Reflections on October 2008

October seemed to fly by and there was a lot ground covered. First of all I asked the question of whether Science can be advanced through blogs and provocatively offered to develop a model of insular cortex function through the blog medium. Watch this space!

How mental health services operate or are developed was tackled from a number of perspectives. A review of a book on the Henderson Hospital showed the therapeutic community approach to services in which both patients and staff jointly decide who comes into the community, who leaves and where patients contribute to the treatment of fellow patients. Mental health was examined from a global perspective in the admirable series on Global Mental Health which began as a call to address mental health issues across the world and consists of a very detailed set of papers with plenty of evidence to back up arguments and identify current global needs and practices. A review of the third in the Global Mental Health series looked at how minimal resources can be used effectively in places where this is absolutely necessary. The impact of bereavement theory on art therapy was discussed in this review and it was interesting to note how a profession can take theoretical models and try to relate them directly to practice. Also the possibility of using self-help books within a service has been used already with the five-areas approach for anxiety workbook. This adds to other emerging self-help solutions for people with common conditions such as anxiety and depression which includes online computer-based psychotherapy when however this is appropriately incorporated into services.

In terms of dementia there were many relevant articles and news items. There was a review of a paper examining striatal glutamate pathways in the elderly and the relationship to cognitive function. Perhaps this might one day become a target for therapy. There was a finding that in mild cases of Alzheimer’s Disease, two pathologists rather than one might be needed to confirm a diagnosis and in another study in the same post there was a finding that nearly half of cases of vascular cognitive impairment non-dementia resolved spontaneously. One third of people with Parkinson’s disease had their diagnosis changed during the course of follow-up for various reasons in one study. There was also a finding that in over 50% of cases dementia was of mixed aetiology and that the synucleopathies rarely occured alone. Given the importance of cardiovascular risk factors in dementia recent studies in Diabetes showing the benefits of tight blood-pressure control as well as insulin, metformin and sulphonylureas may be relevant in this context. The comparative benefits of psychosocial approaches and medication in dementia as well as their additive benefits were examined in this study. MCI was associated with apathy, delusions and depression in one study with a comparator group without MCI. Gingival bleeding was associated with impairment on a digit subtraction test. Another long-term study found potentially important relationships between mid-life religious practice and dementia in later life. There was an interesting article on medications seen in a memory-disorders clinic which is reviewed here.

In Schizophrenia research there were a number of findings. Thus the relationship to schizophrenia of the structure of the Anterior Cingulate Cortex as well as metabolic processing in the corpus callosum were identified. The important question of recovery of schizophrenia was also raised in one article reviewed here. Preliminary findings suggest a relationship between maternal haemaglobin and schizophrenia although the authors of this study recommend further confirmatory studies. Reinforcement learning was found to be significantly associated with negative symptoms in one study. Ultra-high risk factors predicted conversion from prodrome in 16% of people in one study. Concurrent substance misuse was one of the most significant risk factors for relapse in first-episode psychosis in another study. Risk for coronary heart disease with different antipsychotics was also evaluated in the CATIE study. EPSE’s were found to be equivalent in prevalence between first and second-generation antipsychotics in a study discussed here. There was also an association between the dosage of a medication and adherence found in one study. An open-access article looked at brain development in schizophrenia with onset in childhood. This is of relevance to Crow’s model of schizophrenia which was revisited in this review. Also CBT showed equivalence to treatment as usual in psychosis in one study.

In Liaison Psychiatry there were no differences between men and women in functioning following adult brain injury in one study. The EPIC-Norfolk study found an association between major depressive disorder and ischaemic heart disease. Curiously however the Baltimore Longitudinal Study found no association between depression and media intimal thickness. Social desirability was one of the most significant predictors of adherence in Coronary Artery Disease in one study. Mood disorders, anxiety disorders and alcohol misuse were increased in Rheumatoid Arthritis in a World Mental Health Survey. Potential interactions to look out for in treating depression in people with breast cancer were discussed in the American Journal of Psychiatry. The Rotterdam Study found an association between total sleep duration and cholesterol levels.

Philip Cowen developed a model of the role of Serotonin in an article which was reviewed here. The concept of mood-stabilising neurons in Bipolar Disorder was discussed in one paper. Grey matter volumes in different brain regions in depressed patients were found in one prospective study. Meanwhile another theory has been developed which suggests that psychotherapy in depression targets the prefrontal cortex and medication targets the amygdala. A 1946 British Cohort Study found that 25% of people were taking antidepressants at 10 years and that antidepressant use was associated with a lower risk of subsequent mental disorders. A Whitehall study found an association between sick leave due to depression and cancer which will necessitate further studies to clarify the relationship.

In Learning Disabilities an exciting development was the finding of a cause for Bloom’s syndrome involving the interaction of several gene products. The importance of the region 1q21.1 in addition to being associated with schizophrenia is also associated with autism and learning disabilities.

A Norwegian Twin study has found that Antisocial and Borderline Personality Disorders contain more overlap than other Cluster B Personality Disorders and have given estimates of the heritability in each case. Higher than normal body weight was associated with Paranoid, Avoidant and Antisocial Personality Disorders and being underweight with Schizoid Personality subtype in another study.

There were a number of developments in child psychiatry. The MindHacks Blog which was reviewed here contains a wealth of useful information and reflections amongst which was a reference to the creation of a child brain image database which may help to better understand mental illnesses with onset in childhood. Bipolar disorder in children is an emerging area where there has been recent evidence supporting the diagnosis. This does however provoke strong reactions particularly in terms of drug treatment when those with different and sometimes opposing perspectives want to do their best for the child. There was also a study finding an association between parenting behaviours together with children’s aggression and peer victimisation. A large Swedish National Cohort Study has found a number of associations with children being taken into foster care.

An association between Obsessive-Compulsive Disorder and brain injury affecting specific regions was discussed.OCD was also associated with a number of white matter abnormalities in a Diffuse Tensor Imaging study.

Francis Crick’s theory of the role of the Thalamic Reticular Nucleus has been validated by recent research. Crick who is more famous for his work on the double-helix, suggested that the Reticular Nucleus which covers the outer surface of the Thalamus, processes information before it reaches the cortex. In a well-publicised study, people who felt less in control were more likely to observe patterns in random noise in one study and it has been suggested that this might for example be relevant in people who are experiencing a paranoid psychosis. If this were the case, we might expect to see a relationship between valid measures of ‘control’ and certain psychotic experiences. The use of Transcranial Magnetic Stimulation in coma also shows promise in some cases. There is also a peptide antagonist being developed for Migraine which should avoid cardiovascular interactions. Hippocampal volume has been found to vary with the menstrual cycle in one study. There was also some research on the Insular Corex which I will use to sketch out a very brief model for future development.

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.

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