Category Archives: reflections

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.

Meditations on Twitter

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.

Reflections on November 2009

In November 2009 there were reviews of studies on the prediction of age-specific dosing of antipsychotics, mental health informatics applications and infrastructures, consultation-liaison services and an investigation of a relationship between the metabolic syndrome and depression. There were some very good blogs which were reviewed including PsychBrownBag which provides analysis of psychology research studies and clinical questions and FABLE, which investigates the relationship between the body, emotions and the literature. There were also media reviews of programs/podcasts on language and the relationship between genetics and late-life depression. There were several book reviews including those on the nature of science and the impact of technology on culture. In the news there was a report commissioned by the UK government highlighting risks associated with antipsychotic use in dementia and giving recommendations to which there were several institutional and organisational responses. Other developments included a study suggesting that there may be optimum levels of Beta-Amyloid for memory functioning, the construction of an 11.7 Tesla MRI scanner in France, the estimate fromone large survey that 1/4 of all psychotropic medications prescribed in the USA were by psychiatrists, a Norwegian study showing marked reduction in separation of couples when using ‘client feedback’ therapy and a recent discussion about possible changes to the Asperger syndrome diagnosis in DSM-V.

Biological Psychiatry Article Reviews

Review: The Genetic Basis of Human Brain Evolution

Review: Predicting Age-Specific Dosing of Antipsychotics

Review: The Genetics of Delirium

Review: Valproate and Neuroprotection

Social Psychiatry Article Reviews

Review: Ubiquitous Healthcare Service Using Mobile Phone Technology

Review: The Use of Health Information Technology in Seven Nations

Review: Comparison of Consultation-Liaison Services in the United States and Japan

Review: The Alignment of Information Systems with Organisational Objectives and Strategies in Health Care

Psychology/Psychotherapy Article Reviews

Review: Research Report on Pain and Depression in Older People

Review: Literature and Happiness

Review: Somatic Awareness and Body Distress Symptoms

Review: Depression. An Important Comorbidity with Metabolic Syndrome in a General Population

Review: A Meta-Analysis of Psychotherapy in Cluster C Personality Disorders

Blog Review

Blog Review: Movies and Mental Illness

Review: We’re Only Human

Blog Review:Psychotherapy Brown Bag

Blog Review: FABLE – Fictional Autobiography of Life Experience

Podcast/Media Review

Media Review: Social Phobia on YouTube

Podcast Review:A Talk by Dr Devdutt Pattanaik

Podcast Review: Simon Moore Interview and Horizons on Language

Podcast Review: UCLA GrandRounds Presentation on Genetics and Late-Life Depression

Book Review

Book Review: The Borderlands of Science

Book Review: Socialnomics

Book Review: Generation Text

Book Review: An Introduction to Dream Interpretation

News in Brief

An independent report by Professor Sube Banerjee, commissioned and funded by the Department of Health on the use of antipsychotics in dementia has been published (freely available here). Professor Banerjee has considered the evidence base including systematic reviews and meta-analyses regarding the use of antipsychotics in dementia and the report contains an estimate of the national morbidity and mortality associated with the use of antipsychotics in dementia. The report recognises the need for antipsychotics in certain situations and goes on to make a series of recommendations which focus in particular on clinical governance, recommendations which should lead to an improvement in the quality of care. The government have produced their response to this document (freely available here) and support these recommendations indicating that a national audit of antipsychotic use in dementia will be undertaken initially at six-months and then annually for at least three years and that the National Clinical Director for Dementia will take on a leadership role in this area. The Royal College of Psychiatrists has welcomed the report and responded here emphasising the need for input of specialist older adult mental health services. The response of the Alzheimer’s Society who have also welcomed the report is here. NHS choices have coverage of the report here.

A study in Nature Neuroscience suggests that Amyloid Beta is integral to memory function and that deviation from optimal levels is likely to lead to pathology. This in turn would suggest that removing Amyloid Beta from the plaque may not be a successful strategy in Alzheimer’s Disease if this optimal level is not addressed. However this discussion is taking place around cellular mechanisms and it will be useful to see how these predictions tie in with the relevant clinical trials. A suggestion has been made that a precursor to Nerve Growth Factor may be involved in the pathogenesis of Alzheimer’s Disease (AD) on the basis of a significant increase in the levels of the precursor in AD post-mortem samples and findings in a murine model. Stroke is related to dementia in a number of ways and modifying stroke risk factors can reduce the risk of dementia. Thus a prospective study (n=3298) with a follow-up period of 9 years showed that moderate or heavy exercise was asssociated with a significantly reduced risk of developing stroke. Thus the risk was 2.7% in those with moderate-to-heavy exercise and 4.6% in those with no exercise. A potentially very useful study used the Alzheimer’s Disease Neuroimaging Initiative dataset to develop a method of analysing MRI data which involves two scans and a focus on loss of tissue in the Entorhinal Cortex and it will be intereresting to see the results of further research in this area. A 32-year prospective study – the Prospective Population Study of Women in Gothenburg found an association between central adiposity in middle age and prevalence of subsequent dementia. They did not find the same relationship between BMI and subsequent dementia but the central adiposity was associated with an approximate doubling of the prevalence of subsequent dementia.

There is a recent study which provides evidence of a relatively small difference in the rate of decline of memory in those with Alzheimer’s Disease with or without diabetes. Those with diabetes had a slower rate of decline (although the effect size was relatively small) and it will be interesting to see further replication studies in this area. Alz Forum have got coverage of the recent Clinical Trials in Alzheimer’s Disease conference in Las Vegas here. They look at the Wisconsin Registry for Alzheimer’s Prevention study, the Memory Capacity Test and research on the CogState test amongst others. There is coverage here of a 20-year longitudinal study published in Neurology which identified associations with the development of mild cognitive impairment and it will be interesting to see how these findings inform further research in this area. This article looks at another study published in Neurology this time on Frontotemporal Dementia (FTD) and finding that 42% of subjects had a family history on the basis of a related outcome measure  (see here for further information). There is coverage of the recent Society of Neuroscience conference in Chicago over at the Alzforum and this featured a number of presentations on Alzheimer’s Disease. A recent study looking at falls in older adults found associations with a number of medications. The researchers in another study looking at falls in the elderly (the MOBILIZE study, n=729) found that those with chronic pain were significantly more likely to fall than their counterparts without.

A neuroimaging  study (n=88) compared people with Asperger Syndrome and Autism with controls and found a significant difference between the Asperger and Autism groups in terms of structural MRI findings with the latter group having increased grey matter volume in the frontal and temporal lobes (Toal et al, 2009). However it will be interesting to see this data be included in a meta-analysis with other similar studies as well as to see the findings of larger replication studies. This study is timely given the recent discussion about dropping the diagnosis of Asperger Syndrome (see below). There is a discussion here of some of the recent genetic evidence of similarities between Schizophrenia and Autism in terms of analysis of copy number variants. The possible role of a form of interneuron known as the gliaform cell in psychosis is discussed in this article.

Articles included a systematic review of RCT’s and observational studies of oral versus long acting injectable (LAI) depots, a review of psychopharmacology and side-effects of LAI’s, a systematic review of second-generation LAI’s and a review of  UK prescribing practice amongst many other articles. The Schizophrenia Research Forum have coverage of a recent murine study showing an association between mutations in the dysregulin gene (which has been associated with schizophrenia in genome wide association studies) and the function of fast-spiking interneurons. The 26th Annual Pittsburgh Schizophrenia Conference took place on November 13th 2009.

An American study showed that just  under half of the 3 to 6 year olds in the study were concerned about becoming obese and one-third wanted to change an aspect of their appearance. Another American study (due to be published next year and with n=184) contrasted brief motivational interviewing with a control intervention (warning about the hazards of drinking and driving) in drink-driving recidivists was associated with a 30% reduction in repeat offences. Using data from the National Epidemiological Survey on Alcohol and Related Conditions, an american study involving data on 43,000 people, older adults (over the age of 60 in this study) with alcohol dependence consumed an average of 40 alcoholic drinks per week compared to ‘between 25 and 35 drinks a week’ in the younger group.

The National Institute of Clinical Excellence has released guidance on the treatment of depression in people with chronic health problems – the quick reference guide is here. A small case series which looked at deep brain stimulation for severe depression provided some evidence of efficacy although given the sample size, it will be interesting to see the outcome of a relevant systematic review or meta-analysis which incorporates this data. An american study is looking at whether PTSD can be predicted by incorporating a number of biological markers. In a study (n=109) of people with depression and controls there was found to be an association between depression and overestimated retrospective recall of somatic symptoms and this is just one of many ways in which depression and physical illness may have complex interactions. There was a recent study which used a large number of outcome measures which investigated collectivist versus individualistic cultures and the authors suggest that the former are associated with a lower genetic predisposition to depression. However it is important to note that there are cultural differences in the use of diagnostic classifications (e.g. see this review).

An 11.7T MRI scanner is being developed in France through a pan-European partnership and is due to begin operating in 2012. In a press release from the company that undertook the researhc, in conjunction with university researchers, the gene product for the gene Rps23r1 was associated with a reduction in two Alzheimer’s Disease related proteins amyloid beta and tau in a murine model. The researchers in a study in Neuron found an association between modifications of cortical theta oscillations and the perception of intact sounds when presented with fragmentary sounds. Thus the implication is that there is an EEG correlate of auditory illusions. Another study offers preliminary insights into the potential role of the delta waves generated in the hippocampus and the authors hypothesise on the basis of their results that the frequency of the delta waves code information about the type of processing that should take place in different regions – processing about the past or present. There is preliminary evidence that inflammation in the hippocampus may be associated with schizophrenia although it will be useful to see the results of further studies in this area.

The researchers in an american study covered here found that of 472 million prescriptions for psychotropic medications prescribed between August 2006 and July 2007, only 1/4 were prescribed by psychiatrists. Virtualised desktops save time in booting up the computer and in this article a proprietary system using virtualised desktops was suggested to save clinicians 30 minutes on average each day. The National Institute of Clinical Excellence has released guidance on mental wellbeing at work. The document has a wide audience including members of the public (where applicable in the UK) and complements previous NICE guidance in the workplace. The quick reference guide contains 5 recommendations relating to strategic/coordinated approaches to mental wellbeing, assessment of opportunities for wellbeing of employees, flexible working, the role of line managers and supporting micro, small and medium-sized businesses. This has been widely reported with a number of articles looking at how these recommendations might impact on health services themselves (see here, here and here). This comes at the same time as a report by the Chartered Institute of Personnel and Development (CIPD) which produced findings from a survey of 2000 employees which included results relating to mental health (covered here). Technology review have a collection of images about representing 100 years of visualising the brain. A comedian has been invited to contribute a humorous perspective to a production on mental health by a primary care trust. There is a clip of the performance in the article and the argument is that the comedy can help to overcome stigma through education. You can see the responses of members of the audience in the clip.

A study of babbling in babies (covered here) found evidence that after only an hour’s exposure to a new language, the baby’s babbling with the speaker of that new language differed from that with speakers of the native language. A recent study involved 205 Norwegian couples and used ‘client feedback’ therapy during problematic episodes in their relationship. At 6-months after the last session, the researchers reported a 50% reduction in divorce or separation rates compared to those who did not receive this intervention. The approach is described as patient focused research (the Research Advocacy Network has more information on this).

