William Yates, M.D.

450 posts · 354,535 views

Physician, Writer and Bird Photographer. Translating Neuroscience Research Into Better Care for Brain Disorders.

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450 posts

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  • August 28, 2014
  • 11:40 AM
  • 135 views

Gambler Sub-types: Three Distinct Profiles

by William Yates, M.D. in Brain Posts

One method to advance understanding of a disorder is to use statistical modeling for sub-type or class analysis.Lia Nower and colleagues recently published the results of such an analysis from the large general population data-set known as the U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).In this sample, 851 adults 18 years and older were identified with disordered gambling.This group then underwent a type of latent class statistical analysis known as the Pathways........ Read more »

  • August 27, 2014
  • 10:58 AM
  • 77 views

Diagnostic Profile in Pathological Gamblers

by William Yates, M.D. in Brain Posts

Behavioral disorders like pathological gambling (PG) rarely occur alone as a single uncomplicated disorder.In a previous post, I noted the overlap of PG with personality disorder, anxiety disorder, depression, bipolar disorder and substance abuse.A recent study from Germany adds to our knowledge of the general diagnostic profile in the PG population.Erbas and Buchner reviewed German national data sources and other German studies to come up with a series of findings:Twelve month prevalence rates ........ Read more »

  • August 18, 2014
  • 10:16 AM
  • 96 views

Guidelines for Treatment of Problem Gambling

by William Yates, M.D. in Brain Posts

Despite the prevalence and impact of problem gambling, few summaries or guidelines address treatment.Searching the guideline.gov website shows no recent additions to the guideline literature.A guideline was published by the Singapore Ministry of Health in 2011. This guideline is still relevant and highlights some of the key elements of a problem gambling treatment program.I will summarize some of these key elements from this source titled: "Management of gambling disorders".  In their summa........ Read more »

Lee KM, Chan HN, Cheah B, Gentica GF, Guo S, Lim HK, Lim YC, Noorul F, Tan HS, Teo P.... (2011) Ministry of Health clinical practice guidelines: management of gambling disorders. Singapore medical journal, 52(6), 456. PMID: 21732000  

  • August 14, 2014
  • 11:17 AM
  • 97 views

FDA Approves Novel Insomnia Drug Suvorexant (Belsomra)

by William Yates, M.D. in Brain Posts

Regular readers of this blog had a heads up last year on the development of orexin receptor antagonists for the treatment of insomnia.I posted a review of an Italian clinical drug trial in humans with insomnia paired with polysomnography. This study used three different doses of a orexin receptor antagonist (10 mg 30 mg and 60 mg).In a second post, I reviewed a sleep lab study of the effects of an orexin antagonist drug compared to zolpidem (Ambien) on sleep architecture.This second study found ........ Read more »

  • August 11, 2014
  • 11:42 AM
  • 105 views

Clinical Drug Trials for Pathological Gambling

by William Yates, M.D. in Brain Posts

Several drug classes hold promise for reduction in pathological gambling behavior.However, there are very few published randomized and controlled clinical drug trials in gambling subjects.Searching clinical trials and gambling on PubMed yields only one small open-label proof of concept trial for the drug tolcapone within the last year.This study found evidence that this COMT inhibitor drug reduced gambling symptoms and was accompanied by fronto-parietal activation on fMRI imaging.However, on sea........ Read more »

Grant JE, Odlaug BL, Chamberlain SR, Hampshire A, Schreiber LR, & Kim SW. (2013) A proof of concept study of tolcapone for pathological gambling: relationships with COMT genotype and brain activation. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 23(11), 1587-96. PMID: 23953269  

  • August 6, 2014
  • 12:01 PM
  • 103 views

Brain Striatum and Loss-Chasing in Gambling

by William Yates, M.D. in Brain Posts

Pathological gambling (PG) is a pattern of gambling characterized by loss of control and large gambling debts.The near-miss phenomenon in gambling is the gaming scenario where gamblers sense they were very close to winning.This near-miss phenomenon can be programmed into slot machines. For example, a gambler might be presented frequently with four cherries when five cherries would result in a huge payout.The response to the near-miss in PG is often a sense that a big win is just around the corne........ Read more »

