Psychiatrists are medical doctors who go to medical school, then have a year as a resident rotating on internal medicine or pediatrics, neurology, and, finally, psychiatry.

They train an additional 3 years to do adult psychiatry or 4 years to do Child & Adolescent Psychiatry (total of 4 or 5 years after medical school).

As medical doctors, they are expected to diagnose mental illness if present but also non-psychiatric causes of mental health symptoms.

For example, an anxious patient may have hyperthyroidism as the cause (the anxiety disappears when the thyroid disease is treated). Another example would be a patient who is depressed due to a medication side effect. The psychiatrist would work with the prescribing physician to change to a different medication.

To illustrate what psychiatrists do, I have helped develop a podcast about psychiatrists (the word means doctor of the mind). It is meant to be entertaining as well as educational. There are 8 episodes.

If you are interested, it can be accessed on Apple podcasts. Just type The Mind Doctor in the search bar. You can leave a review at the end. This is helpful so we know whether this format works the way we intended.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

A recent article by Churchill NW and colleagues in Neurology Vol 103 (7), Apr 8, 2025 was released in a preview form on March 12, 2025. It addresses the long term effects of concussions in athletes.

Typically, an athlete with a concussion during a sports events is evaluated for return to play (RTP) only by clinical evaluation and without imaging studies. So, we typically don’t know with a high level of confidence if there has been any meaningful brain injury.

Researchers in Canada studied college athletes in sports where concussions are not unusual (football, basketball, hockey, lacrosse, rugby, soccer, and volleyball). Of 187 athletes studied, 25 had a concussion during their sport’s season.

These 25 students were compared to 27 students without a concussion who played the same sports, were of the same sex, and had other similar characteristics.

The students all had an MRI of their brain before their sports season began. For those who had a concussion, an additional MRI was done 1-7 days post return to play (RTP), 1-3 months after, and one year after the RTP decision.

The control group of students also had MRI studies of their brain before the season began and repeat MRI studies at these same intervals.

The MRIs were compared to see whether there are any differences between the two groups. There were. Those athletes with a concussion had identifiable abnormalities on their post-concussion MRIs.

These abnormalities included changes in blood flow and tissue in the frontal lobe and other areas of the brain. These changes persisted for the entire year after RTP; later MRI studies have not been done as part of this research, so we don’t know exactly how long these changes can last.

As the lead author of the research article wrote, “The presence of significant, long-lasting brain changes after injury reinforces concerns about the consequences of repeated concussions, and to what extent these effects accumulate over time.”

Although the research did not evaluate the issue of Chronic Traumatic Encephalopathy (CTE), it is a concern in athletes who have had multiple concussions.

According to the Indiana School of Medicine, CTE is a “progressive degenerative disease in people with repeated traumatic brain injury including concussion.” We don’t know what percentage of athletes with multiple instances of concussion will eventually develop CTE.

The University lists a number of concerning symptoms from CTE: “memory loss, aggression, confusion, depression, impaired judgment, difficulty controlling impulses, erratic behavior, suicidal tendencies, anxiety, trouble sleeping, dizziness, and trouble balancing.”

CTE is a serious consequence of multiple head injuries. So far, it appears to affect only a minority of athletes with multiple concussions. However, we also don’t know if later, milder symptoms may be a result of multiple concussions.

Concussions appear to be more concerning than we used to think. Protecting athletes from concussions is an important area for research and development.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

For many years over 4,000 US women died from cervical cancer. Research showed that more than 9 out of 10 cases were due to infection with the Human Papilloma Virus (HPV.).

Fortunately, a vaccine was developed that dramatically reduced the risk of cervical cancer. Additionally, it reduces the risk of several other cancers related to HPV infection (anal, vaginal, vulvar, penile, and throat cancers).

Young women (age 20 to 24) who were screened for cervical cancer from 2008 to 2022 showed that pre-cancer cells and localized cancer of the cervix dropped by 79 to 80%! This is consistent with the new availability of the HPV vaccine during this time.

HPV is spread by intimate skin to skin contact, mainly sexual contact, so it is considered to be a sexually transmitted infection (STI). Both men and women can be infected.

Men can also develop cancer from HPV infection. In fact, 4 out of 10 cancer cases from HPV infection are in men (primarily penile, anal, and throat cancers).

The HPV vaccine is recommended for children at age 11 (it can be given as young as age 9). The idea is to give the vaccine before the person is sexually active.

Two injections are needed about 6 to 12 months apart (3 injections if the vaccine is not started until the patient is older). It is contraindicated if the person is allergic to yeast or is pregnant.

This is a great success story. As an aside, for those of you who read my last blog on the new measles outbreak, just recently one child died from measles. It can be a serious disease that is preventable with the MMR vaccine.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

The CDC reports that there have been measles cases found in 8 states as of Feb. 2025. Currently, there are significant outbreaks in Texas and a neighboring area in New Mexico.