The Lean Healthcare Academy recently had an awards ceremony and a hospital which implemented the Productive Ward was the recipient of an award. The Productive Ward and related Productive Series involve a systematic process to enable improvements in outcome measures such as efficiency (see review here). It is interesting to see how American and Japanese culture and technology is being used to improve care for patients in the NHS in an ever more connected world. The Productive Ward series is covered at the National Institute for Technology here. The series also includes approaches to improve outcomes in community care as well as other types of service.

Evolutionary Psychiatry

The new buzz word in this area is ‘primate archaeology’ which is an attempt to integrate a number of areas including primatology, anthropology and psychology. This article summarises this new ‘movement’ and looks at some very interesting research into the use of stone tools by chimpanzees in what is being described as a parallel with the advent of the stone age in humans.  Dr Shock has a link to a video showing that squirrels work together to recall where food is located in the environment. The combination of social cooperation and memory abilities displayed here may be important in understanding similar abilities in primates including humans. Recent evidence suggests that the Sahara may have experienced wet periods roughly 120,000 years ago and 50,000 years ago and that this may have facilitated the migration of early humans across the Sahara. There is an article at Live Science on the decreasing size of the human brain over the last 10,000 years which asks the intriguing question ‘is our evolution accelerating?’. The FOX-P2 gene product in chimpanzees was found to behave differently to the gene product in humans in a recent study which might contribute to an explanation for the absence of spoken language in chimpanzees.

There is a recent statement from a geneticist Professor Paabo that Neanderthals and humans interbred according to analysis of the Neanderthal genome (see also here)  and it will be interesting to see further evidence when it is published. However the remaining question is whether or not the Neanderthals contributed to the modern human gene pool which is a separate although related question which may be answered with the completion of the sequencing of the Neanderthal genome. If this were so, it would have many implications. Another paper on genetic material – heterochromatin may in the future help to answer the question of whether the offspring would be sterile.

DSM-V

A twitter campaign was started to petition for the inclusion of Depressive Personality Disorder in DSM-V. There was discussion recently of the diagnosis of Asperger syndrome being dropped from the next edition of the DSM and this will mean an expansion of the autism diagnostic category. This was originally discussed in a New York Times article (which requires (free) registration). The article features an interview with Dr Catherine Lord, who is one of 13 members of the working group on autism and neurodevelopmental disorders. The group are considering a number of amendments to the autism diagnosis including the addition of comorbidity that have been associated with the condition including disorders of attention and anxiety. However the suggestion regarding Asperger syndrome has not yet been ratified by the group. There have been a number of responses in the media. This article contains interviews with a doctor who runs a clinic, a parent of a child with Asperger’s syndrome and the president of a non-profit organisation for raising awareness of the condition. There is some information on the DSM-V process here.  There is further discussion of the DSM-V Asperger syndrome diagnosis on the left-brain, right-brain blog and at the time of writing there are 87 comments, testimony to the interest this discussion is creating. Dr Grohol also covers this over at Psychcentral. Professor Simon Baron-Cohen has argued against the removal of the Asperger Syndrome label in this New York Times article. Dr Anestis offers his views on this article and Baron-Cohen responds in this blog post.

At the ISCI healthcare blog there is an article looking at some of the ways in which twitter is being used in healthcare. MindHacks has another news roundup in ‘Spike Activity‘ and included is a link to an interview with Terry Pratchett about Alzheimer’s Disease. The ‘Heal My PTSD‘ blog contains a round-up of Post-Traumatic Stress Disorder (PTSD) news including the use of a virtual reality environment for re-experiencing trauma as part of a therapeutic intervention. This BBC article looks at some of the ways web 2.0 technology is being used by the research community. Patients in the USA are beginning to carry their healthcare information around with them in iPhone apps as reported in this article. The Science in the Open blog has an article looking at how an open collobarative framework might change science (Science 2.0) with the possibility of the science being separated into data acquisition, data analysis and dissemination of results. An article here looks at recent research which counters the argument that use of the internet has casued people to become more isolated. They cite research which suggests that people are not more isolated than in 1985 and elsewhere that people who use the web regularly are more likely to participate in social activities such as meeting up with friends . See here for more information.

In the BJPsych there is an interesting article by Professor Michael First who writes about the potential for harmonisation of DSM-V and ICD-11 which is a widely discussed topic (First, 2009). There are a number of points of interest in the article and he notes that there are investigators involved with revisions of both systems which should help to contribute to attempts to harmonise both systems. The discussions around these systems will no doubt increase*.

Psychiatry 2.0

In a small study, participants were observed using search engines. The researchers concluded that search strategies were influenced by the learning styles of the participants and that participants often used search engines to confirm then own recall of a subject. A recent MyPublicServices event was held to discuss ways in which social media might impact on public services. It was suggested at the conference and reported in this article, that social media may impact on public health service delivery as it has done in many other sectors and that a constructive approach to using social media in th9s area could be adopted. One research study into viral marketing campaigns focused on the characteristics of e-mavens – people who spend a lot of time online**. E-maven’s characteristics were identified and those that were more likely to forward viral material onto others scored more highly on measures of individualism and altruism. The FDA has convened the social media hearings to examine the issue of regulation of pharmaceutical companies use of social media and this has been widely discussed in the mainstream media, the blogosphere and the twittersphere. An article here has lots of discussion in the comments section.

This BBC article looks at Google Wave and includes a interview with the founders and some examples of use. Google wave is a collaborative tool that is described as facilitating the linking of ideas and data, allowing for instance data to be inserted relatively easily by multiple authors into a collaborative document. There is further coverage of Google Wave applications in this article which contains an embedded video and lists uses including research where Google Wave has provided benefits. The ICS healthcare blog has an article on how the doctor-patient relationship might be changing due to the influence of factors such as health 2.0. Ted Eytan in his blog has coverage of a study published in May that involved a focus group of patients who use the internet. The findings included an expressed interest by the people in the study to have access to their medical records. ‘360 digital influence’ discuss trends in the use of social media by doctors here including a look at research in this area.

Dr Shock links to an educational video about the redesign of the PubMed interface which is useful for those undertaking literature reviews, database searches and related activities. Sandy Gautam has started a new blog – My 2 Brains and in this post he reflects on twitter including a look at how it relates to the expression of self. MindHacks has his weekly round up here. Mind Hacks has another episode of Spike Activity where he reviews the news including a link to a study showing an association between creativity and horizontal eye movements, adding to previous research suggesting an association with recall of information.There is an article here about web-based healthcare. The Journal Cell has an article on twitter and at least one of the scientists quoted in the article found that it was useful in keeping up to date with developments in their field.

The ‘Heal My PTSD’ blog has a news round-up which includes the use of telemedicine for PTSD. John Grohol has an article at PsychCentral on how ‘first impressions count’ online and argues that these impressions are formed through inspection of photographs and he also reports on a study looking at Facebook use which is due for publication next year. There is a presentation available here on how web 2.0 might affect education. The Gov 2.0 conference is due to take place online on December 10th 2009. Biomedcentral has an open-access article on a ‘database of everything’. A German petition is currently underway requesting that all publicly funded studies should be made available through open-access articles. The ZZoot blog has coverage of a recent workshop on the future of the semantic web for scientific communication. In this article there is a look at an organisation which matches researchers with research participants.

The Google Wave tool which has been recently rolled out enables live collaboration using a number of tools and in this article Leah Betancourt discusses some of the ways this is being used in the creation, dissemination and discussion of news. Conventional methods for disseminating scientific/clinical information including conferences, journals and books are now in the process of being transformed by such tools. Another development which has the potential to have a profound impact on society, Government 2.0 was discussed at a recent conference. The idea here is that citizens can both engage with and contribute to the decision-making process of government. As an example this may impact on the way in which different segments of society are represented and this in turn could impact on health and illness on a number of levels. The American Association for the Advancement of Science has set up an expert lab to help government engage with citizens using technology and enabling them to tap into ‘crowd expertise’. There is a video on the expert lab here. In an american survey by Manhattan Research, 39% of doctors stated that they had communicated with patients online although the insurance-based nature of the healthcare system may influence such relationships. An article here looks at how doctors are using technologies such as twitter and the iPhone in their practice.  Meanwhile the Danish Government is intending to go paperless by 2010.

It is a privilege for the TAWOP blog to have been included in a list of 100 blogs for psychology students and there are many interesting blogs included in this list.

References

Michael First. Harmonisation of ICD-11 and DSM-V: Opportunities and challenges. The British Journal of Psychiatry. 2009. 195. 382-390.

Toal F, Daly EM, Page L, Deeley Q, Hallahan B, Bloemen O, Cutter WJ, Brammer MJ, Curran S, Robertson D, Murphy C, Murphy KC, Murphy DG.Psychol Med. 2009 Nov 6:1-11. [Epub ahead of print]. Clinical and anatomical heterogeneity in autistic spectrum disorder: a structural MRI study.

Twitter

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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).

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.

Reflections on October 2009

October 2009 featured World Mental Health Day (October 10th) reminding people of the importance of mental wellbeing. There were a number of papers reviewed covering in particular mental health informatics and cognitive impairment. Blogs reviewed focused on mental health informatics topics including an open-source healthcare database MRS. There were some interesting podcasts reviewed which included an interview with Professor Sir David Goldberg as well as a lecture in which the benefits of bringing positive psychology into psychiatry were considered. Books reviewed covered evolution, psychoanalytic and related theories and sociological topics. In the news there was a look at studies on olive oil and amyloid plaques, an association between cholesterol in middle-age and subsequent Alzheimer’s Disease, the efficacy of telephone-based delivery of CBT, an increase in antidepressant prescriptions in the UK, new electrophysiological findings about the functioning of Broca’s area, a Japanese supercomputing project to simulate life, new findings about Dimebolin’s receptor sensitivity and the development of the Neuroscience Information Framework Version 2.0.

