Dementia Awareness Week (TM) starts on May 19th and ends on May 25th 2013. This is the annual flagship event of the Alzheimer’s Society.  This is an opportunity of organisations and individuals to get involved in raising awareness of Dementia.

What is Dementia?

Dementia is a degenerative disease which affects the Nervous System. Dementia can affect the Cortex – the area we traditionally think of as the Brain and the Subcortical areas – the areas beneath the Brain. Some forms of Dementia can also directly affect the Peripheral Nervous System. Dementia is a progressive condition. This means that it can get worse with time. Dementia is also defined as irreversible meaning that the underlying changes in the Nervous System do not get better.  Although these underlying changes might not get better, a person’s general functioning may improve with certain types of input or else a person can be supported with different services that can compensate for functional difficulties. People with Dementia can still enjoy a great quality of life even though they might be experiencing these difficulties.

Although the word Dementia is a single word it actually covers a large number of conditions. The most common forms of Dementia that affect the Brain are Alzheimer’s Disease, Frontotemporal Dementia, Vascular Dementia and Lewy Body Dementia. The most common forms of Subcortical Dementia are Subcortical Vascular Dementia, Parkinson’s Disease, and Huntington’s Disease. Whilst Multiple Sclerosis is not commonly thought of as a form of Dementia it can nevertheless slow down the speed of thinking and affect the ability to organise information (executive functioning). There are also a large number of other rare conditions that can lead to Dementia such as Wilson’s Disease, AIDS-related Dementia and Creutzfeld Jacob Disease.

Understanding what type of Dementia someone has is important because it can help people to understand the strengths and weaknesses a person might have as well as how the disease might progress. Even so there is a lot of individual variation. For instance if someone has Vascular Dementia following a Stroke or several Strokes there are many different parts of the Brain that can be affected. Although some important functions are localised in certain Brain regions, the Brain is a complex, plastic organ. This means that the Brain has multiple areas for some functions and there is therefore a lot of redundancy built in for some functions. Therefore Vascular Dementia following a Stroke in one region of the Brain may produce a subtly different picture to that following a Stroke in another region of the Brain (although Strokes do not necessarily cause Vascular Dementia).

What is Alzheimer’s Disease?

Alzheimer’s Disease is one of the most common forms of Dementia. When people develop Alzheimer’s Disease under the age of 65 we call it Early Onset Alzheimer’s Disease. When they develop Alzheimer’s Disease over the age of 65 we call it Late Onset Alzheimer’s Disease. There are a number of genes that have been associated with Early Onset Alzheimer’s Disease. When a person has Alzheimer’s Disease they can progress quickly or slowly and there is still a lot of research needed to understand why this is so. Alzheimer’s Disease has a number of associations. In the brain’s of people with Alzheimer’s Disease, researchers have found structures called neurofibrillary plaques and tangles. These structures are found both outside the nerve cells and inside the nerve cells and to properly understand this researchers use microscopes. Alzheimer’s Disease is also associated with a deficit in a chemical called Acetylcholine and this is the basis for using a class of drugs known as the Acetylcholinesterase Inhibitors. Another class of drugs acts on the NMDA receptors in the Brain which helps with a memory function known as Long Term Potentiation or LTP for short.

Biological Markers and Dementia

Researchers are looking for biological markers that can predict Dementia. These include markers in the blood, markers in the Cerebrospinal Fluid (this means extracting the fluid bathing the brain using a lumbar puncture), genetic analysis (using methods such as Genome Wide Association Studies (GWAS)) and neuroimaging findings using Magnetic Resonance Imaging (MRI), Diffuse Tensor Imaging MRI (DTI), Positron Emission Tomography (PET), Electroencephalography (EEG), Magnetoencephalography (MEG) and Single Positron Emission Computed Tomography (SPECT).

What is Mild Cognitive Impairment?

There is also a condition known as Mild Cognitive Impairment. This is not quite the same as Dementia but even so, people are struggling with one or more areas of their cognition. They might be having difficulties planning or organising material or remembering appointments. The diagnosis is made with paper and pen testing as well as other investigations and a history. The importance of Mild Cognitive Impairment is that even though it isn’t Dementia, one day people might develop Dementia. Having this diagnosis means people can link in with services and check for signs of Dementia.

The Importance of the Multidisciplinary Team in Dementia

As well as biological approaches to Dementia in terms of medical treatment, important approaches include psychological and social approaches. With psychological approaches, specialists will look at cognitive-behavioural approaches for people with Dementia who might be disturbed and agitated. This can happen in people with advanced Dementia after many years of having Dementia (although many people do not get disturbed in this way). These approaches can help people with Dementia to express themselves in different ways and also helped loved ones and carers to better understand what they might be experiencing.

There are many types of professionals that bring their skills to help in different ways. Occupational therapists can see how people with Dementia function in their homes and using this knowledge can help families to support people at home when this might not have been possible otherwise. Nurses can visit people at home and get an overview of their function and bring a number of skills to improve quality of life and identify important needs that otherwise might have been missed. Nurses also manage people with Dementia when they are admitted to hospital and will pay attention to the smallest details of their care while they are in hospital to ensure they receive the best possible care. Social workers can bring a broad set of skills to support people with Dementia and will have a detailed knowledge of how to bring external care into the home to help people overcome their functional difficulties and manage or else to find suitable places that can support people with Dementia and give them a good quality of life. Physiotherapists can help people with Dementia to minimise the risk of falls and help with therapeutic physical exercise as well as bringing a number of other skills to help a person with Dementia and their family build a therapeutic routine. Behind the scenes the unsung heroes are the managers, who manage these activities and the administrators coordinating and communicating these activities to ensure that they run smoothly.

The General Practitioners/Primary Care Physicians that are the custodians of the community who identify people who may have or be at risk of Dementia and ensure that they receive a diagnosis of Dementia and receive appropriate services. There also a number of important voluntary sector services that support people with Dementia.

Carers for People With Dementia

People who care for people with Dementia are often loved ones – spouses or other family members. Being in a relationship can be different from taking on a caring role. Sometimes these can work well together and the caring role doesn’t make too much of an impact. At other times the caring role can involve a lot of commitment with interrupted sleep and a need to remain in the house to look after the person with Dementia who is unable to be left alone at home. Fortunately services can help in these circumstances and there are options such as respite care that can work really well or carers that can come into the home to support carers who can take time out to rest and return to the caring role.

