiatry, explains that although it is necessary to treat depression because it is a serious illness, it is equally important for older women to discuss their treatment options with their physician before committing to one because of the various risks involved.

The DSM IV defines depression as experiencing feelings of sadness, helplessness and hopelessness. It is a state of low mood and aversion to activity. Episodes of depressed mood are a core feature in various psychological disorders.

Some symptoms of depression can include:
  • Anxiety
  • Sleep disturbances
  • never seem to be enough
  • dullness
  • chronic sadness never seeming to end
  • obsessions
  • shakiness when feeling most down
  • mood swings
Medications used to treat depression:

Tricyclic antidepressants
  • Amitriptyline
  • Imipramine
  • Nortriptyline
  • Desipramine

  • Side effects: Fatigue, dry mouth, blurred vision, light-headedness
Selective serotonin-reuptake inhibitors (SSRI)
  • Fluoxetine
  • Fluvoxamine
  • Sertraline
  • Paroxetine

  • Side effects: Nausea, gastrointestinal upset, sleep disturbances, headache, agitation
Reversible inhibitors of monoamine oxidase:
  • Moclobemide

  • Side effects: Insomnia, headache, constipation
5-HT2 antagonists:
  • Nefazodone

  • Side effects: Fatigue, light-headedness, nausea, headache
Serotonin-norepinephrine reuptake inhibitors:
  • Venlafaxine

  • Side effects: Nausea, agitation, sweating
MAOIs (monoamine oxidase inhibitors):
  • Phenelzine (Nardil)
  • Tranylcypromine (Parnate)
  • Isocarboxazid (Marplan)
  • Selegiline (Emsam)

  • Side effects: Drowsiness, Constipation, Nausea, Diarrhea, Stomach upset, Fatigue, Dry mouth, Dizziness, Low blood pressure, Light-headedness, Decreased urination, Decreased sexual function, Sleep disturbances, Muscle twitching, Weight gain, Blurred vision, Headache, Increased appetite, Restlessness, Shakiness, Trembling, Weakness, Increased sweating
“Depression is a known risk factor for cardiovascular disease and premature death, and one of the reasons that tricyclic antidepressants are used less frequently is their potential for negative effects on heart function. Selective serotonin reuptake inhibitor (SSRI) antidepressants have fewer side effects in general and are known to have aspirin-like effects on bleeding, which could protect against clot-related cardiovascular disorders.”

Although no relationship was established between antidepressant use and heart disease, follow-up appointments nearly six years later indicated that participants using antidepressants had an increased risk of death and those treated with SSRIs had an increased risk of stroke.

Even though results seem frightening it seems to me that further investigation is needed as there are several problems with this study. The researchers have not distinguished whether the problem really lies within the link between antidepressants and cardiovascular disease or depression itself and cardiovascular disease. Prior studies will show that depression has risks that are just as high as those who use antidepressants in this study. If anything, the study may indicate that treatment with antidepressants could exacerbate those risks. After careful review of this study, it seems difficult to place blame on antidepressants, but more could be revealed with further investigation.

Additionally, the study does not specify whether these women were being treated for depression or for anxiety nor is there any indication that lifestyle factors such as stress, smoking or diet have been accounted for. Furthermore, the study is too group-specific; therefore it cannot suggest that results can be generalized to the other populations, such as men or premenopausal women unfortunately.

Despite the lack of concrete evidence, it seems logical that women with cardiovascular risks would benefit from exploring treatment options other than antidepressants, but in the end, for most, the benefits of antidepressants may far outweigh the costs.

Increased Risk of Death, Stroke in Postmenopausal Women Taking Antidepressants, Study Finds
Monoamine Oxidase Inhibitors
Medications for Treating Depression

© www.mentalhealthblog.com

January 3, 2010

Sunday, January 03, 2010
A recent study, Ginkgo Evaluation of Memory (GEM), by Beth E. Snitz, Ph.D., of the University of Pittsburgh, demonstrates that the use of the herbal supplement Ginkgo biloba does not slow the rate of cognitive decline among older adults as construed.

