Reflections on August 2009

In August 2009, a Twitter was launched allowing updates and a look at relevant areas in the ‘twittersphere’. I also experimented with the news in video format (see the videos below). Medical/biological psychiatry articles reviewed included one on risk factors for falls in dementia. Psychotherapy/psychology papers reviewed included Winnicott’s influential paper on transitional objects. In terms of social psychiatry articles the ‘New Horizons’ document was looked at and this is currently in consultation and will form a blueprint for the next 10 years of the NHS Mental Health Strategy, building on the National Service Framework. These are exciting times and feedback is currently being sought from interested parties (see here and here). Books reviewed included ‘Evolutionary Psychiatry. The Origins of Psychopathology’ which I found particularly interesting as this field holds many implications for reinterpreting illness and health (evolutionary psychology) and perhaps facilitating the integration of psychological, sociological and biological domains as well as delineating boundaries. Further episodes of John Betts series on Jungian Analytic Psychology were reviewed including a look at Jung’s concept of the active imagination. Blogs reviewed included Linguistic Anthropology which covers a variety of area relating to language. In the news amongst many studies, there was a study that provided evidence of a significant association between the consumption of a Mediterranean Diet and prevalence of dementia, a study on EEG patterns in Alzheimer’s Disease and Frontotemporal Dementia with intriguing findings, another study demonstrating the efficacy of using iron particles to label cells for MRI detection, a survey on polypharmacy, Donepezil in vascular dementia, a finding that the MECP-2 gene (associated with Rett Syndrome) may have a wider role in the development of brain structure, the use of ultrasound in ablation of tissue in functional neurosurgery and the demonstration of perceptual rivalry in the sense of smell.

Biological Psychiatry Article Reviews

Medication Adherence and Admissions in Bipolar Disorder

Incidence and Prediction of Falls in Dementia. A Prospective Study in Older People

Neuroprotection for Huntington’s Disease. Ready, Set, Slow

Social Concepts are Represented in the Superior Anterior Temporal Cortex

Psychological Psychiatry/Psychology/Psychotherapy Article Reviews

A Balanced Psychology and a Full Life

Can the Brain Understand The Brain

Winnicott on Transitional Objects and Transitional Phenomena

Neuropsychological Deficits Associated with Alzheimer’s Disease in the Very Old. Discrepancies in Raw v Standardised Scores

Social Psychiatry Articles Reviews

The Social Connectedness of Older Adults: A National Profile

The Neuroscience Information Framework

Research in the Field of Psychiatry

New Horizons: Towards a Shared Vision for Mental Health

Social Buffering. Relief from Stress and Anxiety

Book Reviews

Qualitative Psychology. A Practical Guide to Research Methods

On Death and Dying

The Talking Ape. How Language Evolved

Textbook of Evolutionary Psychiatry. The Origins of Psychopathology

Podcast Reviews

Betts on Jungian Analytic Psychology #19

Betts on Jungian Analytic Psychology #21

Betts on Jungian Analytic Psychology #22

Betts on Jungian Analytic Psychology #23

Betts on Jungian Analytic Psychology #24 and #25

Blog Reviews

Singularity Hub

Wolfram Alpha Blog

Psyche Babel

Linguistic Anthropology

Miscellaneous Articles

The Amazing World of Psychiatry: A Psychiatry Twitter


Research in Mood Disorders

A post-mortem study (n=27) compared 17 people who had developed late-life depression with 10 controls and the researchers found a significant reduction in the volume of the pyramidal cells (to a greater extent in layer 5) throughout the cortex in the depression group. Interestingly the layer 5 cells are more susceptible to ischaemic damage which has also been noted to be more prevalent in people with late-life depression suggesting a possible hypothesis which could be explored in future studies (Khundakar et al, 2009).