  • July 30, 2014
  • 11:24 AM
  • 135 views

Violent Death Rates Increased After Traumatic Brain Injury

by William Yates, M.D. in Brain Posts

Anecdotal reports have linked traumatic brain injury with later violent death including death by suicide.Few large epidemiological studies have been published on this association.However, a recent Swedish population study published in JAMA Psychiatry provides valuable insight into this issue.Seena Fazel and colleagues from the University of Oxford, University College London and the Karolinksa Institute examined a large database of over 200,000 patients with TBI.Cases of TBI were identified from ........ Read more »

  • July 29, 2014
  • 11:17 AM
  • 168 views

Treating Sleep Problems Following Traumatic Brain Injury

by William Yates, M.D. in Brain Posts

Sleep problems are common following traumatic brain injury (TBI).In a previous post, I reviewed a study of the risk factors for sleep disorders following TBI.The most severe TBI is a risk factor for hypersomnia. Anxiety and depression following TBI increase risk for insomnia complaints.Few large studies of treatment for sleep problems after TBI exist. However, a recent manuscript outlined the potential benefit of treatment of sleep disorders in a series of 12 subjects.Catherine Wiseman-Hake........ Read more »

  • July 25, 2014
  • 11:02 AM
  • 168 views

Risk Factors For Sleep Disturbance After Traumatic Brain Injury

by William Yates, M.D. in Brain Posts

Sleep disturbance following traumatic brain injury (TBI) is a common clinical challenge.Hypersomnia and insomnia can both been seen in the TBI population.The risk factors related to TBI-related sleep disturbance are not well known. Identification of risk factors can provide insight into clinical assessment and management.Lijun Hou and colleagues recently examined risk factors related to subjective sleep complaints in a series of 98 TBI subjects.The study sample include adults admitted to a ........ Read more »

  • July 14, 2014
  • 10:44 AM
  • 132 views

Cognitive Reserve Boosts Traumatic Brain Injury Recovery

by William Yates, M.D. in Brain Posts

Cognitive reserve (high educational attainment, high IQ) is known to reduce or delay the risk for Alzheimer's disease.However, the effect of cognitive reserve on recovery from traumatic brain injury (TBI) is less well studied.Two recent research studies support the beneficial effects of cognitive reserve on TBI.Schneider and colleagues examined a series of 769 adult TBI subjects using the TBI Model Systems Database.This cohort was followed during rehabilitation for a period of at least one year......... Read more »

Schneider EB, Sur S, Raymont V, Duckworth J, Kowalski RG, Efron DT, Hui X, Selvarajah S, Hambridge HL, & Stevens RD. (2014) Functional recovery after moderate/severe traumatic brain injury: a role for cognitive reserve?. Neurology, 82(18), 1636-42. PMID: 24759845  

  • July 9, 2014
  • 12:06 PM
  • 152 views

Brain Hippocampus Atrophy in Traumatic Brain Injury

by William Yates, M.D. in Brain Posts

Understanding the specific brain regions vulnerable to traumatic brain injury (TBI) is important for assessment and intervention research.Two areas of active research include studies of brain white matter using diffusion tensor imaging and assessment of regional brain atrophy using magnetic resonance imaging (MRI).Two recent MRI studies have suggested the brain hippocampus may be a region of vulnerability to TBI.A Canadian study by Robin Green and colleagues used brain MRI to examine a cohort of........ Read more »

Green RE, Colella B, Maller JJ, Bayley M, Glazer J, & Mikulis DJ. (2014) Scale and pattern of atrophy in the chronic stages of moderate-severe TBI. Frontiers in human neuroscience, 67. PMID: 24744712  

Singh R, Meier TB, Kuplicki R, Savitz J, Mukai I, Cavanagh L, Allen T, Teague TK, Nerio C, Polanski D.... (2014) Relationship of collegiate football experience and concussion with hippocampal volume and cognitive outcomes. JAMA : the journal of the American Medical Association, 311(18), 1883-8. PMID: 24825643  

