Douglas Berger, Psychiatrist in Tokyo: Transcranial Direct Current Stimulation and neuroplasticity?6/26/2018
Transcranial Direct Current Stimulation and neuroplasticity? Only 18 subjects open-label no control group or placebo: http://tinyurl.com/y7zexgsw Improved mood not asso w/neuroplasticity so that neuroplasticity has not been shown w/tDCS in depression.
For more information about Douglas Berger Psychiatrist Tokyo visit the following websites:
Douglas Berger, Tokyo Psychiatrist comments on, “The Best and Not so Great Articles of 2017.”6/26/2018
Original article: http://www.psychiatrictimes.com/psychotherapy/best-and-not-so-great-articles-2017 By Jerald Kay. MD. December 2017 issue of the Psychiatric Times.A few points regarding the articles presented:1. On the Roy-Berne et al. article on “highlighting the myth of precision psychiatry”. I think Dr Kay and others need to have a long-term perspective. While genetic testing is a science in the embryo stage, it is not completely a myth. See this incredible study below. We need to be patient as this kind of science moves forward in the next 100-200 years-but it is not myth.
A population-based study of KCNH7 p.Arg394His and bipolar spectrum disorder. Hum Mol Genet. 2014 Dec 1; 23(23): 6395–6406. Strauss, et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4222358/ From the abstract: “We conducted blinded psychiatric assessments of 26 Amish subjects (52 ± 11 years) from four families with prevalent bipolar spectrum disorder, identified 10 potentially pathogenic alleles by exome sequencing, tested association of these alleles with clinical diagnoses in the larger Amish Study of Major Affective Disorder (ASMAD) cohort, and studied mutant potassium channels in neurons. Fourteen of 26 Amish had bipolar spectrum disorder. The only candidate allele shared among them was rs78247304, a non-synonymous variant of KCNH7 (c.1181G>A, p.Arg394His). KCNH7 c.1181G>A and nine other potentially pathogenic variants were subsequently tested within the ASMAD cohort, which consisted of 340 subjects grouped into controls subjects and affected subjects from overlapping clinical categories (bipolar 1 disorder, bipolar spectrum disorder and any major affective disorder). KCNH7 c.1181G>A had the highest enrichment among individuals with bipolar spectrum disorder (χ2 = 7.3) and the strongest family-based association with bipolar 1 (P = 0.021), bipolar spectrum (P = 0.031) and any major affective disorder (P = 0.016). Although our genome-wide statistical results do not alone prove association, cumulative evidence from multiple independent sources (parallel genome-wide study cohorts, pharmacological studies of HERG-type potassium channels, electrophysiological data) implicates neuronal HERG3/Kv11.3 potassium channels in the pathophysiology of bipolar spectrum disorder.” On the Leichsenring F, et al. article on comparing CBT with psychodynamic therapy. Any head-to-head comparisons are necessarily unblinded, neither patients nor therapists can be blind, there is no blind-placebo comparator either, and there is no way to filter out patient preference or treater bias. All the study endpoints are subjective and there is no way to robustly and logically compare these modalities as there is some improvement seen in every group that has some expectation and hope and receives a helping hand. Conclusion: these studies are a non-inferiority examination of subjective parameters of a human condition leading to no possible scientific conclusion.
Watson will see you now: a supercomputer to help clinicians make informed treatment decisions. Doyle-Lindrud S., Clin J Oncol Nurs.2015 Feb;19(1):31-2. https://www.ncbi.nlm.nih.gov/pubmed/25689646 +“IBM has collaborated with several cancer care providers to develop and train the IBM supercomputer Watson to help clinicians make informed treatment decisions. When a patient is seen in clinic, the oncologist can input all of the clinical information into the computer system. Watson will then review all of the data and recommend treatment options based on the latest evidence and guidelines. Once the oncologist makes the treatment decision, this information can be sent directly to the insurance company for approval. Watson has the ability to standardize care and accelerate the approval process, a benefit to the healthcare provider and the patient”. Doug Berger MD, Ph.D. US Board-Certified Psychiatrist Tokyo, Japan For more information about Douglas Berger Psychiatrist Tokyo visit the following websites: Douglas Berger, Psychiatrist in Tokyo comments on, "Sex Addiction: Playing Now in Theaters"6/22/2018
Douglas Berger, Psychiatrist in Tokyo comments on, "Sex Addiction: Playing Now in Theaters", By Roberta Zanzonico, MD and Renee M. Sorrentino, MD, Psychiatric Times, January 2018.
Original Article: http://www.psychiatrictimes.com/article/sex-addiction-playing-now-theaters This article seems mired in needless philosophic details about how to care for this 85 year-old man with vascular dementia admitted to a psychiatry ward and who is a danger to other residents at his care facility, refusing oral and effective valproic acid and requiring several emergency antipsychotic injections. His daughter is ok with spiking his food with valproic acid but against antipsychotic treatment. It is clearly much more unethical not to treat this man and let him harm his co-residents, nor to have to force injections on him which is a bit cruel. The treatment team is probably more worried about a legal case than ethics. Assuming we did not live in a society with laws, it is simple enough to spike his food/drink with valproic acid solution and tell his daughter to continue to spike his food/drink at his residence or back home. Hopefully he would agree to blood tests, if he doesn't, the alternative is forcing injections on him that should have blood testing anyway. The answer is a no-brainer. Because we live in a society with laws, his case should be petitioned by the hospital in court as soon as possible. Until the court date, he can be deemed acutely dangerous to others and that spiking his food/drink was better than forcing injections on him. -If the court rules he can just have his food/drink spiked for his condition regardless of acute danger, all is well. -If the court rules his food can't be spiked/drink unless he is acutely dangerous, then the treatment team can note that his condition makes him acutely dangerous daily (regardless of his actual behavior), and the daughter can decide to do what she feels is right for him, i.e., spike his food/drink when he is discharged, at her own legal risk. -If the court rules that he cannot be given medication in his food/drink without his permission, regardless of the daughter having medical decision power and her agreement, the case should be appealed. If the appeals court still agrees with the lower court, then the man can be forcibly injected as needed and the case repeatedly appealed. This situation would be a failure of the legal system not of medical care. Ward staff might be able to refuse to take part in involuntary injections, or quit their job, on ethical grounds, further placing the legal system as the cause of a medical-mess. Doug Berger, MD, PhD U.S. Board-Certified Psychiatrist Tokyo, Japan For more information about Douglas Berger Psychiatrist Tokyo visit the following websites: |
Author - Douglas BurgerBilingual Psychiatrist located in Tokyo. Archives
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