Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Fact: all psychiatry is subjective, no blood tests nor MRIs or EEGs prove any exist but in degrees away from "normal" as determined by a psychiatrist.

However: Mt Sinai, VCU, U of Wisconsin, UCSF and many others have studies on brain injuries (of various degrees......which related not only all mental illnesses to head injuries (neural trauma) from such minor injuries as birth, a fall from a bike, getting hit by a basketball, to more serious injuries. They are all related to dementia, ADHD, memory loss, learning ability, mental illness, addiction, homelessness, cognitive impairment, parkinsons, ms, alzheimers, ptsd, chronic fatigue syndrom, loss of motivation and self, depression, and dozens of other illnesses. This is the disease and life provides an ever increasing nuber of peope in a flattening binomial distribution on the statistical edges. It can be shown by various blood tests, and MRI studies and other neurological tests. Yet Psychiatry prevents further help as these charlatans have much to lose, nothing to gain from its research and proof Dr. Freud was simple a cocaine addict and imaginative....cocaine is the natural legal form, its racemic mixture (ritalin) is legal, doctor and pharma push it. cocain illegal and you go directly to jail (in the US) yet the l form, which should (if pure) be far more useful. This is beside my point however. This could be the basis for almost all peculiar behavior from the mean, and deserves far more study as the cause, versus what psychiatry treats which is the symptoms they do not understand. Yet TBI and lesser forms only now becoming clear as personality changing events (from Iraq soldiers returning to actresses falling on bunny slopes skiing)....yet is given little credence as research is difficult. But possible. Good by psychiatry, hello psychology, neuroscience and neurology. This is worthy of enormous study. studies on all head injuries and resulting changes in behaviorial statistics, and knowledge of its importance a

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

As in Mt Sinai study, all head injuries reported to doctors and hospitals across the country should be followed over time, using imaging devices, blood tests, cognitive testing ability, and behavioral changes (by friends, relatives, and the individual as well) plus EEGs and MRI-As, changes in endocronology and hormoned levels, and issues the head injury develops into over time much as the heart test and life style study and diet in New England. Stem cell growth mechanisms as cures, electromagnetic, and other and any concepts used in attempts and treatment of each case as individual (oxygen popular in japan). the levels of dopamins, other neuro trasmitters acetyl choline levels, NMDA serotonin, norepinephrine, and exactly how one can spur stem cells in the brain into growth mode. Rats etc used only as subjective as human studies are required.

And time. Difficulty exists without radioactive labelling what neurotransmitters actually change and boost learning and growth. And particularly in the hippocamus. Vs a control naturally in all cases.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

my view is at birth, the conehead normal birth begins something, and often damage can occur. Chemicals etc as well. Shaken baby syndrom but in general the binomial distribution of any issue is almost a straight line at the mean a very steep curve, variance due only to birth issues, and genetics. As aging occurs, but age 10 the curve flattens, at 20 further yet, by 80 it is very flat with the mean far from the number of points far out on the curve. All the "mental illnesses" could be addressed this way, ADHD, MS, Parkinsons, dementia etc as stated above.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

No, one the severity of the brain injury, and if localized (as in concussions) vs nonlocalized (which could be determined via TMS amd EEG activity so imaging, behavior, EEG, and blood testing (including hormonal changes). Phinneas Gage will praise you for this on judgement day (if one exists).

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

I feel all benefit....from the vicitims of those "going postal" to the lost and depressed to those now seeing shrinks (good word for it) who do not recognize the disease but only had you kleenex (pills) for the cold symptoms....the runny nose. The changes in behavior that suddenly finds those addicts, or homeless, or shizoid, or manic depressive, would all be helped and society as a whole. Productivity increase. etc.

Describe any health-related risks, side effects, or harms that you are concerned about.

No one will allow you to cut their cranium in half to allow testing of levels in the brain, so the only harmful effect I can imagine would be from using labelled compounds known to be trasmitters, known to be greater (or lesser) in various nerve cells, glia and synapses to find the effect of various rehab or cures that may be available. This can be kept low.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Dementia, including Alzheimer's disease
• Depression and other mental health disorders
• Developmental delays, attention-deficit hyperactivity disorder, and autism
• Functional limitations and disability
• Obesity
• Substance abuse

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)
• Other

Importance

Describe why this topic is important.

Explain why humans lie kill steal fight become less than their potential or lose it over time? It importance may explain our actions and enable us to live well, be smarter, act far more humanely to each other, etc end homeless ness, financial inability that comes with cognitive or emotional issues, addiction in many ways and force us to reevaluate how to raise children, what to provide for those injured and save us from so much twisted thinking (I will not use the word mental illness) and abberant behavior.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

my iq of 160 reading a book daily, great at math, research productive, creative, happy, making money to the extent wished, great relationships, growth of self and self esteem, memory......then I fell down 18 feet and no longer can read, hate music (loved and played it before, cant sleep for days, then do nothing but sleep, lethargic, went from running to sedentary, cognitive impairment, anger and instead of direction in my life, seem to do nothing and go in circles....my entire life changed in one day in that fall. And I am not who I was. I do not know this me. And yet to society, after being highly productive I am now toss away garbage and I would say from experience not one in 300 doctors has knowledge of the impact of brain injuries. And mine is relatively mild, but am less but a large degree than I was or could be and there is no help. Psychiatry is meaningless, and prevents health care coverage for this, medicaid coverage, and most treatments in medicare ....only Iraq has brought this to light, and in conjuction with neuroplasticity work, and the Mt Sinai studies.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

There is no consensus. No certainty in treatment and so few even bother with one. of the 1.4 million reported (and how many are not is unknown) the lucky ones (50,000) die, 200,000 plus get some treatment (but usually are sent not to neurologist but the dreaded psychiatrists.....who prevent change...) and the rest live increasingly desparate lives with addictions, frustration, mental illness caused by their injury, depression, early dementia and can addiction, homelessness and live far below their potential prior to their fall......and this obviously is a contentious debate, from parkinsons, ms, schizophrenia, adhd, etc....yet they all seem to have a commonality, that if studied intensely, could effect policy in obvious ways and in agreement.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

I will be dead long before there is an answer.

Describe the timeframe in which an answer to your question is needed.

50 years but much knowledge would arrive early on

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

none

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

I will be dead long before there is an answer.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

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