Monthly Archives: December 2008

Mental Capacity Act 2005 Deprivation of Liberty Safeguards

The featured paper is a Department of Health consultation document on the Deprivation of Liberty Safeguards entitled ‘Mental Capacity Act 2005 Deprivation of Liberty Safeguards: consultation on the Mental Capacity (Deprivation of Liberty: Monitoring and Reporting) and (Deprivation of Liberty: Standard Authorisations, Assessments and Ordinary Residence) (Amendment) Regulations 2009 and which is freely available here.

The document is a brief but interesting one which contains a set of questions for the reader and an invitation for the reader to submit feedback before the deadline in January 2009. Essentially the Deprivation of Liberty Safeguards are a set of safeguards that are applied to people who have or might have their liberty restricted through the use of the Mental Capacity Act. This arose in response to a European Court of Human Rights Judgement on the case HL v UK 2004. This consultation document covers a number of proposed amendments.

The Deprivation of Liberty Safeguards on the Care Quality Commission (CQC) is being set up to oversee the implementation of schedule A1 to the Mental Capacity Act and within the document is the proposal that this commission should prepare a periodic report on the implementation. The requirements of the assessors are also stipulated in terms of indemnity and insurance.

There is also a proposal that the commission is able to visit hospitals and care homes, interview people within care homes and hospitals and also expect reports to be prepared on request by the care homes and hospitals.

It can be argued that whilst there will be increased bureaucracy from the implementation of this amendment to the Mental Capacity Act there will be expected to be a corresponding increase in resources allocated to the consideration of these issues in patients. While it can be argued that such actions already take place without the need for formalisation, the act of formalising the process brings its own benefits.

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.

Predictors of Driving Cessation in Mild-To-Moderate Dementia

The featured paper is ‘Predictors of driving cessation in mild-to-moderate dementia’ by Herrmann and colleagues. This paper is by a group of Canadian Researchers and in the context of estimates of 500,000 Canadians with dementia by 2021. They also cite the American Academy of Neurology which provides clear guidelines for driving cessation using Clinical Dementia Ratings. The authors wanted to examine the factors which cause people to stop driving.

The researchers sampled 883 patients over the age of 60, living in the community with a diagnosis of dementia (DSM-IV criteria) and Global Deterioration Score of less than 5 indicating mild dementia. A number of cognitive measures were used including the Modified Mini-Mental State Examination and the Neuropsychiatric Inventory in a 3 year follow-up period. Test centres involved physicians from different disciplines – General Practice, psychiatry and neurology.

The average age of the sample was 77 years with a mean Mini-Mental State Examination Score of just under 22. 28.2% were still driving and 516 people were no longer drive. Of these people 4.7% had been involved in a ‘motor vehicle collision’ and 11.6% had their licenses revoked. A Cox survival analysis was performed to look at the factors associated with people remaining as drivers. At baseline nearly 3/4 of the drivers remaining were men and the factors that predicted cessation of driving included MMSE, GDS stage and behavioural problems (using the NPI). The items from the NPI which had the greatest significance were agitation/aggression (which reduced the likelihood of cessation), hallucinations and apathy (increased the likelihood of cessation). The authors suggest reasons for the NPI item associations with hallucinations being a marker of disease severity, apathy being likely to lead to cessation and aggression potentially leading to less direct communication about driving from others although each of these suggestions could form the basis for further research to assess their validity.

This is an important area of research and this paper provides some interesting results.

STT2

References

Herrmann N, Rapoport M, Sambrook R, Hebert R, McCracken P, Robillard A, for the Canadian Outcomes Study in Dementia (COSID) Investigators. CMAJ. 2006. 175(6). 591-595.

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.

MRI Measures of Temporoparietal Atrophy During Prodromal Alzheimer Disease

The featured paper is ‘MRI measures of temporoparietal regions show differential rates of atrophy during prodromal AD’ by Desikan and colleagues.

The authors cite evidence for atrophy of temporoparietal regions in longitudinal studies in people with Mild Cognitive Impairment (MCI) who progress to Alzheimer Disease and this study is a logical progression from these previous findings.

66 people were selected from a larger group of 339 people recruited from the media. The inclusion criteria are not given but instead the reader is referred to another paper. In essence this means that another paper is required for a more detailed appraisal of this study. People were stratified according to their status at entry into the study and subsequent conversion to MCI or probable Alzheimer Disease (AD). The authors state that there was a difference in age between those who converted from MCI to probable AD and those with MCI at baseline and follow-up (non-converters) and that there was no difference in other demographic or genetic variables. Inspection of the table in the appendix revealed a difference of two years between the groups. A 1.5 Tesla scanner was used for image acquisition. The follow-up scan protocol varied between groups. Thus for controls and non-converters comparison occurred at 3 years whilst for those that converted it was as close to the time of confirmed diagnosis as possible. 14 regions of interest were identified from the temporoparietal region and a ‘Free Surfer’ Software package was used for analysis. The authors used published boundary definitions to validate their regions of interest. The authors used the MANOVA to evaluate annual atrophy rates in the regions of interest using the different groups as variables.