Book Review


Book Review: The Greatest Show on Earth

Book Review: Alfred Adler on The Education of Children

Book Review: The Divided Mind

Book Review: Linked

Book Review: Outliers

Podcast/Media Reviews


Podcast Review: Nature Neuropod Oct 28th 2009

Podcast Review: October 2009 Edition of American Journal of Psychiatry

Podcast Review: Nature Podcasts from October 2009

Podcast Review: Acta Scandinavica Psychiatrica Interview with Professor Sir David Goldberg

Podcast Review: Bringing Psychology’s ‘Positive Psychology’ to Psychiatry

Blog Review

Blog Review: Doctor Dymphna’s Diliberations

Blog Review: Open MRS

Blog Review: Medical Ethics Blog

Blog Review: Mobile Healthcare

Blog Review: New Media Medicine Blog

Social Psychiatry Article Reviews


Review: Accuracy of Prevalence Rates in Multiple Sclerosis

Review: The Genetic Epidemiology of Neurodegenerative Disease

Review: Mobile and Fixed Computer Use by Doctors and Nurses on Hospital Ward

Review: YouTube and ‘Neurological Knowledge’

Psychology/Psychotherapy Article Reviews


Review: Implicit and Explicit Aspects of Sequence Learning in Presymptomatic Huntington’s Disease

Review: Cognitive Impairment in MS: Evidence-based analysis

Review: Differential Cognitive Impairment for Diverse Forms of Multiple Sclerosis

Review: Vascular Cognitive Impairment No Dementia (VCIND)

Biological Psychiatry Article Reviews


Review: Beyond the Brain in Huntington’s Disease

Review: Relationship Between 24-hour Blood Pressures, Subcortical Ischemic Lesions and Cognitive Impairment

Review: Autophagy in Neurodegeneration and Development

Review: Striosomes and Mood Dysfunction In Huntington’s Disease

Miscellaneous

World Mental Health Day

News Round-Up October 2009

In this article there is coverage of a prospective cohort study in Honolulu which includes post-mortems to clarify the processes leading to the dementia. The study has been going on for many decades and the researchers have now accumulated data from close to 800 autopsies and are able to compare this with neuropsychological and other data. NHS Choices discuss a study involving Olive Oil and finding that it binds to A Beta-derived diffusible ligands (ADDLs) and influences in turn their binding to synapses which may have implications for the disease process in Alzheimer’s Disease. In America, a group of neurologists have developed consensus guidelines for the use of cognitive enhancers in adults without dementia. Another study involved contacting retired American Football (NFL) players and conducting a survey over the phone. The researchers found a much higher prevalence of dementia in the NFL players than the national average. In one study there was found to be an association between plasma levels of ABeta42 and risk of conversion from Mild Cognitive Impairment to Alzheimer’s Disease and it will be useful to see further replication of these findings. Levels of a class of transcription factors NFAT’s (Nuclear Factors of Associated T-Cells) was significantly elevated in the hippocampi of subjects with Mild Cognitive Impairment or Alzheimer’s Disease compared to controls and at least one pathway has been suggested between activation by Amyloid plaques and expression of regulated genes.

A prospective California study with 9000 subjects provided evidence of an association between higher levels of cholesterols in people aged in their 40’s and the subsequent prevalence of Alzheimer’s Disease in their 60’s to 80’s. The article is freely available here. Analysis of the data from the Nun study continues with over 500 brains obtained post-mortem. The Nun study followed up several hundred nuns, examining a large number of factors and identifying associations with Alzheimer’s Disease. In this article you can watch an interesting video containing interviews with some of the nuns as well as a post-mortem dissection of a brain with enlarged ventricles. The Nuns have been very generous in ensuring that their brains can be used for research after their death and this type of research is very important in coming to a better understanding of the disease process. A study has provided evidence of a possible association between a virus XRV and Chronic Fatigue Syndrome. In a study of people with Parkinson’s disease using a driving simulator and comparing this group to age-matched controls, the Parkinson’s subjects were significantly more likely to experience a crash under low visibility settings than the control group. There were a number of factors including visual processing speed which were significantly associated with driving performance in the simulator. A phase 1 clinical trial is currently underway to examine the potential neuroprotective role of the antibiotic Minocycline in acute ischaemic stroke. Experimental evidence has shown that expression of IL-6 in murine brain can lead to removal of amyloid plaque by microglial cells. There has been significant evidence to suggest a role for inflammation in the disease process and these new findings show that the relationship between inflammation and build up of Amyloid Plaques in the brain is complex.

An American study provided evidence of the cost-effectiveness of telephone-based Cognitive Behavioural Therapy for depression in primary care (covered here and here) although the application of these results will depend on local protocols and service structure. The study is in the Archives of General Psychiatry. Aaron Beck who developed CBT was awarded the Lasker prize for clinical research. A prospective study involving 10,094 subjects over 4 years looked at adherence to a Mediterranean diet and new-onset depression and found evidence of an inverse relationship between increasing adherence to the diet and incidence of new-onset depression. A study in the BMJ showed an increase in the number of prescriptions of antidepressants from 1993 to 2004 and this was attributed to the use of long term prescriptions. There is further coverage here. In a cross-sectional study of symptoms in people with bipolar disorder (n=88) published in the journal of the World Psychiatric Association, the researchers found a significant association between the mixed affective state and negative cognition and hyperactivity (article freely available here). In a study of people in the Andean highlands in Ecuador (n=167), the researchers used the Spanish version of the Beck Depression Inventory II and identified that the scores on the somatic component of the scale were significantly higher than the cognitive component (article freely available here). The researchers interpreted this as  resulting from the influence of culture on the expression of the depressive illness.

Scientific American have coverage of some studies supporting the hypothesis that long term relationships foster creativity. In the studies they contrasted analytical with creative thinking. The types of relationships considered were tested indirectly by the use of imagination or by presentation of words with subtle meanings related to the paradigm. However it could be argued that the relationship status of the subject would provide more convincing evidence. A conference on empathy took place at the end of September 2009 and the conference website can be found here. There has been a relative large study comparing people with Tourette’s and OCD with healthy controls and finding no significant evidence of the former conditions with Streptococcal throat infection. There is contrary evidence which suggests that Strep throat infections can be associated with autoimmune processes which involve the central nervous system and these are termed PANDAS. In an intracranial electrophysiological study published in Science, the researchers provided evidence that language processing occurs in Broca’s area and is divided into processes for grammar, meaning and articulation with each process being separated by milliseconds. There is a preliminary report on a new technology which measures electrical signals between the central nervous system and the vestibular apparatus in the ear. The Australian research team state that they are able to characterise responses in a number of central nervous system disorders and they include depression. There is a website which details the technology and which also contains a link to a promotional video. Using Medline, I was able to find 5 studies including 1 on schizophrenia and 1 on depression, although both had small sample sizes they provided data on the application of the technology. It will be interesting to see  further published data with larger sample sizes as this becomes available.

A 1 Billion dollar Japanese project to create a supercomputer which will amongst it’s many functions will aim to simulate life is currently underway and is covered here. In the Proceedings of the National Academy of Sciences there is a paper on the use of a new genome sequencing technology – whole exome sequencing (which focuses on genes coding for proteins rather than the entire genome sequence) in a case which resulted in a rapid diagnosis and it will be interesting to see further developments in this area. The Natural Health Service is an ambitious project being undertaken in the NHS to plant 1.3 million trees which should reduce the carbon footprint of the NHS.

Research In Dementia

The researchers found that gamma-secretase, an enzyme implicated in Alzheimer’s Disease pathology binds to a class of  transmembrane proteins known as tetraspanins  (Wakabayashi et al, 2009) as well as to a number of other proteins. The tetraspanins have a number of different functions within the cell and it will be interesting to see how gamma secretase relates to these functions. There is further coverage here. An in-vivo study has provided evidence that Dimebolin has a high affinity for the Serotonin 5HT6 receptor in vivo (Schaffhauser et al, 2009). Dimebolin under the name Dimebon was trialled in Alzheimer’s Disease and showed promising results. There may be a focus on this receptor for therapeutics if these results are replicated. A small study of people with Alzheimer’s Disease (AD) compared with people with mild cognitive impairment and healthy controls (n=55) provided evidence that there was a correlation between the PET and CSF markers of ABeta but that they did not correlate significantly with cognitive impairment (Jagust et al, 2009). There is an interesting article on the National Dementia Research Brain Bank here. A meta-analysis of prospective and case-control studies examining the relationship between smoking and Alzheimer’s Disease which adjusted for a number of factors including tobacco company affiliation of the studies showed that smoking was a significant risk factor for Alzheimer’s Disease (Cataldo et al, 2009). A post-mortem study comparing the brains of people who had Alzheimer’s Disease and hyperphagia with those who did not found a significant reduction in 5HT4 receptors in the former group  (Tsang et al, 2009).

Evolutionary Psychiatry


There is also evidence that neighbouring groups of Chimpanzees approach the same problem in different ways which the researchers have interpreted as cultural differences. Such interpretations may have implications for developing models of human culture. Steve Peters, psychiatrist and coach for the Olympic Cyclists is appearing on a television program to work with members of the public to improve their fitness. In this article that covers the story, Steve Peters discusses some of the underlying theory he uses (which appears to relate to evolutionary psychology). An anthropological study looked at old world monkeys and found that increasing neocortical size was associated with the ability to form large social networks. Researchers have provided indirect evidence that Macaque monkeys experience the ‘Uncanny Valley‘ effect. This effect describes the tendency for people, or monkeys in this case, to become uncomfortable if computer simulations of members of their species are too realistic. The finding in monkeys suggests an evolutionary basis for this effect. It will be interesting to see if this has implications for social bonding. An fMRI study in monkeys and humans provided evidence of activation of the inferior Parietal lobe in humans alone when watching tool-using activities. There were a number of other areas that were activated in both humans and monkeys when undertaking this task. There is an estimate from one study that each person has roughly 100 new mutations in their genome based on an analysis of the difference in genes in two chinese men who shared an ancestor at the beginning of the nineteenth century.

Psychiatry 2.0


Over at Science Life there is coverage of the Neuroscience conference in Chicago which amongst other items reports on a talk by Erik Kandel, the genetics of anxiety and neuroscience in social media. October 19-23rd was Open Access week and over at Beta Science, Morgan Langille writes about the use of an open-access website BioTorrents for sharing data and other resources. Over at Medical News Today there is a look at an association between gamma synuclein and depression. Software Advice has an article on iPhone applications for doctors and medical students. The Neuroscience Information Framework Version 2.0 is now online. The NIF is described as

A dynamic inventory of web-based neuroscience resources: data, materials, and tools accessible via any computer connected to the internet

The NIF is also described as a National Institute of Health Blueprint for Neuroscience Research initiative (see also this review of a paper on the Neuroscience Information Framework). The NIF Tools include a registry of electronic catalogues of neuroscience resources, a ‘deep web’ resource – the NIF Data Federation, the NIF Web Index – essentially a search tool for neuroscience information on the internet and the NIF vocabulary which includes Neurolex. Neurolex is a neuroscience lexicon which at the time of writing contains 7972 terms. Such a lexicon has implications not just for the ability to find relevant information on the internet but also has potential for facilitating neuroscience dialogue.

References


Cataldo JK, Prochaska JJ, Glantz SA. Cigarette Smoking is a Risk Factor for Alzheimer’s Disease: An Analysis Controlling for Tobacco Industry Affiliation. J Alzheimers Dis. 2009 Oct 8. [Epub ahead of print]

Jagust WJ, Landau SM, Shaw LM, Trojanowski JQ, Koeppe RA, Reiman EM, Foster NL, Petersen RC, Weiner MW, Price JC, Mathis CA; Alzheimer’s Disease Neuroimaging Initiative. Relationships between biomarkers in aging and dementia. Neurology. 2009 Oct 13;73(15):1193-9.

Schaffhauser H et al. Dimebolin is a 5-HT6 antagonist with acute cognition enhanching activities. Biochemical Pharmacology. Vol 78. Issue 8. pp 1035-42. 2009.

Tsang SW, Keene J, Hope T, Spence I, Francis PT, Wong PT, Chen CP, Lai MK. A serotoninergic basis for hyperphagic eating changes in Alzheimer’s disease. J Neurol Sci. 2010 Jan 15;288(1-2):151-5. Epub 2009 Oct 8.

