Monthly Archives: May 2009

News Round-Up: May 5th Edition

News In Brief

A combination of pain self-management and close monitoring of antidepressant treatment shows promise in treatment of comorbid depression and pain in a recent study in JAMA. In a study of 248 people (median age 82.4), 11% experienced both dysphonia and hearing difficulties and also a higher incidence of depression. Watching a video showing people with dementia interacting with others including famly was found to influence end of life planning in elderly people.A study looking at the side-effects of acetylcholinesterase inhibitors has been published recently and the author recommends increased awareness to improve recognition of side effects. A study looking at parent and children’s eating habits using the healthy eating index, found that in general there was a small association between the two and that a number of other factors influenced children’s eating behaviour although there was demographic heterogeneity within these associations. Parental violence was associated with increased risk of depression and alcohol dependence in one study and although there are many possible confounders, the authors did control for a number of variables including social stressors. The authors of a meta-analysis of randomised-controlled trials of web-based or computer based software for smoking cessation found an approximate two-fold increase in smoking cessation compared to those that tried to stop smoking alone.

A study in nature provides evidence that the theta oscillations recorded from the hippocampus do not represent synchronous firing but instead a wave progressing through the hippocampus with the phases of the oscillations coding for spatial information also. Variations in the FOXP2 gene in mice have been associated with changes in the ultrasonic pitches generated by baby mice. The FOXP2 gene is thought to be involved in speech and language in humans. The action of BDNF in the ventral tegmental area has been causally associated with opiate dependence in one study published in Science.

A 3-year project referred to as Charm is looking more closely at how people’s decision making is influenced by knowing what other people are doing. There is recent evidence that the recession is impacting on research grants in the life sciences.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

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: Jung on Typology

The featured podcast is Betts on Jungian Analytic Psychology Episode #13 and freely available here. In this episode, Betts continues his discussion of typology and focuses on how to determine the superior function. He distinguishes the introvert and extrovert and notes that:

The introvert presents themselves to the world using their second best function

Betts likens the superior function to the captain steering the ship and the auxiliary function being the first mate. So if a person is an introvert, other people will not obtain a good sense of that person from their immediate interactions. It will take some time for them to become familiar with the person’s introspective processes. Betts also gives the listener a quick guide to the functions. There then follows an interesting discussion of how functions can be undifferentiated when as in the case of extraversion they may take on a more egocentric quality akin to the properties of the unconsciousness or manifesting in the anima/animus. What was also interesting was that when using the less well developed functions the person may experience ‘ambivalence’ or ‘ambitendency’ (which I also note in some circumstances can be examples of psychopathology). However it was when Betts was reading a quote from Jung that things got really interesting. Jung had created the typing, it appears, on the basis of some assumptions. So for instance, he demarcates thinking and feeling as being mutually exclusive. Of course, on further reflection, they are not necessarily exclusive and indeed may be very closely connected. Gary Kasparov, former world chess champion describes his experience of the relationship between thinking and feeling

Emotion is a critical element of decision-making, not a sin always to be avoided…..On some occasions this anxiety created negative emotions like doubt. More often it generated greater creative tension, greater supplies of nervous tension, which is a chess player’s lifeblood

So here then is an example of the importance of emotions in a game that is classically considered to be one of abstract reasoning. The concept of the inter-relationship of thinking or decision making and emotions was explored in detail in Damasio’s celebrated book ‘Descartes Error’ reviewed here. So the question here is ‘has Jung made a mistake in clearly demarcating thinking and feeling?’. Not necessarily – as these are preferences. However if people during the process of individuation focus on developing one specifically to the exclusion of the other, then they might possibly be working against their biology. The potential significance of this issue means that it should at least be considered as a starting point for further discussion.

