There were many interesting developments in 2011. The world population reached 7 billion although this is an estimate in the absence of a global census. A population of this size brings with it many challenges but technology (particularly social media) brings the world’s population closer together. For me one of the most remarkable studies was the functional Magnetic Resonance Imaging study of Gallant and colleagues. By gathering an extraordinary amount of data and using a very smart approach to the analysis of this data they were able to correlate the activity recorded in the visual part of the brain (occipital cortex) with what was being seen by the person and indeed to predict this with astonishing accuracy. Two illustrative videos from this study are to be found below. However Rene Descartes, the 16th Century French philosopher may have the last word here as it still doesn’t answer the thorny question of where the experience of seeing is being experienced – although things have moved on and our conception of dualism is more concerned with the language of mind and brain rather than a distinction between mind and body. Various brain related technologies or new applications of established technologies have been developed including a method to improve learning through the application of electrical currents which is in the very early stages of development (demonstrated at the British Science Festival), functional Electrical Impedance Tomography by Evoked Response to investigate consciousness in people undergoing anaesthesia, an early trial of Transcranial Magnetic Stimulation in the management of post-CVA dysphagia, EEG/fMRI combinations to investigate lucid dreaming and brain reading – the use of artificial intelligence to analyse brain imaging data as well as Deep Brain Stimulation associated with neurogenesis in the Hippocampus. Much of this work is in the early stages and the efficacy of such approaches will be established in due course. The House of Commons Science and Technology Committee Report makes recommendations for the process of publishing in scientific journals following a number of recent controversies in this area.
Professor Simon Baron-Cohen presents an important hypothesis in his book ‘Zero Degrees of Empathy’ in which he reframes Personality Disorders as disorders of empathy. Given the practical utility of such a framework this would benefit from a wide and prolonged debate. Genetics is advancing at a phenomenal pace – an obvious example being the field of personal Genomics where you can send off a sample of genetic material to a Genomics company for sequencing and receive detailed information about your genetic make-up. A recent genetics study looked at gene expression in the Prefrontal Cortex and after using over a trillion pieces of data, the researchers concluded that there was more variation in gene expression in the same person over their lifespan than between people. There was also evidence of the role of epigenetics in longevity – non-DNA factors that contribute to gene expression – in one species where the methylation of DNA was found to contribute to 30% of the variation in longevity. While advances in technology are remarkable there is a lot of research which suggests that lifestyle also plays an important role in the health of the brain. On the theme of lifestyle, the Royal College of Psychiatrists also published a report on substance misuse in older adults. Prime Minister David Cameron’s Health and Social Care Bill is passing through the House of Lords currently (a line-by-line reading is due to be scheduled) and when implemented will mean a number of significant changes in UK healthcare. This is also taking place in the context of a wider ‘Big Society’ implementation which was reflected in the New Year’s honours list.
In relation to mood disorders, one longitudinal study lasting several decades and being moderately sized provided good evidence that antidepressants are associated with a reduction in suicide. Another study found that acetylation of DNA histones was associated with some cases of Schizophrenia thus adding to the number of associated conditions that can be included in the differential diagnosis while another study provided evidence of an increased number of de novo mutations in 40 genes compared to unaffected relatives. Thanks to new developments in genetics there has been a recently characterised condition known as Hereditary Diffuse Leucoencepalopathy with Spheroids (HDLS) which one group thinks will be increasingly recognised with increasing availability of diagnostic testing. Schmidt and colleagues published their initial findings on different rates of progression of Alzheimer’s Disease and it will be interesting to see further work in this area. The World Alzheimer’s Report 2011 concludes a concerning figure of roughly 36 million people around the world who are estimated to have Alzheimer’s Disease but have not yet received a diagnosis. Normal Pressure Hydrocephalus can be associated with cognitive impairment but shunting doesn’t always reverse the cognitive impairment. In one small study the researchers provided evidence that this may result from comorbidity in those cases.
Genetic data has helped to answer questions about human migration patterns. Recent analysis concluded that Australian Aborigines are the first humans to have left Africa some 62 to 75,000 years ago followed some 50,000 years later by a second wave of migration. What is even more remarkable is that a new group of ancient hominids have been discovered and are known to have contributed to modern human populations. They are known as the Denisovan’s and are known from DNA analysis of a finger bone in a Siberian Cave. They diverged from our family tree some 300,000 years ago but after this period of separation contributed to the modern human gene pool. Little is known about them except that at 30,000 years ago they were using necklaces suggesting some degree of sophistication and that they also interbred with Neanderthals. Thus an important part of our historical narrative is being filled in by genetics and archaeology which has otherwise been lost from oral or written traditions.
