Monthly Archives: July 2012

#10 Problem Areas in Evolutionary Psychiatry and a Suggestion of Some Principles for Their Resolution

As readers of this blog will know, i’ve been very interested in Evolutionary Psychiatry as a subject which is potentially helpful in answering difficult questions about mental illness. In terms of trying to explain mental illnesses there is a circularity which is best summed up with nature versus nurture arguments. One person will suggest that an illness results from genetics whilst another will say that it results from the effects of the environment. Another group will opt for a bit of both. Some scientists get excited when new ideas such as epigenetics promise a neatly packaged answer to these complex issues. The field of Evolutionary Psychiatry is relatively new and follows on from Evolutionary Psychology. Psychiatrists such as Professor Tim Crowe have however suggested evolutionary explanations of Schizophrenia many decades ago. Such explanations have nevertheless remained relatively isolated in the context of the extensive number of mental illnesses described in the Diagnostic Manuals. In this sense it is still possible to say that Evolutionary Psychiatry is a relatively recent development.

The Psychiatrist Professor Martin Brüne has written an interesting book on the subject (see Appendix) although there still remains a lot of work to do in making this subject relevant to Clinical Psychiatry. I would anticipate that probably the best way that Evolutionary Psychiatry could inform clinical practice is through the development of models which can be tested. Such models backed up with supporting evidence at the population or sample population level I think would provide the starting point for further discussion. There are a number of Psychiatrists publishing in this area and Evolutionary Psychiatry is therefore beginning to develop a firmer foundation.

In this broader context I have detailed several problem areas in Evolutionary Psychiatry which will need to be considered in the development of a theoretical framework and unfortunately some of the circular arguments above still apply but at least there is one more theoretical tool to be applied.

#1 The Development of a Suitable Language. Psychiatry traverses many domains ranging from the functions of genes through to the effects of an illness on social functioning. Each of these areas requires a different level of explanation and even a different research paradigm. The language of Evolutionary Psychiatry has to have validity at each of these levels and be able to meaningfully navigate between each of these explanatory levels.

#2 The Problem of Neuroanatomy. Neuroanatomical problems of localisation are well recognised. Is there a part of the brain where a particular function is located? In parallel with nature versus nurture arguments, arguments in the field of neurophysiology/neuroanatomy centre around serial versus parallel processing. In other words a function in the brain can either result from a localisation of that function within one area in a hierarchical fashion or in several areas operating in parallel. Regardless of the source of evidence, disentangling these possibilities has been extremely difficult. With the most complex functions this becomes extremely difficult.

#3 The Sensitivity of the Material. One of the difficulties with discussion of illnesses in an evolutionary context is the sensitivity around whether such illnesses have adaptive value. For people suffering with such illnesses and those caring for or involved with the treatment of people with these illnesses the very nature of the discussion can be very controversial. A case in point is a discussion about the adaptive value of Depression (see here also).

#4 The Genetic Explanation. In a similar vein to some of the previous point, to talk about adaptation you have to talk about genes. If you don’t have the gene(s) correlate(s) of an illness then you don’t have the basis for the evolutionary discussion about the illness.

#5 The Definition of Illness. How an illness is defined is a complex subject area that reflects a consideration of the available evidence by experts. Such definitions represent judgements of the evidence in the context of extreme complexity as the above discussion illustrates.

#6 The Limits of Biological Explanation. In order to discuss what effect the gene or genes are having there has to be clarity on the constraints of the biological explanation. This assumes that the gene associations have been identified. The following debate at Yale illustrates many of the difficult issues around evolutionary explanations of behaviour (although we need to also explain inner experiences).

In particular, the question at 55.08 and the responses are well worth listening to.

#7 The Adaptive Value of a Single Gene. In the mathematical analysis of evolutionary concepts there are simple systems with well understood traits that have single gene mechanisms. Take Mendel’s analysis of plant hybridisation as an example. However if there is an argument about the adaptive value of a single gene in humans how can we be sure that the advantages or disadvantages of a single gene are not being masked by all of the other genes in the genome? In other words before we start analysing the effects of gene transmission can we be certain that the single gene contributes to adaptation to the environment? So long as the gene can be transmitted to the next generation it has demonstrated fitness in that generation. Nevertheless so have a large number of other genes. Indeed there are several mental illnesses where we can be confident that genes have a small effect size and that more than one is involved.

#8 The Changing Environment. Since our evolution from the earliest life forms has taken over 2 billion years the environment has undergone remarkable changes. Without question we have lost the opportunity to ask what the environment was which prompted the success of a certain trait and the associated gene or genes in a great many cases. In practical terms this perhaps limits the more certain discussions to cases which are well documented.

