Walter A. Brown, MD



November 01, 2007

Many of the things that we busy ourselves with have no apparent utility. Blogging, playing games, and collecting come to mind. To declare that we are compelled to do these things may be too strong, but we do pursue these activities with little deliberation and without concern as to their usefulness. The ubiquity of these pursuits suggests that these activities or their variants helped humans survive at some point and that they now rest on innate brain programs.

Research on Psychedelics Making a Comeback

October 01, 2007

In 1993, Charles Grob, MD, professor of psychiatry and pediatrics at the University of California, Los Angeles (UCLA) School of Medicine, and a research team were invited to study the physical and psychological effects of ayahuasca, a plant mixture that produces psychedelic effects.

Ameliorating Stressors May Alleviate MS

August 01, 2007

For 2 decades Maggie McPhersun's physicians had attributed her fatigue, episodes of choking, and periodic imbalance and numbness to chronic fatigue or depression. But the 51-year-old registered nurse and artist from Brunswick, Maine, knew that something was very wrong. When an MRI finally revealed multiple sclerosis (MS) lesions, the first thing McPhersun felt was relief. She finally had a sensible explanation for her symptoms.

Insights Into Mood and Cognitive Disability in MS: Recognition and Treatment

April 01, 2007

Depression and cognitive impairment are common in patients with multiple sclerosis (MS) but often are overlooked. These complications affect not only general quality of life but also complicate core symptoms of the disease. Depression in MS is well documented and easily treated while cognitive impairment sometimes needs a sharper eye to detect.

Broken Sleep May Be Natural Sleep

March 01, 2007

Once again your patient, an accountant and tax specialist, is complaining about his sleep. More nights than not he awakens at about 2 am. An hour goes by, sometimes 2, before he returns to sleep. You've prescribed 4 different hypnotics. Each gave the same unsatisfactory result. For 2 weeks, your patient got the 8 hours of uninterrupted sleep he-and you-seek, but then the old pattern returned. Following your instructions, he avoids caffeine, doesn't exercise after 6 pm, and confines his activities in bed to sleep, but to no avail. You refer him to a sleep laboratory, and the results there are entirely consistent with what he's been telling you. In the sleep lab he falls asleep at 11 pm, awakens at 2:30 am, returns to sleep at 4 am, and awakens for good at 7:30 am. He does not have sleep apnea, restless legs syndrome, or depression.

Ketamine and NMDA Receptor Antagonists for Depression

February 01, 2007

In recent months, it's been the rare week that doesn't come with a report about the dangers of antidepressants. These drugs do have their drawbacks, but the dangers they pose are not their main problem. Their biggest shortcoming is that they don't work very well; fewer than half of the patients treated with them get complete relief, and that relief takes an unacceptably long time 2 o 3 weeks t kick in.

Finessing the Fine Line Between Pain Management and Opioid Addiction

February 01, 2007

Up to 30% of patients for whom opioids are prescribed for chronic pain show an escalating pattern of opioid abuse characterized by taking more opioids than prescribed, seeking early refills, and finding additional sources of opioids. Although many of these drug-seeking patients are addicted to opioids, some are suffering not from addiction but from inadequate pain management, according to Martha Wunsch, MD, chair of Addiction Medicine and associate professor of pediatrics at Edward Via Virginia College of Osteopathic Medicine (VCOM) in Blacksburg.

Caveat Emptor: The Prospect of PFO Closure for Migraine

December 01, 2006

On March 13 at this year's meeting of the American College of Cardiology (ACC) in Atlanta, investigators from the United Kingdom unveiled the results of the Migraine Intervention with STARflex Technology (MIST) trial. The MIST trial is the first controlled study to examine the effect of patent foramen ovale (PFO) closure on migraine headache.

Depression in Parkinson Disease

November 01, 2006

Prevalence of depression in PD is estimated to range from 7% to 76%. The variation is largely attributed to the diversity of the populations under study, differences in the definition of depression, and the fact that some studies used point prevalence and other studies used monthly prevalence. Also, the prevalence of depression varies with fluctuations of cognitive status and other comorbidities that are an integral part of PD.

Understanding and Using the Placebo Effect

October 01, 2006

Most physicians make at least some use of the placebo effect to enhance treatments, whether they realize it or not. This article examines the extent of the placebo effect in patients with psychiatric illness, and reviews what is known about how placebos work.