Research in Dementia

The authors of an imaging study (n=comparing people with Alzheimer’s Disease or Mild Cognitive Impairment with healthy control used a ligand for the Alpha4Beta2 nicotinic acetylcholine receptor and found no significant difference between the groups after controlling for multiple confounders before concluding that this supported the hypothesis that aceytlcholine reductions are observed late in Alzheimer’s Disease (Mitsis et al, 2009). A double-blind placebo-controlled trial of Donepezil in Vascular dementia (n=707 completers) showed evidence of a small but significant improvement on ADAS-cog scores (0.6-1.15 points) at 54 weeks (Wilkinson et al, 2009). In a survey of hospice Medical Directors in the USA anticholinesterase inhibitors and NMDA receptor antagonists were prescribed in a small subset of people with advanced Alzheimer’s Disease and reasons given included stabilising cognition and addressing problematic behaviours suggesting a benefit for formal studies to address these issues (Shega et al, 2009). A small study (n=29) in female Chinese caregivers of people with dementia in Hong Kong found a significant improvement in self-efficacy of managing problematic behaviours in the people they were caring for (Au et al, 2009). In a retrospective analysis of data from an RCT of Rivastigmine in Mild Cognitive Impairment (n=1018) there was found to be a significant reduction in the rate of cognitive decline of male BuChE-K carriers (a variant of the Butylcholinesterase Enzyme Gene) and also in female BuChE wt/wt carriers (Ferris et al, 2009). The authors of a recent randomised double-blind study of Donepezil in young adults with Down Syndrome treated over a 12-week period concluded that the results supported the safety of Donepezil in people with Down syndrome although the efficacy results were more difficult to interpret (Kishani et al, 2009). In a post-mortem study there was found to be a case of Alzheimer’s Disease without uptake of radiolabelled Pittsburgh compound B (PIB) and the authors suggest that this compound might bind differentially to various forms of multimeric ABeta. The implication if this holds is that a PIB negative finding might not always exclude the diagnose of Alzheimer’s Disease. However as this is a single case, it will be interesting to see if these results are replicated (Rosen et al, 2009).

Research in Psychosis

In a study in which two psychiatrists assessed 100 inpatients, the diagnosis of schizophrenia was found to occur more frequently when using ICD-10 criteria compared DSM-IV and the researchers suggest that this might be due to the absence of an exclusion of an affective syndrome in ICD-10 (although there are references to affective symptomatology in ICD-10)(Cheniaux et al, 2009). In a longitudinal structural MRI study, people with schizophrenia were divided into good and poor outcome groups and in the latter group there was found to be a significant assocation with reduction in the volume of the putamen (Mitelman et al, 2009). In an 18-week double-blind flexible dosing study (n=147) of Clozapine and Ziprasidone in people with treatment-resistant schizophrenia the researchers concluded that both medications showed similar efficacy with reduction in PANSS scores being the primary outcome measure (Sacchetti et al, 2009).

Miscellaneous Research

In a study of residents in long-term care who were referred for psychiatric assessment (n=868) there was found to be elevated Thyroid Stimulating Hormone (TSH) in 10.8% of people and a significant association of elevated TSH with female gender (Sabeen et al, 2009). The authors of a systematic review looked at services providing acute time-limited residential alternatives to inpatient psychiatric ward treatment for people needing acute admission. The authors described their search strategy and were able to identify 27 studies for inclusion in their review. They assessed the quality of these studies and found that a number of the studies didn’t conceal allocation of subjects or adjust for confounders although they did provide evidence of outcomes comparable to acute inpatient treatment in a number of studies. The authors concluded that more research was needed in this area although there was ‘preliminary evidence’ to support the community-based alternatives examined* (Lloyd-Evans et al, 2009).

News in Brief

In a rather ingenious study (which is open access and freely available here) cognitive impairment and depressive were assessed in 16,800 participants in a cohort study and the results were correlated with data on ‘two-week average sunlight exposure’. The researchers did find a significant association between cognitive impairment and the sunlight exposure so it will be very interesting to see if this is replicated and if so how such a relationship might be working. In another study published in the Proceedings of the National Academy of Sciences, alpha-synuclein has been found to be transmitted from one cell to another within cell cultures and there was further supporting evidence for such an association and this has implications for therepeutic approaches in Parkinson’s Disease and related conditions. In a structural MRI study looking at 679 people (>=65 years) there was found to be an increased association between memory impairment and white matter hyperintensities and also an association between strokes and  non-memory cognitive impairment which remained after correction for factors such as APOE4 status and age. The authors of a PNAS study demonstrated increased toxicity associated with increased size of ABeta dimers that constitute the ABeta plaques. In a prospective longitudinal study of 1880 New York community dwellers there were found to be significant associations between consumption of a Mediterranean diet, exercise and a reduction in the prevalence of dementia. The authors of one paper examine the hypothesis that the Raphe nuclei might be an important component of the pathology of Alzheimer’s Disease (Simic et al, 2009). Further evidence for a link between Frontotemporal Dementia and Amyotrophic Lateral Sclerosis (ALS) has been found in a post-mortem study where the FUS (fused in sarcoma) protein (associated with ALS) was found in the neuronal inclusions in 15 people with frontotemporal dementia (Neumann et al, 2009). An analysis of the data from the Alzheimer’s Disease Neuroimaging Initiative provides further support for the hypothesis that conversion from Mild Cognitive Impairment to Alzheimer’s Disease is strongly influenced by Medial Temporal Lobe volume and particularly the volume of the hippocampus (Risacher et al, 2009). A small study involving 34 people without evidence of cognitive impairment, at post-mortem found a significant correlation between performance on a smell test (the Brief Smell Identification Test) and Alzheimer’s Disease pathology (Wilson et al, 2009). The smell test however can be influenced by smoking.