#9 The Level of Explanation at Which We are Satisfied. How sophisticated do we want our explanations? Take Circadian Rhythms for instance and their relation to the importance of the sleep-wake cycle and sleep disorders. There is already a large body of research into Circadian Rhythms from the simplest to the most complex organisms with well characterised cellular pathways. Will explanations of the adaptive advantage of certain genes early in the evolutionary timeline suffice as explanations for why certain sleep disorders persist?

#10 The Persistence of Adaptation. Also relevant to #9 all organisms continue to adapt to their environment. Therefore it is not only the environment but our own genomes that have changed significantly over time. Since we cannot go back in time and observe these adaptations we are dependent on the available historical data as well as indirect evidence from experimental evidence in organisms that resemble those in our early timeline.

As a result of these #10 problems, there are some principles which are worth considering in an Evolutionary Psychiatry framework.

#1 The Development of a Vocabulary for Evolutionary Psychiatry. The field will require a vocabulary of terms which are relevant to the different levels of analysis. This should be relatively easy to begin with because such vocabularies have already been developed within the different research paradigms. However members of those research communities should be involved in validating the terms with appropriate mechanisms for review.

#2 The Development of a Grammar Suitable for Traversing Explanatory frameworks. The grammar referred to here is not the basic grammar of the English Language but the rules governing the use of terms from different paradimgs. In order to construct explanations that begin with genetics and end with social functioning we have to be very clear that in moving from one to the other we have the appropriate evidence base to support such transitions. This will necessitate a consideration of many examples of such transition including representatives from different research paradigms.

#3 The Establishment of a Hierarchy of Explanations. In just the same way as the Cochrane Foundation has established a hierarchy of evidence to support the use of different forms of clinical treatment, we should be no less rigorous in our description of the explanatory models we are using. By using very limited explanations of the success of certain genes which are well characterised and supported we can assign them a high degree of confidence. By considering factors such as the effect size of genes, the effect of learning and response to treatment, the confidence we have of the biological contribution to the illness we can begin to build an estimate of the confidence we can have in a limited but predictive model. These models can inform experiments.

#4 The Establishment of a Biological Index for an Illness. We can use some of the factors mentioned in principle #3 to establish a biological index for an illness. This is the likely contribution that biology has to the illness. The index can be as simple as a range from 0 to 100. There is already a great deal of data on the heritability of certain illness particularly from twin studies. However this is not exactly the same as the biological contribution to an illness since non-heritable biological contributions are also possible. For example spontaneous mutations or acquired brain injury.

#5 The Establishment of a Reliability Index for Illnesses. Operational definitions are field tested to ascertain reliability data. In addition further work is carried out to characterise this reliability data in clinical rather than research settings. An accessible reliability index will inform the most productive areas of research.

No doubt there are other principles which may better serve the goal of addressing these problems but with time such an approach would help to bridge the gap between theoretical discussions of Evolutionary Psychiatry and the clinical applications which may accelerate progress within this field.

Appendix

Evolutionary Psychiatry Resources on this Site

Index: There are indices for the TAWOP site here and here 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.

British Prime Minister Opens Dementia Café

The British Prime Minister has opened a Dementia Café at Middleton Grange Care Home in Hailey, Oxfordshire (see coverage here also). The Prime Minister has sent out a powerful message of support for people with Dementia. Dementia Cafés operate throughout the UK and offer a number of invaluable services for people with Dementia and their carers including advice and support. Dementia Cafés are derived from the concept of Alzheimer Cafés which were pioneered by Dutch Psychologist Dr Bère Miesen in 1997. Alzheimer’s Disease is one of many forms of Dementia although Dr Mieson intended the Alzheimer Cafe for people with all forms of Dementia. People also refer to Memory Cafés and there is already an online UK directory of Memory and Alzheimer Cafés.

Index: There are indices for the TAWOP site here and here 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.

Should Science Journals Publish Referees Comments with the Papers and Include Sample Workings of Any Statistical Analysis?

I just saw this post (via @Ed Yong). This may just be a typo and more to do with the editing process within the Journal. However its a starting point for discussion of a related issue of transparency in Journals. Scientific research covers a vast expanse of knowledge and this must be matched by the knowledge of the reviewers for those papers. There are various other factors which contribute to the decision to accept or reject a paper in a journal. There is some evidence to suggest that papers can get through with flawed statistical analysis and there is undoubtedly scope for improving the peer review process. Indeed there were some interesting recommendations in the House of Commons Science and Technology Committee Report. I have two suggestions – should Journals include the comments of the peer reviewers with the final paper so that readers get an insight into how the paper was accepted and identify any flaws in the process? This is a slight variation on the open review process that is beginning to trend in the open science movement. If this became mandatory for all Journals then it would put in place the infrastructure necessary to drive up peer-reviewing standards. The second idea is for Journals to include sample workings of statistical analysis from the researchers. If statistical errors do get though into publications then what better way to improve standards than to include such data for the more statistically savvy readers to check. For clinical data it is necessary to ensure that any data is anonymised and that any samples do not reveal information about individual subjects within the study.