Wakabayashi T, Craessaerts K, Bammens L, Bentahir M, Borgions F, Herdewijn P,Staes A, Timmerman E, Vandekerckhove J, Rubinstein E, Boucheix C, Gevaert K, De Strooper B.Nat Cell Biol. 2009 Oct 18. [Epub ahead of print]. Analysis of the gamma-secretase interactome and validation of its association with tetraspanin-enriched microdomains.

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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.

Reflections on September 2009

In September 2009, there was a review of an article on the construction of a diagnosis which is topical given the pending DSM-V and ICD-11. There were also reviews on the Delusional Misidentification Syndromes and one of Winnicott’s articles – on primitive emotional development. There were reviews of a number of articles on both delirium and dementia as well as a review of articles on the impact of technology on healthcare. The last of Betts podcasts on Jungian Analytical psychology at the time was reviewed although having said that another has now been added. Books reviewed covered topics including the effects of exercise on the brain and the relationship between therapy and culture. There was also commentary on the use of twitter in association with the blog. Two big studies published in Nature Genetics were reported in the news, both of which looked at genes strongly associated with Alzheimer’s Disease. There was also a look at a study using a new side-effects checklist for antidepressants. There were also interesting findings on the benefits of reminiscence therapy for memory and on communication of information on medications.

Psychology/Psychotherapy Articles Reviewed

Review: Review Article on Cognitive Dysfunction in Multiple Sclerosis

Review: The Delusional Misidentification Syndromes: Strange, Fascinating, and Instructive

Review: Winnicott on Primitive Emotional Development

Review: ‘Development of Criteria for a Diagnosis’ or ‘The Pathology of the Midnight Snack’

Biological Psychiatry Articles Reviewed

Review: Frontal-Subcortical Dementias

Review: MRI Atrophy In Alzheimer’s Disease

Review: Delirium. Sifting Through the Confusion

Review: Clinical Decline and Education in Frontotemporal Lobar Degeneration

Social Psychiatry Article Reviews

Review: Why Is There Paper In The Paperless System?

Review: Can Wireless Text Messaging Improve Adherence to Preventive Activities? Results of a Randomised Controlled Trial

Review: Dementia and It’s Implications for Public Health

Review: US Public Survey of Mobile Health Technology

Review: Junior Physician’s Use of Web 2.0 for Information Seeking and Medical Education. A Qualitative Study

Podcast Reviews

Podcast Review: September 2009. 3rd Edition – August 2009. Nature Neuropod.

Podcast Review: September 2009 2nd Edition

Podcast Review: Betts on Jungian Analytic Psychology #27 and #28. Individuation

Betts on Jungian Analytic Psychology #26: Jung on Individuation Part 1

Blogs Reviewed

Blog Review: The New Social Workers Blog

Blog Review: Jung Currents

Blog Review: The Differential Biology Reader

Blog Review: Modern Psychoanalysis

Books Reviewed

Book Review: One Nation Under Therapy

Book Review: 50 Philosophy Ideas You Really Need to Know

Book Review: Spark

Book Review: Jung. On the Nature of the Psyche

Miscellaneous

Stigma. Worse Than Psychosis

Blog Twittering 8 – Twitternet Addiction

Blog Twittering 7

Blog Twittering 6

Blog Twittering 5

Blog Twittering 4

Blog Twittering 3

Blog Twittering 2

Blog Twittering 1

News from September 2009

Research in Dementia

Three genes associated with Alzheimer’s Disease were identified in 2  studies published in Nature Genetics. Amouyel and colleagues conducted a two-part study (Amouyel et al, 2009). In the first part of the study they undertook a Genome-Wide Association Study involving 537,029 single nucleotide polymorphism’s (SNP’s) in a French sample of 2032 people with Alzheimer’s Disease and 5328 controls.As there were multiple comparisons, they needed to control for this (with a Bonferroni correction) and a marker in the CLU gene on chromosome 8 (8p21-p12) showed a statistically significant correlation just above the threshold.

They then attempted a replication in the second stage which involved 3978 probable cases of Alzheimer’s Disease and 3297 controls. This second stage involved subjects from Spain, Belgium and France. They confirmed a statistically significant association of CLU with the probable Alzheimer’s Disease subjects and additionally found a significant correlation with CR1 on chromosome 1 (1q32). The researchers then estimated the contribution of each gene to the risk of Alzheimer’s Disease and estimated that the attributable risk for APOE (a well established risk factor for Alzheimer’s Disease) was 25.5%, for CLU it was 8.9% and for CR1 it was 3.8%. Nevertheless the CR1 did not show up in the first stage of the study.

In the second study, Professor Julie Williams and colleagues (including Professor Michael Owen) undertook another two part study. This involved ‘up to 19,000 subjects’ in the initial stages of the study, these subjects being recruited from Europe and the United States. Again, this was a Genome Wide Association Study. After quality control measures, they looked at 529,205 autosomal single nucleotide polymorphisms in 3,941 people with Alzheimer’s Disease and 7,848 controls. They identified one marker in CLU (the same gene identified in the study above) and a second in the PICALM gene on chromosome 11. Importantly both of these findings were replicated in the second stage of the study which involved 2,023 people with Alzheimer’s Disease and 2,340 age-matched controls.They then looked further to see if they could identify which areas within the gene were significantly correlated and produces some candidate regions. The team point out that there are other significant genes which wouldn’t have been identified in this analysis.

Thus the three identified genes were CLU, PICALM and CR1.

The CLU gene (Clusterin) which was identified in both studies encodes an apolipoprotein which together with APOE is found in the central nervous system as well as other tissues. There are many suggested pathways for the involvement of CLU in the pathology of Alzheimer’s Disease. Thus CLU is found in the amyloid plaques found in Alzheimer’s Disease and there is evidence also suggesting that it may be involved in the removal of Beta Amyloid from the brain (by forming soluble complexes which can cross the blood brain barrier) and may play a role in inflammation in the brain.

The PICALM gene which was significantly associated with Alzheimer’s Disease in the second study encodes a protein that is involved in endocytosis. Mutations in PICALM (phosphatidylinositol-binding clathrin assembly protein) may therefore interfere with the transport of materials into the neurons and the team suggest that synaptic vesicle cycling may affected (for another study looking at vesicle cycling see the study below which involved a newly discovered protein – the Flower protein which may be involved in Calcium regulation within the neuron emphasising the importance of endocytosis in neuronal functioning).

The CR1 gene which was significantly associated with Alzheimer’s Disease in the second stage of the first study, encodes a receptor for C3b protein. The C3b protein forms part of the complement cascade and again there is some evidence suggesting that it may be involved in the removal of Beta Amyloid. The CR1 receptor may be involved in the process of phagocytosis  – when material is ingested by the immune cells.

Now that these gene associations have been identified it will be interesting to see further replication studies as well as studies examining the possible roles of these genes in further detail.

The N60 region of the RanBP9 protein has been associated with an increased production of Beta-Amyloid production using post-mortem and cell culture data and these findings may lead to the development of novel therapeutic interventions for Alzheimer’s Disease. This protein binds to another protein which is involved in the movement of RNA through the pores in the nuclear membrane. RanBP9 interacts with several other proteins also.

Financial Skills and Risk of Dementia

Predicting which people with Mild Cognitive Impairment go on to develop dementia is an area of current research interest. There are many studies using different methodologies looking into this question. One predictor is that the size of the Hippocampus (size is inversely correlated with dementia risk) which has a robust evidence base. However, a recent study provides evidence that financial skills may be another marker of risk and this has been widely reported in the media (e.g. here, here and here). A research team, just published in ‘Neurology’ found that people with Amnestic Mild Cognitive Impairment who scored poorly on the Financial Capacity Instrument were more likely to develop dementia. The sample group were people with Amnestic MCI and are therefore already a select group who have been assessed as having formal difficulties with memory. They were being scored on a tool which measures financial skills. The size of the study is relatively small (n=163) and of these, 25 people with Amnestic MCI went on to develop dementia.

There was found to be a significant association between a variant in the gene LINGO1 and Parkinson’s Disease and Benign Essential Tremor suggesting that this gene may be involved in both conditions. The gene variant is identified with approximately 5% of people with either condition. A gene sequencing process mrFAST (micro-read Fast Alignment Search Tool) has demonstrated utility in detecting duplicated genome sequences and the researchers have noted an increased number of copy number variants in genes which are located in a segment of the genome which underwent significant duplication in the ape/human ancestor. The process has implications for detection of diseases in which copy number variants need to be estimated and has also been used in the 1000 Genome Project.

Research on Antidepressants

The British Journal of Psychiatry featured two interesting studies on antidepressants. The first featured a patient rating scale for antidepressant side-effects – the Antidepressant Side-Effect Checklist (AEC) which is included in the Appendix for the paper (Uher et al, 2009). The researchers compared this patient rating scale with a clinician rating-scale, the UKU in 811 subjects with depression who were participating in an open-label trial comparing Nortriptylline with Escitalopram. The Nortriptylline was included because of a strong affinity for noradrenergic receptors (it would have been interesting to see whether similar findings would have occurred with Reboxetine). They found that after correcting for the severity of depression, the AEC scores predicted discontinuation of escitalopram (although curiously not the Nortriptylline) and validated the use of the instrument for the purposes of establishing side-effects in antidepressants. In another study, this time qualitative, the researchers explored the emotional side-effects of the SSRI’s. The responses from the participants were grouped into 7 categories and there were many interesting comments from the participants (Price et al, 2009). Both a reduction in ‘positive’ and ‘negative’ emotions were reported and there was some supporting evidence from an analysis of comments on several depression related online forums. The authors suggest further quantitative studies to investigate the findings from this study.

Miscellaneous Research

new finding reported in the journal Cell is that cells are able to move using a newly identified mechanism which involves a folding of the membranes to form filopidia and this involves the use of a protein sRGAP2 which is associated with neurodevelopmental disorders. This may have important implications for the understanding of neurodevelopment.

News In Brief

In analysis of data from the Maastricht Aging Study, 35 healthy older adults without cognitive decline were compared with 30 older adults who displayed cognitive decline (using thresholds on several outcome measures) and in the latter group there was found to be a significant reduction in grey matter volume in the hippocampus, hippocampal gyrus, frontal and cingulate cortices. Some evidence that reminiscence therapy can improve memory in the elderly is provided from a review of reminiscence therapy studies that was published in Scientific American Mind which also looks at other outcome measures. It will be interesting to see the results of a meta-analysis once further studies are available.

A meta-analysis of prospective studies of people with cancer and comorbid depression found that depression was associated with a significant increase in mortality and the paper is freely available here at the time of writing as well as being reported on here. A PET study of 53 people with ADHD compared to 44 healthy controls provided evidence for reduced dopamine receptors in the Nucleus Accumbens.

Two large studies ( n=2978 and n=1760) published at PLOS Medicine, looked at how patients make choices regarding medications and amongst the findings, people were best able to understand medication outcome information if this was presented in simple frequencies (e.g. per 100 of the population). Further information on the trials can be found here and here together with a discussion of shared decision making here. An emergency mobile text message system for people unable to use their voices in calls is being trialled by a number of UK telecommunication companies.

