Monthly Archives: October 2008

Can We Advance Science Through The Use of Blogs?

The question i’m asking here is whether a blog can advance science, not just by communicating science, but by actually contributing to a modification of scientific knowledge. In some senses, if we are to accept the wisdom of Thomas Kuhn, who proposes that science advances through revolutions rather than incremental changes, then perhaps blogs could offer an appropriate medium for advancing science. There are a number of reasons for this.

Firstly articles in blogs can be produced at a rapid rate. If we compare these with journals then we can see that there is considerable flexibility afforded to the author in avoiding the restrictions imposed by editorial style, peer review and the cultural environment that all constrain the ‘successful’ articles. In effect, we are talking about self-publishing. This however is also a criticism that can be levelled against blog articles. Peer-reviewed science journals can offer the necessary censoring of articles that are unlikely to relate to reality by using the expertise of the peer-review panel and with careful consideration. Additionally, the competitive process could be argued to lead to a higher quality of articles than without such a process although this in itself is open to debate. For instance, cultural constraints may mean that successful articles are those which resonate with cultural wisdom which may be nothing more than fashion.

Secondly blogs are a medium for communication which previously were predominantly only possible through paper publishing, which is relatively costly and less accessible (depending on the distribution channels). The reader can successfully argue that prior to blogs, there were other means of communicating with an audience using the internet or computers including the production of websites or specialised software programs. However these required more technical expertise, necessitating either outsourcing or time spent specialising in developing information technology skills, both of which require investment of resources.  In effect, the blog allows the scientist or those with an interest in science to communicate with an audience with minimal investment of additional resources.

Thirdly, the blog offers an almost real-time interactive experience with the audience through the use of comments. This has been one of the highlights of using blogs offering the tantalising possibility that collaboration can lead to an evolution of ideas or models. This is dependent however on the level of exposure of the blog articles together with the decision of the reader to contribute. However, a criticism here is that sophisticated models require the reader to have some level of expertise before being able to meaningfully contribute. Nevertheless, it could also be argued that if the articles are clearly written and in effect  communicated, then the reader should be able to meaningfully contribute without needing this special level of expertise.

Fourthly by utilising the blogosphere, scientists can tap into a global network of relevant expertise. Provided these experts are motivated to interact with each other and constructively criticise each others ‘blog models’ then a very fluid medium for scientific evolution is possible which would complement other scientific media. A criticism of this however is the issue of intellectual property. If a scientist publishes their theory online, then they have little protection against the use of their ideas by others. Blog articles can be modified and thus if someone publishes the same theory in a paper publication which is archived then the latter publication’s validity is easier to prove. For blogging science to proceed under these circumstances there would need to be an archiving mechanism for selected blog articles so that the scientists ‘intellectual property’ can be protected.

Fifthly the blog can use a number of media – audio, video, text and graphics to communicate ideas fluidly and effectively. This brings the possibility of science becoming more like a conversation than the sometimes space-constrained, formal, passive and unnatural form of communication that can sometimes be seen in journal articles. Indeed, the way in which blogs could revolutionise science is to produce video (video blog) representations of models explained by the author and  responded to by interested readers again in video format. This would produce a ‘distributed conversation’ which if used correctly could advance models more quickly.

I will test this hypothesis by developing a ‘blog model’. In this case it will be the model of the insular cortex regulating the intensity of emotional experiences through the use of GABA receptors. By exploring the possibilities afforded by the blog medium, I will test the efficacy of the ‘blog model’ by attempting to produce a realistic model of insular cortex function in relation to emotional experience.

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Blog Review: All in the Mind

‘All in the Mind’ is a blog by Natasha Mitchell who is a science journalist. The blog which started in October 2007 covers neuroscience issues and is aimed towards a general audience. The blog popularises neuroscience and this is accomplished through the clarity of writing together with an audio series featured on ABC radio. In this article there is a discussion of a number of situations in which one group of people have committed acts of injustice against another group. The story of Romeo Dallaire’s despair at the genocide in Rwanda which he felt helpless to prevent is compelling and Mitchell references a film ‘Shake hands with the devil’ which covers this in more detail. Such issues in which the lives of many people are impacted should surely feature highly in the priorities of the scientific research community. The issue of negative drug studies not being published is covered here although regulatory changes should address this. Mitchell has very put an image of her own brain up here for readers to see! Here is a discussion of Doug McGill’s thoughts on ethics in journalism and here is a video interview with Clive Thompson of Wired magazine about blogging. Here is a transcript of an interview with Patrick Wall who with Ron Melzack developed the Gate Control Theory of Pain whilst this article features Goodna, one of the oldest asylums in Australia with links to an audio show on this.  What struck me when reading this blog was the highly specialised nature of science journalism and the tremendous good work that is done by this group in communicating a technically demanding subject.

