Review: The Genetics of Delirium

 

The paper reviewed here is ‘The Role of Genetics in Delirium in the Elderly Patient’ by van Munster, Rooij and Korevaar. In the abstract van Munster and colleagues write that

‘Two important gaps in daily practice with delirium are the pathophysiological obscurity and the low recognition rates. Genetics offers the possibility to contribute knowledge to both of these gaps with its unique and diverse techniques‘

The authors give an overview of delirium in the introduction before going on to consider the syndrome of delirium. They consider the difficulties of diagnosis given the relatively short window of time which may be available to make the diagnosis as well as a number of other practical issues. The authors consider briefly and in turn several hypotheses about the aetiology of delirium including the dysregulation of dopamine or acetylcholine, the stress response and the immune response particularly the response involving cytokines. The authors then go on to consider the genotype and phenotype of delirium.

The authors hypothesise that if genetic risk factors are present, the precipitants for an episode can be ‘milder’. They also suggest that the study of the genetics of delirium is comparatively more difficult than with other diseases as the average age of onset of delirium may be causally related to the relative dearth of twin studies in this area. They then look at the methodology of genetic studies including the gene-wide association studies and look at some of the advantages comparing them with invasive procedures.

They use the broad categories describe above to suggest some suitable candidate genes which are listed in table 1. These can be compared with the genetic studies that have already been carried out and which are described in a later section. A number of the studies examining APOE4 associations for instance have not produced such interesting findings. The authors conclude with some suggestions of how future studies can facilitate a better understanding of the role of genetic factors in delirium including cohort studies.

I was persuaded by a number of the arguments particularly the suggested model combining precipitants with the genetic risk factors. While there is no explicitly stated methodology for the construction of the paper the authors have used a systematic approach towards the article which identifies a list of candidate genes as well as justifying an investigation into the genetics of delirium as well as highlighting potential difficulties of such an approach. This is a young field and articles such as this provide a useful overview.

References

van Munster B C, de Rooij S E and Korevaar J C. The role of genetics in delerium in the elderly patient. Dement Geriatr Cogn Disord. 2009. 28. 187-195.

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Blog Review:Psychotherapy Brown Bag

The blog reviewed here is ‘Psychotherapy Brown Bag. Discussing the Science of Clinical Psychology‘.

Appearance and Design

The background is white including in the title pane. The title pane features what looked to me like a series of progressively fading blue trees. However this might be a concrete interpretation. So they could also be letters (o, p and q) which is consistent with the image of a blog (words) or people with the tear drop shapes representing heads (so looking from above it would be a group of people huddled together) which would fit with psychology (maybe this is a variant of the Rorschach test!). Just below the title pane is an index – here the reader can navigate using the archives menu while there is also an ‘About Us’ and ‘Links’ section (amongst others) that can be accessed. The articles occupy the left two-thirds of the screen. On the right hand one-third of the screen there are a large number of features – a search bar, twitter, options, RSS feed icon, subscribe option, recent comments, recent posts and categories as well as adverts. At the end of the articles themselves there are a number of options including the ability to disseminate the articles using social media tools as well as a rating system.

Articles

The first article in the archives is from February 2009. A number of articles contain a number of references to the research literature, suporting the main arguments in the articles  themselves. Many of the articles give an overview of a topic (e.g. Distress Tolerance in Problematic Behaviours). In an article on binge eating, Anestis explains the diagnosis in more detail and also includes links to a number of books on the subject. In this article, he explores impulsivity in detail. The authors cover current research, discussing studies in detail. For instance in this article, there is a discussion of a study looking at an interesting (almost abstract) computerised therapy for social anxiety which showed promising results. Indeed there is a series of articles on online treatment approaches for different conditions (e.g. insomnia). Michael Anestis, doctoral candidate in clinical psychology, writes two interesting articles on dialectical behavioural therapy and explains how this can be used with a mindfulness-based approach (see here and here). The authors also look at the use of approaches to specific contexts  (e.g. see this article). A number of the articles address commonly posed questions such as this article on why group data is useful for informing individual therapeutic approaches. In an article about a related topic, Anestis addresses the role of clinical intuition versus actuarial approaches to decision making. A number of articles such as this one on Post Traumatic Stress Disorder look at changes that might take place in DSM-V.

Conclusions

The ‘Psychotherapy Brown Bag’ blog is in my opinion an excellent resource for those wanting to learn more about different forms of psychotherapy both from an experiential and more prominently an evidence-based perspective. The authors have written a number of very interesting and useful articles on pragmatic issues and have utilised a systematic approach in doing so. They also intersperse these articles with commentaries on contemporary issues for instance news stories reported in the media.

 

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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.