Moments of clarity in dementia patients at end of life: Glimmers of hope?

Social robot kids hosptial neurosciencenews’It happens unexpectedly: a person long thought lost to the ravages of dementia, unable to recall the events of their lives or even recognize those closest to them, will suddenly wake up and exhibit surprisingly normal behavior, only to pass away shortly thereafter. This phenomenon, which experts refer to as terminal or paradoxical lucidity, has been reported since antiquity, yet there have been very few scientific studies of it. That may be about to change.

In an article published in the August issue of Alzheimer’s & Dementia, an interdisciplinary workgroup convened by the National Institutes of Health’s (NIH) National Institute on Aging and led by Michigan Medicine’s George A. Mashour, M.D., Ph.D., outlines what is known and unknown about paradoxical lucidity, considers its potential mechanisms, and details how a thorough scientific analysis could help shed light on the pathophysiology of dementia.…’

Via Neuroscience News

Better Care Urged for Bipolar Patients’ 1st Manic Episode

Therapy teenager young man large bigstock 1376x1032’An international team of experts argues that better care for people experiencing their first manic episode is urgently needed and that more research needs to go into treatment solutions for bipolar disorder.

In a new paper, published in The Lancet Psychiatry journal, the authors describe patchy and inconsistent care, widespread failure to detect bipolar disorder early enough, and a lack of guidance on how to treat people experiencing mania for the first time.…’

Via PsychCentral

As a practicing psychiatrist, I’d like to suggest that the approach of this ‘international team of experts’ may be faulty. This may have something to do with the divide between clinicians and the academic psychiatric pundits, who I would venture to say see far fewer real-world patients.

Bipolar disorder is a condition that can only be properly diagnosed by observing and understanding the longitudinal course of the patient’s presentation over time. Thinking you know what is going on when you take the snapshot view at a moment in time is immensely problematic. It may be clear at the time of a ‘first manic episode’ that a person’s condition declares itself as bipolar disorder but not necessarily. It is often not clear even when faced with the patient in front of you in the moment that what they are experiencing is a manic episode. The symptoms they might display, possibly suggestive of mania — increased energy, decreased sleep, loquaciousness, ambition and confidence, brightening of mood, irritability, agitation and raciness, perhaps some telltale psychotic symptoms — could also be indicative of a number of other illnesses or temperaments when taken in isolation.

‘Better care for people experiencing their first manic episode’ is often not possible precisely because it is not prudent or sometimes not even possible to diagnose it as mania. The mindset of the rapid rush to judgment embodied in the article has arguably played a large part in the epidemic over\diagnosis of bipolar disorder and concomitant rush to overtreatment, to the detriment of our patients.

Soros and Koch Brothers Team Up to End US ‘Forever War’ Policy

‘Besides being bilionaires and spending much of their fortunes to promote pet causes, the leftist financier George Soros and the right-wing Koch brothers have little in common. They could be seen as polar opposites. Soros is an old-fashioned New Deal liberal. The Koch brothers are fire-breathing right-wingers who dream of cutting taxes and dismantling government. Now they have found something to agree on: the United States must end its “forever war” and adopt an entirely new foreign policy.

In one of the most remarkable partnerships in modern American political history, Soros and the Koch brothers are joining to finance a new foreign-policy think tank in Washington. It will promote an approach to the world based on diplomacy and restraint rather than threats, sanctions, and bombing. This is a radical notion in Washington, where every major think tank promotes some variant of neocon militarism or liberal interventionism. Soros and the Koch brothers are uniting to revive the fading vision of a peaceable United States. …’

Via The Boston Globe

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