Miscellaneous
Congratulations to Professor Sue Bailey who was appointed as President of the Royal College of Psychiatrists and to the outgoing President Professor Dinesh Bhugra who has become president elect of the World Psychiatric Association. A study in the Journal of European Neuropsychopharmacology provides evidence that psychiatric illness is the leading cause of illness in Europe. There is an interesting editorial in the October edition of the British Journal of Psychiatry by Harrison and colleagues (Harrison et al, 2011) the premise being that psychopharmacology should take on a more central role within the profession. It will be interesting to see if and how this debate develops particularly in terms of modelling the practical implications and implementation according to context. The BMA have brought out new guidelines on protecting vulnerable adults. There is a write-up of a study comparing 23,199 people who experienced traumatic brain injury and received care in hospital with 69,597 people without traumatic brain-injury who received care in hospital. The researchers found that within 3 months of the injury, the traumatic brain injury group had a 10-fold higher prevalence of stroke than the non-traumatic brain injury group with just under 1 in every 33 people being affected. This increased risk decreased with time but at 5 years was 2.3 x higher than the non-traumatic brain injury group. The researchers also found that a number of characteristics of the brain injury including fracture of the skull modified risk.
In a study published in ‘The Psychiatrist’ (Perecherla et al, 2011), a research team looked at a person’s understanding of their medication in a group of older adult inpatients on a psychiatry ward (n=86). They thought that people might have a better understanding of the medication for their medical illnesses rather than the mental illnesses. However they found that people had a roughly equivalent understanding of the drugs for their medical and mental illnesses. Although they used a screening tool to exclude those with cognitive impairment, this still appeared to play a role in a person’s understanding of their medication in some of the people. There is an interesting article on Medically Unexplained Symptoms illustrated with cases and diagnostic algorithms available here.
In a remarkable study researchers have been able to intrepret the activity in people’s visual cortex and correlated this with video images. These results are a convincing demonstration of the validity of functional Magnetic Resonance Imaging (although there are various nuances in the interpretation of the results). To get to these results the researchers used large datasets and long training periods for the subjects which consisted of the researchers themselves. Firstly the researchers needed to correlate activity in multiple areas of the visual cortex with large numbers of video segments. For this the subjects had to watch a lot of video clips whilst being scanned to build up the library of video clip-activity pairs. The researchers developed an understanding of the relationship of perception of different line orientations and other basic visual information to brain activity. Then the researchers’ program scanned through 18 million seconds of video footage from YouTube generating likely brain activity correlates. Then the subjects watched a new set of previously unseen clips and the software translated the brain activity into the nearest matches from the 18 million second sample set. The end results are the blurry images seen below.
The researchers however could sharpen up the videos by refining the program. There are many obvious questions to ask here. For instance when we use imagination one hypothesis states that imagination utilises the visual cortex rather than higher association areas. The researchers would be able to investigate this by asking subjects to imagine a scene whilst recording brain activity before translating this. These results would also be incredibly important for researchers investigating the causes of visual hallucinations in people with Schizophrenia and Dementia.
A research group have presented their findings at the British Science Festival. They have used an electric stimulating device to apply a small electrical current to the motor cortex in order to improve learning on a motor task. It will be interesting to see further details on the research when they are published. There has been a recent study looking at response to social stress. The study was modestly sized (32 participants) and the researchers used fMRI to analyse brain activity in response to social stressors. They found that people in urban areas responded differently to those in rural areas. Participants in urban areas were more likely to activate the Amygdala and those in rural areas were more likely to activate the Cingulate Cortex in response to the social stressors presented in the study paradigm. The results are discussed in the context of other researhc which shows a higher prevalence of Schizophrenia in urban areas and the suggestion from this study at least is that growing up in an urban area may lead to a difference in the way the brain responds to stressful situations. However it must be said that this a small study and this hypothesis needs rigorous testing. Researchers have used a technique known as ‘Functional Electrical Impedance Tomography by Evoked Response’ fEITER to investigate ‘consciousness’ in people undergoing anaesthesia. Crudely speaking, as the consciousness levels were found to decrease there were corresponding changes in actvitiy in defined anatomical regions. Although this preliminary report is a little vague, the research team are still analysing the data but the combination of the effectiveness of the new technology and the correlation of activity with levels of consciousness will be very exciting results if this holds up to further analysis. There is a write-up of an interesting study relating GABA levels in the brain to ability to learn motor tasks. GABA levels in the brain were measured using a technique referred to as Magnetic Resonance Spectroscopy. The researchers were able to use a standardised test which involved the application of a direct current to subjects’ scalps. This is known to produce a change in GABA levels. The magnitude of the change in subjects was found to positively correlate with the rate at which subjects learnt on motor tasks. It will be interesting to see further research in this area. A review of two decades of functional Magnetic Resonance Imaging studies has been completed by the Wellcome Trust and they conclude that there is still much work to be done in translating findings into the clinical arena (see here). In a potentially very important study, researchers have identified evidence that Magnetic Resonance Imaging scanners may have an effect on the fluid in the inner ear canals causing subjects to experience nystagmus and symptoms such as vertigo. The researchers also suggest that this could interfere with the results of fMRI studies. The researchers methods were quite ingenious. They conducted the study in the dark but used night cameras to monitor the subjects eyes for nystagmus. They also involved two subjects with labyrinthine disorders. These two subjects did not experience nystagmus whilst other subjects did. No doubt this study will receive close interest from the neuroimaging community.
