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Brian Buggie, MD
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People with bipolar disorder often demonstrate well-known behavior patterns that are a signature of their condition. For example, the manic phase is often characterized by hyperactivity, which can be measured by an accelerometer and with a GPS device, by rapid speech, which can be monitored by speech analysis and by frequent conversations, which can be monitored through phone records.

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"It's unlikely that most people with a mental illness have it as a result of infection," he says, "but it would be reasonable to hypothesize that a subpopulation of people with depression or bipolar disorder or schizophrenia ended up that way because an infection activated their immune-inflammatory system."

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The Sinclair Method for alcohol addiction is a treatment that could help many people if more physicians in the US realized that it existed. It was developed in Finland, and is an accepted medical treatment over there. The Sinclair Method involves taking one 50mg pill of naltrexone in a specific way. It is taken once daily, and it must be taken one hour before drinking. Over time, the medication diminishes the desire to drink. The eventual diminished desire to drink only occurs when the naltrexone is repeatedly and consistently taken one hour before drinking. The maximum dosage per day is one 50mg tablet. The naltrexone is not taken on non-drinking days.


Dr. Sinclair hypothesized that alcohol produces positive reinforcement in the brain in a way that is similar to opioids (narcotic painkillers). His research showed that alcohol produced positive reinforcement by releasing endorphins that bind with opioid receptors in the brain. Activating these receptors causes a release of dopamine. Dopamine is a neurotransmitter that is responsible for feelings of pleasure, reward, and euphoria. Dr. Sinclair reasoned that a solution to stopping the reinforcement cycle might be to block the receptors every time alcohol was used. Dr. Sinclair then tested his theory using naltrexone, an opioid blocker, with very positive results.

The main goal with the Sinclair Method is to achieve the process of extinction for cravings for alcohol. With extinction, when a behavior which was pleasurable and positively reinforcing, becomes less pleasurable and less positively reinforcing, the behavior gradually stops occurring. This gradual process eventually leads to less cravings and less desire for alcohol. The goal with the Sinclair Method is to eventually enable people to either stop drinking or to moderate their drinking. The success rate with the Sinclair Method can be as high as 80% in people who consistently use the method properly.

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"Experts say the case for limiting the use of benzodiazepines is particularly compelling for patients 65 and older, who are more susceptible to falls, injuries, accidental overdose, and death when taking the drugs. The American Geriatric Society in 2012 labeled the drugs “inappropriate” for treating insomnia, agitation, or delirium because of those risks."

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Don’t nap too long, especially if it’s a week day and you’re working. Experts warn that the longer the nap, the more likely you’ll wake up groggy, a feeling that can last up to 30 minutes. So what’s the sweet spot to feel the benefits of a nap? As little as 10 to 20 minutes will leave you refreshed, energetic and mentally sharper. On the weekends when alertness is less important, longer naps are ok, but try to avoid ones that last more than an hour so they don’t interfere with nighttime sleep.

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Yelp Review:

"Dr. Buggie is a fantastic psychiatrist!  I have been his patient for over 6 months now and his diagnosis and treatment plan has positively changed my life in more ways than I ever anticipated.  He is easy to speak with, knowledgeable, and thorough which helped me to better understand my treatment plan and anticipate any issues that I might face down the road.  I would recommend anyone to Dr. Buggie as he is one of the most relatable and down to earth doctors I know!"

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Orthorexia Not Recognized As An Official Diagnosis.

The Washington Post (11/5, Kaplan) “Morning Mix” blog reports that most physicians do not “yet recognize ‘orthorexia’ an official diagnosis.” The term describes an obsession with eating foods considered healthy and systematically avoiding specific foods in a belief they may be harmful. According to the Post, “orthorexia was considered as a new diagnostic category for the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the ‘bible’ of diagnostic criteria published by the American Psychiatric Association, but it was ultimately discarded” due to an insufficient number of published studies “on the condition to distinguish it from other eating disorders.”

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Ketamine was developed as an anesthetic and received FDA approval for this use in 1970. Decades later, it became popular as a psychedelic club drug. And in 2006, a team from the National Institute of Mental Health published a landmark study showing that a single intravenous dose of ketamine produced "robust and rapid antidepressant effects" within a couple of hours.

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The Food and Drug Administration has approved these drugs to treat alcohol disorders:

Naltrexone: Kills the buzz some get from drinking
Acamprosate: Reduces irritability and other withdrawal symptoms
Disulfiram: Creates unpleasant symptoms after drinking

Drugs approved for other purposes that show promise with alcoholism include:

Gabapentin (for epilepsy, pain): Lessens anxiety and other withdrawal symptoms
Topiramate (for epilepsy, migraines): May limit impulsiveness
Varenicline (for quitting smoking): Blocks receptors associated with cravings

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In pilot studies, botulinum toxin A (BTA) has shown efficacy in improving symptoms of depression. Although considered safe, BTA is not FDA-approved for psychiatric indications, and Medicare and commercial insurance do not reimburse for this procedure for depression. Larger studies are underway to determine if this novel treatment can be introduced into practice.
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