What the heck is DSM5 and why should I care?

DSM5 stands for "Diagnosis and Statistical Manual of Mental  Disorders 5".
             You should care about it because whether you are deemed to be normal or a nut case may depend on what it has to say. 
             "So who authorizes this?" you may ask.
              The American Psychiatric  Association.
             Well, who would use this catalog that was last updated by  the APA in 2013  and has 947 pages and over 300 psychiatric diagnoses?
              Your Lawyer, your Insurance Company, Your Doctor for instance, not to mention your psychiatrist.
               First published in 1952 (DSM1), it was 130 pages long and listed 106 mental  disorders, so as you can see, we are a lot crazier in 2013, even though a number of the diagnoses in DSM4 have been removed!
               The DSM was originally published as a text to help physicians diagnose the myriad presumed pyschiatric  signs and symptoms but has now become the basic criterion for decision making in the insurance, legal  and governmental  arenas.   It was supposed to help define that fine line between  normal life reactions and mental disease, like when does normal grief at losing a loved one become a psychiatric illness.  It has become increasingly difficult to determine where normalcy ends and disease begins.  When  should  we put a very active child into the abnormal group and put him/her on medications that themselves may effect their delicate brains.  Experts in  the field cannot resolve this dilemma but it is sufficiently critical  for the criticism of the most recent DSM to have resulted in a petition by 13000 mental  health care workers sponsored by mental health organizations which called for an independent outside review of the document.
              Follow my blog for further discussion in  the coming weeks and post your comments.
                 
              

Make me Manly!

              Big Pharma is working really hard to create life-long medication requiring 'diseases' that it blithely advertises to the public.  The latest of these 'diseases' is Low T.  The real name for Low T  is hypogonadism which is not a very catchy title, so one can see why a  catchier title  was  desirable.   The ad usually start with a big handsome 45+ guy who is feeling a little down, golf swing not what it used to be and obviously no hot shot  in the sac anymore.  Next, the 'wonder drug' schtick and while you watch the post treatment cheerful man now smiling happily while his sweetie sidles up to him, the narrator cheerfully runs  through the myriad side-effects so rapidly that I  can't keep up with  them, even though I already have a pretty good idea of what they are.  Some are serious.
             "Low T," is an advertisement that Big Pharma is pushing these days that  would make it appear that low testosterone is an almost universal disorder and that any male over 45 years old  better get in and see their doctor They are meeting with considerable success in promoting the various preparations of testosterone as some sort of wonder drug, although the condition of low testosterone is actually quite rare (about 2%, I believe though I'm too lazy to look  it up!) . A lot of men, who don't need it are taking it by one route or another - you can even get it as an underarm roll-on.  It's about a 2 billion dollar a year industry and growing.

Ode to a Lifelong Friend!

I lay you, faithful stethoscope to rest,
Against how many hearts have you been pressed?
 The secrets of the airways all laid bare,
As you measured sounds of heart and air,
No MRI or CAT scan will astound,
The way you did just listening to the sound.

Oh mighty stethoscope you told me much,
And confidence exuded from your touch.
Now relegated to a lowly role.
I still think that you head the Honour Roll!

Time to consider the victims!

           Three RCMP officers were killed and two wounded by a worse than worthless piece of humanity who set out to "bag himself some cops". I really think we need to re-institute the death penalty.
           In my young days, I was a physician to the RCMP and for years looked after Regina RCMP establishment, one of the two major training centres in Canada.   One of my responsibilities was doing physicals on prospective recruits and then looking after them during their tough training period. ( I have written an amusing piece about that elsewhere). During many years of association with the Force, I was almost always impressed with the quality and dedication of these young men.
          Many of them had wanted to be RCMP officers since they were in school. Most of these men (and now women) know they may be putting their lives on the line.
           So, when I read about Justin Bourque coming out of his hole, unarmed, with his hands up and saying "I am done", I knew it was time to bring back the death penalty.
           Three young police officers have been deprived of their lives, two more seriously injured, family and children deprived of father and husband, and I grieve for them, while this monster will lead a rather comfortable life in the relative luxury of a modern Canadian prison.