There is evidence that Deep Brain Stimulation may be associated with neurogenesis in the Hippocampus. There is a write-up of one study which provides preliminary evidence of a benefit from Transcranial Magnetic Stimulation in post-stroke dysphagia. This was a small trial and it will be interesting to see the results of further studies in this area. Researchers used EEG and fMRI to investigate lucid dreamers. The lucid dreamers were scanned whilst asleep and signalled that they were dreaming of clenching their fists by moving their eyes horizontally several times. Only two episodes were captured but they displayed similar activity to hand clenching. However these results should be viewed with caution as only two episodes were captured and it will be interesting to see the results of replication studies. ‘Brain reading’ which is a combination of using neuroimaging data and making predictions based on analysis using artificial intelligence software is discussed in this article in relation to recent research into alcohol use and craving. In a freely available paper researchers used fMRI to investigate imaging of future events (via MariaPage). They found evidence that when subjects had successfully recalled their imagined future events there was evidence that the right Hippocampus was activated. The researchers suggest that the Hippocampus is used to store the details of these imagined events. This continues the debate on the role of hippocampus in imagining future events. In another study the researchers examined the visual perception of objects. Visual information in the form of parts of a car were presented to the subjects with a number of transformations making it more difficult to identify the moving objects. In order to process the visual information the researchers suggested on the basis of their evidence that the visual information was being grouped and that the subjects were processing the data at a rate of about 10 groups per second. Furthermore the groups were being processed one at a time. If this is replicated then it means that when we perceive visual motion – for instance a group of cars driving down the road we would be processing them not as a group of cars moving but a sequential processing of individual cars. However the brain may have additional techniques for processing ‘natural’ visual information in contrast with the abstract information presented in this experiment. Researchers examining the auditory processing areas in the cerebral cortex in humans have better characterised the processing activities. Much like the processing of vision, the processing of sound involves ‘what’ and ‘where’ streams. The researchers in the study reported on here have investigated the ‘what’ stream and identified three components which analyse basic tones, multiple tones and speech sounds such as vowels. This better understanding will be useful into a number of illnesses in which speech is affected. Dr Shock has a piece on Deep Brain Stimulation in Alzheimer’s Disease here.
There is a very interesting article on culturomics in the journal Nature. Aiden a researcher is looking into analysing the content of culture through the textual analysis of books. He’s collaborated with Google who released a tool called the ‘Google Ngram Viewer’. Essentially the tool enables people to search all the books Google has digitised. The article discusses some of the controversies in this emerging field of the digital humanities. Playing about with the Ngram Viewer tool I got some interesting results. Here’s one for psychiatry
This is showing a peak of the term ‘psychiatry’ in books in the late 1970 followed by a consistent decline. However there has to be some caution in interpreting the results. For instance we need to ensure there is no selection bias in the books that have been digitised and to know what percentage of the books published at that time are included in the analysis. Also are there any statistical comparisons between the years which would help to interpret apparent visual trends that are generated? Still if there is a large enough sample of books it does present an interesting proxy to culture and can be used to frame further investigation. For instance books can be sampled to confirm the results. If the results above are valid then we can ask what was happening in the late 1970′s in psychiatry? Also why has there been a decline subsequently? Perhaps the ascent in the 1940′s and 1950′s was associated with the advent of treatments including ECT, antipsychotics and antidepressants. Here are some other interesting results.
For psychosis there is a decline in more recent times (although the same is not true for the term schizophrenia).
For Autism there is a marked increase in the use of the term in more recent times.
For PTSD there is an increase with a slight dip at the end of the graph.
For Dementia there has been a large increase in the use of the term in the digitised books. The tool is a easy to use and opens up many possibilities in exploring cultural phenomenon including the wider discussion of illnesses and their treatments.
The connections betweeen groups of neurons are extremely complex with large numbers of synapses. Studying these networks has been accelerated through the development of microscopy techniques as well as software programs. A group in Germany have used a program called KNOSSOS in conjunction with a collaborative approach between researchers to characterise a network of 100 neurons and there is a write-up here. Professor Sheng Ding in colloboration with Professor Stuart Lipton at the University of California San Francisco (USCF) has transformed human skin cells into neurons which will have many potential applications. The team took skin cells from a 55 year old lady and converted them to neurons using a combination of genes and microRNA. In another development the cost of personal genomics has come down with one company offering 80 x coverage (meaning that the genome is covered 80 times to reduce the risk of errors). It will be interesting to see how this will be linked in with mainstream health services. Meanwhile a new centre for neuroscience is being built at University College London. There is a brief write-up here on how cognitive biases can influence judgement in science. There is also a brief but interesting write-up of the science of team training here. Recent research suggests that when people are presented with weak evidence to support an argument that this is less persuasive than having no evidence at all (via MariaPage). A recent study suggests that near-death experiences are associated with serotonin. There is a write-up of a study in C.Elegans worms which looks at heritability of longevity. The researchers found that the methylation of DNA in the worms accounted for up to 30% of the variation in longevity. They argue that this is a non-DNA form of heritability. If these findings were generalised to humans it would mean that in studies of aging, researchers would need to look for patterns of methylation of DNA and not just for longevity genes in order to gain a better understanding of aging.
