In this post I will reflect on some of the previous posts in July. As psychiatry is influenced by a vast number of areas it is unsurprising that creating a coherent narrative for last month’s posts may be less than straightforward. Another point is that the influx of information can be overwhelming, so its useful to reflect on what were the most important areas. I also want to have a bit of fun and see if I can draw links between news items although I wouldn’t take this too seriously as they may be quite tenuous.
Psychiatry – General Points
Perhaps the most important topic last month was wishing psychiatry a happy birthday. It’s been 200 years and psychiatry is still going strong! Also of interest was Niall McLaren’s suggestion of a theoretical vacuum in the biopsychosocial model used in psychiatry.
This was a big month for prevention and treatment in Alzheimer’s Disease. Having a partner and doing exercise were both shown to be protective. Two potential breakthroughs came with Dimebon and Rember. The Alzforum was reviewed and provides an invaluable internet resource. Another useful resource was a paper reviewing the different treatment options in Alzheimer’s.
The big breakthrough was the identification of chromosome’s associated with Schizophrenia. Also of interest was the lack of an association between executive functioning and coping abilities in one study. Following my review of Podcasts last week, one reader, Les, responded to my comment on schizophrenia being associated with spontaneous mutations. Les noted that there is theory of the male biological clock and the idea that as males get older there is damage to stem cells and an association between older paternal age and schizophrenia and other conditions. This leads me to a speculative hypothesis. Do older males in a species contribute to greater diversity in the population and increased adaptivity when the environment is rapidly changing. The reasoning is as follows. There is evidence that there are more mutations in sperm as men get older and mutations contribute to the adaptivity of the species to the environment. In a stable environment, the younger fitter males are well adapted to the environment and would be expected to be better at passing on their genes. However if the environment is rapidly changing, then the species needs to adapt and solve novel problems posed by the environment. The fittest young males will pass on their genes with few mutations. These genes however contain solutions to the old environment. The mutated genes of the older males will contain potential solutions to the new environment and will be more likely to produce offspring that increase the fitness of the population. This is however speculation. There are at least two arguments against this. Firsly the fittest males may be fit because they have genes which allow them to adapt to any environment. Secondly there may be a heterogenous group of genes already in the population which may confer fitness to adapt to the new environment. In other words a population may contain a wide variety of genes within the population which allows it to adapt to changes and makes new mutations less necessary.
Neurotic, Stress Related and Somatoform Disorders
D-Cycloserine was shown in a meta-analysis to help overcome anxiety when used with exposure therapy. PTSD was found to be associated with smaller hippocampi in war veterans and in Iowa, mental health professional are anticipating a rise in disorders such as PTSD following floods in the area.
Putting some of these things together, the following speculative hypothesis can be formulated: Following a natural disaster, the cognitive capacity of the local population will be reduced during a critical period. The reasoning is as follows. Following a natural disaster there will be an increase in PTSD after the initial period of shock. WIth time the prevalence of PTSD will decrease. In between, there is a critical phase during which time there is a higher prevalence of PTSD. During this period of increased prevalence, the hippocampal volume of the population will be smaller due to the decrease in volume in those with PTSD. Since the hippocampus is involved in memory which is essential for cognitive tasks, the overall cognitive capacity of the population may be decreased. The problem with speculation however, is that it is just that. We can also argue for instance that the opposite might occur. A well demonstrated phenomenon in psychology is that of the Yerkes-Dobsen Law. The Yerkes-Dobsen Law says that there is an optimum level of anxiety for performance. Below a certain level of anxiety and we will not perform tasks as well, and similarly above these levels. We could therefore argue that following a natural disaster, anxiety will be increased in the population and people will be more responsive to events in the environment. This is why it’s important to test theories out with studies.
Books about Bipolar Illness and Online therapy were reviewed and both books were comprehensive and well thought out.
I reviewed a few very good blogs including ShrinkRap, The Carlat Psychiatry Blog and PsychCentral. These gave perspectives on medication, psychological approaches and general psychiatric issues and were both thought provoking and entertaining. I also caught a glimpse of an avalanche of blogs over the hill (so to speak) and will be moving slowly through this as I continue to review blogs and gain a better understanding of what’s out there (i’ve been very impressed so far)!
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.