There were six regions of interest which were found to differ between converters and non-converters these being

Hippocampus (large effect size)

Temporal Pole (large effect size)

Entorhinal Cortex (large effect size)

Fusiform Gyrus (large effect size)

Middle Temporal Gyrus (large effect size)

Inferior Temporal Gyrus

Interestingly there was no difference between non-converters and controls in regions of interest.

Converters and controls differed in the following regions

Hippocampus (large effect size)

Entorhinal Cortex (large effect size)

Temporal Pole (large effect size)

Middle Temporal Gyrus (large effect size)

Fusiform Gyrus (large effect size)

Inferior Parietal Lobule

The authors found that three areas in particular – hippocampus, temporal pole and entorhinal cortex were particulary effective in disciminating between converters and non-converters and controls. The atrophy rates in these regions were also correlated with clinical severity and the rates for these three regions were aggregated to produce a more effective predictor of conversion. The authors also corrected for age and found that this did not alter the findings for the three regions described above.

The study provides useful evidence of regions that might be implicated in conversion to Alzheimer Disease and which fit with other lines of evidence for pathogenesis. It will be interesting to see if these findings are replicated and the impact that this will have.

STT 3

References

Desikan R, Fischl B, Cabral H, Kemper T, Guttmann C, Blacker D, Hyman B, Albert M and Killiany R. MRI measures of temporoparietal regions show differential rates of atrophy during prodromal AD. Neurology. 2008. 71(11). 819-825.

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.

News Round-Up: December 2008 4th Edition.

There is a report on a new measure of atrophy in the Medial Temporal Lobe and it’s use in predicting dementia as well as a case report on blindsight.

Dementia

A new visual scoring system for rating atrophy of the Medial Temporal Lobe has been tested in a study of people with probable Alzheimer Disease (n=53), no cognitive impairment (n=117) and non-amnestic mild cognitive impairment (n=46). People with no cognitive impairment were used as the reference group and the use of a cut-off score of 1.33 on the MTA score showed 85% sensitivity and 82% specificity for probable Alzheimer Disease (STT2).

Psychosis

A reduction in grey matter volume in frontal, temporal and parietal regions was found in people with at risk mental state who went on to develop psychosis in one study involving 20 people (10 people developing psychosis) (STT4). A post-mortem study found decreased neuronal cell number in layer 2 of the dorso-caudal region of the insular cortex in schizophrenia relative to controls (STT4). In another study there was found to be a reduction in putamen volumes bilaterally in people with schizophrenia (STT4). In a secondary analysis of 240 people with first episode psychosis there was found to be remission in 36.7% (remission being correlated with many factors including increased symptom change with time).

Miscellaneous

There was widespread reporting on a man with blindsight who was successfully able to navigate objects in a corridor. This presumably represents unconscious processing in intact accessory visual pathways.

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.

Podcast Review: John Betts on Jung – Episode 2

The featured podcast is the 2nd in John Betts series on Jungian Psychology. Betts narrates clearly and through his explanations, the concepts are easy to understand. Betts tells that we need to learn 100 new words in order to be able to talk comfortably about Jungian Psychology. The topographical model of the psyche is then discussed in which the consciousness, personal unconsciousness and collective unconsciousness occupy progressively lower levels on a triangle which in turn is encompassed by the body. I do have some reservations about the term ‘body’ although it is used very briefly here. Bodily feelings are also referred to as interoceptive and discussed by Craig in his excellent article on interoception reviewed earlier. Their representation in the brain particularly in areas which have close interconnections with those subserving the suggested functions of the ego mean that the term ‘body’ is in need of a tighter definition.

Betts then discusses the ego, the psychological structure which imposes order on our conscious experiences. The ego is described by Betts as having five functions in Jungian psychology

1. Stability of Personality

2. Stability of Identity

3. Cognition

4. Executive functioning

5. Reality testing

Interestingly it could be argued that these are functions of the frontal cortex although it would be necessary to see how these functions have been arrived at – in other words were these Jung’s original intentions or were they subsequent developments influenced by cognitive neuroscience. Regardless of how it is arrived at, Betts offers us some interesting insights using this conceptualisation. For instance, personality disorders are considered and discussed in terms of an instability and it is this instability that causes other people to have difficulty in relating to that person. Betts then discussed structures at the unconscious level – complexes which are  associations of theme-based feelings which can occasionally enter consciousness resulting in a ‘complexing out’. Betts then considers structures at the level of the collective unconscious with archetypes, looking particularly at their manifestation through symbols. This episode offers some valuable structure around which to build other elements of the theory and it is clear that a lot of thought has gone into making this accessible.