As always Betts is able to bring Jung to a wider audience and thereby facilitates a wider debate and enrichment of culture and Jungian analytic theory.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

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: Stu’s Views & MS News

The featured blog is ‘Stu’s Views & M.S. News‘ by Stuart Schlossman who was diagnosed with multiple sclerosis in 1998 and has put considerable effort into sharing news about multiple sclerosis with others through his blog. The homepage contains a series of links to YouTube videos on different aspects of Multiple Sclerosis located at the very bottom of the screen. The right hand panel contains links to medical sites as well as the blog archive. The first post is listed as April 2, 2007 and tells the reader about a subscription news service that is available. In this post, Stuart tells us more about his aims – to empower other people with M.S through sharing of knowledge

A particular strength of this blog is the incredible rate at which it is updated and links are made to the latest news stories. Topics covered in the news updates range from how the blood-brain barrier affects illness severity, collagenase-2 as a therapeutic target for maintaining blood-brain barrier integrity, new delivery systems for baclofen, a nationwide program in Ireland for people with MS, parallels between a benign condition – Balo’s disease and MS, and a link to an article by the National MS Society listing clinical trials in 2009. There are links to M.S organisations such as MS News, links to websites on MS, the myelin repair foundation and  MS Blogger sites. There is also a series of diary-like posts ‘Merely Me‘.

There are frequent updates on therapeutic approaches that are being trialled including an AMPA-type glutamate receptor antagonist, a trial of Maestro-o3, FTY720, BHT-3009 a DNA vaccine, SF-1019, fluoxetine, naltrexone, frampridineteraflunomide, laquinimod, functional electrical stimulation, methylphenidate, PI2301, cladribine, pioglitazone and Symadex. Stuart also shares with us his own experiences in managing his illness and engages in dialogue with the readers for instance when he takes a brief hiatus from his medication. As the blog is written for people with M.S, there are a number of articles which inform the reader about the basics – what is myelin?, various hints and tips about injections, facial pain, vertigo, common questions about MS, assistive devices and types of MS. Along the way, Stuart includes humorous clips to entertain and complement the other posts.

This is an excellent blog by Stuart Schlossman which contains a vast amount of information on MS including links to organisations, basic information about MS as well as recent research developments.

Conflict of Interest

One of my articles was linked to in this blog.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

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: Stroke. Epidemiology, evidence and clinical practice.

The book reviewed here is  ‘Stroke. Epidemiology, evidence and clinical practice’ by Shah Ebrahim, a professor of epidemiology of Aging and Rowan Harwood, a consultant in geriatric medicine. The authors have accumulated a vast knowledge in this area and this shows in the detailed evidence based discussions that occur in the clearly structured sections of the book.

The book starts with an introduction to economics and epidemiology giving the reader an overview of some of the discussion that follows. They consider risk factors, looking at causality including the Kock postulate and Hill’s criteria before looking at different aspects of individual and population risk as well as confounding factors. Variation in disease patterns across places and times are examined next and various risk factors for occlusive and hamorhagic stroke are discussed including the intriguing association of stroke with ‘febrile illness’ and the season of the year. The authors then go on to the issue of diagnosis looking at various diagnostic measures such as specificity and senstivity and also covering vascular dementia. Here they not that that

From the pointof view of stroke epidemiology it is reasonable to consider vascular dementia as a presentation of stroke and where technically feasible and clinically appropriate to reduce remediable vascular risk factors‘.

There is quite an interesting look at some of the literature on diagnostic accuracy which considers the influence of clinical setting and physician characteristics amongst other factors. They also look at the closely related area of  clinical disagreement. Certain symptoms, from their review, seem to improve agreement such as dysphagia and deviation of eyes. They look at investigtions covering some of the difficulties in interpreting CT scans as well as some disagreements that have occurred with reporting particularly with lesions location. They also look at attempts at standardising the reporting procedure and decision-making trees for CT scan diagnosis and MRI as well as  investigation of the carotid arteries.