There is evidence from a small Japanese study (n=48) that male teenage young offenders are more likely to misinterpret disgust as anger than male teenage non-offenders. An interesting study provided evidence that early stages of the visual perception process were influenced by cue associated emotions and memories. Subjects were presented with faces showing different expressions and the subject’s rating of the emotions in the expressions was correlated with the activation of  their own facial muscles when the same faces were re-presented after having been modified to exhibit a neutral expression.

comparison of longitudinal and retrospective studies provides evidence that people underestimate their experience of mental illnesss retrospectively. An American study of physician-patient interactions in primary care practices in Baltimore found a significant difference in communication-related outcome measures between white and black patients in areas including psychosocial interactions in consultations relating to blood pressure control. The researchers suggest that interventions focusing on doctor-patient communication may influence ‘racial disparities in the care of patients with high blood pressure’ although such research may have benefits in other areas of health care. The BMA has released a new document on ‘the effect of alcohol marketing on young people‘ and there has been wide reporting on this in the media.

A new gene association with deafness has been identified. Loxhd1 mutations impair functioning of hair cells and subsequently with hearing. Mutations of this gene were found in some families with deafness  (in a genetic database with genetic samples from hundreds of families with deafness). A protein – called the Flower protein – has been recently identified and found to play a role in the processes of endo and exocytosis whereby neurotransmitters are packaged into vesicles, released from the neuron and the membrane resorbed. Aggregates of the protein form channels which allow the entry of calcium into the cell and the research team suggest that this protein could be responsible for the close and necessary coupling of endocytosis and exocytosis.

Evolutionary Psychiatry

Evidence has been found that a species of New World Monkey – the Cotton Topped Tamarin are able to distinguish between ‘affiliate’ and ‘fear’ music produced by other monkeys. Such studies are useful for debates in Evolutionary Psychology. In a fascinating anthropological study of the fairy tales Little Red Riding Hood shows that this fairy tale probably has a very ancient origin. There were subtle differences across the world – for instance in China the wolf is replaced with a tiger. The most closely related versions to the modern European were those from Nigeria and Iran. There are many forms of analysis of fairy tales including psychoanalysis (see here, here and here for instance. A study published in Science (n-192) and using a public goods game paradigm (used in the study of group behaviour) provided evidence that using a reward strategy for ‘good behaviour’ produced better outcome (e.g. contributions to the group) than with the use of punishment for ‘bad behaviour’. A team looking into the extinction of Neanderthals have found the remains of late ice age animals in a cave in Torquay and the remains include what could be a 25,000 year old Hyena.

Psychiatry 2.0

An application – healthii - has been developed with the intention of improving the well-being of people engaged in social networking online. A recent trial on Twitter at the end of August and the findings should be reported in the near future. A Twestival Local (a local festival on twitter) is taking place (see the site here) to raise money for charity. There are two types of festival – one is global and the other involves individual cities which are identified on the map here. This shows one of the many extraordinairy ways in which Twitter is impacting on society globally. A study looking at twitter provided evidence that 20% of twitters  involve exchanging information about ‘products’. Epi Collect Software on mobile devices has been piloted which enables ‘citizen scientists’ to gather data for science projects incorporating their location within the data.

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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.

Reflections on July 2009

July saw the 1st Anniversary of ‘The Amazing World of Psychiatry’ blog and the TAWOP Index links to previous articles (sometimes the links in the Index don’t work properly – technical issue). I will be putting some articles together (a little late) for the 1st Anniversary so watch this space! In the medical articles, two more papers from the ‘Puzzlingly High Correlations in fMRI Studies of Emotion, Personality and Social Cognition’ were reviewed, while in the psychology/psychotherapy articles a number of Winnicott’s papers were reviewed. For social psychiatry, there were a number of interesting issues examined in the papers reviewed including ‘What Should Psychiatrists Be Doing in the 1990’s’ and social networks in the prevention of dementia. Books reviewed included ‘Positive Psychology in a Nutshell’  and blogs reviewed included Brains on Purpose (which covers conflict resolution and other topics), Dr Jeff and Dr Tanya’s blog about psychiatry and the interesting ‘Small Gray Matters’. Various podcasts were reviewed. In the news, there was further support for computerised CBT, a large case-control study providing evidence that copy number variants contributed up to one-third of the risk for Schizophrenia, a relationship between centrally-acting ACE inhibitors and decreasing cognitive decline, a relationship between diet and cognitive decline and the efficacy of a web-based program in reducing alcohol consumption in college students, amongst other studies.

1st Year Anniversary of TAWOP Blog

TAWOP Index

Medical Articles

Understanding the Mind by Measuring the Brain

Reply to Comments on ‘Puzzlingly High Correlations in fMRI Studies of Emotion, Personality and Social Cognition’

The Ubiquitin-Proteasome Pathway in Huntington’s Disease

Results of Phase III of the CATIE Schizophrenia Trial

Psychology/Psychotherapy Articles

Winnicott on the Antisocial Tendency

Winnicott on Paediatrics and Childhood Neurosis

Winnicott on Metapsychological and Clinical Aspects of Regression

A Meta-Analysis of Self-Help Therapy for Insomnia

Social/Epidemiological Articles

Modernising Mental Health Services for People Who are Deaf

Huntington Disease in County Donegal

What Should Psychiatrists Be Doing in the 1990’s?

Social Networks and Their Role in Preventing Dementia

Estimating Future Numbers of Adults with Profound Multiple Learning Disabilities in England

Book Reviews

An Introduction to Neuropathology

Huntington’s Disease. Second Edition

Positive Psychology in a Nutshell

What is This Thing Called Science

The Woman Who Couldn’t Forget

Blog Reviews

Dr Jeff and Dr Tanya’s Blog

The American Journal of Neuroradiology Blog

Origins – A History of Beginnings

Blog Review: Brains on Purpose

Small Gray Matters

Podcast Review

July 2009 – 1st Edition

Science Podcasts

July 2009 – 3rd Edition

Betts on Jungian Analytic Psychology #18

News Round-Up For July 2009

Research in Dementia

In a study of relevance to old age liaison services, the authors of a longitudinal study looking at older adults admitted as emergencies to hospital characterised the prevalence of dementia according to age stratifications. The authors found an as expected increase in prevalence with age rising to 75% over the age of 90 in women and 48.8% in men over the age of 90. 41.3% of admissions resulted from urinary tract infections or pneumonia(Sampson et al, 2009). In a case-control study of people with Late-Onset Alzheimer’s Disease (AD) (217 people with AD and 76 controls) there was found to be a significantly increased proportion of people with type A personality types compared to controls (Nicholas et al, 2009). In a small study comparing 13 people with frontotemporal dementia with 12 people with Alzheimer’s Disease and 20 people with Semantic Dementia using structural MRI longitudinally (1 year)  – there was found to be a significantly greater rate of atrophy in the frontal lobes in FTD than the other two groups and a similar rate of atrophy in the temporal lobe in semantic dementia and AD (Krueger et al, 2009).

Research in Mood Disorders

A randomised control trial looked at computerised CBT (cCBT) delivery in a primary healthcare setting. The 303 participants with depression were allocated to treatment as usual, cCBT (using the Colour Your Life program and without support) or cCBT plus treatment as usual. In the first two groups there was a relatively poor adherence to treatment but in the analysis there was found to be no significant difference between the groups on the primary outcome measure – BDI-II scores. The authors conclude that supported cCBT might fare better. It would be interesting to see if the program could be modified to increase adherence rates (de Graaf et al, 2009). In a study of 1147 parents (>60 years old) whose children migrated out of the district of the parent there was found to be a decreased prevalence of depression in the parents (article freely available here)(Abas et al, 2009). In an open-label flexible-dosing trial of Ziprasidone for acute bipolar mania (n=65), 98% of the adverse events were classed as mild to moderate in severity. Improvement in Mania Rating Scale scores was comparable across the examined subpopulations – those with mania alone, mixed episode and also with or without psychosis (Keck et al, 2009).

Research in Psychosis

The authors of a paper propose that Toxoplasma Gondii may produce psychosis in hosts as a mechanism to enhance fitness of the pathogen and advocate further research to test their hypothesis (da Silva and Langoni, 2009). The authors of a genome wide analysis (analysing the data from a previously published study) found significant evidence of an association between the research diagnostic criteria Schizoaffective Disorder Bipolar type and variations in the GABA receptor particularly GABRB1 which they argue is further evidence in support of the diagnosis of Schizoaffective Disorder and it will be interesting to see further studies examining this potential relationship more closely (article freely available here)(Hamshere et al, 2009).

News in Brief

A widely reported case-control study in Nature (also hereherehere and here although some of the reported sample sizes differ) looked at copy number variants in people with (n=3332) and without (n=3587) schizophrenia. The researchers found that there was a large number of variants that were associated with schizophrenia and were also found in people with bipolar disorder.  Furthermore these variants were estimated to contribute to a third of the risk for schizophrenia. Two further studies were conducted by different groups and the results from all three were pooled. Significant associations were found with the Major Histocompatability Complex on Chromosome 6 as well as the myosin gene.

There have been a lot of studies looking at the possible benefits of the ACE inhibitors in reducing the risk of dementia but a new study gives a twist to the story. This is a prospective study involving people without dementia at baseline and the researchers selected 1074 participants from the cohort. They found that taking a centrally-acting ACE-inhibitor was associated with a 65% decrease in cognitive decline (using a modified version of the Mini-Mental State Examination) and that taking a peripherally-acting ACE-inhibitor was associated with a 73% increased risk of dementia compared to those taking other antihypertensive medication. This study occurs in the context of other studies suggesting a benefit of the ACE-inhibitors in dementia on various outcome measures. However it is important to note that the participants in this study were being treated with antihypertensives and were thus a selective group. This may be an important finding and the investigation of the actions of the centrally-acting ACE-inhibitors may well give  some important insights into dementia. It will be very interesting to follow the necessary subsequent research in this area. The authors of a longitudinal Finnish study involving 2000 middle-aged subjects who were followed up over 20 years later provided further evidence that the APOE 4 variant was associated with a higher prevalence of Alzheimer’s Disease. A similar increase was also found in association with being separated from a partner before age fifty. A study has provided indirect evidence that Granulocyte Colony Stimulating Factor  (GCSF) might prevent the build up of Beta-Amyloid plaques in the brain which would be relevant in Alzheimer’s Disease. It will be interesting to follow further studies in this area.

Researchers at the University of California have identified an association between PTSD and increased risk of subsequent dementia using information from a database on 181,093 veterans over the age of 55-years although this association did not occur after controlling for depression, substance misuse and traumatic brain injury. An engineered protein that can be extracted from goat’s milk has and which interacts with the Beta-Amyloid protein has been suggested as a potential prophylactic agent for people who carry a variant of the Butylcholinesterase inhibitor gene.  Several studies were presented at the 2009 International Conference on Alzheimer’s Disease which this year was in Vienna. Thus evidence was presented that strictly adhering to a diet for hypertension – the Dietary Approaches to Stop Hypertension (DASH) Diet was associated with improved cognitive functioning compared to those who didn’t adhere as consistently. There were 3,831 participants over the age of 65 who were followed up over 11 years. Adherence to the diet was represented by an ‘adherence score’ and associations with cognition were also found for fruit and vegetables as well as low fat dairy products. In another of the studies, a prospective study of 3075 people aged 70-79 there was a significant association between sedentary lifestyle and lower cognitive scores (modified MMSE) as well as between declining scores and declining physical activity. Another of the studies, this time in post-menopausal women showed a benefit on cognition for moderate exercise but a detrimental effect for chronic strenuous exercise although the study included a small number of participants (90) and it would be interesting to see further replication studies.