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Book Review: Perspectives on the Henderson Hospital

The featured book is ‘Perspectives on Henderson Hospital. 2nd Edition’ edited by Fiona Warren and Bridget Dolan. Henderson Hospital is a therapeutic community that the authors write was established in 1947 originally for veterans of the second world war. Since this book was published  in 2001, there has been some suggestion that the Henderson Hospital might close leading to an online petition. However this webpage about the Henderson Hospital is worded in the present tense and outlines available services noting that the residential facility is closed.

The book itself is a collection of papers about the Henderson Hospital with a foreward by the editors Fiona Warren and Bridget Dolan. In the chapter, effectively a paper from the International Journal of Therapeutic Communities the author J Whiteley discusses the history and development of the Henderson. A number of staff from the Henderson have gone on to direct units elsewhere, introducing elements of this model of care.

The model in which residents and staff both have a say in the running of the unit is markedly different from what would be thought of as the usual inpatient psychiatric models and is described here (potential resident recruits have been interviewed for admission)

‘After the formal group interview, there is a closed discussion, by staff and residents, of the candidates. This culminates in a democratic vote, by residents and staff, for and against admission of each candidate’

There are a number of chapters which examine boundary issues. Brief excerpts of actual cases illustrate how the community responds when a person tests the boundaries and how in turn this impacts on the person who has crossed the boundaries. What is interesting in this chapters is the concepts of the community being therapeutic and the need to avoid it becoming ‘stale’ and thereby untherapeutic. Such conceptualisations allow a different perspective on how therapy is possible.

From the various studies within the book, the therepeutic community appears to be suited to the treatment of people diagnosed with personality disorders and this is also reflected in the composition of residents in the community in some of the mentioned studies. There are various studies which look at outcome measures both in the short term (1 year) and medium term, looking at correlations with length of stay, symptoms of borderline personality and cost-effectiveness of treatment.

The Henderson Hospital has become synonymous with the term ‘therapeutic community’ which in turn invites the question of ‘why do we do the things we do, in the way that we do’. This book offers the reader both historical and ever-fresh contemporary perspectives on practice.

References

Perspectives on Henderson Hospital. Edited by Fiona Warren and Bridget Dolan. 2001. Henderson Hospital.

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Global Mental Health Series: Treatment and prevention in low and middle income countries

The featured article is ‘Treatment and Prevention of Mental Disorders in Low-Income and Middle-Income Countries’ by Professor Vikram Patel and colleagues, the third in the Global Mental Health series. The aims of this paper were to examine treatment and prevention of mental disorders in low and middle-income countries by focusing on depression, schizophrenia, alcohol misuse and developmental disabilities.

The authors describe their method for identifying relevant papers which includes a search of the PsiTri database. Randomised controlled trials in low and middle-income countries were selected although multicentre trials which partly took place in high income countries were excluded.

11501 trials were identified but of these only 10%  took place in low and middle-income countries. More than half of this latter group involved studies looking at treatment of schizophrenia in China. Roughly 25% of the trials in low and middle-income countries looked at depression, with 75% looking at schizophrenia and only a small number of studies looking at alcohol misuse.

The studies considered took place in many different countries and corresponding health infrastructures. Studies were identified which showed the benefits of antidepressants, psychoeducation and group interpersonal therapy for depression. There were other studies which showed equivalent efficacy of first and second generation antipsychotics for schizophrenia as well as family interventions. Brief physician-delivered interventions, acamprosate and naltrexone showed benefit in alcohol misuse and dependence.in developmental disabilities studies showed the benefits of rehabilitation programmes, parenting skills groups and for the use of methylphenidate in ADHD. The authors then examine some of the treatment trials in more detail and also looked at work done on prevention some of which was done at the level of government e.g. taxation for alcohol use. There was also a discussion of some work on Iodine in reducing prevalence of developmental disabilities.The authors then look at some more detailed cost-benefit analyses of treatment interventions before reaching a number of conclusions the most important of which I thought was the need for scaling up of effective and evidence-based intervention programmes.