  • July 8, 2014
  • 11:15 AM
  • 143 views

Millions Lack Level I Trauma Care Access in the U.S.

by William Yates, M.D. in Brain Posts

Trauma results in 180,000 deaths per year in the U.S. and disproportionately affects children and young adults. The Centers for Disease Control (CDC) recently published a review highlighting unintentional injury and violence as the leading cause of death in the U.S. for those in the one to 30 year old age group. Additionally, trauma produces significant disability through residual effects such as like that often seen following traumatic brain injury.Trauma centers are hospital-affiliat........ Read more »

Haegerich, T., Dahlberg, L., Simon, T., Baldwin, G., Sleet, D., Greenspan, A., & Degutis, L. (2014) Prevention of injury and violence in the USA. The Lancet, 384(9937), 64-74. DOI: 10.1016/S0140-6736(14)60074-X  

Garwe T, Cowan LD, Neas B, Cathey T, Danford BC, & Greenawalt P. (2010) Survival benefit of transfer to tertiary trauma centers for major trauma patients initially presenting to nontertiary trauma centers. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 17(11), 1223-32. PMID: 21175521  

Bukur M, Felder SI, Singer MB, Ley EJ, Malinoski DJ, Margulies DR, & Salim A. (2013) Trauma center level impacts survival for cirrhotic trauma patients. The journal of trauma and acute care surgery, 74(4), 1133-7. PMID: 23511156  

MacKenzie, E., Weir, S., Rivara, F., Jurkovich, G., Nathens, A., Wang, W., Scharfstein, D., & Salkever, D. (2010) The Value of Trauma Center Care. The Journal of Trauma: Injury, Infection, and Critical Care, 69(1), 1-10. DOI: 10.1097/TA.0b013e3181e03a21  

  • July 7, 2014
  • 10:50 AM
  • 149 views

The Geography of Traumatic Brain Injury Death in U.S.

by William Yates, M.D. in Brain Posts

In the last post, I examined some recent research in the epidemiology of traumatic brain injury (TBI).Two studies showed the top two causes of TBI to be motor vehicle crashes and falls.In this post, I will review some recent data on the geographic variability of TBI in the United States.The Centers for Disease Control provides an online tool called WISQARS that allows users to search for a variety of statistics related to unintentional injury by state in the U.S.They have recently added a iPad a........ Read more »

Centers for Disease Control and Prevention (CDC). (2013) CDC grand rounds: reducing severe traumatic brain injury in the United States. MMWR. Morbidity and mortality weekly report, 62(27), 549-52. PMID: 23842444  

  • July 3, 2014
  • 11:50 AM
  • 181 views

Epidemiology of Traumatic Brain Injury (TBI)

by William Yates, M.D. in Brain Posts

Traumatic brain injury (TBI) contributes significantly to mortality and long-term disability.In the U.S. there are an estimated 52,000 deaths yearly due to TBI with over 1,000,000 emergency room (ER) visits.Understanding the epidemiology of TBI can provides clues to designing prevention programs.Four relevant recent research studies provide insight about the epidemiology of TBI.TBI in hospitalized patients in Scotland Tara Shivaji and colleagues in Scotland examined the prevalence and patte........ Read more »

  • June 24, 2014
  • 12:22 PM
  • 154 views

E-cigarettes and Smoking Cessation

by William Yates, M.D. in Brain Posts

Electronic or e-cigarettes are a tobacco cigarette alternative that is growing in popularity.Proponents of e-cigarettes note the product contains no carbon monoxide, tar or other tobacco residue. The inhaled vapor in e-cigarettes is primarily nicotine.Additionally, some proponents of e-cigarettes declare the product is associated with reduction or cessation of tobacco-based cigarette use.Unfortunately, this is an area where public health trends come before scientific research data is collected. ........ Read more »

Bullen, C., Howe, C., Laugesen, M., McRobbie, H., Parag, V., Williman, J., & Walker, N. (2013) Electronic cigarettes for smoking cessation: a randomised controlled trial. The Lancet, 382(9905), 1629-1637. DOI: 10.1016/S0140-6736(13)61842-5  

