Monthly Archives: January 2012

The Interaction Between Values and Illness: Personality Disorders

One of the categories of Psychiatric illness is the Disorder of Adult Personality. ICD-10 features the Personality Disorder in Section F60-69 and the diagnostic features can be viewed online here. The Personality Disorders are complex and many professionals will spend their entire careers in the study of the Disorder of Personality as well as the clinical management of people who have received this diagnosis. The Personality Disorders are controversial for many reasons. These controversies range from consideration of whether a core feature of our identity can be medicalised through to the accuracy of these labels in describing such an identity across many settings. The overlap between many of the Personality Disorders also presents challenges. Many of these discussions are played out in the establishment of services such as the Dangerous Severe Personality Disorder services. A key feature of Personality Disorders though is that they are maladaptive. In other words in social groups, the Personality Disorder would causes difficulties for the person and others within the group.  Looking at the conditions described in ICD-10 and selecting the Dissocial Personality Disorder, perhaps the most widely known of the Personality Disorders we can see a number of the features including a

Disregard for social obligations

This leads on to the subject of interest – how do values and illness interact? The Personality Disorders are the best example of this interaction. So why would those with a diagnosis of Dissocial Personality Disorder have a ‘disregard for social obligations’? The description of the Personality Disorders leaves a lot of scope for interpretation and the existence of these features is a key part of the diagnosis. Once this is acknowledged the Biological/Psychological/Social Models are invoked and explanations ranging from the immature Cerebral Cortex through to experienced trauma are invoked. However I would argue that there is a key step which is being missed in the movement from identification of features to explanatory models and that is the invocation of capacitious decision-making

A Role for the WillIs there a Volitional Class of Disorders of Adult Personality?

I would argue that with regards to ‘disregard for social obligations’ a key question needs to be asked. Has the person made a conscious decision to hold these values with an understanding of the consequences. In other words are these capacitous values. By considering the will, the ability of a person to make capacitious decisions we can divide people showing a ‘disregard for social obligations’ into two groups – those that have made this out of choice and those that have not. For those that have made the explicit decision to hold these values they could be classed as a ‘Volitional’ Dissocial Personality Disorder. In this case, if the person is seeking help to relate with others their treatment approach would necessitate capacitious decision making with regards to treatment.

Are there Non-Volitional Disorders of Adult Personality?

There are two obvious reasons why a person might hold these values regarding social obligations

1. These values were learnt during a period when the person was non-capacitous – in early childhood for instance. The difficulty here is that disorders of emotion and attachment in Childhood do not necessarily lead to disorders of Adult Personality. Similarly not all people who develop disorders of Adult Personality have experienced difficulties in Childhood. A consideration of age and development issues does not necessarily fully address the subtleties of maladaptive Personality and perhaps would not be expected to given the many experiences we have which are able to shape our Personality. Nevertheless the issue of capacity with regards to values may be useful in areas of scientific enquiry investigating these conditions in more detail.

2. The person does not have the biological apparatus necessary to understand social meaning. Empathy is the construct most relevant to this possibility. If a person lacks the ability to understand another person’s mind then a ‘Disregard for social obligations’ moves away from being a choice to a Disorder of Understanding. Professor Simon Baron-Cohen’s ‘Zero Degrees of Empathy’ explores this subject in more detail. The most widely known disorders of Empathy are the ‘Autistic Spectrum Disorders’ and here there has been a large body of literature exploring underlying neurobiological explanations.

Whilst the above is merely speculation based on a consideration of the issues the subject of how we choose to hold the values we do has many profound implications which extend far beyond discussions of health and illness.

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.

 

 

 

Brodmann Area 22: A Brief Review of the Literature Part 2

Brodmann Area 22, Derived from Gray’s Anatomy 20th Edition 1918 Lithograph Reproduction, Public Domain

 

The brain is a complex structure and but can be organised according to several principles. One approach is to characterise the brain regions according to the microscopic properties of these regions.  More specifically the neurons are organised differently between regions. Some regions may contain unique types of neurons. This approach to understanding the organisation of the brain was proposed by the German Neuropathologist Korbinian Brodmann and resulted in the eponymously named Brodmann Area. There are 52 areas in all and I have covered other Brodmann Areas elsewhere in this Blog. This is the second in a series on one of these areas – Brodmann Area 22. A simple search strategy was adopted. The term ‘Brodmann Area 22′ was used to search in Medline using the PubMed interface. Relevant results were identified and included.

