Monthly Archives: April 2010

Blog Review: Beaker – A Medical Research Blog

The blog reviewed here is ‘Beaker – A Medical Research Blog‘ which I came across from one of Boraz’s Twitter posts.

Appearance and Design

The blog features a grey background with a diagonal white lined design. The central pane containing the text has a white background. The title pane features a photograph of two scientists focusing on a task next to the title of the blog. The articles are of a good length, informative, titled with author details, comment enabled , tagged and posted in specific categories. The articles are generously illustrated with high quality and relevant photographs including micrographs. There is one caveat however. In many of the articles, the reader must click on the ‘read the rest of the entry’ link at the bottom of the summary for each post in order to read the full post. The blog can be navigated using functions in the right hand panel – according to tags, categories and recent posts. There is also a search box. There are external links as well as a link to donate to the Sanford Burnham Institute.

Content

As would be expected from a large institution, there are frequent events (e.g visits by influential figures to the institute) and reports on research studies that are being undertaken. In this post for instance, the author succinctly describes an approach to designing new molecules that is being pursued at the institute by one researcher.  This post explains the role of messenger RNA and refers to a symposia on mRNA being held at the Institute.  As the blog is relatively young there are 15 posts at the time of writing.

Conclusions

This is a young blog which demonstrates how an institution can effectively represent itself through the use of social media. Indeed with a large number of employees and students, an Institution has a marked advantage if it is able to efficiently leverage its resources through the medium of social media. For the reader, the posts are well written and offer insights into the interesting research that is being undertaken at the Institute. This blog would particularly appeal to those interested in working or studying at the institute, readers with an interest in research or those interested in representing their institute through social media.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. 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: Learning From Experience

The paper reviewed here is ‘Learning from Experience’ by Jerry Tew, Colin Gell and Simon Foster and freely available here. This is a 66-page document which outlines material useful for course instructors in higher education mental health courses to enable the involvement of service users and carers in service development. The intended audience is somewhat wider however and this is explained more fully in ‘The Purpose of the Guide’. The authors then discuss how students typically learn about mental health subject matter in courses such as medicine and psychology. Forming a partnership with service users and carers is then contextualised in ‘Setting the scene’ where it is identified as one of the ten essential shared capabilities by the National Institute for Mental Health in England. They go on to write that

Service users and carers have a unique contribution to make to training in core professional skills, such as listening, communication, empathy, advocacy and offering counselling or advice

They further write about the experience of involving service users in the teaching thus

Also it requires a humility that allows teaching staff to give up any vestiges of a superior ‘expert’ status based on ‘knowing best……..Teaching staff may learn new knowledge, skills and ideas from the service users and carers with whom they are working, and benefit from ongoing and constructive challenges to their value base

Potential benefits for service users are also discussed including the contribution that this can make to recovery.  The authors include a useful section ‘Pointers to good practice’. In the third section, the authors present the multiple ways in which service user contribution has been realised. These approaches range from inclusion in training through to e-modules, drama and experience sharing. There is also a discussion of how service users can contribute to course planning with examples as well as for student selection, student assessment and course participation. The authors then discuss some of the practical aspects of implementing these suggestions identifying possible barriers as well as presenting a template. They look at issues such as capacity, infrastructure and employment or contracting. The authors then include a section on evaluation with some useful feedback forms included. The document finished with the conclusions and appendix.

This is a useful document for organisers/trainers of mental health courses. Some of the suggestions here would be suitable for application in service development also.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. 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: Differentiating Cognitive Profiles of Illnesses in Later Life

The paper reviewed here is ‘Differentiating the Cognitive Profile of Schizophrenia from that of Alzheimer Disease and Depression in Later Life’ by Mulsant and colleagues and freely available here. In the abstract the authors conclude that

Patients with LLS (Late Life Schizophrenia) have a different cognitive profile than patients with AD (Alzheimer’s Disease) or DEP (Depression in later life). Particularly, memory impairment in LLS seems to be more pronounced in learning than recall

