INTERESTING TIMES

These notes from the Oct 15, 2013 Grand Rounds at OHSU in the Psychiatry department. Watching it online, it's about "what you need to know about the new DSM".
( notes )

It's scheduled to come out in May 2013, and this doc (Allen Frances, MD) asks the question: is the APA going to release it because it is needed and helpful and founded for psychiatric treatment? Or because they want the income from the release of a new book?? He has a good grasp on where the system fails and what needs to happen next. He'd like to see changes based in science, and is keenly aware of the degree to which psych diagnosis is inexact and the pathophysiology of these diseases uncertain.

You have to create a login to read here:
http://www.medscape.com/viewarticle/763886?src=mp&spon=38

Here are his concerns that the current DSM-IV does not deal with:
20x autism rates (is everybody really autistic??)
20x childhood bipolar rates
3x ADHD rates
2x adult bipolar rates
"Misuse of the label "paraphilia NOS" to sanction the questionably constitutional involuntary commitment of rapists as a veiled form of preventive detention"

And here are the things he is worried will be stuffed prematurely into the DSM-V:
Disruptive mood dysregulation disorder
Minor neurocognitive disorder
Removing the bereavement exclusion for major depressive disorder (sadness not allowed!)
Lowered ADHD threshold (by raising the allowed age of onset to 12) (how does this work??)
Lowered threshold and poor reliability for generalized anxiety disorder
Combining substance abuse w substance dependence under "addictive disorders" (low reliability and unnecessary stigma)
A category for "behavioral addictions" that will promote "Internet addiction" as a NOS diagnosis. (Next: "addictions" to sex, shopping, work, golf, boating)
Pedophilia criteria wording that tries to sneak in hebephilia (preference for early pubescent teens) and invites forensic abuse
Making binge-eating a mental disorder
An unusable personality section that the APA Assembly voted unanimously to oppose

This is a new finding. The earlier in life that the traumatic insult occurs, the greater the effect. The brain develops differently as a result, and there is a great chance of comorbidities. SOURCE: http://www.medscape.com/viewarticle/749564?src=mpnews&spon=12

Also interesting, the mortality gap between normal people and those with mental illness is getting larger. All current mental health efforts are not yet improving the odds of survival for those with bipolar and shizophrenia. SOURCE: http://www.medscape.com/viewarticle/749687?src=mpnews&spon=12

On managing aggressive schizophrenics: http://www.medscape.com/viewarticle/749195?src=mp&spon=12

http://www.jarrow.com/product/188/Neuro_Optimizer consider this product via Vitacost



MY QUESTIONS
what are food sources of citicholine? can we get it from eating brains?
there is choline in eggs and liver. is there citicholine?? how much??
how easily does choline convert to citicholine?
can we support the conversion?
can we by pass this supp using diet???

CHOLINE DEFICIENCY is common (not citicholine, mind you!)
suspect if: fatty liver, hemorrhagic kidney necrosis, infertility, growth impairment, bone abnormalities, hypertension, cancer, atherosclerosis, glaucoma, neuro dz: Alzheimer's,. bipolar. LABS: incr ALT, incr HCYS

( notes, some background, links )

Test will be case based multiple choice and matching.
The test will be for 30% of your grade. Lecture will start at 9:10 on GI health.
( original from KP, revision in process, goldmine here, dig for conditions )

Well so we already knew that drugs that increase serotonin levels decrease bone density over time. Medscape's new report says that osteoporosis is associated not just with SSRIs, but with benzos and some mood stabilizers other than lithium. Tricyclic antidepressants are protective for bones, but they have other gnarly side effects.

They've also found that mental disorders themselves have significant bone correlations. Dementia, schizophrenia and alcohol dependence are associated with reduced bone density. Depression is associated with less osteoporosis---which makes sense if you think that a lot of depression is due to low serotonin levels. Bipolar disorder and drugs other than alcohol were not found to have any correlation with osteoporosis.

Aside: FDA has released new warning that Tramadol (an opioid) increases suicide risk.