Dementia Awareness Week Events

There are a number of events during Dementia Awareness Week (TM). An overview is given at the Alzheimer’s Society website. At the Guardian there is a piece by Kirsty Day about her father, a former journalist who later developed Dementia. The Express has a feature article by Pippa Kelly which includes a look at the work of the Admiral nurses.

The Shields Gazette looks at events in South Shields including a Dementia Café (also featured at the Austrian Tribune). The Haringey Advertiser looks at local events. The St Helens Star looks at local events including a drop-in service. The Portsmouth News features an article by Luisa Castle. The Bromley Times looks at open days in the area. This is South Wales looks at a series of local events. This is Total Essex looks at  a Brentwood charity event.

The Warrington Guardian features a look at the Mayor opening a local event. The Westmoreland Gazette looks at events taking place throughout Morecambe Bay. The Lynn News looks at events taking place in Fakenham and Hunstanton. Your Thurrock looks at local events including a screening of the film ‘Darkness in the Afternoon’. The Lancashire Evening Post looks at local fund-raising events.

The Hartlepool Mail has a detailed breakdown of local events. The Dorset Echo looks at local events. The Advertiser and Bicester Review looks at local events including a singing event. EDP 24 looks at local events including a tour by a local MP. The Wiltshire Gazette and Herald looks at the local Dementia Adviser Service. The Ulster Star looks at Dementia in pets.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

*Conflict of Interest – I am an Older Adult Psychiatrist

Events

Today is International Nurse’s Day. This is in commemoration of the birth of Florence Nightingale and the theme for this year’s day is Closing the Gap: Millenium Development Goal.

Dementia Awareness Week 2013 takes place on the week of May 19-25th.

The Freudian Clip Film Club in conjunction with Dr Raj Persaud is presenting the ‘Silver Linings Playbook’ on May 28th in London (for details see here).

Dr Raj Persaud and Professor Simon Wessely are hosting a conference on the subject of DSM-5 in London (see here and here).

Appendix

Positive Psychology Resources on this Site

News Round-Up 2008-2011

News Round-Up 2012

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

The National Institute for Mental Health (NIMH) is an American institution leading research into mental illnesses. Recently Dr Thomas Insel, Director of NIMH wrote an article on his blog about the future research direction for NIMH. Dr Insel’s wrote about the reliability and validity of diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders – the American Diagnostic Manual.  The comments have been read and disseminated on a number of sites (e.g here, here, here, here and here). Before taking a closer look at these comments there is some benefit in looking more closely at reliability and validity.

Reliability of Diagnostic Systems

When we talk about reliability of diagnostic systems we are referring to the consistency of that diagnostic system. Reliability is a little bit more complicated than that though and there are several subtypes. The most commonly used form of reliability is inter-rater reliability. Suppose two people use the same rating instrument to rate the same person with the same presentation. If their scores correlate well then there is a high inter-rater reliability. Conversely if their scores do not correlate well then there is a low inter-rater reliability. Having a high inter-rater reliability for a diagnostic system is a good thing to have as a general rule.

Validity in Diagnostic Systems

We can have a high inter-rater reliability for a diagnostic system but the next question we need to ask is whether it really means anything. This is the issue of validity. We can give raters very detailed instructions on how to take several measures during an assessment. The raters can do this repeatedly and the measures can match up very well between the raters. At the end of the process, although the raters have done well to match the ratings of the other rater, if the ratings don’t map onto a valid construct there is little practical benefit from their efforts.

When we talk about mental illnesses, we want to make sure that these illnesses have construct validity (as with reliability there are several types of validity). In other words do the diagnostic criteria represent the phenomenon of interest. If raters measured the height and weight of subjects they might have a high inter-rater reliability but the results wouldn’t necessarily have much to do with Depression by themselves. The rating instruments should be relevant to the core features of the construct of interest.

Taking a Closer Look at the NIMH Article

The NIMH article begins with an introduction to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There is a look at reliability as a particular strength. Following this there is a look at validity and a comparison of mental illnesses with other types of illness. The article covers the Research Domain Criteria (RDoC) Project, an ambitious project which aims to redefine mental illness along biological routes. The NIMH strategy is described as having these main assumptions and approaches

1. A diagnosis-independent approach to exploring symptoms and biology. However researchers will also take diagnostic entities and look at subdivisions or consider several groups of diagnostic categories together.

2. Analysis will focus on functional domains

3. Cognition, emotion and behaviour result from brain circuits and a better understanding of such circuits would facilitate the development of new and improved treatments

The major RDoC research domains are listed as

‘Negative Valence Systems
Positive Valence Systems
Cognitive Systems
Systems for Social Processes
Arousal/Modulatory Systems’

There are many interesting points in this article which hold promise for the future and which will benefit the understanding of mental illnesses. However this article should be understood in the wider context without which there is a potential for misinterpretation.

Effective Biocognitive Markers Already Exist for Several Disease in DSM-IV

To demonstrate this let us consider the DSM-IV diagnosis of Delirium – 293.0.  Broadly speaking the diagnostic criteria state that Delirium involves a disturbance of consciousness, a change in cognition, that these changes happen over a short period of time and that there is evidence from multiple sources of the aetiology and that these sources include laboratory findings. Since there are many tools for effectively assessing cognition and the aetiology can be supported by laboratory findings we can see that biocognitive markers are central to this diagnosis.

Although Delirium can have a mild course with rapid improvement it can also be a serious condition. In the NICE guidelines it is stated that

‘….This can have serious consequences (such as increased risk of dementia and/or death)…‘  p.63

Delirium is a very common illness. Measuring just how common Delirium can be is complicated by the choice of rating instruments, the setting in which Delirium is assessed, the training of the assessors as well as the characteristics of the population being assessed (just as with many other illnesses). Again in the NICE guidelines on the basis of an analysis of the literature it was stated that

‘Rates of Delirium ranged from 14% (Radke 2008) to 64% (Zou 1998) in the hospital setting, 86% (Ely 2001; Ely 2001b) in the ICU setting; and 25% (Laurila 2003) in the mixed setting (hospital and nursing home wards)‘

As the NICE guidelines demonstrate there are also effective management approaches for Delirium. In summary, Delirium is a common and potentially serious condition for which there are effective management guidelines.