In the third part, the authors cover management of stroke with prevention, acute treamtents, rehabilitation and preventing recurrence. In keeping with the general theme of the book, the authors provide a structured evidence-based approach to prevention and along the way pose the question of whether a patent foramen ovale should be closed? The authors then consider acute management the domain of the hospital specialist. The authors then cover rehabilitation with inpatient rehabilitation, early discharge and domiciliary rehabiliation again examing the supporting evidence in some detail. The authors then look at preventing occurrence including long term anticoagulation as well as carotid endarterectomy.In terms of prognosis the chapter on mortality usefully considered the value of  prediction highlighting important factors such as urinary incontinence and disability which may however represent stroke severity. Recurrence. The authors also look at the effects of stroke including psychiatric and physical consequences followed by prognosis and carers.

This is a clearly structured examination of the many aspects of stroke, from epidemiology through to diagnosis and treatment which looks closely at the supporting literature.

References

Shah Ebrahim and Rowan Harwood. Stroke. Epidemiology, evidence and clinical practice. Second Edition. Oxford University Press. 1999  (2001 Reprint).

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

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.

Review: Software Support for Huntington’s Disease

The featured paper is ‘Software Support for Huntington’s Disease’ by Conneally and colleagues and freely available here. I have included this paper under the social psychiatry category as it examines the effects of changes in technology on understanding of an illness – Huntington’s Disease. The authors describe the MEGADATS database which was developed to help the researchers enter pedigree information from the Huntington’s Disease Research Roster into a database. At the time of the study, the roster had information on nearly 92,000 people – quite a remarkable number and testimony to the dedication of the team organising this roster which started in the 1979 (the website can be found here and at the time of writing contained 134,000 individuals). The authors go on to describe the types of information that are stored in each of the MEGADATS and Roster databases as well as the possibility of passing queries across both databases. The authors then describe the complexities that arise from having such a large database particularly when a person can be included in two pedigrees as a result of marriage to a partner from an affected pedigree. The authors then cover some of the more technical aspects of the software-hardware interface such as printing which are most likely quite dated now. However in the conclusion the authors cover some of the remarkable accomplishments that have been contributed to by the establishment of these databases including the identification of the candidate gene on the short arm of chromosome 4 as well as identification of heterogeneity in the disease.

In summary this is a descriptive paper, showing some of the significant ways in which the establishment of a registry and databases for analysing data has ultimately had an impact on people’s lives through the effects of the gene discovery.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

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.

Review: Familial Psychiatric Presentation of Huntington’s Disease

The featured paper is ‘Familial Psychiatric Presentation of Huntington’s Disease’ by Lovestone and colleagues and freely available here. In this paper the authors report a family, several members of which have either established or presumed Huntington’s Disease.

(Professor Metwally has a very good site on neurology here and has two videos on YouTube showing choreiform and ballismus movements.

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A description of a family pedigree as presented here can effectively be thought of as a case series where all members are immediate family members. As a case series this study would have a number of limitations including selection bias, lack of operationalised psychometric outcome measures, occasional use of second person accounts for the history, a heterogenous approach to data collection and the retrospective nature of material. Nevertheless despite all of this the study is rich in content. We see that two male members of the family developed psychosis – one involving auditory hallucinations and the other what appears to be a possible somatic hallucination (although it is difficult to tell). Two of the female members develop depression. Also SPECT data is available on one person and shows frontal hypoperfusion before any other evidence of illness is identified. Here we can with this dataset start to generate hypotheses which is where it starts to get really interesting. Generating some of these hypotheses does of course start on the shakiest of foundations. For instance, can we say that during the prodromal phase that males may develop perceptual abnormalities and females may develop disturbances of mood. Such a hypothesis would need to be tested in a larger study or alternatively a literature search may identify relevant data. Another hypothesis that could be tested is whether SPECT frontal hypoperfusion deficits are a surrogate marker for the prodromal phase of the illness and whether there is a correlation with psychosis or affective disorders.  The authors are understandably cautious and cover all bases with their hypotheses  which includes the possibility of the psychosis in family members resulting from a confounder for instance in linkage disequilibrium.

