Monthly Archives: September 2010

Social Factors in Schizophrenia

There is a review on social factors in schizophrenia by Jill Hooley which is freely available here. Hooley begins by introducing the concept of social competence and provides convincing evidence that this is a useful construct to consider. She then goes on to describe the constituents of social competence – the social skillset and social problem solving along with the evidence pointing to impairments in these areas in people with schizophrenia.The effects of gender on social competence as well as the relationships with friends and family are also discussed before Hooley finishes with a look at the effects of social skills training. The evidence cited here is quite positive in outlook. In the discussion Hooley draws comparisons between Schizophrenia and Asperger Syndrome and there could probably be a rich exchange of ideas and understanding between the associated fields of research. Throughout the paper schizophrenia is referred to as a broad category and it would be interesting to see how the central arguments are modified according to the subtype of schizophrenia. What would also be interesting would be a look at outliers who still qualify for the diagnosis but maintain social competence or excel in social interactions. In summary, I thought this was a concise and useful introduction to social factors in schizophrenia.

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.

Emotion and Schizophrenia

There is a review article on emotions in schizophrenia by Kring and Capinigro freely available here. Emotions are a complex phenomenon and unsurprisingly the authors spend the first part of the review focusing on what they mean by emotions and what research in this area has revealed. What they discuss are the many similarities in reporting of emotional experiences between people with and without schizophrenia. They mention specifically supporting studies examining physiological skin responses and blink responses as physiological markers of emotional experiences. In terms of imaging studies, the authors discuss some of the mixed findings around Amygdal and Prefrontal Cortex activity using fMRI and suggest that perhaps the ambiguities are due to a paucity of data.  On moving to the combination of emotion and cognition the authors discuss some interesting findings around anticipatory pleasure and recall of emotional stimuli. The authors finish by discussing the CANSAS trial and interventions including CBT in this area. The review covers a lot of ground and summarises current knowledge in a complex multidiscplinary field which should hopefully yield therapeutic benefits particularly for negative symptoms.

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.

Cardiovascular Risk Factors and Prevention of Dementia

There is a systematic review of the effects of interventions for cardiovascular risk factors on prevention of dementia by Ligtart and colleagues which is freely available here. The authors select a number of vascular risk factors for investigation – hypertension, hyperhomocysteinuria, dyslipidaemia, NIDDM and obesity. They select randomised controlled trials of interventions for these risk factors by searching several databases including Medline. They list the search criteria and after identifying a large number of papers are able to exclude many of these leaving 43 for futher analysis. There are no firm conclusions from the analysis as there are a number of difficulties the authors encounter. Many of the papers use dementia as a secondary outcome measure and so perhaps what this means is that the selection criteria are too narrow at this point in time to reach meaningful conclusions. The authors note that there are a number of studies underway which are focusing on interventions for these risk factors. Thus a repeat of this analysis in a few years time may be warranted. There are some positive findings amongst the results and the association between vascular risk factors and prevalence of dementia is supported by an abundant evidence base although the possibility of confounders should be borne in mind. I thought that the tables of results for selected studies as well as the guide for interpreting studies were particularly useful products of this review.

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: September 2010 4th Edition

  • There is a small 6-week  study (n=54) in the Journal of Clinical Psychiatry examining the use of valproic acid in people with Bipolar Disorder I or II depression. This is a double-blind randomised placebo controlled trial with the valproic acid group associated with 38.5% v 10.7% (placebo) of subjects meeting response criteria (p=0.017 0.17). Depression was assessed using the MADRS although the difference in remission rates (rather than response criteria) has a p-value of 0.208.
  • Current Directions in Psychological Sciences have an open access edition focusing on Schizophrenia here while there is an open-access review of Aripiprazole in the treatment of late-onset schizophrenia here.
  • Percentage thickness changes in the inferior temporal and right fusiform cortices at six-months were associated with reduction in memory performance in this relatively small study (n=142) of older adults.
  • There is a review article here on the three newly classified variants of primary progressive aphasia.
  • Diffuse Tensor Imaging was useful in discriminating between amnestic Mild Cognitive Impairment (MCI) and non-amnestic MCI in this moderately sized study (n=418).
  • A structural 3T MRI study (n=50) examining age associated changes in the hippocampus identified these changes in the subiculum but found no evidence  in other subfields.
  • CSF levels of Beta-Amyloid were inversely associated with years of education in this study which recruited 70 people with a diagnosis of Alzheimer’s Disease.
  • Links between DISC1 and APP gene products were identified in this study. The write-up is very good and essentially this research suggests a link between genes associated with Schizophrenia and Alzheimer’s Disease respectively. The functional links were identified in a neurodevelopmental model and involve interactions of the gene products during migration of neurons. On the basis of their findings the researchers hypothesise that the Amyloid Precursor Protein (APP) acts as a scaffold that interacts with the DISC-1 protein to facilitate migration. The role of the APP in Alzheimer’s Disease is different and so this study is not suggesting a link between the diseases although it is becoming clear that these two proteins have important biological functions.
  • Mind Hacks has another round-up of Spike Activity here and also has a book in the pipeline which I’m sure will be well worth looking out for.