Given the above whenever there is a generic statement about the lack of biological/biocognitive markers for a psychiatric/ICD-10/DSM-IV diagnosis this can be challenged with reference to Delirium. Anyone making a generic statement of that nature must be able to justify this with specific reference to Delirium.

There are other examples in the Diagnostic Manual which demonstrate that biocognitive markers can be central to diagnosis.

Mind and Brain Are Inseparable When We Consider Mental Illnesses

In some discussions about diagnosis there is an apparent disconnect between mind and brain. If we move to a purely biological perspective then we lose the rich world of the mind – the inner world of conscious experience. Whether a person chooses to seek help for diagnosis, whether they understand the diagnoses that are given to them and whether they accept the treatment, or have the capacity to make these choices are all essential aspects of Psychiatry inseparable from the diagnosis in the real world.

Many illnesses are better understood from the perspective of the mind. When we tease out beliefs about the world, the role of volition and the modification of an illness by factors such as attention and transient emotional experiences we are dealing directly with the mind. Such information can be invaluable and it is difficult to see how this can or should be replaced with a simple biological marker.

The languages of mind and brain are both valid. Metaphorically speaking building a bridge between these languages appears to be more fruitful than a closure of the bridge altogether. Symptoms are used throughout medicine when diagnosing illnesses ranging from Influenza to Arthritis. Symptoms represent the language of the mind and play a key role in diagnosis when other supporting evidence such as laboratory tests are taken into consideration by the physician.

Why the Proposed NIMH Research Strategy Can be good for DSM and ICD

The proposed strategy described above has several interesting features. First of all it is no bad thing if there is a systematic attempt to deconstruct diagnosis by considering symptoms alone. If new diagnostic categories emerge then like the current diagnoses the underlying theory must withstand the scrutiny of science. Axiomatic truths will prevail and assumptions that do not stand up to close scrutiny will disappear over time. The diagnostic system will simply adapt to the scientific evidence.

With the NIMH focus on subtypes of current diagnoses, there will be a research drive to further refine current diagnoses. By looking across diagnostic categories researchers will be able to find common themes which can inform the underlying theory of illnesses and facilitate the development of new treatments. The NIMH post comes at an interesting time with the pending publication of DSM-V (see Appendix for a history of DSM-V).

References

Ely EW, Inouye SK, Bernard GR, Gordon S, Francis J, May L, Truman B, Speroff T, Gautam S, Margolin R, Hart RP, and Dittus R  Delirium in Mechanically Ventilated Patients: Validity and Reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU),JAMA: Journal of the American Medical Association,286(21):2703. (2001)

Ely EW, Margolin R, Francis J, May L, Truman B, Dittus R, Speroff T, Gautam S, Bernard GR, and Inouye SK  Evaluation of Delirium in Critically Ill Patients: Validation of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU),Critical Care Medicine,29(7):1370. (2001b)

NICE. Delirium: Diagnosis, prevention and management. Clinical Guideline 103. July 2010.

Radtke FM, Franck M, Schneider M, Luetz A, Seeling M, Heinz A, Wernecke KD and Spies CD Comparison of Three Scores to Screen for Delirium in the Recovery Room,British Journal of Anaesthesia,101(3):338. 2008.

Zou Y, Cole MG, Primeau FJ, McCusker J, Bellavance F,and LaPante JL. Detection and Diagnosis of Delirium in the Elderly: Psychiatrist Diagnosis, Confusion Assessment Method, or Consensus Diagnosis? International Psychogeriatrics, 10(3). 303-8. 1998.

Appendix – Recent History of Development and Debate on DSM-V

Appendix I – Other DSM-V Articles on the TAWOP Site

Explaining DSM-V: Interview with Professor David Kupfer, Chair of the APA DSM-V Taskforce

Causality and DSM-V

Appendix II – Previous DSM-V Related News Items Discussed on the TAWOP Site

The news items below are unedited and must be interpreted in terms of the subsequent developments.

2011

DSM-V and ICD-11

The draft DSM-V criterion for a mixed depressive episode are being expanded to fit more closely with clinician’s experience and there are further details here. The new version of the World Health Organisation Classification of Disease (ICD-11) is displayed in draft version here. This is a work in progress with daily updates and it will allow people to comment from July 2011 onwards. I checked out the Mental and Behavioural Disorders section and there was just a little information there (relating to indexes for mortality) at the moment. The World Psychiatric Association have a very interesting paper on the use of the ICD-10 diagnostic system by psychiatrists. The researchers surveyed 4887 psychiatrists across the world using an internet based survey tool. The use of ICD-10 varied from 0% in Kenya and 1% in the USA to 100% in Kyrgyzstan, FYRO Macedonia and Slovenia. 71% of the psychiatrists surveyed used ICD-10 as their main diagnostic system. DSM-IV was the main diagnostic system for 23% of the psychiatrists surveyed (unweighted). 14.1% (unweighted) of the sample set ‘sometimes’ used a diagnostic system and 1.3% used the older versions of ICD-10 – ICD-9 or ICD-8 for diagnostic purposes. There is also a critical look at DSM-V at ‘Boring Old Man’ which highlights the wider debate in society.

2010

The draft changes for DSM-V have been published by the American Psychiatric Association Draft Development Team for DSM-V here. I might have overlooked something but it looks as though it is an overview of the changes being suggested for specific conditions that are being presented.

Dementia Reclassification?

Firstly I was interested in what amounts to a wholescale reclassification of the Dementias and related conditions into Major and Minor Neurocognitive Disorders. There are some nice ideas contained within this move including the consideration that it is not only memory which needs to be affected. However I was unclear on reading the descriptions of whether it would include the subtypes as I could find no mention of this. However it would be unusual if the various subtypes of dementia for which there is an abundance of evidence were not included as subtypes within this framework as this could be considered a step backward. Additionally I couldn’t find any mention of the term Mild Cognitive Impairment (although there are some broad similarities with minor neurocognitive disorder) and the various subtypes for which there is an emerging evidence base and which is the focus of research in the hope that a better understanding could lead to prevention or amelioration of subsequent dementia.

Mental Disorders Due to a General Medical Condition

There were very few changes here. One suggestion was to use a catatonia specified elsewhere instead of catatonia secondary to a medical disorder.

