Here’s another reflection on the month just ending, trying to make some kind of narrative sense of events.
August 2008 was the month of the Beijing Olympics when the whole world stopped for two weeks and watched the best athletes in the world compete against each other. Michael Phelp’s eight gold medals (7 world records) and Usain Bolt’s 3 gold medals (3 world records) were phenomenal achievements as were Chris Hoy’s remarkable three gold medals in the cycling. Hopefully the Olympics will inspire many people to take up healthy levels of exercise (with a careful choice of treadmill settings!). It’s important to remember that it’s not just the winning athletes that are important but all of the participating athletes and indeed the people of the world coming together to celebrate the games. This surely must be the greatest success of the games. Having said that, Great Britain were particularly proud of their athletes performance which was above expectations and the role of psychiatrist Steve Peters with the Olympic cycling team was examined in the media.
In other areas there were a lot of (sometimes complex) developments in many areas of psychiatry.
In treatment resistant depression, there were studies showing the efficacy of deep brain stimulation of the subcallosal cingulate gyrus and another study using the vagus nerve stimulating device (this also looking at Bipolar depression). Another novel approach examined was augmentation with N-Acetylcysteine. There was further validation of the concept of vascular depression in the elderly as well as evidence of changes in cognition related grey matter areas in mild cognitive impairment in the elderly also. This suggests a possible mechanism relating depression and impaired cognition that can be explored in future studies. The importance of early compliance with antidepressants was emphasised in one study and the short term efficacy of pulsed IV clomipramine combined with oral treatment was shown in another study (although there was no placebo group).
With Schizophrenia, things were more complicated yet. Research suggested that negative symptoms could be predictive of functional abilities. Furthermore there was a role for improving negative symptoms with muscarinic agonists. A role for a nicotinic receptor subtype in Alzheimer’s psychosis means that acetylcholine may be an emerging hot topic in schizophrenia research. A reduction in processing speed in first episode psychosis and altered firing activity in sophisticated combined imaging techniques means that there may be emerging neurocognitive markers of psychosis. I’m tempted to bring in another marker used in a separate context – the amyloid beta peptides which have been shown to increase with improvement in neurological status after brain injury. In other words the higher the amyloid beta peptide, the more effectively the brain is functioning under these circumstances. It would be possible to speculate that in first episode psychosis with slower processing speed, there may be a reduction in these peptides – perhaps we will see research in this area. There was other research pointing towards a neurodevelopmental aetiology – stress during pregnancy, grades in exams and enuresis in childhood. In both Alzheimer’s Diseaes and Schizophrenia there was research showing difficulties with theory of mind, a concept which is classically associated with autism. The buzz word at the moment is social cognition and research has shown that in schizophrenia, difficulties in this area may be related to a special type of memory relating to keeping track of one’s own actions. Crow’s model was also examined, which relates to asymmetry and language together with epigenetics. Intriguingly in China, more women develop Schizophrenia than men! The other interesting finding was some very strong evidence to support the role of culture in religious delusions.
The importance of dissociation in adolescence as a predictor for later dissociation was also shown which i’m sure will have implications for trauma research. Exercise was shown to be effective in countering antipsychotic-related weight gain. A curious finding was the implication that genes may be predictive of both tendency to exercise and anxiety/depression scores in twins although the exercise didn’t appear to influence the latter independently. The influence of culture in China in one paper offers a useful starting point for an examination of the impact of culture on the relationship between neurasthenia, chronic fatigue syndrome and depression.
Several books were reviewed including the Maudsley Guidelines, Humanizing Madness (with a very interesting biocognitive theory), Handbook of Psychopharmacology (Lifespan approach) and the Old Age Psychiatry Handbook. There were also several interesting blogs including the entertaining ‘Mental Nurse’, the brain-work-out ‘Neurocritic’, the marathon ‘Psychcentral’, the inspired ‘Furious Seasons’ and the political ‘The Psychiatrist’ blog.
Addendum September 2nd 2008
There were also studies with large numbers of people showing statins and ACE inhibitors (v other antihypertensives) were protective against dementia (and the latter reduced morbidity quite dramatically) although the latter study still awaits publication. The study looking at altruism in 3-8 year olds was also potentially quite important.
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