Method


  • All cases referred to a memory service for consultation were analysed. I wasn’t absolutely clear if this was done retrospectively or prospectively but from the wording it seemed to be retrospective.
  • People referred to the service underwent psychiatric and neurological assessments and DSM-IV criteria were used for the diagnoses
  • All people referred to the service underwent the following neuropsychological test battery as routine and these test scores were included in the analysis
  1. Animal Fluency
  2. Boston Naming Test
  3. Clock Drawing Test – Freedman Scale
  4. California Verbal Learning Test II – Short Form (CVLT)
  5. Dementia Rating Scale-2 (DRS)
  6. FAS Letter Fluency (FAS)
  7. Luria Alternating Diagrams
  8. Mini-Mental Status Examination
  9. Trail Making Test A and B
  10. Wisconsin Card Sorting Test – 64
  • It didn’t look as though a single specific hypothesis was being tested. Instead the demographics and cognitive test results from the different groups – DEP, AD, LLS and control group were being compared.
  • In the first phase of the statistical analysis, ANOVA was used.
  • When differences between groups were identified using the ANOVA, a Bonferroni correction was made for multiple comparisons
  • Cohen’s D was used for differences between the LLS and other groups

Results

  • LLS (n=25)
  • AD (n=15)
  • DEP (n=15)
  • NC (n=12)
  • I thought Figure 1 was a very useful summary of the data and quite intuitive. The Late onset Schizophrenia group are acting as the reference group. In this diagram, group differences at p<0.001 are highlighted with ***. From looking at differences of this significance I noted the following
  • The LLS group were significantly better on a number of memory tasks than the AD group
  • The control and DEP groups were significantly better than the LLS group on the FAS, DRM memory, WCST categories, CVLT short and long delay free recall
  • I wondered if the latter findings were tapping predominantly into frontal lobe function and the AD group findings into medial temporal lobe function

Discussion

  • In the discussion, the authors comment on the hierarchy of memory impairment across groups
  • The researchers note that the groups have small sample sizes which would reduce the power of the study
  • They note the memory impairment of the LLS group compared to the DES and control groups on a number of memory tasks

I thought this was a neat study, showing how service data can be effectively utilised to examine group differences in cognition. This research approach should be reproducible across other services although the components of the test battery will vary. Even so, examination of group differences including vascular dementia and frontotemporal dementia using different test batteries would be valuable.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. 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: Retrospective Analysis of Rivastigmine for Alzheimer’s Disease with and without Hallucinations

The paper reviewed here is ‘Effects of Rivastigmine in Alzheimer’s Disease Patients With and Without Hallucinations’ by Jeffrey Cummings and colleagues and freely available here. In the abstract, the authors write that

Hallucinations predicted greater treatment responses to oral Rivastigmine

In the introduction, the researchers cite evidence that a cholinergic deficit is associated with hallucinations in Lewy Body Dementia and Parksinons’ Disease with Dementia. The  evidence of this association between cholinergic deficits and hallucinations forms the rationale for the current study where the researchers are investigating the effects of Rivastigmine on hallucinations in people with Alzheimer’s Disease.

Method

  • The researchers pooled data from two clinical trials although I wasn’t clear on how these studies were selected. There may be a bias towards a positive effect as unpublished negative studies may not have been included in this analysis.
  • The 2 studies were randomised and placebo-controlled
  • The ADAS-cog was used as a primary outcome measure
  • The Clinician’s Interview based impression of Change plus Caregiver impression was also used as a primary outcome measure
  • The presence of hallucinations were identified using the BEHAVE-AD (Behavioural Pathology in Alzheimer’s Disease Rating Scale) and confirmatory analysis was undertaken on the change from baseline at 26 weeks
  • Physical illness was not an exclusion criteria unless severe
  • Participants continued on medication for comorbid physical illness and thus the populations better approximated that which would be expected in clinical practice
  • Use of psychotropic medication was an exclusion criteria (albeit with a small number of exceptions)
  • Both trials were of 6 months duration
  • Rivastigmine capsules with flexible dosing up to 12mg/day in 2 divided doses were used
  • The lower target dose of Rivastigmine was excluded from this analysis although I wasn’t clear on the reason for this
  • The ANCOVA and ANOVA were used in the statistical analysis