“The randomized, double-blind, placebo-controlled clinical trial included 3,069 community-dwelling participants, ages 72 to 96 years, who received a twice-daily dose of 120-mg extract of G biloba (n = 1,545) or identical-appearing placebo (n = 1,524). The study was conducted at six academic medical centers in the United States between 2000 and 2008, with a median (midpoint) follow-up of 6.1 years. Change in cognition was assessed by various tests and measures.”

In 2000, older adults that had normal to mild cognitive impairment were chosen and observed. The researchers placed the subjects into 3 distinct groups. Some were given a placebo over the 8 year period. Others were given either Ginkgo biloba or the placebo, where their group identity was not disclosed to the participant or the experimenter. The third group was randomly assigned to either of the groups. Double-blind studies are said to achieve greater scientific rigor than other types of research. The conclusion of this double-blind study is that Ginkgo biloba is not effective in reducing the incidence of Alzheimer dementia or dementia in general. In addition, no evidence was found to support any effects on memory, language, attention, visuospatial abilities and executive functions. Furthermore, no differences were detected through age, sex, race, education or baseline cognitive status.

Basically, no evidence was found to support the widely marketed fact that Ginkgo biloba slows the rate of cognitive decline.

What is Ginkgo Biloba?

Ginkgos are very large trees, normally reaching a height of 66–115 feet, with some specimens in China being over 50 m. The tree has an angular crown and long, somewhat erratic branches, and is usually deep rooted and resistant to wind and snow damage. A combination of resistance to disease, insect-resistant wood and the ability to form aerial roots and sprouts makes ginkgos long-lived, with some specimens claimed to be more than 2,500 years old. Extreme examples of the Ginkgo's tenacity may be seen in Hiroshima, Japan, where six trees growing between 1–2 km from the 1945 atom bomb explosion were among the few living things in the area to survive the blast. While almost all other plants and animals in the area were destroyed, the ginkgos, though charred, survived and were soon healthy again. The trees are alive to this day.

Extracts of Ginkgo leaves contain flavonoid glycosides and terpenoids and have been used pharmaceutically. Ginkgo supplements are usually taken in the range of 40–200 mg per day. Ginkgo has many alleged nootropic properties, and is mainly used as a memory and concentration enhancer, and an anti-vertigo agent. According to some studies, in a few cases, Ginkgo can significantly improve attention in healthy individuals. Allegedly, the effect is almost immediate and reaches its peak in 2.5 hours after intake.

Ginkgo has been used for…

  • Alzheimer's disease
  • Improving blood flow
  • Protecting against oxidative cell damage
  • Blocking the effects of platelet-activating factor (platelet aggregation, blood clotting)
  • Intermittent claudication
  • Easing the symptoms of tinnitus
  • Improving cognition and fatigue in those with multiple sclerosis
  • Arresting the development of vitiligo
Ginkgo may have undesirable effects, especially for individuals with blood circulation disorders and those taking anticoagulants such as ibuprofen, aspirin, or warfarin. Ginkgo should also not be used by people who are taking certain types of antidepressants (monoamine oxidase inhibitors and selective serotonin reuptake inhibitors) or by pregnant women, without first consulting a doctor.

Side effects can include…

  • possible increased risk of bleeding
  • gastrointestinal discomfort
  • nausea
  • vomiting
  • diarrhea
  • headaches
  • dizziness
  • heart palpitations
  • restlessness
Other precautions…

Ginkgo biloba leaves contain long-chain alkylphenols together with the extremely potent allergens, the urushiols (similar to poison ivy). Individuals with a history of strong allergic reactions to poison ivy, mangoes, and other urushiol-producing plants are more likely to experience an adverse reaction when consuming Ginkgo-containing pills, combinations, or extracts.

The nut-like gametophytes inside the seeds are particularly esteemed in Asia, and are a traditional Chinese food. When eaten by children, in large quantities (over 5 seeds a day), or over a long period, the raw gametophyte (meat) of the seed can cause poisoning by MPN (4-methoxypyridoxine).

Bottom line...

It is very important to remember that herbal supplements are not regulated by the FDA in the US and Canada’s regulation of such health products is quite often confusing and inconsistent. Therefore, personal responsibility is essential when relying on this type of treatment.

Ginkgo Biloba Does Not Appear to Slow Rate of Cognitive Decline


© www.mentalhealthblog.com

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