In one study, antibodies against ABeta peptide were found to decrease with advancing age and in people with Alzheimer’s Disease. Interestingly health control subjects were found to have antibodies against a number of antigens from plaques found in rare forms of dementia although the significance of this is far from clear. In another study, severe Chronic Obstructive Airways Disease was associated with significantly decreased performance on a validated 35-point cognitive scale compared to performance in a control group without COPD after controlling for possible confounders. The authors of a meta-analysis looking at 118 neuropsychological tests in the discrimination of Vascular Dementia and Alzeheimer’s Disease concluded that only 2 tests were effective in discrimination – the emotional recognition and delay recall tasks – but concluded that multiple sources of information were needed for the purposes of discrimination. In a similar vein, a team at the Mayo Clinic have been developing an MRI protocol for discriminating Alzheimer’s Disease, Frontotemporal Lobar Degeneration and Lewy Body Dementia. The protocol is referred to as the STAND-Map protocol (Structural Abnormality Index). The protocol is apparently effective at discriminating ‘75-80%’  of cases although the results are due to be presented at a conference and it will be interesting to have a closer look at the breakdown of figures. Mutations in the protein LRKK2 are associated with Parkinson’s Disease and the authors a new study found that another protein referred to as CHIP binds to LRKK2 and modifies the levels of LRKK2 and it will be interesting to see the results of further studies in this area. A widely reported study showed an improvement in aged mice’s memory and attention when given large amounts of caffeine and an associated reduction in levels of Beta-Amyloid. Asystematic review of first and second generation antipsychotics found no evidence of efficacy in prevention of delirium in hospitalised patients and equivalent efficacy in treatment of delirium. In an interesting prospective study in older adults (n=49), MRI white matter hyperintensities were associated with a significant risk of developing dementia and the researchers correlated the volume of these lesions with the risk of developing dementia. A number of findings in Alzheimer’s Disease Research were reported at the British Pharmacological Society’s Summer Meeting in Edinburgh including evidence of a protective effect of flavinoids against the neurotoxic effects of Beta-Amyloid plaques. The REVEAL study provides evidence that disclosing information about APOE4 carrier-status to children of parents with Alzheimer’s Disease does not result in significant short-term psychological distress. A receptor has been found in the basal forebrain which responds to ABeta Protein in Amyloid plaques and may be related to the effects of plaques on acetylcholine levels.

An intriguing study with many ramifications involved looking at the effects of anger on measures of carotid artery flow in 3  groups of subjects of increasing age. The researchers found that anger was associated with vasodilation of the carotid arteries and that this effect did not occur in those with hypertension suggesting a possible mechanism for stress associated myocardial infarct. The authors of a recent survey of people who remained at home in New Orleans during Hurricane Katrina suggest on the basis of the results their decisions may be related to valuing a sense of community and that they did not view themselves as ‘powerless’. Repeating positive self-statements was associated with a decrease in self-esteem in those with already low self-esteem compared to those with high self-esteem in one study. The authors of a genetic study conducted in samples from a number of different ethnic groups have reported an association between perfect pitch and chromosome 8. A small fMRI study provided evidence of increased activity in the inferior frontal sulcus during language tasks involving identification of different pronunciations. The authors suggest that this region is involved in categorisation for both language and non-language activities.

A randomised placebo-controlled trial (using placebo patches) of nicotine patches involving 400 smokers compared those taking nicotine patches before stopping smoking versus taking placebo. Both groups then used the nicotine patches for 10 weeks. At 10 weeks 22% of the first group had abstained from smoking compared to 11%  of those taking the placebo before stopping smoking. Adults grow new neurons in the brain – referred to as neurogenesis. The authors of a recently published study found an association between neurogenesis in mice and an improved ability to form more finely detailed spatial maps of the environment suggesting that these new cells are functional which in turn implies that they are integrating with other neurons that form memory.  Data from the Dunedin study in New Zealand provided evidence that certain aspects of the family history was useful in stratifying risk of recurrence of specific mental illnesses. The authors of a Cochrane review concluded that preventive psychological intervention (CBT and counselling) after trauma may not prevent onset of PTSD symptoms. This study was looking at prevention rather than treatment of PTSD. However in treatment of PTSD there is a good evidence base for psychological treatments. Researchers are beginning a study into the use of echolocation in blind people to help them navigate around the environment – this involves producing a clicking sound with the use of the tongue on the palate. The echoes from the clicks should allow determination of objects in the environment and this has already been used.

A recent Cochrane review looked at interventions for reducing alcohol misuse in university students and the authors examined 22 controlled trials with a cumulative total of 7275 college students finding that web-based/computer feedback was associated with a significant reduction in a number of outcome measures including drinking frequency, quantity, binge drinking and peak blood alcohol content. Patterns of substance misuse are being studied in Oregon, USA by analysing waste water before it is treated.  A small fMRI study provided preliminary evidence that improvement in multitasking through training is associated with changes in activity in the posterior prefrontal cortex. A small study has provided initial evidence of a significant association between performance on a smell-test and response to Donepezil according to clinical impression in people with mild-to-moderate Alzheimer’s Disease. A study of young-onset dementia (n=235) found a high prevalence of psychiatric and behavioural disorders. A prospective study looking at people with Alzheimer’s Disease found a significant association between the use of antihypertensive medications and a lower rate of cognitive decline and higher MMSE scores at baseline even after controlling for blood pressure.

The authors of another Cochrane review concluded that there was insufficient evidence at this point to recommend the combination of Clozapine with another antipsychotic for treatment-resistant schizophrenia. In another Cochrane review which included data from 11 randomised-controlled trials with a cumulative total of 2441 adults identified as heavy drinkers, the authors found benefits for brief interventions with a reduction in alcohol consumption at 1-year follow-up although there weren’t found to be benefits for self-reported alcohol consumption and number of binges. In another Cochrane review there was found to be a significant benefit for the use of TCA’s or SSRI’s in the treatment of depression in primary care in adults (under the age of 65) based on analysis of 14 studies comparing TCA’s or SSRI’s with placebo with a cumulative total of 2283 participants*. In a study looking at prevalence of dementia in later life in low and middle-income countries and involving data from 14, 960 participants there was found to be a significant and inverse relationship between fish consumption and prevalence of dementia in later life. Another study didn’t show a benefit of DHA in mild-to-moderate Alzheimer’s Disease  on the ADAS-Cog after 18 months of treatment although another study did show a benefit for older adults with mild memory impairment Evidence for a possible role of fibroblast growth factor (Ffg) in development of the frontal cortex through radial glial cells was provided in one study and there is the suggestion that alterations in the Ffg may have a significant influence on the size of the frontal cortex in humans. In a series of recent studies a large number of acetylation switches(3600) have been found in a similarly large number of proteins (1750) which may be of relevance to a number of diseases and it will be interesting to see the results of subsequent research based on these results. A new ultrasound tool which samples at 125 Hz is being used in attempt to better classify African click languages. New radiocarbon dating, dates human remains in Gough’s Cave, Somerset to 14,700 years ago while a female Gibbon has been observed to slam a metal door in way which accentuated her territorial song suggesting a distant beginning for the use of percussion.

A committee found evidence of an association between Agent Orange exposure in Vietnam war veterans and risk of developing Parkinson’s Disease based on an an analysis of  16 studies looking at the effects of the herbicides. The authors conclude however that other types of study are needed to examine this association in more detail. A new Xenon delivery system has been developed which may have benefits in protecting against hypoxia-induced brain injury in humans. A single-blinded study (n=78) looked at improving attention (4 types described) in people who had developed a stroke by using Attention Process Training. Although they did find an improvement in attention with this training, at 6-months. A research team at the University of Vermont have been analysing text strings in blogs to estimate how ‘happy’ people are by looking at sentences with the words ‘I feel..’ in them. They were able to use 10 million sentences (from this site) and amongst their many findings they noted that people increasingly used the word ‘proud’ at the time of President Obama’s election, that Michael Jackson’s death was associated with a big drop in the valence scores (valence scores were calculated by rating each type of emotional word to estimate) and that teenagers were more likely to use the word ’sad’ in the sentence. As the 2012 Olympics approaches a new report has been published which reviews evidence from over 500 papers as well as expert interviews on crowd behaviours – the Understanding Crowd Behaviours Report. A computer simulation of organisms which uses simple variations in behaviour showed that turn-taking developed when organisms with different behaviours ‘locked’ into each other’s behaviour. In essence this suggests that individuals pursuing their own interests can engage in turn-taking behaviour. However this does not negate the possibility that turn-taking can occur for altruistic reasons particularly as decision-making is influenced by many factors in more complex organisms.  The authors of a meta-analysis looking at data involving over 8000 subjects concluded that people are more likely to discount information that contradicts the beliefs they already hold and that this tendency is influenced by a number of factors including personality type as well as the context of these beliefs. The authors of a paper looking at studies reported as randomised controlled trials in China identified 2235 studies and contacted the authors/coauthors. They report that less than 7% of the studies referred to as randomised controlled trials involved true randomisation. However this will not be limited to China and is relevant to the wider issue of research methodology.

* The authors note that a number of the trials were funded by pharmaceutical companies.

References

Abas MA, Punpuing S, Jirapramukpitak T, Guest P, Tangchonlatip K, Leese M, Prince M.Br J Psychiatry. 2009 Jul;195(1):54-60. Rural-urban migration and depression in ageing family members left behind.

de Graaf LE, Gerhards SA, Arntz A, Riper H, Metsemakers JF, Evers SM, SeverensJL, Widdershoven G, Huibers MJ.Clinical effectiveness of online computerised cognitive-behavioural therapywithout support for depression in primary care: randomised trial. Br J Psychiatry. 2009 Jul;195(1):73-80.

da Silva RC, Langoni H. Toxoplasma gondii: host-parasite interaction and behavior manipulation. Parasitol Res. 2009 Jun 23. [Epub ahead of print].

Hamshere ML, Green EK, Jones IR, Jones L, Moskvina V, Kirov G, Grozeva D, Nikolov I, Vukcevic D, Caesar S, Gordon-Smith K, Fraser C, Russell E, Breen G, St Clair D, Collier DA, Young AH, Ferrier IN, Farmer A, McGuffin P; Wellcome Trust Case Control Consortium, Holmans PA, Owen MJ, O’Donovan MC, Craddock N. Br J Psychiatry. 2009 Jul;195(1):23-9. Genetic utility of broadly defined bipolar schizoaffective disorder as a diagnostic concept.

Keck P E, Versiani M, Warrington L, Loebel A D, Horne L. Long-Term Safety and Efficacy of Ziprasidone in Subpopulations of Patients with Bipolar Mania.  J Clin Psychiatry. 2009. 70(6). 844-851.

Krueger CE, Dean DL, Rosen HJ, Halabi C, Weiner M, Miller BL, Kramer JH. Alzheimer Dis Assoc Disord. 2009 Jun 30. [Epub ahead of print].Longitudinal Rates of Lobar Atrophy in Frontotemporal Dementia, Semantic Dementia, and Alzheimer’s Disease.