This paper covers diverse issues. What impressed me most about the paper was the emphasis that was placed on the effectiveness of resources. Thus using scarce resources to their maximum benefit has implications for mental health programmes not only in low and middle-income countries but also in high-income countries. Now that there is a good evidence base for interventions, how quickly will we see the development of effective programmes which are scaled up in the areas where they are needed most?

STT1

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

The Implications of Bereavement Theory for Art Therapy

The featured paper is about bereavement theory and its relationship to art therapy in a paper titled ‘Current bereavement theory: Implications for art therapy practice’. The aims of the paper are to outline some contemporary theories of bereavement and how they might impact on art therapy. The authors begin by looking at Freud’s theory of bereavement which was first described in the paper ‘Mourning and Melancholia’ in 1917. In this theory, Freud described a number of stages through which a person passes following bereavement in which they work through the loss. This theory however has been criticised for a number of reasons including the need for distinct and sequential phases of grieving as well as the limited emotions considered in the process.

They then go on to discuss two contemporary models of bereavement – the dual process model and the meaning-reconstruction model – together with their implications for art therapy.

In the dual-process model, Stroebe and Schut propose that bereavement involves the person addressing their loss (loss-orientation) at the same time as adapting to their new life after the loss (restoration-orientation). The person does not move from one phase to another but rather goes through periods of focusing on one or the other of the orientations. This move between orientations creates meaning for the person. In terms of art therapy, the authors suggest that the therapist can recognise these orientations and allow the person to explore them through the medium of art.

In the meaning-reconstruction model, Neimeyer adopts a constructivist approach and proposes that during bereavement, a person focuses on meaning. This occurs in a number of ways – the construct of death as well as the self-narrative may be reconstructed (this can be done in relation to the deceased as well as important others). Also the role of feelings as contributing to the creation of meaning is suggested. When identity is reconstructed, this has implications for relationships with others which may need to be re-evaluated. This can be supported in therapy through the use of role-playing or exploration of relationships through other media.

The authors discuss a number of other issues including similarities and differences between the two models above. They also describe the use of a memorial piece to structure the grief that may occur during significant anniversaries.

This paper is interesting for a number of reasons. Firstly the authors focus on the possibility that disturbing emotions can serve a purpose – for instance in generating meaning which in turn may drive changes in identity. These considerations can also be relevant in the adjustment disorders. Secondly the authors examine how the practice of art therapy might be influenced by theoretical developments and in particular by theoretical models. This is done explicitly and it perhaps is even driven by a search for another (more practical) meaning in the models. Thirdly gaining such insights into the work of colleagues can facilitate the identification of relevant resources for patients and services.

STT1

References

Lister S, Pushkar D and Connolly K. Current bereavement theory: Implications for art therapy practice. The Arts in Psychotherapy. 35. 2008. 245-250.

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Striatal Glutamate Levels and Cognitive Decline in the Elderly

The paper reviewed here is ‘Low striatal glutamate levels underlie cognitive decline in the elderly. Evidence from In Vivo Molecular Spectroscopy’ published in the journal Cerebral Cortex.

The aims of the paper are clearly stated – to examine the levels of glutamate in three areas which are projected to from the cerebral cortex – these being the striatum, cerebellum and pons – and to identify any correlations with cognitive function in both the elderly and young.

In order to achieve this the researchers led by Natalie Zahr use Magnetic Resonance Spectroscopy which allows them to detect the signatures of molecules from the resonance waveforms that are detected using this technique. Apparently it has been difficult to detect Glutamate using this technique as the patterns it produces overlap with those of other molecules. I didn’t understand from reading this paper how these difficulties were overcome

The authors selected the three targets for the projections as mentioned above – cerebellum, striatum and pons – and by hand selecting areas on the images, then examined the relative signal intensities of the different molecules that were recognised. These included choline containing compounds, total creatinine, N-acetylaspartate and of course glutamate.