Personality Disorders

There are some big changes in the Personality Disorders. These have been reduced from 10 to 5. One of the difficulties with the current Personality Disorder types is the diagnostic overlap. A person may fulfill the criteria for more than one type of personality disorder. There are a number of changes to the criteria which should improve reduce the number of comorbid personality disorder diagnoses. A simple Likert-scale is used for quantifying personality and personality traits and the five types are Borderline Personality Disorder, Antisocial/Psychopathic Type, Avoidant Type, Obsessive-Compulsive Type and Schizotypal Type.

Substance-Related Disorders

There are a large number of new diagnostic labels being considered for inclusion and subsuming current labels. For instance alcohol dependence syndrome may be subsumed under Alcohol-use disorder. Cannabis withdrawal is another diagnosis being introduced. The discussions around the terms ‘addiction’ and ‘dependence’ are discussed below.

Schizophrenia and Other Psychotic Disorders

There are big changes to the diagnosis of Schizophrenia with a proposal for removing subtypes including Paranoid Schizophrenia, Disorganised and Catatonic schizophrenia. Changes are being suggested in order to bring DSM-V into closer alignment with ICD-10. Proposed changes to the criteria for Schizoaffective Disorder are meant to increase reliability. ‘Psychosis Risk Syndrome‘ is being introduced (see further discussion below) and a Catatonia Specifier is being suggested. This is apparently because catatonia is ‘often not recognised’.

Mood Disorders

Mixed anxiety and depression disorder is being introduced with criteria that avoid ambiguity. This is currently included in the appendix of DSM-IV. There is a proposal to rename Dysthymic Disorder as chronic depressive disorder. There is a proposal to replace Bipolar Disorder Most Recent Episode Mixed with a mixed specifier. There are a number of changes in the criteria of Manic Episode particularly around energy levels.

Anxiety Disorders

The proposal is to include Obsessive-Compulsive Disorder under a new category of ‘Anxiety and Obsessive-Compulsive Spectrum Disorders’. The changes here are further discussed in the ‘PsychBrownBag’ Blog and the ‘OCD Center of Los Angeles’ Blog below.

Somatoform Disorders

There is a proposed amalgamation of four conditions into ‘Complex Somatic Symptom Disorder‘ but for further discussion see the ‘OCD Center of Los Angeles’ Blog below.

Factitious Disorders

The proposal is to reclassify Factitious Disorders under Somatic Symptom Disorders.

Dissociative Disorders

Theere is a proposal to subsume Dissociative Fugue under Disssociative Amnesia. Similarly there is a proposal to remove Dissociative Trance Disorder and integrate the criteria into the diagnosis of Dissociative Identity Disorder which has a number of other proposed changes.

Sexual and Gender Identity Disorders

There are a number of new diagnoses.

Eating Disorders

A new diagnosis of Binge-Eating Disorder is recommended (for further discussion see below). In Anorexia Nervosa there is the proposal to remove the criterion of amenorrhoea whilst in Bulimia Nervosa there are some proposed changes to the frequency of binge eating episodes and the purging criteria.

Sleep Disorders

There are a number of new conditiosns (a number of which subsume other conditions) including Klein-Levin Syndrome, Primary Central Sleep Apnoea, Primary Alveolar Hypoventilation, Rapid Eye Movement Behaviour Disorder and Restless Leg Syndrome amongst others. There are a number of changes to the criteria for narcolepsy including hypocretin deficiency.

Childhood disorders

There are a large number of suggested changes including the removal of Rett’s Disorder, a number of proposed changes to the Attention Deficit and Hyperactivity Disorder criteria, the inclusion of Post-Traumatic Stress Disorder in school age children and Temper Dysregulation Disorder with Dysphoria which is further discussed below. Interestingly the wording for Separation-Anxiety Disorder may be changed so that it can be used with adults also. This is because there is evidence for an adult separation-anxiety disorder.

Impulse Control Disorders Not Elsewhere Classified

There is a proposal to include Pathological Gambling with substance-related disorders. There are proposed changes for Trichotillomania further discussed below.

Adjustment Disorders

There is a proposal to move Adjustment Disorder to a grouping of Trauma and Stress-Related Conditions.

Discussion of the Draft DSM-V Changes Elsewhere in the Media

Links to some of the discussions elsewhere in the media are given below.

General

The Time article looks at a number of proposed changes for DSM-V which includes the criteria for making a diagnosis of depression,use of a continuum and the case for autistic spectrum disorders, the possible grouping of non-dependence inducing substances together with dependence inducing substances in the addiction and related disorders, reducing the number of personality disorder types and making some amendments to some of the sexual disorders. Over at PsychCentral, Dr Grohol looks at a number of features of the DSM-V draft. He is encouraging of the inclusion of Binge Eating Disorder, but is critical of the criteria used in Minor Neurocognitive Disorder, Behavioural Addictions and also Temper Dysregulation Disorder which has a narrow time period fo 6 to 10 years for diagnosis. Over at the ‘Psyche Brown Bag‘ blog, Joyce Anestis comments on the restructuring of the multiaxial system as well as the arrival of a number of new disorders including ‘hoarding disorder’, ‘olfactory reference syndrome’, ‘skin picking disorder’ and ‘psychosis risk syndrome’ amongst others and is also confused by the proposed changes to the personality disorders. The Times has a look at a number of the proposed changes including ‘sluggish cognitive tempo disorder’. Web MD has an article on the changes and features an interview with Dr First who is critical of the utility of the diagnosis of ‘Psychotic Risk Syndrome’.

Dr Dan Carlat has a discussion of the proposed criteria on his blog and seems fairly positive on these (however I would just add that there are neurobiological criteria for a number of disorders in DSM-IV/DSM-V draft e.g Hypocretin Deficiency in Narcolepsy above). He notes that Temper Dysregulation Disorder is being favoured as it would avoid a diagnosis of Bipolar Disorder in children in a number of cases. He’s in favour the use of addiction in place of dependence or abuse and also the use of the concept of Binge-Eating Disorder. The New York Times has a piece featuring interviews with several psychiatrists and 230 comments at the time of writing. Integral Options cafe has links to a number of posts including those on the NPR site. An article at the NPR website examines the limits of the checklist approach and how severity might be measured when using a dimensional approach. The Economist has a piece on the history of the diagnostic criteria but also cover some of the disputes that have taken place. ‘DSM-V and ICD-11 watch’ have some interesting links as well as a brief look at suggestions for medically unexplained symptoms. Dr Finnerty has an overview of proposed changes as well as some useful links. Mind Hacks has coverage here and here. The APA have a facebook site that interested readers can join.