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 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. There have been some interesting recommendations by the House of Commons Science and Technology Committee Report (see also coverage here). The MP’s make recommendations including training of scientists undertaking the peer review as well as increased transparency, availability of the data online and use of pre-print servers to improve the peer review process. These recommendations were made in light of controversies such as those surrounding the MMR Vaccine. Interestingly the pre-print server model was very instructive in an academic debate in neuroimaging.
In a longitudinal study (the three-cities study) looking at the use of the Mediterranean Diet researchers found that women with the highest adherence to the Mediterranean diet had a 50% risk reduction in incident disability (evaluated using two measures of functioning) relative to the group with lowest adherence. Previous research supports a beneficial effect of the Mediterranean Diet as in a BMJ Meta-analysis (freely available here)(see also discussion on this blog here, here, here and here). There is interesting coverage of a recent study suggesting that components in the blood influence neurogenesis in the central nervous system in an age-dependent manner. An intuitive finding but one which is useful to know nevertheless is that planning meals can be both economical and lead to healthier eating as the researchers in this study found.
In a story that has provoked a widespread response in the Anthropology community a US politician has suggested that there isn’t a need for more Anthropology students at University in Florida. Within the statement he comments on anthropology not being a science and implies that it doesn’t lead to good job prospects. There are some similarities between anthropology and psychiatry in that both are fields which involve the overlap of science and the humanities. Indeed Anthropology celebrates and brings an invaluable understanding of the diversity of humanity and so a criticism of Anthropology becomes a criticism of the need to understand this diversity. Anthropologists have also made significant contributions to a variety of fields and it is at times such as this when the profession answers its critics that the significance of this field can be better appreciated and is also a time at which the profession strengthens its identity. The American Anthropological Association has responded with a statement. There is also an interesting podcast interview here. However the truly inspiring response is this one which details the work of anthropologists in Florida and the impact that this is having. There are lessons about these responses that can be transferred to psychiatry. The Blog Linguistic Anthropology has a round-up of not-for-profit anthropology journals here.
On the theme of Anthropology, ethnographer Sarah Pinto writes a very interesting article on the study of patient’s movements in psychiatric wards at the anthropology website Somatosphere (via VaughanBell). Somatosphere also have a round-up of 2011 here. In a post-mortem study in which researchers used 49000 gene probes in 269 brains across the lifespan, researchers obtained over a trillion pieces of information and found evidence that the expression of genes in the prefrontal cortex peaks just after birth. Following this a number of genes switch off and reduce towards middle age. In older adults the genes are increasingly expressed. The write-up covers a number of other studies with complex but very interesting results. In one study using 1.4 million probes to examine 57 human brains, the researchers found evidence that the brain location and timing influenced gene expression more significantly than individual variation. Accelerometers were used to identify an asymmetric arm swing during gait as an early manifestation of Parkinson’s Disease in this study.
There’s an interesting report on Kevin Healy who is described as having ‘highly superior autobiographical memory’ and who states that he has remembered all the calendar dates since 1752 and that he is able to remember significant dates from his own life. He is asked questions during the interview and is able to give accurate responses. His abilities are reminiscent of those of the famous Russian mnemonist Solomon Shereshevsky who was studied by Alexander Luria and also to Jill Price. There is a write-up here of a study published in the journal Age in which the researchers looked at the performance of sportspeople in a various fields. They found that peformance for swimmers peaked at age 21 and for chess grandmasters at 31. In the November issue of The British Journal of Psychiatry there is a special mention of psychiatrist Dr Henry Rollin who having celebrated his 101st Birthday is continuing to submit papers to journals! There is a short piece on a doctor who is still working at 100 here. An open access journal ‘Longevity and Healthspan‘ has recently started up.
In the November issues there is also a study on the effects of the Nagasaki bombing at the end of the World War II on the mental health of the local population. The researchers looked at people that had been in the area near the blast but without exposure to the radiation compared to a control group who were not in the area of the blast. A key finding was that survivors of the nuclear blast were more likely to suffer mental illness when they were in the vicinity of the blast compared to the control group. This was assessed using the General Health Questionnaire 28 score. Part of this finding could be accounted for by knowledge about nuclear blasts. Thus those who did not understand that a nuclear flash was not associated with radiation injury scored more highly on the GHQ 28 than those who understood that witnessing the flash would not in itself cause radiation injury. This means that not understanding the nature of the nuclear flash had consequences for survivors mental health that appeared to last throughout their lives.
There is an interview with Professor Simon Baron-Cohen on his book ‘The Science of Evil’ here. ‘Zero Degrees of Empathy’ is a new book by Professor Simon Baron-Cohen (see reviews here, here, here, here, here and here). Baron-Cohen presents an important hypothesis in which he reframes several personality disorders as being primarily disorders of empathy. This hypothesis has a number of important implications particularly in terms of how services might relate to people with these personality disorder labels. Given the implications for society this book offers an important step forward in opening up a wider debate on how society might reframe this relationship. However Baron-Cohen also looks at the concept of evil and gives examples whilst suggesting that this concept can also be understood in terms of empathy. However this is slightly more complicated and several of the reviewers above have focused on these arguments rather than the personality disorder issues. With the preparation for DSM-V there may be a case for a more pressing discussion of the reinterpretation of personality disorders such as narcissistic, borderline and antisocial personality disorder in the relevant forums.