Results

  • 1424 subjects were included in the analysis
  • Mean age was 73.2 years
  • Mean duration of dementia was 39.1 months
  • 23% of patients on Rivastigmine reported hallucinations at baseline
  • 19% of patients on placebo reported hallucinations at baseline
  • The researchers write that ‘At 6 months, a mean improvement of 0.5 points on the ADAS-cog was seen in patients with hallucinations at baseline treated with rivastigmine, while patients without hallucinations at baseline showed a 0.3 point decline’. The improvement in ADAS-cog scores in the AD group with hallucinations was significant at below the 5% level.
  • There was a greater decline in the placebo hallucinator group compared to the placebo non-hallucinator group

Discussion

The researchers note a small and statistically significant effect of Rivastigmine in improving ADAS-cog scores in people with AD and hallucinations. They also note an increased decline in ADAS-cog scores in the subjects with hallucinations at baseline and they speculate about the role of the basal forebrain acetylcholinergic projections. In order to further test the cholinergic hypothesis of hallucinations, I thought it would be interesting to include all acetylcholinesterase inhibitors in all forms (e.g capsules) to further explore the hypotheses generated in this paper.

Acknowledgements

The diagram above is by author Ju and denotes the chemical structure of Rivastigmine. The image is in the public domain and further details can be found here.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. 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.

News Round-up: April 2010 3rd Edition

Miscellaneous

  • A small PET study shows evidence of hypometabolism in the Superior Temporal Gyrus in people with Temporal Lobe Epilepsy (TLE) with deja vu compared to healthy controls and people with TLE without deja vu
  • The authors of a paper in the open access journal Trials look at unpublished Stroke trial data which if published has the potential to influence practice

Research in Dementia

  • Donepezil in a 24-week placebo-controlled trial in Vascular Dementia with ADAS-cog primary outcome and differential effects according to hippocampal volume (n=974)
  • Negative finding of association between metabolic syndrome and risk of dementia (n=749)

Psychiatry 2.0

  • There is another episode of Spike Activity with links to an article on the relationship between dreams and memory and a podcast featuring interviews with artists explaining how they visualise their artwork.
  • At the Mental Nurse blog there are a number of interesting blog links  including a review of a BBC documentary on medication
  • Dr Shock reviews a study investigating the relationship between Facebook use and academic performance
  • At the Singularity Hub blog there is a discussion of a recent study suggesting that 15% of the variation in intelligence in Williams Syndrome is associated with a single gene – STX1A
  • At the Somatosphere blog there is a review of a recent book on the globalisation of mental health
  • At the ‘All in the Mind’ blog there is an article on a recent mock trial in which the role of neuroscience is examined
  • A the Citation Needed blog there is a review of a recent study with negative findings on ‘Brain Training’ programs

Evolutionary Psychiatry

Neanderthal Man

Did the Neanderthal contribute to modern human populations?

In a widely reported study (see here, here and here) presented at the American Association of Physical Anthropologists, researchers looked at regions of DNA in the genomes of 1983 people from Europe, Asia, Africa, the Americas and Oceania. These regions are known as microsatellite regions and vary between populations. By looking at the degree of variation, the researchers were able to produce a corresponding evolutionary timeline factoring in variables such as estimated mutation rates. The researchers predicted two time periods during which interbreeding with another species was necessary to account for their findings. These periods were 55,000 years ago for the Eastern Mediterranean and 45,000 years ago for Eastern Asia. The candidates for interbreeding include Homo Neanderthalensis and Homo Heidelbergensis. Such interbreeding could potentially explain the recent finding of a possibly previously unknown hominin – Denisova hominin – found in Siberia. The estimated periods of interbreeding also correspond approximately to the finding of pigmentation on clam-shells in Spain which are thought to have been used as body paint by Neanderthals. Needless to say if these findings are confirmed by a soon-to-be complete analysis of the Neanderthal genome then they would have wide ranging implications. The period of approximately 60,000 years ago corresponds to the lower limit of a hypothesised bottleneck of human evolution in which the human population may have been on the verge of extinction with only a few thousand members although this is a controversial hypothesis.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. 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: Spread the Word

The blog reviewed here is ‘Spread the Word. EMDR transforms trauma‘. In the about section, the philosophy underlying the blog is explained. The blog draws on the contributions of the wider EMDR community to highlight aspects of  EMDR ranging from successful application through to practical tips.