Nicholas H, Moran P, Foy C, Brown RG, Lovestone S, Bryant S, Boothby H. Int J Geriatr Psychiatry. 2009 Jul 6. [Epub ahead of print]. Are abnormal premorbid personality traits associated with Alzheimer’s disease? – A case-control study.

Sampson EL, Blanchard MR, Jones L, Tookman A, King M. Br J Psychiatry. 2009 Jul;195(1):61-6. Dementia in the acute hospital: prospective cohort study of prevalence and mortality.

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Reflections on June 2009

In June, I continued to look at some of the responses to Vul and colleagues paper on fMRI. What I found interesting about these papers is that they address underlying statistical principles important not just for fMRI studies but also a lot of other research which involves looking at large amounts of data. Indeed it looks increasingly clear that statistics itself is undergoing big changes as scientists acquire ever larger quantities of data. Perhaps these changes in science parallel those in wider culture where in a relatively short space of time people have routinely acquired gigabyes of data in the form of films and music. So in the Vul study, some name calling in the field of fMRI has attracted a lot of attention but perhaps this ‘story’ has run so far because of the tacit acknowledgement that we are flooded with information and people have doubts about whether this is being managed effectively. Some of the most interesting comments I found in these articles were by statisticians who advised researchers to return to basics – don’t analyse data twice and make sure there is enough information there to be able to draw sensible conclusions. One author even went as far as to say that the smaller studies aren’t particularly helfpul.

In terms of psychotherapy/neuropsychology articles, I looked at some more of Winnicott’s papers. Winnicott was a paediatrician who developed his own interpretation of psychoanalytic theory from his clinical practice. In one of his papers, we get to see a case being managed at home in the 1950’s. It’s difficult to know how it would be managed today as this would depend to some extent on local service provision but the intensive non-pharmacological home treatment of a psychotic teenager by the family in conjunction with Winnicott was anxiety provoking to read particularly as there was no mention of a medical work-up although it seemed to work out in the end in this case (for the period of follow-up). In clinical varieties of transference, Winnicott manages to convey some dense philosophical and clinical concepts in a few pages which makes for tough reading. I get the impression of a very intelligent man who is constantly innovating and building his theoretical framework – putting the pieces of the jigsaw together. I also wonder at times why he seems to have been marginalised. I suspect that this is more to do with having a smaller sphere of social influence than Freud or Klein rather than any difficulties with the theory although I’ve only had some very rudimentary thoughts on why this might be. One thing which must count in Freud’s favour is the sheer volume of his output. I also had a look at some neuropsychological studies in Multiple Sclerosis and SLE where there is central nervous system involvement. These are complex areas at the interface of functional neuroanatomy and neuropsychology where as far as I can determine the interface is still far from being clearly delineated. There is much work that remains to be done on identifying neural correlates of psychological constructs due to a range of theoretical and pragmatic issues although these papers provide pointers in the right direction perhaps.

In terms of social psychiatry articles, I reviewed a few more Department of Health documents and as always am impressed by the logistics that are involved whether this be the involvement of large groups of stakeholders in the consultation process or a theoretical analysis of the impact that policies might have. The Dementia Care Strategy has received a lot of attention recently and rightly so as it is intended to improve services for people with dementia, an area that governments around the world are recognising as one of the biggest population health issues for the 21st century. What was also interesting to see that web 2.0 technology is being incorporated into nursing and medical school curriculum although this study focused on trends in the use of this technology on the basis of a survey rather than on the practical aspects of how these technologies can be adapted for medical education.

In the books section there was a mixture of psychological and neurobiology with Oliver Sacks bridging the two in Seeing Voices, a book about deaf people who use signing to communicate. Sacks in his usual engaging style takes us into the world of the deaf community which he is able to do because he has a talent for understanding other people’s experiences and for conveying this to the reader while at the same time giving us flashes of neurological insight which spin our perspectives around in an instant. McAlpines ‘Multiple Sclerosis’ is an impressive work highly organised and covering many areas of research and understanding of the illness which includes careful explanations of relevant physiology and immunology. Understanding MRI was another book I was impressed by, this time for the simplicity in the work which takes us through some of they physics of imaging through to the practical issues that influence the images produced with a conscious effort by the authors to involve as little maths as possible (although I think it’s perfectly reasonable to include maths in a book – perhaps in the appendix where the reader can consider it as optional). Waking dreams focuses on the imagination and as far as I understand has been quite influential.

Dharmendra Modha’s cognitive computing blog gives us insights into IBM’s blue brain project which aims in the longer term to make simulations of the human brain a reality and is a useful way to keep a finger on the pulse of this area of computing. The other blogs reviewed contain useful educational resources for patients. Betts continues to look at Jungian Analytic Psychology and how it can be used for the analysis of a special form of literature – mythology and fairy tales. While often associated with childhood, Betts shows us how sophisticated these stories can be with multiple layers of subtlety that have the potential to give us insights into ourselves. In the news there were lots of interesting stories including a new screening test that has been trialled in Alzheimer’s Disease, the demonstration of benefits of Donepezil in people with mild cognitive impairment and depression, a csf peptide that might be a useful biomarker for Alzheimer’s Disease, the effects of sleep deprivation on brain activation (fMRI), the relation of the protein Rhes to Huntington’s Disease, a pilot study of Donepezil in Schizophrenia, parallels between Amitriptylline and nerve growth factor and further evidence supporting a relationship between dyslexia and the cerebellum.

Medical Articles

Medical Progress – Treatable Dementias

Correlations in Social Neuroscience Aren’t Voodoo

Correlations and Multiple Comparisons in Functional Imaging – A Statistical Perspective

Big Correlations in Little Studies

Discussion of Puzzlingly High Correlations in fMRI Studies of Emotion, Personality and Social Cognition

Psychology Articles

Dissociable Deficits in Multiple Sclerosis

Neuropsychological Impairment in SLE: A Comparison with Multiple Sclerosis

Symptom Tolerance in Paediatrics

A Case Managed at Home

Clinical Varieties of Transference

Social Psychiatry Articles


Web 2.0 Tools in Medical and Nursing School Curricula

Consultation Response and Analysis. National Dementia Strategy

Topic Selection Process for Technology Appraisals. A Consultation Document

Developing Services for Carers and Families of People with Mental Illness

Book Reviews


Understanding MRI

Waking Dreams

McAlpine’s Multiple Sclerosis. Third Edition

Seeing Voices

Blog Reviews


Dharmendra S Modha’s Cognitive Computing Blog

Braindisease’s Weblog

Marks Psychiatry

Buckeye Psychiatry, LLC

Podcast Reviews


John Betts on Jungian Analytic Psychology Episode #14

John Betts on Jungian Analytic Pyschology Episode #15

John Betts on Jungian Analytic Psychology Episode #16

John Betts on Jungian Analytic Psychology Episode #17

News Round-Up

Research in Mood Disorders

A small case-control study involving people with Bipolar Disorder, unaffected first-degree relatives and controls and using Diffuse Tensor Imaging found evidence of reduced structural integrity in the corpus callosum genu as well as the left superior and right inferior longitudinal fasciculus. There was also evidence of distributed areas of reduced structural integrity in unaffected relatives but it will be interesting to see the results of larger replication studies (Chaddock et al, 2009). In a study with 86 subjects, people with intermediate onset bipolar disorder were found to have increased a significant reduction in sulcal index in the right prefrontal cortex compared to controls and people with early onset bipolar disorder (Penttilä et al, 2009).

Research in Dementia

A recent study in Brain provided evidence for discriminating primary progressive aphasia (semantic type) from semantic dementia including changes in the middle and superior temporal gyri and inferior and medial temporal lobes (Mesulam et al, 2009). Putamen volume was found to be decreased in people with Frontotemporal dementia compared to people with Alzheimer’s Disease in one small structural MRI study (Looi et al, 2009). A retrospective post-mortem study provided further evidence of an overlap between Alzheimer’s Disease, Frontotemporal Dementia and Lewy Body Dementia using current diagnostic criteria (Piguet et al, 2009). A recent secondary analysis provided evidence that the Clinical Dementia Rating scale has remained valid for over three decades by correlating the scores with those of other psychometric measures (Williams et al, 2009). In a location-matching task – a visual task there was found to be less activation on fMRI in people treated with Galantamine for 3 months in this small study (Bokde et al, 2009). A swedish follow-up study of up to 40 years showed a significant increase in risk of all-type dementia in people with mid-life obesity (odds ratio 1.59 p=0.002) as well as an increased risk of Alzheimer’s Disease and Vascular Dementia (Hassing et al, 2009).

Soy isoflavones supplementation was associated with a significant improvement in spatial memory scores in a 12-week double-blind placebo-controlled cross-over trial involving 34 men and the authors suggest that this may be related to ‘oestrogen activation’ (Thorp et al, 2009). In a 10-year follow-up of people without dementia (the Baltimore Longitudinal Study of Aging), in the mild cognitive impairment group compared to the control group (1017 observations) there was found to be a significant differences in volume change in a number of areas including the hippocampus, superior parietal and frontal regions (Driscoll et al, 2009). Homocysteine levels at baseline were significantly associated with rate of decline of CAMCOG scores in a study involving 94 people with Alzheimer’s Disease over the age of 75. There were at least 3 6-monthly visits but participants could be included for up to 9.5 years and the authors suggest an intervention trial (Oulhaj et al, 2009). The authors of a small case (n=14) series of people with subcortical vascular dementia or Alzheimer’s Disease were able to identify cerebral microinfarcts more commonly in the latter group particularly in the occipital cortex. They hypothesise that the Amyloid plaques may predispose to cerebral microinfarcts (Okamoto et al, 2009).

In one post-mortem study all subjects with Lewy Bodies were retrospectively found to be functionally impaired although the calculation of an odds ratio was not possible (paper freely available here) (Byford et al, 2009). A type of swelling in the Purkinje cell axons referred to as a Torpedo was found to be elevated in people with Alzheimer’s Disease, Parkinson’s Disease and to a greater extent in cerebellar essential tremor in this post-mortem study (Louis et al, 2009). In an autopsy series (n=466) there was found to be no association between a measure of atherosclerosis in the circle of Willis (a marker of large vessel disease) and amyloid plaque in the frontal cortex or neurofibrillary tangles in the hippocampus (Luoto et al, 2009).

Research in Psychosis

Lurasidone was found to significantly improve Brief Psychiatric Rating Scale scores in people with schizophrenia and an acute psychosis in this 6-week randomised double-blind placebo-controlled trial (n=90 in each arm of the trial) in Japan (Nakamura et al, 2009). In a small open-label trial of augmentation with Donepezil in 28 people with schizophrenia there were found to be significant improvements in attention, memory and other cognitive measures (Chung et al, 2009). A naturalistic study (n=325) provided evidence that had greater efficacy for treatment of schizophrenia (using outcome measures including the PANSS) than chlorpromazine or haloperidol (Ravanic et al, 2009).

