Andrew Bishop, MD

Andrew Bishop, MD Dr. Bishop is a Psychiatrist in Jackson focused on treating a variety of mental health disorders.

To my one or two followers, you may wonder why a psychiatrist is posting on blood pressure control. There are several re...
01/31/2025

To my one or two followers, you may wonder why a psychiatrist is posting on blood pressure control. There are several reasons. First, healthy patients are generally happier patients. Second, the brain does not exist in isolation from the rest of the body. Third, the study design mirrors the usual treatment strategies employed in the clinic and is uncannily parallel to the treatment strategies utilized in treating mental conditions.
The finding that even after aggressive treatment there is a significant proportion of the patients with poorly controlled hypertension. This mirrors the situation with mental conditions. This finding is in a condition, hypertension, where the pathophysiology of hypertension has been known for decades. The author cites several possible explanations for this finding.
So, if you have hypertension, what are you to do.
First, the doctor's office is not the ideal place to check your blood pressure.
I instruct my patients to purchase a reliable bp cuff, one that fits properly, and monitor.
Second, check your blood pressure and pulse perhaps two times per day, say morning and evening, when you are calm and relaxed.
Third, make a list of these readings and over a month's period of time, average the readings. This will give you a reasonable estimation of your blood pressure.
Fourth, take your medicine. Medicine in the bottle never lowered anyone's bp. As you can see from the referenced study, it may take 3 or more meds to lower the bp to an acceptable range.
Fifth, do healthy things. I have posted previously about these.
To your good health.

Blood pressure control among individuals with hypertension in both high-income and in low-income and middle-income countries (LMICs) is low, resulting in avoidable and expensive strokes, heart attacks, kidney failure, dementia, and other negative health outcomes. Among individuals with hypertension....

This article popped up on my internet feed today and may have on yours as well. I spend a considerable amount of time ea...
12/20/2024

This article popped up on my internet feed today and may have on yours as well. I spend a considerable amount of time each day counseling patients on the things this article stresses. I will note that although the medications have the potential to have the mental health benefits mentioned at the end of the article, my experience is that the effects are more subtle than profound.
The first two items in the article are the most important and both are based on the fact that about a third of the weight lost during GLP-! treatment is muscle weight. When you take into account that the average person loses about 1% of muscle mass per year over the age of 50 years, then you have a condition of clinical concern in the older patient.
As a rule of thumb, to keep the muscle mass up in the older patient, you need about 1 gram of protein per pound of body weight. This is about twice what the dietary guidelines recommend. The same is true of fiber.
You need to get at least 30 to 50 grams of soluble fiber per day and some additional insoluble fiber would be good also.
You will need to put the extra protein to work with some strength training. In the older person and in females this will not likely result in bulky muscles, but it will stimulate the muscles to produce more mitochondria (the energy machine of the muscle cell) and therefore burn even more calories.
Here's to a healthy and happy new year.

How to preserve muscle, avoid hair loss, ride the mental roller coaster, and more.

This is a great service to our community on many levels. I am impressed with this business on so many levels. This is wh...
12/18/2024

This is a great service to our community on many levels. I am impressed with this business on so many levels. This is what it means to give a hand up and not a handout. As the old tag line at First Baptist Jackson used to say, "connecting people, transforming lives".

A non-profit cafe that focuses on training individuals with disabilities officially opened its doors for business Saturday in Ridgeland.

The actual study that this report is based on is behind a paywall, so I have not read the primary source. However, this ...
12/18/2024