The authors have produced an interesting paper containing various types of data for hypothesis generation for testing in studies with relevant methodology.

STT5

Steps To Treatment (STT)

STT = Steps To Treatment. An estimate of the number of steps between the results and translation into treatment. This is an opinion.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

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.

Review: SPECT, MRI and Cognitive Dysfunction in Multiple Sclerosis

The featured article is ‘SPECT, MRI and cognitive functions in multiple sclerosis’ by Pozzilli and colleagues and freely available here. The aim in this study was to clarify the distribution of 99mTc HMPAO (used as a marker of cerebral blood flow) in the brains of people with relapsing-remitting multiple sclerosis with ‘mild physical and cognitive disturbance’. The authors selected 17 people with Multiple Sclerosis from a Multiple Sclerosis outpatient clinic. However the selection criteria aren’t clear – there is no mention of consecutive patients being considered or random assignment otherwise.  The exclusion criteria are clearly stated as those with chronic progressive illness and MMSE scores less than 23 or a score greater than 4 on the Kurtzke Expanded Disability Status Scale. There is some information on the sample demographics/scores with an average MMSE of 28.5. I wasn’t able to identify power calculations for estimating sample size.

A neuropsychological test battery was administered including verbal memory digit span component of the WAIS and measures of auditory and visual memory amongst others. 17 people with Multiple Sclerosis but without cognitive impairment were selected matching for basic demographics. Patients underwent an MRI scan using a 1.5 Tesla scanner and a neuroradiologist who was blinded to the diagnosis rated the white matter lesions. The lesions were classed as single or confluent. The area of the corpus callosum was identified by what sounds like manual demarcation on the imaging software. I wasn’t clear on how the ‘graphic table’ worked but presumed that the software had a function for calculating areas that had been demarcated. SPECT scans were also obtained and rated by investigators blind to the diagnosis. The researchers chose several regions of interest and ‘normalised’ the data. This involved dividing the activity in voxels by the average whole brain voxel activity.

Here’s a link to an Open University video on SPECT being performed on the heart which shows the general principles of SPECT.

On the neuropsychology tests the MS group performed significantly worse than controls on language tests, short term verbal memory, rey auditory verbal learning and figure memory. However a number of the cognitively impaired patients were unable to complete some of the tests.

The Mann-Whitney U test was used to analyse the lobar asymmetry values presumably because the data was ranked after being normalised. The Mann-Whitney U test is being used for comparison of ordinal unpaired data to see if they come from the same distribution. Here’s a video on YouTube that covers the Mann-Whitney U test (albeit at the end) and also with some focus on the software being used.

For the SPECT and MRI data, there were only a few significant differences between the groups. Thus there was a significantly larger third ventricle index value in the cognitively impaired group, and significantly larger asymmetric cerebral blood flow values in the control group in the parietal and temporal lobes compared to people with cognitive dysfunction. The authors concluded that the auditory test was one of the most sensitive at picking up memory impairment. It wasn’t clear if this was related to the significant differences they found in the cerebral blood flow in the temporal lobe in the two groups. They also commented on the most sensitive associations with cognitive dysfunction being the corpus callosal area and third ventricle width which itself might reflect atrophy of related areas. The sample size is relatively small and it would be interesting to see if these findings were replicated on larger sample sizes. The corpus callosal fibres obviously interconnect the hemispheres but does this reduction simply mean that there are less connections and that this results from the disease process. As this is a cross-sectional study we don’t know if these findings are independent of the disease process itself.

This is a small study which generates testable hypotheses for use in further studies.

STT4 (larger replication study with confirmation of findings, construction of appropriate rehabilitation strategy, intervention with appropriate rehabilitation strategy in further trial and if successful, incorporation of treatment strategy into policy)

Steps To Treatment (STT)

STT = Steps To Treatment. An estimate of the number of steps between the results and translation into treatment. This is an opinion.

Responses

If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk

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.