There are some interesting results from a study in elementary schools in Hawaii where the researchers have provided evidence of a benefit from adding ‘character building’ to the curriculum. This was associated with reduced suspensions and absenteeism among other findings. There is an interesting reappraisal of the diagnosis of Dangerous and Severe Personality Disorder by Dr Duggan in the British Journal of Psychiatry. He argues that there have been both advantages and disadvantages to the programme which have included additional funding and research in this area although there have been difficulties in using the diagnostic criteria as prognostic indicators. Duggan also writes that there is a move to ‘phase out’ the DPSD programme.
The recent riots starting in Tottenham, London and extending to other parts of England is likely to have impacted on Mental Health Act assessments amongst the many other serious consequences. There have been a number of commentaries on the riots. In this article by Natalie Wolchover there is a discussion of crowd behaviour in terms of the Elaborated Social Identity Model. The Research Digest has links to a number of articles commenting on the riots from a psychological or neuroscience perspective. There is also this article in Psychology Today looking at the possible role of Mirror Neurons (see here and here) and empathy. Although the application of theories to speculation about the events can be useful there is also a role for quantitative and qualitative research to test the hypotheses in the recent events (i.e the conclusions can be data driven).
The United Nations are projecting that by October 2011 the world will reach a population of 7 billion. Previously the 2010 UN estimates varied from projections of between 6.2 billion people and 15.8 billion people by 2100 depending on fertility rates. These figures also reflect changing demographics with an ageing population across the world as life expectancy increases. A paper published in the journal Science shows how education can significantly influence these projections. There is an article at Scientific American on the global population estimate of 7 billion. Although there have been other estimates which suggest it has already happened there has been no Global Census. The author of this article suggests that a new city of 1 million people needs to be built every 5 days to meet the expected population increase over the course of this century. While this is speculation it is interesting to note that there are significant differences between urban and rural areas in the pattern of mental illnesses (e.g see here). Were such demographic shifts to be realised it would have significant implications for the configuration of psychiatric service provision.
Mood Disorders
In a study of 56 people with DSM-IV diagnoses of Major Depressive Disorder with psychotic features, 41% had revised diagnosis within 2 years including Bipolar Disorder. In an American study looking at older adults admitted to hospital and followed up 3 months after discharge the researchers found that at follow-up 81% of those that were depressed had been depressed on admission to hospital. The researchers interpreted this to mean that most of the cases of depression at follow-up represented persistent depression rather than new onset of depression during the course of the admission. In a 27-year longitudinal study (n=757) researchers looked at people who had been diagnosed with a mood disorder (depression, mania or schizoaffective disorder). They examined the association between antidepressant use and suicide attempts or completed suicides using a propensity model which provides an estimate of a treatment effect in this type of study design. The researchers found that the antidepressants were associated with a large reduction in suicide attempts or suicides
‘Quintile-stratified, propensity-adjusted safety analyses using mixed-effects grouped-time survival models indicate that the risk of suicide attempts or suicides was reduced by 20% among participants taking antidepressants (hazard ratio, 0.80; 95% CI, 0.68-0.95; z = -2.54; P = .011)‘
This is a big effect size in a study with a large sample size over a very respectable follow-up period and will surely contribute to the debate in this area. A moderately sized study (n=200) investigated gender differences in presentation of acute mania. The researchers found that there were statistically significant differences between men and women in presentation and that
‘a predominance of anxiety and depressive symptoms was found in women, whereas increased psychomotor activity was prevalent in men‘
In the British Journal of Psychiatry there is an interesting paper looking at the associations between anxiety in older adults and cognition (Butters et al, 2011). The researchers compared 160 people without dementia meeting the DSM-IV criteria for Generalised Anxiety Disorder (GAD) with a control group (n=37) without a history of psychiatric illness. The Hamilton Rating Scales for Depression and Anxiety were used as well as a neuropsychological battery. The researchers found that the GAD group performed significantly worse than the control group (after a step-wise Bonferroni correction) on the letter number sequencing, the D-KEFS sorting test and the RBANS immediate memory and delayed memory tasks. These findings remained after excluding subjects who met criteria for Major Depressive Disorder which was expected to be a significant confounder. Escitalopram was part of the treatment program and Escitalopram use was associated with an improvement in the D-KEFS scores – a measure of executive function. In subjects that experienced a significant improvement in self-reported anxiety (using the Clinical Global Impressions scale) there was a corresponding improvement in RBANS immediate and delayed memory scores. The study has generated some very specific hypotheses for further testing. A moderately sized study (n=234) showed a significant positive correlation between early response to medication in acute mania in the first week and treatment outcome. A large prospective trial (n=660) of combination antidepressants versus monotherapy as a first-line treatment for depression provided evidence during the 7-month follow-up period that the two combination treatments were just as effective as monotherapy in this study. However only two combinations were examined and combination therapy is not usually considered as first-line treatment in various guidelines.