Using an analysis of EEG data from patients with Frontotemporal Lobar Degeneration and Alzheimer’s Disease, a team has found further evidence that in Alzheimer’s Disease there is increasing disconnection between areas in the brain. However they found that communication between areas became more structured in people with FTLD. The findings are relevant in terms of a disconnection hypothesis which maintains that in Alzheimer’s Disease there is a loss of function resulting from impaired communication between brain regions. A research team in Germany have provided evidence of ferritin in neurons in Parkinson’s disease. Iron metabolism has been implicated in the disease process and previous research has identified the ferritin in the glial support cells (see also this article in which the Diamond Light Source Synchrotron is being used to examine iron distribution in Parkinson’s Disease). An Israeli study has provided preliminary evidence for the viability of mesenchymal stem cells (which means there is no need for embryonic cells) in a model of Huntington’s Disease. By ‘labelling’ the cells with iron particles they were able to follow their progress using Magnetic Resonance Imaging and observed them migrating to their destination. It will be interesting to see further use of this neuroimaging technique as well as the work with stem cells. In a study looking at the MECP2 gene (methyl CpG binding protein 2). A mutation in this gene results in Rett Syndrome, a developmental disorder associated with seizures and cognitive impairment. The research team looked at the gene and the surrounding DNA in a total of 940 people who were healthy or who had developed dementia or psychosis. They found that one specific allele of MECP2 was associated with a number of changes in the structure in the brain including a reduction in the surface area. They also found that variations in the surrounding region were associated with structural changes in the brain and this gene region may turn out to have an important developmental role. Another study provided evidence that formal education reduced the risk of Alzheimer’s Disease even if there was a reduction in brain volume. New drugs – ATPZ’s have been identified which prevent the formation of  Alzheimer’s Disease tau protein clumping in vitro.

A German team have provided evidence that two Parkinson’s Disease associated genes – Parkin and PINK1 interact to maintain mitochondrial function and the researchers suggest that this may have implications for possible disease-modifying therapies. In a study of people who had developed concussion (20 subjects and 20 controls), neuropsychological testing identified executive impairment but CT and MRI scans did not pick up evidence of injury. However the researchers also used Diffuse Tensor Imaging and were able to identify areas of injury with particular involvement of the prefrontal cortex which was consistent with the neurospychology results. The researchers also found a significant association between the DTI identified injury and the executive performance  and the research team suggest that this provides evidence for a role for DTI in concussion. One research team have used ambient background noise during training exercise to help people with Parkinson’s Disease learn how to speak louder as the condition can affect their expressive speech. The team is now looking to make small modifications to their approach. There has been confirmation of the efficacy of delivery of a gene for Nerve Growth Factor in a murine model of Parkinson’s Disease in one study. The gene was delivered using a modified Adenovirus and the expression of the gene was modified with Doxycycline. A large study provided some preliminary evidence of a relationship between increasing diastolic blood pressure and cognitive impairment in people over the age of 45. The study involved 30,228 subjects from the longitudinal REGARDS study (Reasons for Geographic and Racial Differences in Stroke) but the association here was drawn from cross-sectional data obtained from the cohort and so it would be interesting to see replication using longitudinal data and other cognitive measures that are used for assessment of mild cognitive impairment. One study looking at older adults (over the age of 70)  (n=94) investigated the relationship between Body Mass Index and cortical volume as measured using tensor based morphometry. The researchers found a significant association between increasing Body Mass Index and a reduction in cortical volume and it would be interesting to see large replication studies.

In a recent poll by the Royal Pharmaceutical Society of  457 people over the age of 65, just under half of respondents reported that they were taking 5 or more medications and 60% thought that they were experiencing adverse side-effects. An american study of 630 drivers aged 55 to 93 found that 28% of the drivers were not aware of the effect of medications on driving. An intriguing in vitro study provided evidence that the antipsychotic pimozide kills several types of cancer cells. There has been a suggestion of closer monitoring of antipsychotic initiation in older adults with diabetes following the results of a longitudinal study of 13,817 older adults (>65 years) who had commenced antipsychotics and finding that compared to a group who had stopped antipsychotic medication 180 days previously there was an elevated prevalence of hyperglycaemia. In a recent poll of 2000 people over the age of 16, there were found to be gaps in knowledge in the respondents in areas of potential importance – for instance 26% of respondents did not think there were approaches to reducing their risk of developing dementia.

