News Roundup: September 2011 2nd Edition

There has been a response from the Professor Sue Bailey, President of the Royal College of Psychiatrists together with representatives of the other Royal Colleges and other professional bodies to the proposed ‘Health and Social Care Bill’. Readers can see an extract from the letter at the GP online website.

Ben Goldacre has an interesting article on apparent flaws in neuroscience research. Goldacre looks at a paper by Niewenhuis and colleagues where they examine 513 papers and identify a systematic error in statistical analysis. Essentially positive findings in response to interventions are reported without comparison with the control group. The approach by the authors is somewhat reminiscent of the Vul et al paper on Neuroimaging research (see here) in the sense that both approaches can be considered as meta-research. In light of the controversial surrounding the MMR Vaccine a report by the House of Commons Science and Technology Committee (see also here) included a number of recommendations that may be helpful in challenging the difficulties reported by Niewenhuis and colleagues. There is also a need for an international response to fully address the issues.

In an American study based at the Mayo Clinic, researchers examined the role of an imaging technique known as Proton Magnetic Spectroscopy in identifying the factors influencing the load of Beta-Amyloid peptide which is thought to be central to the degenerative process in Alzheimer’s Disease. They included 311 people who didn’t have any cognitive impairment and used (11)C-Pittsburgh compound B (PiB) Positron Emission Tomography and (1)H Magnetic Resonance Spectroscopy to image one part of the brain – the Posterior Cingulate Gyrus. With the PET imaging the researchers were able to image the Beta-Amyloid load. With the Magnetic Resonance Spectroscopy, the researchers were able to image the levels of choline in the Posterior Cingulate Gyrus. This is used as a measure of turnover of cell membranes.

Choline, (http://en.wikipedia.org/wiki/File:Choline-skeletal.png), Public Domain

They were also able to image the levels of creatinine which is thought to be relatively stable and useful for comparing with other molecules of interest (such as choline). The ratio of choline to creatinine can therefore be used as a marker of  cell death which is useful for investigating neurodegenerative conditions. Similarly the researchers also investigated the ratio of myo-inositol to creatinine which is again useful in the investigation of neurodegenerative conditions. As expected, the researchers found that the Beta-Amyloid load was significantly associated with both the choline/creatinine and myo-inositol/creatinine ratios. However the researchers also found that the choline/creatinine ratio was significantly associated with performance on a number of cognitive tasks including tests of memory independent of the Beta-Amyloid load. The researchers suggested that the relationship between the choline/creatinine ratio and the impaired performance on cognitive tasks resulted from another process independent of the Beta-Amyloid load. In other words they thought that the probable cell death resulted from a process independent of Alzheimer’s Disease – vascular injury for instance. This is an interesting approach and raises a number of questions. For instance does this relationship predict conversion from to Alzheimer’s Disease or Vascular Dementia? What happens to these relationships in the Hippocampus, a brain region with much closer involvement in the degenerative process in Alzheimer’s Disease. What happens when the choline/creatinine ratio is followed up at multiple points to obtain an average value over a time period? It will be interesting to see further research in this area.

In a small study (n=64) comparing people with Alzheimer’s Disease with controls, researchers investigated the use of EEG in diagnosis. They found that was a small improvement in sensitivity when the EEG left hemisphere alpha/theta index was combined with a number of cognitive parameters compared with cognitive parameters alone. From a theoretical perspective it will be interesting to see other biomarkers correlates of these findings in larger replication studies.

The authors of one paper report on two cases of Posterior Cortical Atrophy with different forms of alexia. The researchers found evidence of differential hypoperfusion and it is important these hypotheses will need examination in large replication studies.

Evolutionary Psychiatry

There has been a further interpretation of the findings of Ardipithecus Sediba with the researchers suggesting that the multiple adaptations make A.Sediba a likely candidate as our ancestor, preceding Home Erectus. However this assumption is controversial and others argue that the findings are important because they show that various permutations of adaptations are viable n the hominid lineages. What is also interesting is that the researchers have made the casts of A.Sediba available for researchers around the world which should facilitate the necessary discussion to fully contextualise the findings.

There is an interesting article (via VaughanBell) in Scientific American on group violence across primates.  The researchers cite evidence of a relationship between food availability and violent group behaviour. However there is a limit to how much this hypothetical relationship can be used as an explanation for specific instances of behaviours in humans without being informed by high quality data about those same episodes.

Appendix –  Annual News Roundups

News Roundup 2008

News Roundup 2009

News Roundup 2010

An index of the site can be found here. The page contains links to all of the articles in the blog in chronological order. 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.

2 thoughts on “News Roundup: September 2011 2nd Edition

  1. André

    I dared to write today because lately my mind has been wracked by a difficult dilemma.
    I am a general surgeon and I have already completed my residency but this field is definitely not my vocational one.
    For some time now I have been thinking of beginning a new residency, and it seems to me that I could dare to follow my instinct. I have the deep felling that psychiatry is my calling, not a very rational feeling based on many solid arguments as I didn’t have an extended interaction with this specialty. Mainly I wish for something more inner oriented and providing a training that will allow to better understand my nature and simultaneously the others.
    On this particular moment I fell that I am a man trying to make a good decision but I fear that this move could finally be done a little bit too sudden, like a big leap into a dark zone without the proper tools or knowledge.
    By all accounts I am conscious it is a great change, but I motivate myself to become more fearless and somehow to master my doubts.
    I wish to explore a little bit in advance, to have just a glimpse, throughout your answers (if you will be so king to consider giving me one), the concept of being a psychiatrist , to gain some inside information about the ordinary life of a psychiatrist, the everyday challenges and difficulties one must confront and overcome.
    Basically I want to know if it could be hard for someone with a somatic background to reshape his pattern of thinking and found interest and finally joy in this field of psychiatric disorders?
    I know for a fact that I am a high motivated individual with a positive attitude towards new challenges and I feel prepared on the rational level but am I really prepared emotionally to climb this abrupt slope facing my career?
    I am not trying to spin this as a “my tragedy” kind of story and have a covered incognito counseling session via your blog. I will not dress it up in the narrative of a surgeon trying to find the metaphor in life and all that nonsense. This isn’t a tragedy, not in the Greek sense of tragedy describing a character’s fall from grace due to an unrecognized, fatal moral flaw nor in the modern sense of it. I am just trying to avoid, with your help, a decision made in circumstances characterized by a momentary lack of information.
    I deeply believe that one’s actions reflect on the intrinsic worth of the individual so, for not devaluating mine in my near future, I dare to ask you:
    – Is psychiatry suitable for a guy with prior surgical background?
    – If am I to follow my instincts and pursue this specialty will I be capable enough to adapt to the new environment of pathologies given the facts that I am 35 years old and I have a rather rigid and “catesian” education?
    Please excuse my lack of eloquence, but as you have already noticed throughout my words, English is not my maternal language.
    Please be so kind and not judge me so hard for my daring.
    André

    Like

  2. Dr Justin Marley Post author

    Dear Andre

    Thanks for your comment and the answer is yes of course a surgeon can make a successful transition to psychiatry. There’s already a lot of psychiatric disorders that are encountered in surgical practice – an obvious example being delirium in the postoperative period as well as all of the liaison psychiatry assessments that are undertaken on surgical wards. As with any branch of medicine there is a period of training at basic and higher levels which can be tailored according to your prior experience. Liaison psychiatry for example is a branch of psychiatry where you would be able to draw on your surgical experience. However just as with any other branch of medicine as you progress through training you will be able to find those areas where you have the greatest aptitude or interest. I wish you all the best if you decide on this!

    Regards

    Justin

    Like

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