‘Addictions’

Stanton Peele covers the proposed use of the term addictions in this ‘The Huffington Post’ article. The ‘Join Together‘ website features an interview with Dr Charles O’Brien who is chair of the APA’s DSM substances related disorders workgroup. He explains the distinction between dependence and addiction and the consideration of including the term addiction in DSM-V. They also discuss the possibility of collecting behavioural addictions together with alcohol and other drug related disorders.

Anxiety Disorders and OCD

Tom Corboy director of the ‘OCD Center of Los Angeles’ writes about a number of proposed changes over at the ‘OCD Center of Los Angeles’ blog. Thus Corboy discusses the suggested use of an ‘Anxiety and Obsessive Compulsive Disorder Spectrum’. Corboy is also critical of the suggestion of agaraphobia without panic disorder, in favour of moving Body Dysmorphic Disorder into the ‘Anxiety and Obsessive Compulsive Disorder Spectrum’ and adding a muscle dysmorphia variant, critical of the aggregation of 4 somatoform disorders including hypochondriasis, in favour of the relabelling of trichotillomania as ‘hair pulling disorder’ and also for the inclusion of skin picking disorder.

Intellectual Disability

Over at the blog ‘Mental Incompetence and the Death Penalty‘ there is a guest post by Dr Watson. He criticises the proposed criteria for intellectual disability on the basis that there doesnt appear to be a consideration of the standard error for IQ testing meaning that there is what he describes as a ‘bright light’ cut-off point of 70 or below whereas in practice there is a group that are scored over 70 who would still be included amongst a number of criticisms.

Bipolar Disorder in Children

Over at the NPR website, there is a wider discussion of the diagnosis of Bipolar Disorder in children as well as the more recent ‘Temper Dysregulation Disorder’.

Autistic Spectrum Disorders

The Left-Brain Right-Brain blog compares the criteria in DSM-IV with those in DSM-V for autistic disorder and autistic spectrum disorders respectively and links to a number of other articles on the subject. There is another discussion of the autistic spectrum disorders proposition here. There is further coverage here and here.

Eating Disorders

Time has a piece on orthorexia which hasn’t made it into the draft version of DSM-V. There is also coverage of the proposed changes at the Ed-Bites blog (with 15 comments at the time of writing).

Dr Dan Carlat takes a further look at the DSM-V draft proposals here. Dr Charles Parker has further coverage here and also over at the Corpus Callosum blog. There is a look at grief in the draft DSM-V proposals at Psychotherapy Brown Bag.

2009

DSM-V and ICD-11

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.

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.

DSM-V is due to appear in 2012. A twitter campaign has been started to petition for the inclusion of Depressive Personality Disorder in DSM-V. 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.

References

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

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

There is a study from Hong Kong in the Australian and New Zealand Journal of Psychiatry looking at relapse rates in first-episode psychosis. The researchers looked at the cumulative relapse rate as well as risk factors for relapse. The researchers identified many risk factors for relapse which included non-concordance with medication (Hui et al, 2013).

There is an open-access article on structural MRI findings in Schizophrenia in the Journal of the Norwegian Medical Association available in both Norwegian and English. The researchers found evidence of reduced Hippocampal volume but increased volume in the Globus Pallidus in study subjects with Schizophrenia compared to controls.

News Roundup Elsewhere

There is a round-up of anthropology news here which includes a brief discussion about how anthropologists are taking on difficult issues such as healthcare access.

Health and Wellbeing

Bolier and colleagues undertook a meta-analysis of positive psychology interventions (see Appendix) in randomised control trials. They looked at outcomes for subjective and objective well-being and depression. The researchers used standardised effect sizes when comparing different treatment approaches.

Diagram from (Bolier et al, 2013), Creative Commons 2.0

The researchers found positive effects for subjective and objective well-being as well as Depression. The results for Depression are shown below.

Diagram from (Bolier et al, 2013), Creative Commons 2.0

For Depression, Cohen’s D was 2.0 (95% Confidence Interval 0.09-0.30 with p<0.1).

A study in the Lancet found no benefit for exercise on Depressive symptoms in nursing home residents in this National Institute for Health Research Health Technology Assessment Programme study. Many studies have found positive benefits for exercise on mental illness including Depression and it will be interesting to see the results of further research in this area.

Neuroscience

A single protein significantly influence both brain expansion and folding during development based on the findings from a study in the Journal Cell (Stahl et al, 2013).

Dr Micah Allen has an interesting piece on what multivariate analysis might mean for understanding functional Magnetic Resonance Imaging data.

References

Bolier L, Haverman M, Westerhof GJ, Riper H, Smit F, Bohlmeijer E. Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health. 2013 Feb 8;13:119.

Hui CL, Tang JY, Leung CM, Wong GH, Chang WC, Chan SK, Lee EH, Chen EY.Aust N Z J Psychiatry. 2013 Apr 23. [Epub ahead of print] A 3-year retrospective cohort study of predictors of relapse in first-episode psychosis in Hong Kong.

Ronny Stahl, Tessa Walcher, Camino De Juan Romero, Gregor Alexander Pilz, Silvia Cappello, Martin Irmler, José Miguel Sanz-Aquela, Johannes Beckers, Robert Blum, Víctor Borrell, Magdalena Götz. Trnp1 Regulates Expansion and Folding of the Mammalian Cerebral Cortex by Control of Radial Glial Fate. Cell, 2013; 153 (3)

Underwood M et al. Exercise for depression in elderly residents of care homes: a cluster-randomised controlled trial. The Lancet, Early Online Publication, 2 May 2013.

Appendix

Positive Psychology Resources on this Site

News Round-Up 2008-2011

News Round-Up 2012

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

General Practitioner Professor Helen Lester recently passed away. Professor Lester had advanced primary care in many areas and had specifically advocated improving healthcare access for people with mental illness. In this regards, the above video is a powerful legacy.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

IBM and the University of Los Angeles are working on using large datasets to improve the care of people with brain trauma. The brief video above gives an overview of this while this interview goes into more details about the structured and unstructured data that is being analysed so as to inform patient care.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

This is a rerevision of the diagram showing the relationship between speech and the three structure model. The model offers a starting point for further exploration and no doubt this diagram will undergo further revisions. The model will need to be tested against the evidence.