When the 12 elderly (67-84 years old) and 12 young (19-33 years old) subjects were compared, glutamate was found to be increased in the cerebellum and pons and decreased in the striatum in the elderly compared to the young group.

In terms of cognition, the elderly performed significantly worse on a number of tests including semantic and figure fluency, working memory (Blocks forwards and backward and stembeng), set shifting and the Stockings of Cambridge task which is a test of spatial planning.

A regression analysis of the test scores and the levels of Glutamate in the different regions was then carried out.  The most convincing correlation was for blocks forward and striatal glutamate (p = 0.0004). The r value was 0.687 with the test scores increasing as did the striatal glutamate. Indeed the same positive correlation held for the four other displayed correlations – between glutamate and 2 tests of semantic fluency, figural fluency and blocks backward.

Initially on reading this paper I focused on the finding that the  glutamate in the striatum decreased with age and in the pons and cerebellum it appeared to increase. It seems almost intuitive that the levels of neurotransmitters would decrease with age in the brain as the number of neurons decreases and presumably the rate of production of neurotransmitters. However the findings in the pons and cerebellum reversed that trend. I was intrigued by this and wondered if perhaps the sample size was too small and also if we could say anything more than this being just an association.

The authors persuaded me in later paragraphs to reconsider the striatal findings though. They show how these findings relate to a much wider literature including studies in people with excision of the frontal lobe and also Parkinson’s Disease. Thus the main hypothesis would seem to run along the lines of the following

Frontal-striatal pathways are important in a number of cognitive functions including executive tasks and working memory.

In the elderly population, performance of these cognitive functions deteriorates.

Glutamate in the striatum decreases in the elderly.

Glutamate in the striatum underlies the cognitive functions discussed above.

A decrease in the glutamate levels in the elderly accounts for the deteriorating cognitive functions.

There are many alternative explanatory hypotheses. For instance, the role of neuronal cell number or other neurotransmitter functions could be equally important. Nevertheless even if these arguments are valid, it would not detract from the hypothesis above which merits further testing. The hypothesis if correct would also inform treatment strategies.

STT5 (Further confirmatory studies required, which can then contribute to a model, which can inform clinical studies, which in turn should determine policy before being used in practice).

Reference

Zahr N, Mayer D, Pfefferbaum A and Sullivan E. Low striatal glutamate levels underlie cognitive decline in the elderly: Evidence from In Vivo Molecular Spectroscopy. Cerebral Cortex. 2008. 18. 2241-2250.

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

October News Review: 4th Edition

In the 4th edition of the news review associations with conversion to schizophrenia are identified and a study finds a high reversion from vascular cognitive impairment non-dementia.

Dementia

A post-mortem study in people with Huntington’s Disease has found a significant reduction in hypocretin-1 neurons compared to controls in the prefrontal cortex and CSF although the clinical significance is unclear (STT5). In a post-mortem study (open-access article) of people with Alzheimer’s Disease or mild cognitive impairment, the authors concluded that when the disease is widespread that agreement between pathologists is good but in the initial stages of the disease there is a need for standardisation of the sampling method and also a need for two pathologists to confirm the results (STT2*). 45% of people with vascular cognitive-impairment non-dementia reverted in this 1-year follow-up study.

Schizophrenia

A study funded by a number of pharmaceutical companies and presented in an open-access paper has found that a partial dopaminergic agonist Bifupronex (20mg) significantly reduced total PANSS scores in people with schizophrenia compared with a placebo group in this 6/52 double-blind placebo-controlled trial (STT4). Ultra-high risk of conversion to schizophrenia was associated with metabolic processing in the corpus callosum and in another study with the structure of the anterior cingulate cortex (STT4).

Liaison Psychiatry

A meta-analysis of non-pharmacological treatments for cancer-related fatigue has found that both exercise and a range of psychological interventions are roughly similar in their benefits (STT2). A qualitative study of 13 studies of brain injury found that there were no differences in functional outcome between men and women with moderate to severe brain injury (STT1). 33% of 66 patients initially diagnosed with Parkinson’s Disease had the diagnosis changed during the follow-up period and this resulted for instance from new developments in the presentation during the follow-up period.

* The treatment in this case is related to the possibility of genetic testing on confirmation of the diagnosis.

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.