A diffuse tensor imaging study (n=20) provided evidence of structural abnormalities in the arcuate fasciculus in people who are tone deaf (half of the subjects were tone deaf). The researchers found that they could not identify the arcuate fasciculus in the right hemisphere. The arcuate fasciculus is a connection between the frontal and temporal lobes. A recent study has demonstrated that ultrasound guided with the aid of Magnetic Resonance Imaging was successfully in ablating tissue in the thalamus in people with neuropathic pain and it will be interesting to follow subsequent research in this area. A mutation in a gene – hDEC2 that occurs in an extended family that require only 6 hours of sleep has been associated with sleep duration using additional indirect evidence. An American cross-sectional study involving 559 women found an association between hopelessness and thickness of the carotid arteries which remained after controlling for depression and other cardiovascular risk factors. The arterial wall thickness is a risk factor for cardiovascular and cerebrovascular disease but it will be interesting to see replication using a prospective study design.

A cross-sectional study (the HUNT study) with 50,843 participants showed a significant association between an increased prevalence of occasional headaches and higher levels of caffeine intake. They also found that lower levels of caffeine consumption were associated with an increased prevalence of chronic headaches. With increasing numbers of under-18 drinkers in the UK developing liver disease and being admitted to hospital, the charity Alcohol Concern has called for an increase in the pricing of drinks. An American study has provided evidence that Alcohol adverts on cable television have a significant correlation with the likelihood of teenager viewing of the cable TV. They found that wine adverts were inversely correlated with an increasing percentage of teenage viewers in the audience but that there was a significant linear correlation with spirits, low-alcohol ‘alco-pop’ drinks and beers. This is interesting in relation to older studies which show that teenagers with ‘media resistance skills‘ in another american study were less likely to drink alcohol. Earlier this year an Australian study provided  evidence that adolescents there were seeing more alcohol-related adverts and the authors recommended a move towards regulation of adverts. In a small study (n=62) smokers were found to have a significantly reduced blood supply to the tongue and smaller flatter fungiform papillae (taste buds). This is also consistent with other research that shows an impaired sense of smell in smokers (see appendix in this article).

In a presentation at the Annual Convention of the American Psychological Association, a recommendation has been made for managing childhood obesity by encouraging positive body image and exercise in children. The NHS has been criticised in a developing argument about the future of American Healthcare and Gordon Brown has joined in the defence of the NHS using twitter! There has also been some recent research on Twitter that shows that just over 40% of the postings contain information about the minute-to-minute actions of the twitterers although just under 40% of postings were conversational. A Stanford study published in the Proceedings of the National Academy of Sciences looked at 100 students, examining how they responded to the data they were presented with. The students were divided into those that those frequently ‘media multitask’ (which means that they take in information from multiple media sources which is contrasted with focusing on a single task at any given time) with those who did not. The group found that the multitaskers performed worse than the comparison group on a number of measures including distractability. The study has been widely reported (e.g. here, here, here and here). In the Blogosphere, the study has been covered over at MindHacks and Not Exactly Rocket Science and the key point is that this study is demonstrating association rather than causality. So for instance, the heavy multitaskers may use this approach because they have a different cognitive profile.

The authors of a Finnish study state that they have found evidence that astrocytes mediate the blood vessel changes that are seen in fMRI studies and it will be interesting to see further information on this study as it becomes available. In a small (n=48) observational study of patients with breast and prostate cancer there was found to be a significant correlation between radiotherapy-associated fatigue and markers of cytokine activity and it will be interesting to see further studies in this area. A study in flies demonstrating two pathways – one for long term memory and the other for short-term memory may be of relevance to humans as there is a human homologue of a gene involved in these memories – Rutabaga.

A study with a small sample size provides initial results that suggest that westerners and East Asian people interpret facial expressions differently with the former group focusing on the whole face and the latter group focusing on eyes. However as noted, the sample size here is small and a larger replication study is needed to draw firmer conclusions in this regards. In another study, there was found to be an association between reading emotional words  and activation of muscles that are used during expression of those emotions. Further, providing people were able to use the associated muscles they experienced the relevant emotions when reading the emotional words and this influenced their judgements. In a study that compared people who spoke two languages with those speaking just one, researchers found that when reading cognate words, that is words that are similar in both languages, the bilingual subjects took less time to read these words suggesting that learning a second language influenced the way the primary language is processed. In an EEG study, the response to value-laden words was found to occur within milliseconds of presentation if this clashed with the person’s values and such information is of relevance to other areas including neuroimaging. A candidate gene KIAA0319 (on Chromosome 6) was investigated in 322 children with Specific Language Impairment and variations were found to be associated with language ability. In another study, researchers found that a phenomenon known as ‘perceptual rivalry’ occurs with the sense of smell. They presented subjects with two competing smells, one for each nostril and the subjects nted an alternation between the experienced smells. Such competition is noted in other sensory systems such as the visual system. The results of one study indicated equivalent efficacy for both red and blue light in maintaining nighttime alertness. In another study when looking at a clock subjects gave different times when either the clock was brought into their field of vision (in which case the time they gave fell behind the actual time) or if their eyes moved to the clock (in which case the time they gave was ahead of the actual time) and the results were interpreted as meaning that the cortical visual perceptual system anticipates the movement of the eyes.