Appendix – Related Resources on the TAWOP Site

In Support of Method

A Review of the Structure of Scientific Revolutions

An Interpretation of Scientific Revolutions

Integration in Neuroscience: A Core Problem – Part 1

Integration in Neuroscience: A Core Problem – Part 2

Integration in Neuroscience:A Core Problem – Part 3

Integration in Neuroscience: A Core Problem – Part 4: A Language for Mind and Brain?

Integration in Neuroscience: A Core Problem – Part 5: A Three Structure Model

Integration in Neuroscience: A Core Problem – Part 6: Reflection on the Three Structure Model

Integration in Neuroscience: A Core Problem – Part 7: The Unconscious in the Three Structure Model

Integration in Neuroscience: A Core Problem – Part 8:

Integration in Neuroscience: A Core Problem – Part 9:

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

The University of Minnesota Libraries has a brief but helpful video featuring their suggested points for assessing reference management software.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Continuing with the contrast illusion theme (see Appendix) I created the above picture to illustrate the theme.  Thus although all of the filled circles are of the same colour, this colour appears different in the context of the background. Quite accidentally there is a further illusion in the picture. The right side may appear wider than the left side. This is because the theme involves a depth perspective. The images on the left appear closer than those on the right and this interferes with the assessment of the width of the image.

Appendix

Explaining the Neurobiology of Illusions – A Talk from Caltech

Do Cats See Illusions Too?

A Visual Illusion Experiment – Part 10

A Visual Illusion Experiment – Part 9

A Visual Illusion Experiment – Part 8

A Visual Illusion Experiment – Part 7

A Visual Illusion Experiment – Part 6

A Visual Illusion Experiment – Part 5

A Visual Illusion Experiment – Part 4

A Visual Illusion Experiment – Part 3

A Visual Illusion Experiment – Part 2

A Visual Illusion Experiment – Part 1

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

In the previous post I looked at GABA receptors in C.Elegans – the Nematode worm. C.Elegans has been extensively studied and there is a very sophisticated understanding of the organism’s biological machinery. What I found fascinating was that the role of the GABA receptors in C.Elegans has been clarified and has been found to play a role in movement as well as a few other functions. There are only 26 neurons in C.Elegans.

C.Elegans

The Nematode worm moves by contracting the muscles on one side of its body whilst relaxing the opposing muscles. The GABA receptors are involved in the relaxation of the muscles.

Muscle Relaxation and GABA Receptors

When people are anxious this can cause the muscles to tense. Some drugs acting at the GABA receptors in humans can reduce muscle tone. Some drugs which target these receptors can also alleviate anxiety. Which comes first? This is the chicken and egg scenario. Do you have to be anxious to have tense muscles or do you become anxious because your muscles are tense.

The James-Lange and Cannon-Bard Theories

The question of whether emotions or bodily sensations happen first is dealt with by the James-Lange and Cannon-Bard Theories. Essentially the two theories take differing positions on the question. The James-Lange theory states that emotions happen in response to information coming from the body. When the heart races you feel anxious. The Cannon-Bard theory says that  emotions and bodily responses occur independently but can be coordinated by the Thalamus.

Nematode Worms, GABA Receptors and Anxiety in Humans

Nematode worms and our ancestors diverged some 800 million years ago. In that space of time Nematodes and our species have continued to evolve. Nevertheless the conservation of the GABA receptors in both Nematodes and our species is evidence of the importance of these receptors. Some simple connections and a narrative can be constructed to account for the above.

1. Nematodes have developed GABA receptors to facilitate movement

2. GABA receptors enable Nematodes to relax muscles to steer and move in certain directions

3. GABA receptors are part of a movement apparatus

4. As species have evolved and become more complex they have become capable of conscious experience

5. The movement apparatus has been conserved but also become associated with other complex phenomenon such as conscious experience

6. In humans muscle groups oppose each other – reciprocal extensor and flexor muscle groups at the elbow are one example.

7. The underlying relationship with GABA receptors remains

8. Action through the GABA receptors relaxes muscle groups and results in accompanying sensory feedback (small variation in the GABA receptor gene may not be related to anxiety but rather it is the physiological effects that the products of these receptor gene variants have in common).

9. This sensory feedback produces an emotional response – lowering of anxiety

While the above supports the James-Lange theory we could argue that there is a bidirectional relationship. For instance a heightened state of anxiety in response to internal stimuli can increase the tension in the muscle groups.

The above is a testable hypothesis. The hypothesis makes a very specific statement about a receptor in adaptive terms. The GABA receptor facilitates movement of the organism. Whilst it may well be wrong it nevertheless contains implicit assumptions which make it testable against the evidence base. The theory in essence states that the GABA receptor function is conserved and associated with increasingly complex phenomenon. If on moving from Nematode worms to humans there was convincing evidence of loss of motor related GABA receptor function in intermediary species this would contradict the hypothesis.

References

Jorgensen, E.M. GABA (August 31, 2005), WormBook, ed. The C. elegans Research Community, WormBook, doi/10.1895/wormbook.1.14.1, http://www. wormbook.org.

Related Resources on this Site

Developing a Model of the Insular Cortex and Emotional Regulation: Part 1

Building a Model of the Insular Cortex – Part 2: Reviewing a Model by Craig – Part 1

Building a Model of the Insular Cortex – Part 3: Reviewing a Model by Craig – Part 2

Building a Model of the Insular Cortex – Part 4: Reviewing a Model by Craig – Part 3

Building a Model of the Insular Cortex – Part 5: The Evolution of the Insular Cortex

Building a Model of the Insular Cortex – Part 6: A Recap

Building a Model of the Insular Cortex – Part 7: The James-Lange Theory

Building a Model of the Insular Cortex – Part 8: The Cannon-Bard Thalamic Theory of Emotions

Building a Model of the Insular Cortex – Part 9: Charles Darwin on the Expression of the Emotions

Building a Model of the Insular Cortex – Part 10: The Limbic System

Building a Model of the Insular Cortex – Part 11: A Second Recap

Building a Model of the Insular Cortex – Part 12: GABA receptors and Emotions

Building a Model of the Insular Cortex – Part 13: GABA receptors and Nematode Worms

What does the Insular Cortex Do Again?