Substance Misuse
The Royal College of Psychiatrists has released a report on substance misuse in older adults. The college report CR 165 is located here and there is an interview with one of the authors of the report Professor Ilana Crome here (reviewed here). The report is detailed and it is difficult to do this justice in a brief summary and so the reader is directed to the link above. However several principles arise from the report. The authors recommend that older adults are screened for substance misuse in primary care using standardised screening tools, that the recommended upper limit for older adults should be reduced (they recommend 11 units a week), that older adults with substance misuse have many unmet needs and benefit from treatment, that binge drinking limits for older adults should be reduced (they recommend 4.5 units as a limit for men and 3 units for women) and that local policies should be developed to facilitate effective management. The authors also have a number of recommendations about training and research including further evaluation of the therapeutic intervention in older adults with substance misuse. There are seven recommendations and components of future strategic direction including an emphasis on multi-agency partnership. There are detailed outlines of therapeutic interventions in the Appendices. What is also interesting is that there are discussion of exemplary service models. One that I found very interesting was the North Southwark team in which it was noted that ‘up to 50% of admission of older people involved a dual diagnosis’ and they go on to note the importance of alcohol misuse in these presentations. In 2002 5% of patients were identified with alcohol misuse and the psychiatrist undertook an MSc in Public Health Medicine. A few years on and with a multidisciplinary community programme to address alcohol misuse the admissions were reduced to 5%.
The report has generated considerable debate in the media (see links below). Indeed spending a little time looking through the comments on two of the sites below, many of the commentators are critical of the report. A number of themes recur in the posts including perceived interference in the lives of older adults, the actions of a perceived ‘nanny state’, anecdotal cases of alcohol consumption in those that reach an advanced age and the association with enjoyment of life. The comments thus provide an ‘audit trail’ for the debate that is happening in society (although there may be a bias in selection in terms of both readerships and those who have commented rather than just read) and this would form a very useful basis for a qualitative analysis. What was striking to me in reading the comments was that the issues that were frequently discussed by the commentators were slightly different to the main emphasis in the report. For instance the report produces important guidance for psychiatrists to help give them the best advice for the patients that they can provide. Such guidance assumes that the patient has a sense of agency – that is that they have a choice on whether to act on the advice rather than being compelled to do so. However many of the comments give an impression of a compulsion to act on this advice and it would be interesting to see where this is coming from. Another point which arises is the understanding of probability or statistical inference. The report cites a large amount of research undertaken in this area which produces statistical results enabling advice to be given in the form of a balance of probabilities. However in many comments there are references to anecdotal reports of alcohol use in those reaching an advanced age – with the implication of the comment being that in those cases the advice was not valid. This though misses the point about the nature of the findings which provide a balance of probabilities. In other words it is more likely than not. Thus in isolated cases there may be counterexamples but as more outcomes are examined the trend will be towards the results seen in the studies i.e it might work for one person but not for 10. This theme about statistics however is common and it would be interesting to see if in this case it relates to a genuine misunderstanding of statistics or an implied risk/benefit calculation that is not explicitly discussed.
NHS Choices gives the lowdown on the report here; Silver Surfer article here; Independent article here; ITN article here; Sky News article here; Daily Mail article here and here (271 comments at the time of writing); Telegraph article here; BBC article here and here. (567 comments at the time of writing); Metro article here; Yorkshire Evening Post article here; Netdoctor article here; Mail on Sunday article here; International Business Times article here; AFP press release here; Herald Scotland article here; Irish Independent article here; NW Evening Mail article here; Visit Bulgaria article here; Ghana Business News article here; Modern Ghana article here; French Tribune article here; De Havilland article here; South Wales Angus article here; Barchester Healthcare article here; The Periscope Post article here; Bournemouth Echo article here; Best Medical Cover article here; Leicester Mercury article here; Bradford Telegraph and Argus article here; Top News United States article here; 4RFV article here; Express article here; Netdoctor article here; Best Medical Cover article here; Just Drinks article here; Candis article here; On Medica article here; Mediplacements article here.
PTSD
One cross-sectional study provided evidence of a positive correlation between hippocampal volume and recovery from PTSD in war veterans although replication of these findings with a longitudinal design is needed. There are articles on PTSD and the Japanese Tsunami here and here. The articles look at the provision of psychotherapists for PTSD and the anticipation that were will be a large increase in demand as a result of the tragic events that occurred recently.
Psychosis
There’s a study in the American Journal of Psychiatry covered at the Schizophrenia Forum here. The reader is directed to the excellent write-up there but essentially this was a 10-year longitudinal follow-up study of 470 people assessed for psychosis at entry into the study. The diagnosis was revised in fifty percent of patients during the course of the study follow-up period. However if the diagnosis was schizophrenia or bipolar disorder these diagnoses tended to be more stable over the follow-up period compared to other diagnoses. Indeed the prevalence of schizophrenia in the cohort increased with time which was interpreted to mean that the symptoms took some time to appear and be recognised. The researchers are intending to extend the study by another decade. Researchers in a large multicentre trial (n=1080) investigated hallucinations in people with schizophrenia and found that there was geographical variation in the presentation of hallucinations. They suggest that this is evidence in support of cultural interactions with psychosis. The authors of a systematic review risk of conversion from Ultra-High risk state for psychosis to actual psychosis looked at 2462 papers and identified 31 which met their inclusion criteria. They concluded that 76% of the people in the high risk category did not convert to psychosis.