Appearance and Design

The background for the blog is dark blue with a central white pane. The title pane features a blue flower design with the title of the blog. Immediately beneath the title pane there are links to the home page and the about section. On the right hand side of the central pane lie the categories index, a search bar and links to external EMDR sites. The categories index features a limited number of categories and communicates the simple and effective organisation of the blog. Posts are comment enabled, dated and include category tags. They are typically text-based and a paragraph or several paragraphs in length.

Content

At the time of writing there are 13 posts in total. The introductory post stipulates that contributions should be a minimum of 200 words in length. This post by Dana Terrell sheds light on the origins of the blog and how she was introduced to EMDR. Several posts detail people’s experience of EMDR. For instance this post is about the use of EMDR for improving success at job interviews while this one describes an application in pain management.

Conclusions

This recent blog about EMDR contains 13 posts but already effectively conveys a lot of the enthusiasm of the posting EMDR practitioners. The posts are generally fairly brief but effectively convey useful information such as the application of EMDR in specific situations. This will be a useful blog to follow for EMDR practitioners or those with an interest in this area

Conflict of Interest

The author has undergone training in EMDR.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. 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: BioTorrents. A File Sharing Service for Sharing Scientific Data

The article reviewed here is ‘BioTorrents: A File Sharing Service for Sharing Scientific Data’ and available at Plos One as an open access article. This is a brief article which outlines the features and potential benefits of BioTorrents and is written by the authors of the software.

There is a clear introduction which outlines why BioTorrents is needed. Essentially in a network, relying on a single node (or server/computer) to distribute data to all of the other nodes in the network is less efficient than using many nodes in the network to distribute that data. This BitTorrents approach works because there is a successful protocol which involves labelling the data so that nodes in the network ‘know’ what data the other nodes have. This approach was developed for BitTorrents initially and was used for distributing generic data. However due to copyright issues of the distributed material on these generic networks, servers were shut down and hence these networks were to some extent unreliable due to the pragmatics of their operation rather than the underlying technology. Hence the BioTorrents variation on the theme in which only legitimate scientific data is transferred across the network thus avoiding the reliability issues described above. The result is that BioTorrents is a useful approach for sharing large scientific datasets across networks and the authors cite large genomic datasets as an example of the data that can be usefully transferred in this way.

I wasn’t clear on the aims of the paper and this is perhaps reflected in the absence of a methodology section. In effect, I think the article is to some extent is a description of the journey of the authors from the identification of the needs through to the construction of BioTorrents and their subsequent observations of the BioTorrents in action. However the structure of the paper is a fairly minor point and instead the technology that is being presented is fascinating and extremely useful.

Screenshot from the website (http://www.biotorrents.net/)

I navigated to the site (see address above) and found it was well organised and easy to understand. There is a FAQ section and the data is hosted on a server at the laboratory of Jonathan Eisen a coauthor of the paper. At the time of writing I could identify 26 datasets. There were a few points I was unclear about. The first was about the ethical aspects of hosting data on these servers. For human data, research should pass through a research ethics committee and data storage is a point for clarification. There is usually an endpoint after which the data must be destroyed. Having data distributed in this way means that potentially the data cannot be destroyed as it may end up on a server somewhere indefinitely. Thus this approach might have implications for ethics protocols. There were two associations that sprang to mind when thinking about BioTorrents. The first was the Alzheimer’s Disease Neuroimaging Initiative which involves a large dataset that can be analysed by researchers from around the world and this might be well suited to BioTorrents. The second was the wayback machine which stores a small percentage of the ‘internet’ indefinitely and two questions I had were whether this would be included in the archived material*

In any case, this has potential applications for research in psychiatry providing such data storage methods have been given ethics clearance and collaborators are located at multiple sites either within LAN’s or at different geographical sites.

* or whether the BioTorrents approach was a useful alternative and distributed method for archiving material of historical interest – a kind of distributed system for storing the internet equivalent of world heritage sites.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. Index: An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. 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.