In an EEG study, a specialised method Electromagnetic Tomography was used to create a model of the source of discharges observed on the EEG in 22 subjects during and after a period of running on a treadmill. Fifteen minutes after the end of the exercise, BA22 was one of the regions showing a decrease in Alpha-2, Beta-1 and Gamma activity. The researchers in this study used depth electrode recording and an analysis of functional connectivity to characterise the responses of different areas to amplitude modulation. The researchers concluded that BA22 amongst other areas displayed evidence of response to amplitude modulation in both hemispheres (see also a study freely available here). In this study, researchers looked at people undergoing surgery for Temporal Lobe epilepsy using functional Magnetic Resonance Imaging to examine the functional connectivity between brain regions. They found that higher preoperative coupling between the Hippocampus and BA22 was associated with a postoperative reduction in verbal learning.

People with Schizophrenia were compared to controls in an fMRI study in which the researchers investigated changes in neural activity with an overlearning task. When the tasks become automatic, there are corresponding reductions in the activity in relevant brain regions. The researchers found this characteristic reduction in both controls and the people with Schizophrenia in a number of regions including BA22 suggesting that this method of learning is intact although changes in working memory in people with Schizophrenia have been identified in some studies. Advanced Glycation end products are compounds which accumulate in the brain with aging. In one study, the accumulation of AGE’s in BA22 was assessed in people who had been diagnosed with Alzheimer’s Disease compared to a control group. The researchers found the characteristic accumulation of AGE’s in the former group compared to the control group and this accumulation progressed through the early, middle and later stages of Alzheimer’s Disease.

Appendix

Brodmann Area 22: A Brief Review of the Literature – Part 1

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 Roundup: January 2012 4th Edition

In a study at Princeton, researchers surveyed 1,100 students and found that having a family history of psychiatry conditions had a significant correlation with a student’s choice of studies (Benjamin et al, 2012). The researchers found that a student of the humanities was twice as likely to report having a family member with a history of a mood disorder while a student of science or a technical subject were three times more likely to report a sibling with an Autistic Spectrum Disorder.

In one study looking at a model of Rett Syndrome, an X-linked neurodevelopment condition affecting girls researchers found that Brain Derived Neurotrophic Factor (BDNF) was markedly reduced in the brainstem. Since BDNF is needed for maintenance and growth of neurons, the researchers suggest this may be a significant factor in the development of Rett Syndrome. However further research will be needed to test this hypothesis.

There is a very interesting scheme in the West Midlands to raise awareness of Dementia. Dr Kaarim Saad, Clinical and Social Care Lead for Dementia at NHS West Midlands unveiled a series of videos designed as a training tool to help teachers in the West Midlands raise awareness of Dementia in schools. More details can be found at the site above including the videos and presentations.

New guidelines on the neuropathological assessment of Alzheimer’s Disease (Bradley et al, 2012) have been published and are freely available here.

In a longitudinal study published in Neurology, the researchers followed up 1450 older adults over 3 years and found that 72/1000 men developed Mild Cognitive Impairment over this period compared to 56/1000 women (Roberts R et al 2012).

References

Benjamin C. Campbell, Samuel S.-H. Wang. Familial Linkage between Neuropsychiatric Disorders and Intellectual Interests. PLoS ONE, 2012; 7 (1): e30405 DOI:

Bradley T. Hyman et al. National Institute on Aging–Alzheimer’s Association guidelines for the neuropathologic assessment of Alzheimer’s disease. Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association. Volume 8, Issue 1 , Pages 1-13, January 2012.

Roberts R et al. The incidence of MCI differs by subtype and is higher in men: The Mayo Clinic Study of Aging. Neurology published ahead of print January 25, 2012,

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.