The actual study that this report is based on is behind a paywall, so I have not read the primary source. However, this report shines a light on a topic that comes up daily in the clinic, i.e., multi-tasking. The author mentions several times in this report that we only think about one thing at a time. Therefore, there is no such thing as multi-tasking. The analogy I often use is that of a juggler. Everybody can toss one ball in the air and catch it. Some people can toss two balls in the air in succession and catch them in succession, others can get in a rhythm and toss several balls in the air in succession and juggle them. The key is, the juggler is not tossing all the balls in the air at the same time, even though at any moment all but the ball in the hand is in the air, and the juggler does not catch them all at the same time. The juggler rapidly moves from one ball to the next in a pattern.
Now, imagine you are at work, the phone is ringing, you are trying to type an email, and the boss comes in, stands over your shoulder and wants a certain file, right now. You have to stop at least two tasks to take care of one task. You cannot do them all at one time.
This report points out that you receive many, many times more information through your sensory input than you can think about (process) at any point in time. When this is in conflict with demands it leads to anxiety, in this case driven by a fear of failure to multi-task (which remember you can't do) or disappointing at least two objects of your attention.
Bottom line, work efficiently, do one thing at a time, prioritize the tasks, and like eating an elephant, take one bite at a time.

Caltech researchers have quantified the speed of human thought: a rate of 10 bits per second. However, our bodies' sensory systems gather data about our environments at a rate of a trillion bits per second, which is 100 million times faster than our thought processes. This new study raises major new...

This is an article on the rapidly growing body of evidence regarding the gut-brain axis. The article is open access and ...
12/11/2024

This is an article on the rapidly growing body of evidence regarding the gut-brain axis. The article is open access and for the curious I recommend downloading and reading. The authors hypothesize that there is likely an imbalance between the pro-inflammatory gut bacteria and the short chain fatty acid producing bacteria. We have known for some time that inflammation plays a role in many (depression is not one thing) cases of depression and that short chain fatty acids are essential not only for good mental health but also for Maintenace of metabolic health in general. What is the health-conscious person to do? Eat a low-calorie diet with very limited rapidly released carbohydrates, e.g., sugar and especially high fructose food, and increase the soluble fiber in one's diet, up to 30 to 50 grams per day. It's not a panacea but it is a start. Let's make America Healthy Again.

A neuroimaging study of unmedicated patients with major depressive disorder (MDD) has uncovered a link between gut microbiota composition and changes in brain function. Specifically, the study found that individuals with higher levels of certain proinflammatory gut bacteria exhibited altered functio...

As a psychiatrist almost all my assessments are based on subjective reports. Most of the interventions that psychiatrist...
12/10/2024

As a psychiatrist almost all my assessments are based on subjective reports. Most of the interventions that psychiatrists utilize have a high safety margin so that therapeutic misadventures do not usually result in patient harm. With pain, the stakes are raised as the interventions are either invasive (surgery, back injections) or in some cases utilize medication with addiction and possibly life-threatening adverse reactions. A valid and reliable physiologic measure of pain would go a long way to getting the right treatment to the right patients in real time.

Pain is defined subjectively, but an objective measure of the experience promises to transform its management

Severe obsessive compulsive disorder is a disabling and miserable condition both for the patient and those that live wit...
12/06/2024

Severe obsessive compulsive disorder is a disabling and miserable condition both for the patient and those that live with the patient. It is also largely refractory to treatment. The usual treatment is with high dose serotonin reuptake inhibitors. Those of us who treat patients with OCD, consider a success rate of 50% of the patients getting 50% better a successful venture. Other medications and augmenting medications add minimally to the effect of the SSRI treatment. Psychosurgical interventions have been around for many decades and are utilized in extraordinary cases. This new story reports on one of those interventions with a 10-year follow-up. The procedure was well tolerated and most of the patients had a favorable response. Only two patients out of 11 had a remission of symptoms and the average response was a 53% reduction in symptoms, demonstrating the resistance to treatment, even with very aggressive treatment. Other surgical interventions for OCD include gamma knife capsulotomy and deep brain stimulation.
A quick scan of clinicaltrials.gov reveals that most of the current OCD clinical trials involve transcranial magnetic stimulation (TMS) or deep brain stimulation (DBS). A medication that inhibits glutamate release is also under investigation. There is one study utilizing Ketamine.
Ketamine is used off label to treat refractory OCD, but to date the results are mixed.
The Brainsway TMS machine is FDA approved for the treatment of OCD, but getting insurance coverage is difficult.
Our research arm MSB Neuroscience regularly scans for trials that we may participate in that will benefit our patients. If you or someone you know is interested in participating in a clinical trial, check out the MSB Neuroscience website and give us a call.