There is a write-up at the Schizophrenia Research Forum on some new trial data on approaches to cognitive and negative symptoms in Schizophrenia. The new approaches include the use of alpha-7 nicotinic cholinergic receptor agonists as well as a GABA-phenothiazine compound although the results from Phase III trials will be needed. A short small-sized trial compared risperidone and escitalopram for treatment of psychosis and agitation showed no difference in efficacy although it would be interesting to see the results of a larger longer-term replication study. There is an unusual case report on ‘cough syrup psychosis’ resulting from excessive use of cough syrup. The authors attributed the psychosis to the ingredient dextromethorphan. One group of researchers examined the question of whether weight gain is a correlate of improvement with antipsychotic treatment in people with schizophrenia. They concluded that an increase in BMI accounted for only 3% of the change in PANNS scores and therefore weight gain was not an important correlate. They go on to discuss the therepeutic implications. The BMJ has an article coauthored by Professor Barnes on whether antidepressants improve negative symptoms in Schizophrenia. The authors conclude that the evidence is equivocal and they offer some practical tips on how to deal with the conclusions from the literature. The authors of this paper on antipsychotic associated hyperprolactinaemia call for randomised controlled trials to evaluate these associations and provide clinicians with guidance on managing these side effects.
People developing a first-episode psychosis after misuse of substances were followed up over a 2-year period (Komuravelli et al, 2011). The researchers found that of the 78 people retained in the study, 46 were retained in follow-up in the services and of these 36 (i.e 78%) had been given a diagnosis of psychosis and this is supported by other similar research in this area. Researchers looked at 65 people with ICD-10 diagnoses of schizophrenia and found that that those with OCD symptoms were more likely to manifest subtle difficulties on motor coordination tests than those without OCD symptoms (freely available here). Furthermore scores on the Positive and Negative Symptoms Scale were more likely to correlate with score on the motor coordination tests in the former group.
In a post-mortem study of people who had been diagnosed with Schizophrenia compared to a control group, researchers have found an association with histone acetylation of DNA. In essence this is the mechanism which enables the DNA to be coiled within the nucleus and the inference here is that this coiling and subsequent gene alteration may be affected in some cases of Schizophrenia leading to potentially new avenues for treatment. In Neuroscience Letters one group reports an association between a common FOXP2 gene variant rs2396753 and grey matter volume in people with Schizophrenia compared to a control group. The FOXP2 gene is thought to play an important role in language. In a moderately sized study (n=225) researchers compared the exomes of people with schizophrenia with relatives and a control group and found evidence that schizophrenia was associated with a high proportion of de novo mutations across 40 genes. A twin study at the Institute of Psychiatry involving twins with Bipolar Disorder or Schizophrenia has identified a number of new candidate regions for disease genes. The authors of a recent meta-analysis concluded that there was no significant relationship between common alleles of the DISC1 (Disrupted in Schizophrenia 1) gene and Schizophrenia.
There is a pilot study of Deep Transcranial Magnetic Stimulation for negative and cognitive symptoms in Schizophrenia (n=15) and on the basis of the results the researchers recommend further research in this area. The author of a review of evidence of ECT in Schizophrenia concluded that catatonic symptoms were the most responsive. While the response of catatonic symptoms to ECT is well established the author also identified a hierarchy of symptom responsiveness on the basis of the review. In a small 8-week study people with schizophrenia either played computer games or engaged in high intensity training (HIT) aerobic exercise. The researchers found a significant improvement in physical outcome measures including maximal oxygen uptake but not in PANNS scores. They recommended HIT in rehabilitation programs. Decreased physical activity was significantly correlated with physical health quality of life in one small study comparing people with Schizophrenia with a control group.
Neuropsychiatry
Researchers have investigated resting state activity in people with agenesis of the Corpus Callosum. Agenesis of the Corpus Callosum is a condition in which the fibres connecting the right and left sides of the brain are absent during development. Previously this was investigated by looking at people who had undergone severance of the fibres in the Corpus Callosum for treating intractable epilepsy. Resting state activity is the activity that occurs in the brain when a person is resting and not engaged in any obvious activity – wakeful rest. The brain areas that are active when recorded using functional Magnetic Resonance Imaging form a characteristic network which has been assumed to involve a communication between both hemispheres of the brain. The researchers in this study found patterns of activity similar to those in people with an intact Corpus Callosum and this raises new questions about the nature of the resting state network. There is a case of Wernicke’s Encepalopathy with involvement of the Fornix at the AJNR blog here.
