Amazing Neuroscience Site

Use with caution--there is so much information here, you may get lost! Allen Brain Atlas,
Here's a short article re: its production: http://www.scientificamerican.com/article/human-brain-map-gets-a-bold-new-update/

I also realize that I haven't yet linked the National Neuroscience Curriculum Initiative, with several psychiatry-specific modules.  It does require you to register, but is free.

Virtual Journal Club--Week of September 12, 2016

Offering you a couple of more challenging discussions of how we evaluate and describe our patients' problems today. Though we frequently refer to our "biopsychosocial fomulations", how often can we truly divide the "bio-" from the "psycho-", and what does it say about our perspectives on psychiatric illness that we attempt to? Kendler, I believe, writes about the limitations of the biopsychosocial model in explaining illness, and Tavakoli, about its limitations in helping us describe and understand our patients. Both offer some alternative verbiage for the task at hand.

Kendler--Explanatory models
Tavakoli--Current Methods of Assessment

September Milestones of the Month--PC2 and MK2

September's Milestones of the Month are basic tools of the trade for us: Formulation and Differential Diagnosis, and Medical Knowledge of Psychopathology.  Again note the development of these skills over time. As a novice, one evaluates, reports, and develops a working diagnosis. As one advances, that working diagnosis becomes more complex, taking into account the patient's development and present stressors. With experience, you will synthesize these into a comprehensive formulation, that accounts for more subtle and idiosyncratic findings.  Along with this, your knowledge grows and develops as well.  Read down the Level 4 column in MK2 and make the mastery of that knowledge your goal by the end of residency.

Virtual Journal Club--Week of September 5, 2016

This week's paper is prompted by the following announcement from the Minnesota Medical Association:

Cannabis Review Panel Begins Consideration of New Qualifying Conditions (9/1/2016)

A review panel established by the Office of Medical Cannabis (OMC) to consider possible additions to the list of conditions that may be eligible for medical cannabis held its first meeting on Aug. 25. The seven-member panel includes three physician members, as well as patient advocates and other health care professionals.

The group is tasked with considering adding qualifying conditions submitted by the public to the OMC. Conditions to be reviewed include:

• Acquired absence of limb
• Arthritis
• Autism, Austism Spector Disorder
• Depression, Treatment-Resistant
• Diabetes
• Ehlers Danlos Syndrome
• Insomnia
• Post Traumatic Stress Disorder
• Schizophrenia

Petitions submitted for the panel’s consideration can be viewed here. Also available are materials prepared by OMC staff that discuss each condition and its symptoms, links to clinical trials of medical cannabis in the condition’s treatment, recommendations from national medical organizations (if any), and organized observational studies of cannabis as a potential treatment for each condition.

The panel’s next two meetings have been set for Sept. 8 and 22, and will include public testimony on the petitions. The group is to make report to the commissioner of the Minnesota Department of Health of its findings by Nov. 1, and the commissioner is required to announce his decision to adopt or deny petitions by Dec. 1, 2016.

Current law allows medical cannabis to be used in the treatment of nine conditions, including seizure disorders, muscle spasms including those indicative of multiple sclerosis, Crohn’s disease, intractable pain, and others.
For more information, visit the MMA’s medical cannabis webpage.

Many of you have heard Dr. Eiman Qureshi's fine presentation on Medical Marijuana at a recent Grand Rounds or Special Topics. If so, you are probably aware that the medical evidence for the effectiveness of cannabis extracts for conditions currently approved in Minnesota (see link) is equivocal at best. Neither is the expansion of the list of these conditions to include PTSD, Autism, and Schizophrenia driven by any strong evidence of clinical efficacy.

The following review, Circumspectives: Does Cannabis Cause, Exacerbate or Ameliorate Psychiatric Disorders? An Oversimplified Debate Discussed, by Margaret Haney and A. Eden Evins (Neuropsychopharmacology 41, 393–401, 2016) is presented as a pro-con dialogue with current references which will summarize that evidence, which in my opinion is at best preliminary, and will contrast it to the ample data that cannabis more likely exacerbates psychiatric illness.

I hadn't intended this blog to become an editorial opinion column, per se--however, I need to say that my first reaction to the MMA announcement above was one of horror. In addition to the likelihood that we are making difficult conditions harder to treat, it appalls me that medical treatment decisions are essentially being made by legislative committee, not by peer review of evidence. Please take some time to review this evidence, and if so moved, I'd urge you to contact the state Office of Medical Cannabis this month with your opinion. health.cannabis@state.mn.us.

Google Drive link: Medical Cannabis for Psychiatry