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 July 2012 3rd Edition

The tragic mass shooting in America has provoked a world-wide reaction and a search for answers to the question of why this happened. Answering this question will require a detailed assessment of the suspect as well as a conviction. People commonly ask if such a person has a mental illness as such behaviour is so far out of the ordinary. However very unusual and terrible behaviours can be carried out by people without a mental illness. That is why it is important to wait for the police investigations and any forensic assessments to be completed as well as a conviction. Finding immediate answers can offer an anxious public reassurance in the short-term but at the risk of getting the wrong answer and stigmatising groups based on incorrect assertions. At Shrinkrap there is a post about Forensic Psychiatrist Park Dietz’s advice on media coverage of mass murders.  Via @VaughanBell there is also an informative interview with Forensic Psychiatrist Professor Paul Mullen where he provides an overview of the historical and cultural context of such tragic events. Professor Mullen also comments on the issue of gun control and behaviour profiles as well as his opinion on solutions.

Appendix

2008-2011 News Round-Up

Index: There are indices for the TAWOP site here and here 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.

National Fragile X Syndrome Awareness Day

Today is National Fragile X Awareness Day. Although this is an American awareness day other awareness days have crossed geographical boundaries. The European Fragile X Awareness Day is on October 12th 2012. Fragile X is the most common genetic cause of Learning Disability and the most commonly known cause of Autism. Fragile X Syndrome results from extra sequences in the Fragile X gene. The gene is known as FMR1. Compared to the more commonly occuring form of the gene there are more CGG sequences or CGG repeats in Fragile X Syndrome. CCG refers to two of the basic building blocks of DNA – Cyotosine and Guanine.

These repeated DNA building blocks significantly alter the function of the protein that the DNA codes for. This protein is involved in neural development. Autism and Learning Disability are classed as developmental disorders.

Index: There are indices for the TAWOP site here and here 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.

Overload – Part of the ‘Hearts and Minds’ Series

Filmmaker Ivan Riches has directed a new film called ‘Overload‘ as part of the Hearts and Minds series.

Overload is a film about the experiences of people living in South London juxtaposed with the theme of overload. The film features a mixture of people discussing their own experiences as well as actors narrating the experiences of others. The film explores sensory experiences as well as the interaction of these experiences with thoughts and memories and the theme of mental health features centrally in the film.

Many of the themes tell us about the universal human experience and will resonate with those outside of South London. The complex and challenging experiences include the sensory overload of busy urban areas, coping with disturbing and recurrent traumatic memories as well as the wariness of crowds. The film deals sensitively with difficult issues and helps the audience unfamiliar with these issues to begin to make sense of them.

However the London music scene with an X-factor candidate awaiting news as well as the red buses and black cabs make the location unmistakeable. The more subtle aspects of South London are manifested through the pervasive influence of the London based creative artists as well as the Mental Health charities and networks. The CoolTan Arts charity including their London based studio feature in the film. Talented young actors also perform a poem from one of the Cooltan Arts poets. The Cooltan Arts website ‘A Funny Farm‘ also features briefly.  The film left me to reflect on the many difficult issues that had been communicated so effectively and also sensitively for an audience that might be unaccustomed to such issues.

Ivan Riches has done a lot of important work with leading mental health charities. Riches has a YouTube channel which features some of his videos. I have written previously about the theoretical possibility of a science DJ – someone who communicates science through images and music. However Riches had already created and posted this masterpiece a year beforehand!

Appendix – Update – A Short Film About the Making of Overload

Index: There are indices for the TAWOP site here and here 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.

Another Paper on the Possible Dangers of Sitting

Another paper on the possible dangers of sitting this time in the BMJ – Open Access. The researchers undertook a meta-analysis. They collated and analysed data from a number of prospective cohort studies. In other words studies where the researchers had followed up a group of people. In these studies, subjects had self-reported the amount of time they had been sitting each day. The researchers found that sitting down for less than 3 hours a day was significantly associated with increased life expectancy compared to the group who sat on average for more than 3 hours a day. The paper includes the strengths and weaknesses of the study. There is also some commentary in the media. At NHS Choices, it is pointed out that many of the possible confounders were not accounted for. In other words there may be another explanation. People might be spending more time sitting because of factors which can reduce life expectancy.

There is more work to be done in this area but there is a narrative emerging. If these findings do hold out then there will need to be an important debate in society about how to reduce sitting behaviour or at least modify sitting behaviour if sitting is indeed found to be associated with health risks. For now though it will be interesting to see how the research community responds to these findings.

Index: There are indices for the TAWOP site here and here 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.