When conventional non-invasive treatments for psychiatric diseases fail, clinicians inevitably have to consider brain surgery. However, brain surgery for psychiatric diseases has long been taboo among the general public due to the infamous history of lobotomy. Thankfully, advancements in brain surge...

First, what is not new here. We have known for a very long time that depressed patients have a negative emotional valenc...
12/02/2024

First, what is not new here. We have known for a very long time that depressed patients have a negative emotional valence. As the article points out, this is usually assessed in humans using the facial emotions recognition test. A depressed person will spend more time looking at sad or neutral faces and a non-depressed person will spend more time looking at neutral and happy faces.
What is new. This article elucidates the pathway in the brain that underlies this behavior. Based on what we already know about functional neuroanatomy one might have surmised a similar pathway. If replicated, this moves our understanding a bit down the road.
What this does not do is predict which antidepressant or which behavioral intervention will work in a given patient. That is a much trickier proposition.
Not to be deterred, we are working on that in our research division by partnering with various companies that are developing biomarker assisted treatments.
Check back regularly for updates and the opportunity to participate in these trials.

A recent study conducted by scientists in France and published in Translational Psychiatry offers new insights into how depression affects the brain’s processing of positive and negative experiences. The research found that during depressive episodes, specific brain circuits become hyperactive in ...

This is a common finding in clinical practice, i.e., someone will have an infection and then have malaise, fatigue and s...
12/01/2024

This is a common finding in clinical practice, i.e., someone will have an infection and then have malaise, fatigue and symptoms similar to fibromyalgia. The patient is often sent to our office to treat depression. Although major depression in some cases has an inflammation component, this presentation is not depression. The graphic below gives a pictorial summary of the article. The article is referenced in this news report and is open access. The article gets deep in the weeds, but if you are willing to wade through it, it is enlightening. The downside of this is that it does not lead to a cure or even a prescription for relief. However, understanding this aspect of this common syndrome may lead to better treatment in the future.

In a detailed clinical study, researchers at the National Institutes of Health have found differences in the brains and immune systems of people with post-infectious myalgic encephalomyelitis/chronic fatigue syndrome (PI-ME/CFS). They also found distinct differences between men and women with the di...

A further elucidation of the NMDA receptor and Ketamine. This adds to the knowledge of receptor remodeling initiated by ...
11/27/2024

A further elucidation of the NMDA receptor and Ketamine. This adds to the knowledge of receptor remodeling initiated by Ketamine treatment. We have had great results with Ketamine treatment at our office. Ketamine is not for everyone, but in those patients for whom it is appropriate, the results are usually very good.

BUFFALO, N.Y. — In recent years, ketamine — long known for its misuse as a psychedelic party drug — has become a “life-saving” medicine for people battling major depression. Patients praise the drug for producing fast and long-lasting results in low doses. Now, researchers at the Universit...

Fascinating report. I have not read the original article yet but will get to it over the weekend. Good thing it is a lon...
11/27/2024

Fascinating report. I have not read the original article yet but will get to it over the weekend. Good thing it is a long weekend as the article is 43 pages long. What my staff refers to as light bedside reading.
Anyway, we have known for decades that there is a connection between the thyroid and the brain. On the one hand you have myxedema madness and on the other hand you have the hyperactivity of hyperthyroidism. We have used thyroid hormone to augment antidepressants in poorly responsive patients (sparking a point of contention between endocrinologists who prefer to use T4 and psychiatrists who prefer to use T3). We know that antidepressants do not work well or at all in patients with low functioning thyroids. As the article eludes, thyroid hormone influences all organs of the body giving rise to organ specific symptoms in the clinically impaired patient.
This current article explores a different angle. These rats, and let's be clear, these are rats not humans, had normal thyroid levels. This article explores the action of thyroid hormone in the normally physiologic range to affect (should I dare say effect) brain rewiring to encourage exploratory behavior.
While exploratory behavior by itself does not explain the category of major depression it does represent one slice of anhedonia.
One more reason why the best practice of psychiatry is built on the best practice of medicine in general. The brain does not exist in isolation from the rest of the body or from the external environment. The brain is the integrating circuit for this interaction.
Happy Thanksgiving.