Insular Cortex Infarction in Acute Middle Cerebral Artery Territory Stroke

The Insular Cortex and Neuropsychiatric Disorders

The Relationship of Blood Pressure to Subcortical Lesions

Pathobiology of Visceral Pain

Interoception and the Insular Cortex

A Case of Neurogenic T-Wave Inversion

Video Presentations on a Model of the Insular Cortex

MR Visualisations of the Insula

The Subjective Experience of Pain

How Do You Feel? Interoception: The Sense of the Physiological Condition of the Body

How Do You Feel – Now? The Anterior Insula and Human Awareness

Role of the Insular Cortex in the Modulation of Pain

The Insular Cortex and Frontotemporal Dementia

A Case of Infarct Connecting the Insular Cortex and the Heart

The Insular Cortex: Part of the Brain that Connects Smell and Taste?

Stuttered Swallowing and the Insular Cortex

YouTubing the Insular Cortex (Brodmann Areas 13, 14 and 52)

New Version of Video on Insular Cortex Uploaded

Contributors to the Model (links are to the posts in which contributions were made – these links may contain further links directly to the contributors)

Ann Nonimous

The Neurocritic

Psico-logica

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

One research group suggests that a protein CD33 may be involved in the development of Late Onset Alzheimer’s Disease through an action on the brain’s support cells – the microglia  http://bit.ly/14oIla3. The talk below covers CD33 amongst many other associations with Alzheimer’s Disease.

Alzheimer’s Disease – From Genes to Novel Therapeutics

Researchers compared two measures of non-motor Parkinson’s Disease symptoms – the MDS-UPDRS Part 1 and the Non-Motor Symptoms Scale NMSS. The researchers found that the scales had good convergent validity generally but not in cases where the non-motor symptoms were severe (Martinez-Martin et al, 2013).

The Journal of Molecular Psychiatry recently started up. There is an editorial here.

There is an interesting write-up at the Schizophrenia Research Forum on the psychosis prodrome from the 2013 International Prodromal Research Network Meeting in Florida.

Researchers in one study found evidence that people with Alzheimer’s Disease may experience difficulties in recognising changes in affect in themselves* (Verhülsdonk S et al, 2013).

There is a look at  Tetracyclines and Amyloidosis in this paper (Stoilova et al, 2013).

Researchers in Japan suggest that there may be subtypes of Alzheimer’s Disease determined by comorbidity on the basis of their neuroimaging findings (Fukazawa et al, 2013).

There is a look at the evidence supporting a relationship between Lithium and neuroprotection in this paper (available at Pubmed Central). The authors recommend further long-term studies to further investigate this relationship.

Researchers in this study used a novel approach for assessing medial frontal lobe function – a test of object alternation (Freedman et al, 2013). The researchers found that performance on an object alternation task was correlated with medial frontal lobe grey matter volume in people with Frontotemporal Dementia.

The researchers in this study find a possible relationship between bradycardia and Frontotemporal Dementia but recommend further research to confirm this relationship (Robles et al, 2013).

Researchers in this study identified differences in visual motion event related potentials between people with Alzheimer’s Disease and healthy controls (Fernandez et al, 2013).

There is a look at subjective cognitive impairment in this paper which is available at Neurologia (Garcia-Ptacek et al, 2013).

News Roundup Elsewhere

Vaughan Bell interviews psychiatrist Professor Michael Owen about the relationship between genes and mental illness.

Psychiatry 2.0

There is an interesting piece on open access science at Ars Technica.

Neuroscience

Kelly Tyrell looks at how science and journalism are coming closer together with the field of data journalism.

Charles Fernyhough looks at neuroscience in fiction in this piece.

New Scientist covers software developed by an Australian group that assesses emotions in photographs in this piece.

References

Fernandez R, Monacelli A, Duffy CJ.J Alzheimers Dis. 2013 Apr 17. [Epub ahead of print] Visual Motion Event Related Potentials Distinguish Aging and Alzheimer’s Disease.

Fukazawa R, Hanyu H, Sato T, Shimizu S, Koyama S, Kanetaka H, Sakurai H, Iwamoto T.Dement Geriatr Cogn Disord. 2013 Apr 13;35(5-6):280-290. [Epub ahead of print] Subgroups of Alzheimer’s Disease Associated with Diabetes Mellitus Based on Brain Imaging.

Garcia-Ptacek S, Eriksdotter M, Jelic V, Porta-Etessam J, Kåreholt I, Manzano Palomo S.Neurologia. 2013 Apr 16. pii: S0213-4853(13)00052-2. doi: 10.1016/j.nrl.2013.02.007. [Epub ahead of print] Subjective cognitive impairment: Towards early identification of Alzheimer disease.

Martinez-Martin P, Chaudhuri KR, Rojo-Abuin JM, Rodriguez-Blazquez C, Alvarez-Sanchez M, Arakaki T, Bergareche-Yarza A, Chade A, Garretto N, Gershanik O, Kurtis MM, Martinez-Castrillo JC, Mendoza-Rodriguez A, Moore HP, Rodriguez-Violante M, Singer C, Tilley BC, Huang J, Stebbins GT, Goetz CG. Eur J Neurol. 2013 Apr 22. doi: 10.1111/ene.12165. [Epub ahead of print] Assessing the non-motor symptoms of Parkinson’s disease: MDS-UPDRS and NMS Scale.

Robles Bayón A, Gude Sampedro F, Torregrosa Quesada JM.Neurologia. 2013 Apr 16. pii: S0213-4853(13)00055-8. doi: 10.1016/j.nrl.2013.02.010. [Epub ahead of print] Bradycardia in frontotemporal dementia.

Stoilova T, Colombo L, Forloni G, Tagliavini F, Salmona M.J Med Chem. 2013 Apr 23. [Epub ahead of print] A New Face for Old Antibiotics: Tetracyclines in Treatment of Amyloidosis.

Verhülsdonk S, Quack R, Höft B, Lange-Asschenfeldt C, Supprian T.Arch Gerontol Geriatr. 2013 Apr 15. pii: S0167-4943(13)00045-9. doi: 10.1016/j.archger.2013.03.012. [Epub ahead of print] Anosognosia and depression in patients with Alzheimer’s dementia.