Whose tissue is it, anyway?

Landmark case.
      If you think your tissue is your own once it is separated from you, think again.  In a precedent setting landmark case in Ontario the court ruled that excised human tissue belongs not to the person from whom it came but to the institution that holds it. Its hard to imagine why anyone would care and I think it's appropriate that it should belong to  the institution because there is a greater likelihood that this would be of  research or teaching value.  It would also be available for a retrospective review where subsequent diagnostic doubt may arise.  I can't imagine many patients saving the tissue for future reference. There are not many reasons I can think of that a patient would want such tissue, or control of it, other than in some rare medico legal issue and that is precisely how this case arose.  In order to verify his diagnosis a physician petitioned the court to examine a small block of liver tissue taken in 2009.  Because it was not clear to whom the tissue belonged the doctor had to seek permission. In this case the court made a rational  and for Ontario, precedent setting decision and determined the tissue belonged to the institution and not to the patient.
       The other reason is a financial one.  If your tissue is used for research and this leads to a new drug or test, that turns out to be a big money maker, if you own the tissue strain that is being used, then you are in a position to profit mightily. 

Brain Games

Neuroplasticity.
                      I'm not going  to bore you with the physiology of  neuroplasticity, you can google or Youtube that , if you feel so  inclined.    I just want to get on the trail of the means by which we can protect, enrich, fortify and increase the capacity of the three pounds of gelatinous genius that resides in its bony crypt in our  heads, before its too late.   So I took the usual route and found my way to POSIT, which  listed a number of programs, thence to www.brainHQ.com which looked like the best of  the  bunch.
                      As soon  as I  went to the site Brain HQ informed me that if I  registered I would be eligible to work on some free exercises that would "sharpen your visual precision and expand your field of  view".  I noted that there were specific groups of  exercises  directed at different  aspects of  brain function.  For instance, I could direct my efforts at any or all of the  following: attention, brain speed, memory, people skills, intelligence and navigation.  All of the above are available for $14 for  a month or $8 a month if you  sign  up for a year ($96).  The free exercises I took consisted of remembering the position in the sky of one of a group of birds flashed on a screen.  This became increasingly complex as one progressed through the tests and if  one stuck with it, one certainly became more proficient.  Whether that proves anything other than practice makes perfect,  is impossible to say, nor would it be fair to expect it to with just a demonstration program.
                       It would probably be worthwhile looking around at a few other such programs before deciding which is  best to enroll in to give it a real trial.  So I am going to do that and try to decide which  is the  best program  to save my  brain and who knows, turn me into a genius!

The Plastic Brain.

Neuroplasticity.
  .
   When I was a medical student, we were taught (and there was no doubt about it) that fairly early in childhood the brain was cemented into shape and incapable of further development or repair, even when diseased or damaged. That belief dramatically effected the concept of what could be achieved in the treatment or management of diseases of the nervous system and greatly limited the horizons.  So when I started reading occasional articles about neuroplasticity in the early twenty first century, I found it very promising.   There is now an irrefutable body of evidence that the nervous system possesses a plasticity we never suspected.  That given favorable circumstances it could repair or remodel itself. That supports the thesis that new synaptic pathways can be developed that  bypass damaged areas of the brain and that structural  remodeling can take place. Even the aging brain can be trained to protect old pathways and develop new ones. The implications of that alone may be enormous.  It is not clear whether  various training activities that have been designed to protect the aging brain or help repair brain damage are effective, although some comments I have read would suggest they are not.  I would like to hear from anyone who has had any experience of such programs before I decide whether to register myself  for one and assess its efficiency in improving memory and general brain agility. In the meantime I intend to look further into the specifics of neuroplasticity, a promising and encouraging phenomenon.