  • June 23, 2014
  • 10:52 AM
  • 154 views

Varenicline for Smoking Cessation

by William Yates, M.D. in Brain Posts

Varenicline is a drug designed to assist smokers in cessation. It is marketed in the U.S. as Chantix.Varenicline is one of the first drugs to target the nicotine receptor. It is classified as a partial agonist, meaning it stimulates the nicotine receptor but to a weaker effect than nicotine itself.The mechanism of action of varenicline differs from that of another smoking cessation drug bupropion marked under trade name Zyban in the U.S.One concern with varenicline is the risk for psychiatric ad........ Read more »

  • June 20, 2014
  • 12:07 PM
  • 176 views

Maternal Smoking and Child Conduct Disorder Risk

by William Yates, M.D. in Brain Posts

Conduct disorder is a serious behavioral disorder of childhood characterized by aggression, destruction of property, lying, theft and violation of rules.A significant number of children with conduct disorder go on to adult antisocial personality disorder.Conduct disorder is known to have genetic as well as environmental risk factors.Darya Gaysina from the United Kingdom and colleagues recently published a review of maternal smoking during pregnancy and offspring conduct problems.This review exam........ Read more »

  • June 19, 2014
  • 11:20 AM
  • 196 views

Smoking and Abnormal Brain Pleasure Response

by William Yates, M.D. in Brain Posts

Smoking cessation in those with nicotine dependence is one of the most difficult challenges for patients and their clinicians.Research targeting the neurobiology of smoking cessation provides hope for designing more effective treatments for nicotine dependence.Takeshi Isomura along with colleagues in the U.S. and Japan recently summarized recent findings in the brain pleasure response in nicotine dependence.The brain ventral striatum region is known to be key in nearly all sensations of pleasure........ Read more »

Peters J, Bromberg U, Schneider S, Brassen S, Menz M, Banaschewski T, Conrod PJ, Flor H, Gallinat J, Garavan H.... (2011) Lower ventral striatal activation during reward anticipation in adolescent smokers. The American journal of psychiatry, 168(5), 540-9. PMID: 21362742  

  • June 10, 2014
  • 10:54 AM
  • 201 views

Smoking During Pregnancy and Fetal Growth

by William Yates, M.D. in Brain Posts

Smoking cigarettes during pregnancy is linked to a variety of adverse effects including increased perinatal mortality, gestational bleeding and placenta abruptio and placenta previa.Newborns of smoking mothers weigh less than newborns of nonsmoking mothers.The specific distribution of target organ growth impairment with maternal smoking is less well studied.Devasuda Anblagan and colleagues in the United Kingdom and Canada recently published a study of fetal organ growth in smoking mothers.Using ........ Read more »

Anblagan D, Jones NW, Costigan C, Parker AJ, Allcock K, Aleong R, Coyne LH, Deshpande R, Raine-Fenning N, Bugg G.... (2013) Maternal smoking during pregnancy and fetal organ growth: a magnetic resonance imaging study. PloS one, 8(7). PMID: 23843995  

  • June 9, 2014
  • 11:04 AM
  • 187 views

Smoking Linked to Brain White Matter Dysfunction

by William Yates, M.D. in Brain Posts

Tobacco smoking and nicotine dependence produce harmful effects on the brain.Some of these effects are related to direct effects on vascular health. Vascular changes seen with smoking are known to contribute to increased risk for stroke and dementia.Advances in brain imaging techniques allow for more direct study on smoking's effect on specific brain structures.Diffusion tensor imaging (DTI) is a relatively recent imaging tool allowing for study of brain white matter function.Brain white matter ........ Read more »

Umene-Nakano W, Yoshimura R, Kakeda S, Watanabe K, Hayashi K, Nishimura J, Takahashi H, Moriya J, Ide S, Ueda I.... (2014) Abnormal white matter integrity in the corpus callosum among smokers: tract-based spatial statistics. PloS one, 9(2). PMID: 24516568  

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