* This may be related to alexithymia although in this paper the researchers refer to ‘anosognosia for affect’.

Appendix

News Round-Up 2008-2011

News Round-Up 2012

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Scientist Cameron Neylon is an advocate for open science and in this video (from the Open Repositories 2012 conference) he talks about many important aspects of open science. Neylon gives examples of scientific communities that have transformed research methodologies through online networks and accelerated analysis of data in the process. He also looks at the issue of increasing the impact of open science through open science networks. There is a question and answer session at the end.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

A Three Structure Model of Neural Activity in Relation to Consciousness and Language

In a previous post I suggested how speech might be accounted for by the three structure model. In retrospect I think there is some modification needed and I propose that speech has three components as per the diagram below.

Speech and the Three Structure Model

Unfortunately it has got a little complicated and the arrows cross each other in the diagram. Nevertheless this reflects the complexity of the interaction between mind and brain. I will explain the three divisions of speech in the three structure model.

With automatic speech, the neural activity takes place in the cranial nerves. At this stage all of the decisions about speech have been made and it has now became a matter of activating the muscle groups in a predetermined manner.

With sensory speech feedback, we become aware of the sound of our own voice as we are speaking as well as the other sensory feedback such as the movement of the jaw and the contact of the tongue with the palate. While it is more likely that this will impact on our consciousness it is also possible for it to act on us unconsciously. For example, if prose is well learnt and it is being repetitively rehearsed it may be possible to divert conscious activity to other matters.

Speech modifiers describes the decisions that are made about how we translate language into speech. Rather than simply speaking our ‘language script’ in a standardised manner, we are able to modify the tone, rate, rhythm and volume of speech. We do this in order to engage with the audience and also to communicate the emotional meaning of our speech. Again this can be conscious or unconscious.

Relationship Between the Three Components of Speech

The relationship is shown in the above diagram.

The description of speech in the three structure model can be better understood by considering the video below.

Vocalisation in a Video by Dr J.P.Thomas

In the above video, the singer is demonstrating scales crescendo/decrescendo whilst stroboscopy reveals the corresponding changes in the larynx. The Larynx is a complex piece of anatomical apparatus featuring intrinsic and extrinsic muscles as well as vocal cords. The vocal cords vibrate up to 100 times per second.

As we view the clip the three components of speech are apparent after further reflection (although strictly speaking this is not speech it demonstrates the principles discussed above).

Firstly the automatic component of vocalisation is apparent. If we volitionally attempted to vibrate the vocal cords 100 times per second by focusing on the vocal cords themselves we would no doubt fail. Seeing the vocal cords might give us the opportunity for finer volitional control but it is unlikely given the rate at which they are vibrating with vocalisation. Additionally as we do not see our own vocal cords when we are speaking, our method of organising their movement must be entirely dependent on auditory feedback. We leave the finer details of achieving these movements to our cranial nerves and instead focus our conscious attention on the end result.

This brings us onto the second component of speech which is sensory feedback. The singer demonstrates a crescendo and decrescendo. Although this may be well rehearsed it is most likely that this technique requires close attention to the vocalisations produced up until that point. This feedback can be used to correct any deviation from the anticipated vocalisation.

Finally there is the crescendo and descrescendo. This is analogous to the speech modifiers which communicate the emotional content of our speech.

Speech remains outside of the three structure model. Nevertheless it is sufficiently complex to be usefully described in relation to the three structure model as it provides us with an intuitively understandable phenomenon that can be explained by this relatively abstract model.

Appendix – Related Resources on the TAWOP Site

In Support of Method

A Review of the Structure of Scientific Revolutions

An Interpretation of Scientific Revolutions

Integration in Neuroscience: A Core Problem – Part 1

Integration in Neuroscience: A Core Problem – Part 2

Integration in Neuroscience:A Core Problem – Part 3

Integration in Neuroscience: A Core Problem – Part 4: A Language for Mind and Brain?

Integration in Neuroscience: A Core Problem – Part 5: A Three Structure Model

Integration in Neuroscience: A Core Problem – Part 6: Reflection on the Three Structure Model

Integration in Neuroscience: A Core Problem – Part 7: The Unconscious in the Three Structure Model

Integration in Neuroscience: A Core Problem – Part 8:

Integration in Neuroscience: A Core Problem – Part 9:

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

One of the reference managers on the market is Endnote. In the above video Janine Lim shows us how to complete several useful tasks with Endnote. In previous posts (see Appendix) we looked at another reference manager – Mendeley. There are many other reference managers in addition to these two which will suit a variety of needs.

Appendix – Related Resources on this Site

Working with PubMed – Part 1: Getting started with a shortcut

Working with PubMed – Part 2: Favoriting abstracts

Working with PubMed – Part 3: Bibliography

Working with PubMed – Part 4: Receiving News Updates on PubMed

Working with PubMed – Part 5: Setting Filters

How to receive research paper e-mail alerts

A Video Celebrating 10 years of PubMed Central

How to improve your search results with Medline

Looking at a Reference Manager: A Brief Look at Mendeley

Looking at a Reference Manager: A Brief Look at Mendeley 2

Looking at a Reference Manager: A Brief Look at Mendeley 3

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

In the last post we looked at the a number of images and altered single characteristics to assess the impact on the contrast illusion. The hypothesis generated was that the letter A when compared to a filled circle could with a graded background produce the illusion of heterogeneity within the same shape (i.e within the letter A). The underlying assumption was that the geometry of the letter A would impact on the perception of contrasting colours in the background and foreground to produce the illusion of variegation. The above diagram was created to test this hypothesis. A cursory examination of the diagram suggests that the hypothesis is incorrect. Nevertheless the more general contrast illusion persists. Both the A’s and the solid filled circles appear lighter on the right than on the left.

Appendix

Explaining the Neurobiology of Illusions – A Talk from Caltech

Do Cats See Illusions Too?

A Visual Illusion Experiment – Part 9

A Visual Illusion Experiment – Part 8

A Visual Illusion Experiment – Part 7

A Visual Illusion Experiment – Part 6

A Visual Illusion Experiment – Part 5

A Visual Illusion Experiment – Part 4

A Visual Illusion Experiment – Part 3

A Visual Illusion Experiment – Part 2

A Visual Illusion Experiment – Part 1

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.