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.

Podcast Review: Interview with Profesor Stefan Priebe

The Royal College of Psychiatrists website features an interview with Professor Stefan Priebe about his recent multinational study investigating the views of people who have been detained involuntarily for treatment of a mental illness (available here) and which was published in the British Journal of Psychiatry. One nice feature of these interviews is that psychiatrists from around the UK take on the role of interviewer. I would argue that as a result of a psychiatrists’ training and experience that psychiatrists have a useful skillset (and even aptitude) to bring to this role as in this case. The interviewer is Dr Saliha Nazir, a forensic learning disability psychiatrist. The audience is able to learn a great deal about Professor Priebe’s research in the space of just under ten minutes. This research highlights differences in satisfaction rates  between countries in those that have undergone involuntary admissions. This might sound slightly paradoxical as the admission is involuntary but the research shows that satisfaction rates tend to increase as time goes on and presumably the health of the sample population improves. The research also highlights predictors of satisfaction and demographic variables of importance which have useful practical implications.

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: The Good Old Age Blog

The ‘Good Old Age Blog‘ is produced by Purdue university which has a centre for aging. The blog has a simple and effective design with many of the links located on the right hand of the screen. There is also a chronological index for the site from which it appears that the blog was created in May 2010. The posts tend to be of moderate length (for a blog), are well written and typically contain several references to the literature. There is an introductory post ‘The Good Old Age‘ which informs the reader about the purpose of the blog while also giving an overview of the author’s interpretation of the changes in the field of gerontology. This article on loneliness in older adults is also very good and discusses health associations, risk factors and management. Although there are relatively few posts, they are of high quality with multiple contributors and they contain multiple references for further reading.

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.

The Moral Sense

The Morals Sense is an audiobook (and paperback) by James Q Wilson. Nadia May narrates the book with an effective use of prosody which I found engaging. Wilson’s thesis is that there is an innate moral sense that is pervasive and which he supports with evidence throughout.  In parts his use of biology to persuade us of underlying principles reminded me of another book with an underlying biological thesis (see review here). Wilson argues that we should look at dispositions rather than universal rules and that the family provides us with the foundations for our moral senses. He covers a significant number of subjects throughout the course of his argument, too many to effectively summarise in a short space. I found his discussion of empathy and sympathy particularly interesting and he argues that sympathy is a fundamental component of our ability to develop morals effectively. He explores many other variables which contribute to these including community values, demographic variables as well as developmental variables.

At one point in the book, Wilson gives an example of the prisoner’s dilemma in which two friends face a  tiger. If they face it together then they will  overcome the creature but if one or the other runs the other will perish. If they both run then one of them will perish. If they want to survive therefore, the solution is for both of them to stay and fight. However he drops in the statement that they should do so after talking it through with each other in order to anticipate each other’s actions. At this point, it became obvious to me that Chimpanzees had already solved the prisoner’s dilemma without any obvious recourse to language. The clip here demonstrates this. This shows one of the chimpanzees using a branch to fend off the ‘leopard’ while the others in the group do not run away but face the creature also. They did not noticeably communicate with each other beforehand and their ‘supportive’ action suggests either that the  chimpanzee-human concestor was able to solve this dilemma also or else that this is a case of convergent evolution. Nevertheless it is only when he frames the classic dilemma in this way that the connection becomes obvious.

Wilson provides us with abundant evidence to suggest that the moral sense is universal in a cultural tour de force. He also delves more deeply into matters with an examination of the insights of philosophers throughout history and encourages the use of a ‘thought experiment’ to further the discussion. Wilson has an extensive knowledge of sociobiology, an interesting thesis and the listener will learn a great deal about human nature after listening to this audiobook.

Reference

James Q Wilson. The Moral Sense. Narrated by Nadia May. Blackstone Audio. 2000.

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.