There has been a presentation on work on lucid dreaming and the relation to dissociation at a recent European Science Foundation workship and there is also a discussion of a threat simulation theory which states that part of the role of dreaming is to recreate the threats that a person has experienced presumably so that they can learn to deal with these threats more effectively (almost like a virtual reality training simulation!). In a relatively small study (n=51) people with and without depression were placed on a weight reduction program and an average 8% weight loss in the depression group was significantly association with an improvement in depression scores although it will be interesting to see the results in the final published form.

Evidence from a Spanish 48,000 year old Neanderthal specimen shows the presence of a gene coding for bitter taste meaning the detection of bitter tastes occurred before the divergence of Neanderthals and humans. A 4000 year old tomb has been found in Forteviot, Scotland causing a significant reevaluation of not only local history but also significant events in Neolithic culture. Researchers found in one study that Capuchin monkeys spent more time near researchers if they mimicked the monkeys which was interpreted as meaning that mimicry is important for social bonding in these monkeys. If such findings are replicated and this mechanism has been conserved through primate evolution it may have implications for social interactions in humans.


Au A, Li S, Lee K, Leung P, Pan PC, Thompson L, Gallagher-Thompson D. The Coping with Caregiving Group Program for Chinese caregivers of patients with Alzheimer’s disease in Hong Kong. Patient Educ Couns. 2009 Jul 18. [Epub ahead of print]

Cheniaux E, Landeira-Fernandez J, Versiani M. The Diagnoses of Schizophrenia, Schizoaffective Disorder, Bipolar Disorder and Unipolar Depression: Interrater Reliability and Congruence between DSM-IV and ICD-10. Psychopathology. 2009 Jul 16;42(5):293-298. [Epub ahead of print].

Ferris S, Nordberg A, Soininen H, Darreh-Shori T, Lane R.Progression from mild cognitive impairment to Alzheimer’s disease: effects of
sex, butyrylcholinesterase genotype, and rivastigmine treatment.Pharmacogenet Genomics. 2009 Jul 16. [Epub ahead of print]

Kishnani PS, Sommer BR, Handen BL, Seltzer B, Capone GT, Spiridigliozzi GA,Heller JH, Richardson S, McRae T. The efficacy, safety, and tolerability of donepezil for the treatment of young adults with Down syndrome.Am J Med Genet A. 2009 Jul 15;149A(8):1641-1654. [Epub ahead of print]

Mitelman SA, Canfield EL, Chu KW, Brickman AM, Shihabuddin L, Hazlett EA,Buchsbaum MS.Schizophr Res. 2009 Jul 16. [Epub ahead of print]. Poor outcome in chronic schizophrenia is associated with progressive loss of volume of the putamen.

Shega JW, Ellner L, Lau DT, Maxwell TL.Cholinesterase Inhibitor and N-Methyl-D-Aspartic Acid Receptor Antagonist Use in Older Adults with End-Stage Dementia: A Survey of Hospice Medical Directors. J Palliat Med. 2009 Jul 21. [Epub ahead of print]

Sabeen S, Chou C, Holroyd S.Abnormal thyroid stimulating hormone (TSH) in psychiatric long-term care patients.Arch Gerontol Geriatr. 2009 Jul 16. [Epub ahead of print].

Sacchetti E, Galluzzo A, Valsecchi P, Romeo F, Gorini B, Warrington L; MOZART Study Group.Schizophr Res. 2009 Aug;113(1):112-21.Ziprasidone vs clozapine in schizophrenia patients refractory to multiple antipsychotic treatments: the MOZART study.

Wilkinson D, Róman G, Salloway S, Hecker J, Boundy K, Kumar D, Posner H, Schindler R.The long-term efficacy and tolerability of donepezil in patients with vascular dementia. Int J Geriatr Psychiatry. 2009 Jul 21. [Epub ahead of print]


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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).


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The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog


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