There have been 90 cases in the South Plains area of Texas; 16 people have been hospitalized. In New Mexico there have been 3 outbreaks (more than 3 related cases).

The cases by age in the U.S. are:

Up to age 5 = 30%

Age 5-19 = 52%

Age over 20 = 16%

Age unknown = 2%

Vaccine status::

Unvaccinated or unknown 95%

One MMR dose 4%

Two MMR doses 0%

It has been known for a long time that two MMR doses are highly effective for prevention of measles. So, the statistics above are what you would expect.

Before 1963, when the measles vaccine became available, we saw many cases of measles. I only saw one case as a resident in family medicine (early 1970s). I never saw another case thanks to the vaccine.

The most serious complications from measles include blindness, pneumonia, and encephalitis (brain swelling). Pneumonia is the leading cause of death in children and in adults over age 20.

Before the vaccine, there were between 400 and 500 deaths per year from measles in the U.S.

The World Health Organization estimates that the measles vaccine has prevented an estimated 60 million deaths throughout the world.

If you or your loved ones have not been vaccinated, I urge you to talk to your doctor about this issue.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Juice-only diets have been touted to clean the bowel and improve health. However, limiting your food intake for a few days or longer to fruit juices for this purpose can remove most of the insoluble fiber in the gut.

Insoluble fiber in whole fruits and vegetables have health benefits. This led researches to study the microbiome in the mouth and the gut in research subjects on a juice-only diet.

The microbiota plays a role in metabolism, the immune system, and brain health. The research mentioned above was done by Sardaro and colleagues and published in Nutrients 2025; 17(3).

The research compared 3 different diets, one of which was a juice-only diet. At the end of 3 days, the gut microbiome “… showed an increase in taxa (types of microorganisms) associated with gut permeability, inflammation, and cognitive decline.”

My suggestion is to include whole vegetables along with juice in your diet. If you are not a vegetarian, including limited amounts of meat is not unreasonable. All things in moderation is good advice.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Tuberculosis (TBC) has existed in humans for thousands of years. In the Middle Ages there was a major outbreak of this infectious disease in Europe that killed a large number of people.

It caused the skin to look pale, so it was nicknamed the “White Plague.” This is different from the “Black Death,” which also had ravaged Europe.

Both of these plagues were caused by different bacteria. Tuberculosis is caused by Mycobacterium tuberculosus, and it spreads by coughing or speaking such that the bacteria are released into the air.

Tuberculosis (TBC) is still with us. For example, there has been an outbreak in the Kansas City area beginning early last year. There have been 67 reported cases.

Although this represents more cases than is usually expected, it is not a cause for alarm. Today, tuberculosis can be treated with a blend of antibiotics. This treatment rapidly reduces the spread of disease from the infected individual.

Also, TBC mainly infects people with certain health problems. In addition, none of the bacteria have been drug-resistant, so standard treatment is effective.

This outbreak in Kansas is a reminder that TBC is still with us. Unlike the Middle Ages, we can diagnose it, there are preventive methods available, there are tests to diagnose it early, and we have effective treatments.

Patients who develop TBC typically have a chronic cough and often cough up blood and/or mucous. Other symptoms that may occur include chest pain, fever, night sweats, chills, weight loss, and fatigue.

It is helpful to know that the Health Department considers it safe to visit Kansas City.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Sexually Transmitted Illnesses (STI) are still occurring in our society. Prevention is recommended. Always using barrier contraception is very important. But what should you do if you forget or decide not to use one?

The CDC has come out with a strong recommendation that people at risk should consider taking an oral antibiotic (doxycycline 200 mg) within 72 hours of oral, anal, or vaginal sex. It has been shown to substantially reducing the risk of developing a bacterial STI.

Who is at risk? The CDC considers men who have sex with men and trans men who have had an STI within the past 12 months are the at-risk group. The sexual behavior includes oral, anal and/or vaginal sex.

People who are considering this form of prevention should be aware of the risks and benefits. Doxycycline given as a single oral dose has few side effects, which are usually mild. It can lead to antibiotic resistance in some cases. However, it has been shown to substantially reduce the risk of a bacterial STI.

There have been a few cases of “intimate partner violence after discovery of doxycycline PEP (post-exposure prophylaxis) use” [CDC].

It is an open question whether heterosexual people with repeated STIs should be offered this prophylaxis treatment after sex.

The CDC recommends that individuals at risk should have testing for STIs every 3-6 months.

This overview is from an article by Floes and colleagues in JAMA.2025; 333 (3): 248-249.

Peter M. Hartmann, MD

Family Medicine & Psychiatry