Thyroid hormone plays a key role in regulating a range of physiologic functions, including metabolism, temperature, heart rate, and growth. It accomplishes this impressive array of activities by interacting with almost every organ system in the body. Yet despite a long history of research on how thy...

This is good news for menopausal women. With any medication there are risks and benefits. Please do your own research an...
11/22/2024

This is good news for menopausal women. With any medication there are risks and benefits. Please do your own research and discuss these and other findings with your physician before deciding to take or not to take any medication.

Short-term menopausal hormone therapy (MHT) did not have long-term cognitive effects when given to women in early postmenopause, according to a study published November 21 in the journal PLOS Medicine by Carey Gleason from the University of Wisconsin-Madison and colleagues.

Interesting finding. This report addresses several issues that complicate this area of translational research. First, da...
11/22/2024

Interesting finding. This report addresses several issues that complicate this area of translational research. First, data input from different scanners at different locations in different patients, even when presenting with the same behavioral phenotype have inconsistent findings. Second, findings generated in the test group do not always make accurate predictions in what we refer to as the withhold group, that is, patients in the same protocol but not analyzed in the initial sample. The third issue, which this report did not address, is data drift or the tendency of the model's predictive ability to decay with time in part due to dissimilarities in the input data. Fourth, it does to some extent validate the RDoc schema in that it demonstrates the same biology in the RDoc phenotype while presenting with varying DSM phenotypes.
Nevertheless, this does significantly move the field forward.

A new approach to analyzing brain scans could help researchers better understand psychiatric illness using much smaller groups of patients than previously thought necessary, potentially accelerating the development of more precise mental health treatments.

B.F. Skinner would be surprised to see this headlined as new finding. However, in a field where few studies stand up to ...
11/20/2024

B.F. Skinner would be surprised to see this headlined as new finding. However, in a field where few studies stand up to the replication test, it is good to see that some ideas do stand the test of time.

Cognitive neuroscientists at Trinity College Dublin have published new research describing a brand new approach to making habit change achievable and lasting.

This is an interesting finding. Of course, this is in mice and not humans, so some skepticism is warranted. It does brea...
11/17/2024

This is an interesting finding. Of course, this is in mice and not humans, so some skepticism is warranted. It does break new ground in our understanding of the formation and generalization of traumatic memories. Perhaps an enterprising pharmaceutical company will explore interventions based on these findings. If so, our research unit will be glad to help with clinical trials.

In mice, stress altered the way that the brain formed memories, resulting in an unnecessary fear response.

Why is this important? Because Tau is the substance inside the nerve cell that causes cell death in Alzheimer's Disease....
11/01/2024

Why is this important? Because Tau is the substance inside the nerve cell that causes cell death in Alzheimer's Disease. This is downstream from the effect of Amyloid in the Amyloid cascade hypothesis and is believed to be a more robust target for disease modification. We will see what happens in this area in the months and years to come.
I am attending a meeting next Thursday in Colorado Springs, CO with some of the researchers in this area. I will post updates from the conference.
I you or a family member or friend has early cognitive decline and wish to be screened for modifiable causes of this, give us a call at the clinic and we will be glad to assess.

The week after seeing its partner Roche cut and run, UCB has

This is very good news. Nothing like having a study to prove what we think we already know. The numbers are very impress...
10/31/2024

This is very good news. Nothing like having a study to prove what we think we already know. The numbers are very impressive and as you can see, beat standard medical care by a wide margin. Remember, diet, exercise, sunlight, sleep, social connectedness and meaning and purpose in your daily life, go a long way to putting your doctor out of business.

New research from the University of Missouri School of Medicine suggests intensive lifestyle interventions are an effective way of treating and improving liver disease.

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