Reflections on November 2008
November has also gone very quickly but there was a lot happening this month.
In terms of news there was found to be a relationship between lissencephaly genes and executive dysfunction in schizophrenia and bipolar disorder. This might be signal a trend towards relating genes to components of an illness (e.g. executive function, memory etc), where these components come together produce an illness and would fit with the evidence suggesting the involvement of many genes. The East London First Episode Psychosis Study found psychosis to be increased in black and ethnic minority groups compared to white british. In a study of twin pairs, the healthy twin of a sibling with schizophrenia was found to have greater whole brain volume reduction and frontal/temporal gray matter volume reduction over 5-years compared to twin pairs without schizophrenia. There was also some evidence of childhood bullying leading to an increased likelihood of psychosis.
Examining the relationship between anticholinesterase inhibitors and circadian rhythms together with polyunsaturated fats and healthy brain again were the topics of 2 review papers. A paradox which needs explaining is the finding that the risk of MCI conversion to dementia decreases as time progresses. There is evidence for Amyloid deposition in Lewy Body Dementia but not in Parkinson’s Disease(PDD) or PDD+. Delivery of a telephone-based service for carers of people with dementia was found to lead to significant improvements in caregiver burden scores. A potential marker of glial cell activity was identified in one study which found increased uptake of the compound [11C]DAA1106 in people with Alzheimer’s Disease suggesting that glial cell activity might be increased. ABeta42 levels were found to be lowest in people with Lewy Body Dementia compared to other types of dementia in one study but highest in Alzheimer’s Disease (as expected). There was some indirect evidence for a more protective role of the Val-Met form of Brain derived Neurotrophic Factor compared to the Val-Val form. A five factor model for predicting conversion from MCI to dementia was found to have 81% sensitivity and included immediate recall, functional assessment, smell test, MRI hippocampal volume and entorhinal volume. A multicentre study found a higher association between depression and dementia in the younger age group and for the most severe cases of depression.
People with Cornelia de Lange syndrome were found to have a higher rate of severe autistic phenotypes. A Western Australian study using a database registry of 245,749 people with mental illness and intellectual disability found that 31.7% of people with intellectual disability had a concurrent mental illness.
There was also found to be a lower prevalence of borderline personality disorders in Spanish immigrants compared to the indigenous population particularly in Asia and Sub-Saharan people. Three subtypes of Narcissistic Personality Disorder are proposed on the basis of one survey of 1200 clinicians and includes the fragile subtype, malignant/grandiose subtype as well as the high-functioning and exhibitionist subtype. Overcrowding on wards was associated with staff’s use of antidepressants in another study.
An expert consensus meeting concluded that the Bipolar Disorder was more likely to be a neurodegenerative disorder than a neurodevelopmental one. One study showed a 67.1% response rate for Mirtazapine and 62.1% response rate for SSRI’s with different side-effect profiles for each. The Health in Men study found a correlation between Homocysteine levels and risk of depression. The Right Anterior Insula was activated in people with depression when anticipating depression in one study (together with the Anterior CIngulate Cortex and the Right Amygdala) perhaps suggesting a reduced ability to modify emotional responses in depression. A hydrolysed protein form of the tryptophan diet was found to have an advantage in effect on mood compared to other tryptophan diets or placebo. In an 8-week RCT of Pre-Gabalin in people with anxiety disorders there was found to be a 2-point advantage over placebo on the Hamilton Rating Scale.
Ghrelin and Obestatin secretion was found to be subtly altered in women with anorexia compared to controls. PTSD was found to influence mortality rates in people who received implantable defibrillators.
In people who had undergone CABG within the last 2 years, depression was associated with a higher rate of new cardiac events. Metabolic syndrome was associated with individual and neighbourhood socioeconomic status in women but not men while at least two pathways were found mediating a relationship between depressive symptoms and HDL-LDL levels. The Rotterdam study found that total cholesterol was positively correlated with sleep duration. The metabolic syndrome was found to be significantly associated with Beck Depression Inventory scores in one study. Paternal age was associated with impairment in social functioning if the father was less than 20 years old or over 45-years old. There was found to be an association between cognitive deficits and a number of psychiatric disorders in swedish army conscripts in one study.
Also in November I set out the basis for a model of Insular Cortex function and although it is very simple at this stage and most likely inaccurate, it at least offers a foundation to improve upon. While at first glance this may seem a little unusual, integrating newly acquired information into a model should at the very least offer a narrative sense about complex data, should allow a person to more easily remember details of studies, to make more informed choices about what they want to learn and to integrate new information more easily. There were a number of papers which were examined which could be helpful in building a model of the Insular Cortex and these include Insular Cortex Infarction in Acute Middle Cerebral Artery Territory Stroke, the Insular Cortex and Neuropsychiatric Disorders, Pathobiology of Visceral Pain, the Relationship of Blood Pressure to Subcortical Lesions, a case of ‘neurogenic’ T-wave inversion and Interoception and the Insular Cortex.
In the podcast reviews there were references to various studies including findings that peak age for researchers in terms of papers was identified as being in the 50′s or 60′s, outcome measures for the SureStart program, health inequalities in green space areas, antipsychotic trials in early-onset schizophrenia, twin studies and bereavement, eIF2 and memory, various relationships of chromsome 17 (evolution, progressive supranuclear palsy, inversion), epigenetics with transmission of maternal RNA and fish that go without sleep. There was also a look at some videos about the Productive Ward.
There were a few books reviewed including Goffman on Stigma, Fundamentals of Adlerian Psychology, Interpreting CT scans of the Head and Hyperchondriac. There were various blogs reviewed including Bipolar Mo, Neuroscientifically Challenged, Somatosphere and MindHacks. In terms of social psychiatry papers there was a focus on the Global Mental Health Series and a DOH policy paper about combating mental health stigma in the workplace. There was a study looking at the phenomenology of delirium, the Impact of Events Scale, Bereavement Theory and Art Therapy.
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