Research in Neurotic, Stress-Related and Somatoform Disorders

In a study which looked at 532 Norwegian people who had experienced the 2004 Tsunami in South-East Asia, the authors repeated measurements of the perceived life threat using a 5-point Likert scale which appears to have been designed for use in this study and which appears to have been validated within the study by correlating with other measures of danger perception. The authors describe an effect they refer to as recall amplification whereby the perceived threat of the original event increased with time. The authors  conclude that their data suggests the current diagnostic criteria for PTSD should be reconsidered particularly as the recall amplification occured independently of the type of events or severity of PTSD symptoms* (Heir et al, 2009).

Research in Liaison Psychiatry

In a systematic review which included 27 studies comparing medical care in those with mental illness and 10 in those with substance misuse versus a control group the results were heterogenous. Some of the studies showed evidence of decreased medical care while others showed improvement in some areas (Mitchell et al, 2009).

Research in Learning Disability

In a large study which involved the use of 11,700 questionnaires for primary school children and the use of the Special Educational Needs register (and ICD-10 research criteria) in Cambridgeshire, the authors produced a revised prevalence estimate of 157 cases of autistic spectrum disorder in every 10,000 (Baron-Cohen et al, 2009).

News in Brief

A tool that takes roughly 5 minutes to complete has been validated in a study which was published in the BMJ and detected 93% of people with Alzheimer’s Disease. Further studies will be needed but this has potential as a clinically useful tool (This paper has been reported widely in the media e.g. here, here, here, here and here). Researchers in Japan have identified a new CSF peptide (APL1beta28) that is associated with brain levels of ABeta42. Another study looked at risk factors that discriminated those who developed cognitive impairment from those who did not and found evidence that protective factors included exercise, not smoking, education and living with a partner. Mild cognitive impairment was associated with a 50% increase in mortality compared to controls and Alzheimer’s Disease was associated with a 300% increase in mortality compared to controls in this longitudinal study with 10-year follow-up. Intermittent exotropia in boys was associated with a higher use of psychiatric services in one study and it will be interesting to see follow-up studies in this area to validate and further clarify the association. Preliminary evidence suggests a reciprocal relationship between APP and a protein called Reelin where higher levels of Amyloid Precursor Protein are associated with lower levels of Reelin.

The authors of a paper using data from the prospective DESCRIPA case-control study found evidence that the characteristic CSF biomarkers of Alzheimer’s Disease increased risk of progression up to 27-fold relative to controls. More details can be found here. Preliminary evidence from one study found that Donepezil was associated with a reduction in progression to Alzheimer’s Disease in people with MCI and depression compared to the control group. The control group took either placebo and Vitamin E and the same effect was not found in people with MCI without depression. Images have been captured of neuronal synapses forming with the involvement of a protein – Neuroligin. A recent potentially important finding is that the response of glial cells is reduced in Alzheimer’s Disease and if this is so it could play a role in the degenerative process. This study did however have a small sample size and the findings are in opposition to the main theory proposing an immune response triggered by the Beta Amyloid plaque. It will be interesting to see the results of larger replication studies. A new protein found in the brain – hypoxia upregulated mitochondrial movement regulator (HUMMR) has been associated with the movement of the mitochondria within cells under conditions of hypoxia. The positioning is suggested to play a role in the removal of calcium ions from the intracellular environment under such conditions and there may be a role in hypoxia secondary to stroke (although further research is needed). Diffraction enhanced imaging has been used to image finer anatomical detail in brains in vivo although the synchotron produced radiation is not viable for clinical use, the researchers state that it establishes the principle of using imaging to obtain highly detailed in vivo images of Alzheimer’s Disease related plaques.

A potentially important study for understanding Huntington’s Disease has been published. The study suggests that a protein ‘Rhes’ which is found only in the corpus striatum interacts with the mutant Huntingtin protein and reduces protein aggregates which subsequent leads to neurotoxicity. There may be an increased research interest in Rhes after these results. Further evidence has been found for the efficacy of Rapamycin in epilepsy and that this can reduce the changes (mossy fibre sprouting) that occur after a kainate challenge with increasing evidence that this is through an action on a regulatory protein. In one study nearly 93% of people with SLE were found to psychiatric conditions including anxiety and depression while in another study 63% of people with Rheumatoid Arthritis were found to have psychiatric conditions predominantly depression and as with previous studies was associated with the characteristics of RA.

A meta-analysis of 14 studies examining aetiology of depression found that variations in the serotonin transporter gene were not associated with an increased risk of depression (This is also covered over by the Neurocritic). An Australian study provided further evidence that depression significantly contributes to quality of life measures if people have concurrent somatic and medical conditions but also that dysthymia more significantly impacted on these quality of life measures. There was evidence of a correlation between dopamine metabolism and reduced grey matter density in people with fibromyalgia compared to controls in a small case-control study. There have been similar studies of this type before, but this 5-year follow-up study of 1238 older adults provided evidence that having a purpose in life was associated with a 50% reduction in mortality. An interesting nurse-led study characterised qualitative aspects of relationships and other changes that occur in people after they have developed a stroke and more information can be found here.

In a 2009 sleep conference a number of interesting findings were reported. Evidence that a number of interventions were effective in insomnia including meditation and CBT was provided while under certain circumstances there was an association between certain types of television and gaming use and insomnia or sleep debt. In a small fMRI study, people with chronic insomnia were found to have increased levels of activation particularly in visuospatial areas compared to a control group when tested on a working memory task***. In another study looking at adults with an average age of 40, less hours of sleep was associated with higher blood pressure. The researchers in a twin study found evidence that intrusive thoughts was associated with the stress-related insomnia. Increased sleep fragmentation was associated with a significant increase in mortality in this longitudinal study involving 5614 subjects. Older adults (aged 59-82) performed better than younger adults (aged 19-38) on cognitive tests after sleep deprivation in one study. From an evolutionary perspective there were a number of interesting findings that may be relevant to complex human phenomenon such as sleep. Thus in one study it was found that queen fire ants can sleep up to 9 hours a day whilst worker ants have small naps of up to a minute through the day suggesting a possible role for genetics in sleep patterns (although environmental cues may possibly play a role particularly as a recent study showed that ants respond to high pitched sounds which may be mimicked by other species and can produce marked behavioural responses). In another study it was found that rats were able to manage risk/reward so as to optimise reward in a task analogous to the Iowa gambling task. A study has recently provided preliminary evidence that paternal investment of resources (using a relevant outcome measure) is associated with the genetic similarity of the child.

One study provided evidence that naming objects may play a role in their perception. In this study people learnt how to group a novel class of object (designed for the study) based on similarities or name the objects. The latter group were better able to process new examples of these objects incorporating all of the features of this object much like one would with a face. More details are available here. In a prospective 5-year study of 906 older adults decreasing social activities (using a Likert Scale) were significantly associated with decreasing motor skills including strength and balance. A comparison of elderly people in the United States (from the Health and Retirement Study) and England (from the English longitudinal study of Aging) found that the American cohort performed significantly better on a number of cognitive measures than their counterparts in England. Members of the researcher team suggested that different treatment approaches to hypertension between the two countries may have contributed to these differences. The long and short versions of the period3 gene have been implicated in response to sleep deprivation and this study found that a different pattern of recruitment of cortical regions in a working memory task which the authors suggest as a potential intermediate step in the causal chain from gene to sleep deprivation response. A study has provided evidence that Amitriptylline binds to the tRKA and tRKB receptors causing dimerisation and results in outgrowth of neurites actions which parallel those of Nerve Growth Factor.

An MRI study (n=77 roughly) of people with dyslexia and a roughly equal number of controls without provided evidence of a difference between the groups in the right cerebellar declive and the right lentiform nucleus (the original article is freely available here). There have been previous studies which have implicated the cerebellum in language. The Canadian ‘Center for Addiction and Mental Health’ recently estimated that 1/25 of deaths globally are alcohol related (also covered here). Gaze is important in human social interactions and one study provided evidence that our interpretation of another person’s direction of gaze is influenced by our understanding of their internal state. These findings are relevant to social cognition theory. The authors of a recently published meta-analysis concluded that CBT was not effective in treatment of schizophrenia or in prevention of relapse in Bipolar Disorder and it will be interesting to see responses to this meta-analysis. A recent study provided evidence that Rhesus monkeys and humans share a similar mechanism for recognising faces by using a paradigm which involved the ‘Thatcher Effect’. This involves inverting facial features, the eyes and mouth and interferes with the task of facial recognition in both species.

In one study, students with higher levels of anxiety were found to spend more time focusing on irrelevant words (distractors) in a reading task. They were also given a maths task and it was found that the correct responses were similar in both the anxiety and control groups but the former group took longer to complete the tasks. (the article is freely available here).

Recent evidence supports an emerging theory of friendships – the Alliance Hypothesis. A previous theory states that people have friendships in which they count up the number of reciprocal gifts or tokens although there is a lot of data that doesn’t support this model. However the authors of the Alliance Hypothesis posit that people have friendships for times of conflict and that they prefer friends who are interested in their needs. A recent study suggests that people rank their friends similarly to how their friends rank them* . The authors of a model propose that marked changes in culture may more influenced by population density than the characteristics of the brain.

A slightly amusing finding occurred in one study looking at students who were using maths software packages for learning. When the students made mistakes they looked for problems with the computer software! In the National Longitudinal Study of Adolescent Health which included 2500 respondents there was found to be an association between carrier status for the MAOA low-activity-3-repeat allele and ‘gang membership’. It will be interesting to see the results of follow-up studies exploring this possible relationship further. In a study of violent recidivists, a lower glycogen level was associated with just under a third of the variation in recidivist offending. A systematic review of the cognitive effects of medications in older adults has been published. An online CBT package which utilises audio, visual and written material (but no clinician!) was used in one study in which participants enrolled for 5 weeks. 35% reported themselves as being ‘much or very much improved’. The authors of a expert-systems based computer program that generates music in response to the listener’s emotions are proposing to make the music copyright free (I haven’t yet been able to find the program online however and it looks as though it is in the prototype stage). It is tempting to speculate that such an approach could be adapted for therapeutic purposes for disorders of emotion and that absence of copyright fees might spur research in this direction. Three 35,000 year-old bone and ivory flutes have been found in Germany.

A study provided evidence that people conceptualise objects that are grouped together as more likely to share similar properties. Subjects were more likely to choose from a widely spaced group if they knew one or more of the objects had defective parts and more likely to choose from closely grouped objects if they knew one or more contained gift coupons**. Another study found that students were able to retain more information when presented with powerpoint slides without the use of animation to add information to the slide in stages. In a Swedish survey of 4500 people it was found that there were more older people (aged 65-79) online and that for all ages, 8% of online activity was spent in the ‘blogosphere’. A recent study involved 1224 bloggers and found that the main principles which bloggers valued were ‘truth, accountability, minimising harm and attribution’. Depending on the purpose of the blog, the priority of these values differed.

Notes

* However it can be argued that recall amplification may be secondary to recurring nightmares or flashbacks. The researchers noted for instance that if people had recall amplification, PTSD did not improve in severity between 6 and 24 months.

** From an evolutionary perspective, this complements the results of another study looking at chimpanzees and finding that they forage for fruits over wide distances and have good recall of trees that are bearing fruit in season. This ability to group objects would be helpful in scanning large areas for food and needing to economically remember where food of interest is located.

*** This may tie in with other research showing increased levels of metabolic activity in a ‘cortical hub’ in Alzheimer’s Disease.

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