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.

TAWOP Featured Blog List 2008

Here is a summary of the blogs that have been reviewed to date. To go to a more detailed review  just click on the main links below and for the blogs themselves just click on the link at the end of the summary. If you think there are any blogs that should be included, you can add your suggestion as a comment.

Psychiatry Blogs

Ars Psychiatrica. Psychiatrist Dr Neil Scheurich looks at the intersection between the arts and psychiatry. There are lots of interesting articles (blog link here).

Carlat Psychiatry Blog. Blog by psychiatrist Dr Dan Carlat examining the relationship between pharmaceutical companies and medical education (blog link here).

Shrink Rap Blog. Engaging psychiatry blog by three psychiatrists with lots of interesting articles (blog link here).

The Psychiatrist Blog. Blog by Dr Michelle Tempest looking at the intersection between psychiatry and politics (blog link here).

Psychology Blogs

Clinical Psychology and Pscyhiatry. A closer look. Blog providing a critique of psychiatry and psychology research (Blog link here).

CogSci Librarian Review. This is a blog by a librarian with an interest in cognitive neuroscience. Lots of useful insights into the resources librarians offer as well as cognitive neuroscience links (Blog link here).

Dr Deb. A psychology blog with articles covering many different areas and which are accessible for a general audience (Blog link here).

Mind Hacks. Popular long-running blog looking at psychology and neuroscience issues (Blog link here).

PsychCentral. Heavyweight longstanding psychology blog by Dr John Grohal who also runs a forum at his website (Blog link here).

Blogs looking at Pharmaceutical Issues

Furious Seasons. Blog by journalist Philip Dawdy who has Bipolar Illness and writes about a number of issues relating to psychiatry and pharma (Blog link here).

Pharma Blog. Blog looking at pharmaceutical news giving a broad overview of developments in the field (Blog link here).

Blogs about Life with an Illness

Aethelread the Unread. Insightful blog by Aethelread who has recurrent depression and writes engagingly about a number of issues (Blog link here).

Bipolar Mo. Blog by a nurse with Bipolar Illness who is also a musician writing about aspects of his life (Blog link here).

Neuroscience Blogs

All in the Mind. Blog by science journalist Natasha Mitchell who also features in the radio show of the same name (Blog link here).

Brain Stimulant. Blog looking at many interesting neuroscience articles including neural prosthetics and computational neuroscience (Blog link here).

The Mouse Trap. Blog by polymath Sandeep Gautam on neuroscience topics as well as interesting theories that he is developing (Blog link here).

Neurocritic. Nice blog with critiques of neuroimaging studies and insights into neuroscience (Blog link here).

Nursing Blogs

Mental Nurse. Enjoyable blog by a group of mental health nurses with a range of perspectives on mental health issues.

Sociology Blogs

Everyday Sociology. A blog on sociology by a group of sociologists giving insights into contemporary events (Blog link here).

Art Therapy Blogs

Sara Roizen. Fine art muralist. A creative blog by artist Sara Roizen who is training to become an art therapist (Blog link here).

Occupational Therapy Blogs

ABC Therapeutics Weblog. Fascinating and at times poignant blog about occupational therapy with heavyweight analysis (Blog link here).

Anthropology Blogs

Somatosphere. Science, medicine and Anthropology. Looking at medicine and science from an anthropological perspective (Blog link here).

Genetics Blogs

The Genetic Genealogist. Blog by a geneticist covering genealogy and related topics in genetics  (Blog link here).

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.

CogSci Librarian Blog Review

The featured blog is ‘CogSci Librarian‘ by Stephanie Wilson Brown an electronic resource librarian at the University of Connecticut. Brown has an interest in the cognitive neurosciences which is reflected in her posts. As a librarian, unsurprisingly, Brown highlights many useful and sometimes esoteric resources on the internet including as examples a list of the 100 most influential works in Cognitive Science, Philosophy resources (including ‘cognitive philosophy’), an article on PrimateLit and psychology books online. There are a number of interesting posts on comparative neurobiology including the Avian Theory of Mind, Gorillas use of Tools, the influence of snakes on primate visual evolution and why elephants are like humans. Brown tells us why she blogs in Another reason I blog which includes highlighting local resources for her place of work as well as letting people know more about library services. Another article about blogging –  science blogging – covers briefly some ways in which ‘scientese’ is translated into plain english and includes mention of a chemistry blog which brings open collaboration online (an alternative to the open collaboration internet model being developed on this blog). Brown also covers a number of other topics of interest in cognitive neurosciences identifying resources and examples include studying the placebo effect with neuroimaging, a Lecture on consciousness, Gratitude is good for you, Managing complexity, reading fiction and the effect on empathy and the Perception of magic. This is a blog with lots of useful links to Cognitive Neuroscience posts which also gives the reader insights into the work of librarians and the resources that they bring.

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.