There is a case report of a person who developed Hashimoto’s Encepalopathy. The researchers completed a neuropsychological assessment and after resolution of the encepalopathy found a residual executive impairment. However case studies are useful in generating hypotheses for further replication studies as there is so much variation between people. There is a write-up of a small study (n=32) investigating amateur football players using Diffuse Tensor Imaging (for further details of the abstract presented at the conference see here as well as the researcher Professor Lipton’s page summarising links to other sites). The researchers found a correlation between self-reports of heading a ball over 1000 times a year and evidence of patterns of brain injury similar to that seen in Traumatic Brain Injury. However the researchers advise due caution in interpretation of these results and suggest that further replication is needed. There is a write-up on a recently discovered genetic condition Hereditary Diffuse Leucoencepalopathy with Spheroids (HDLS) which can now be identified using genetic testing rather than post-mortem analysis and the researchers suggest that this condition may be increasingly recognised.
Dementia
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. 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.
A Dutch group has assessed psychosocial intervention for Alzheimer’s Disease guidelines across 12 European countries using a standardised protocol. Amongst their findings the researchers concluded that
‘The UK NICE SCIE guideline had the best methodological quality and included the most recommendations for psychosocial interventions‘
and that across Europe special attention is needed in terms of updating guidelines with evidence and implementing these guidelines in service delivery. In a longitudinal study involving subjects with non-amnestic and amnestic mild cognitive impairment (naMCI and aMCI respectively) (n=106) amongst other results researchers found that there was a decline in simple attention in both groups but a decline in divided attention in the aMCI group. The researchers suggest further research to corroborate these findings. Psychological constructs influencing verbal fluency were examined in one study which compared young and older adult healthy controls with people with Alzheimer’s or Parkinson’s Disease. Amongst the researcher’s results they found that processing speed was the strongest correlate of verbal fluency performance and they conclude that
‘the primary role of processing speed in performance suggests that the use of fluency tasks as measures of EF or verbal ability warrants reexamination‘
A small study showed a significant inverse correlation between hippocampal volume and CSF p-tau levels in people with Alzheimer’s Disease. There is a write-up at the Alzheimer’s Forum of an interesting study by Schmidt and colleagues in the Archives of Neurology in which the researchers found evidence for a rapidly progressive form of Alzheimer’s Disease both from their own clinical study and also from a review of the literature. However the authors emphasise the need for further work to confirm these results. MRI data from two studies (n=1349) was used to examine the relationship between cortical atrophy and white matter hyperintensities and infarcts in people with Alzheimer’s Disease and Vascular Dementia in this study. The researchers found that cerebral atrophy was correlated with the number of infarcts in people with Vascular Dementia but not Alzheimer’s Disease. An American Committee have revised the criteria for post-mortem diagnosis of Alzheimer’s Disease. The three criterion used are the Braak staging for Neurofibrillary Tangles, Amyloid Beta measures (based on the work of Thal and colleagues) and a CERAD score for neuritic plaques. There is further discussion at the Alzheimer’s Research Forum on these changes. A moderately sized study (n=224) provided no evidence of an effect of cholinergic burden on cognition in people with Alzheimer’s Disease. The researchers compared people with low and high cholinergic burdens and found no significant difference between the two groups. The Alzheimer’s Research Forum reported on the recent Clinical Trials in Alzheimer’s Disease Conference in a series of articles (see here, here, here, here, here, here and here). The coverage includes new developments in Clinical Trials and a closer look at the use of the EEG. In the recent World Alzheimer’s Report 2011 it is estimated that 36 million people around the world with dementia have not yet received a diagnosis.
A role for Early Onset Alzheimer’s Disease related protein Presenilin-1 in a homeostatic scaling a form of synaptic plasticity has been identified in one study. There is a paper (freely available here) on MRI findings in neuroferritinopathy which include Basal Ganglia cysts, cerebellar and cerebral atrophy as well as gliosis. In a recent research study (paper freely available here) the researchers combine resting state and event related fMRI with event related potentials to better characterise the progression from Mild Cognitive Impairment to Alzheimer’s Disease. The researchers in a moderately sized SPECT study investigated aberrant motor behaviour in Alzheimer’s Disease. The researchers draw parallels between aberrant motor behaviour and Obsessive Compulsive Disorder which are supported by the increased uptake of the tracer 99Tc(m) hexamethylpropyleneamine oxime in the OrbitoFrontal Cortex compared to people with Alzheimer’s Disease without aberrant motor behaviour. There is a write-up of the 2011 Alzheimer’s Association International Conference at the Alzheimer’s Forum. Included is some positive news on Bapineuzumab. In a number of trials the use of Bapineuzumab was associated with brain swelling in some of the people taking part. Researchers at the conference presented evidence to suggest that this is associated with treatment efficacy and can be managed without significant complications. However the Phase III trials are ongoing.
At the Alzheimer’s Research Forum there is an interesting write-up of research currently underway in Colombia which involves families with early-onset Alzheimer’s Disease. The write-up emphasises some of the profound ways in which early-onset Alzheimer’s Disease affects families. In one study, the researchers looked at the sensitivity of the ADAS-cog instrument in people with Alzheimer’s Disease. They found that at different stages of the illness, different components of the ADAS cog were effective in detecting treatment effects. A Polish group have reported on differences between people with Alzheimer’s Disease and healthy controls in performance on the pocket smell test providing further evidence of the potential importance of odour discrimination dysfunction as a correlate of pathology. In a small study (n=76), researchers used new research diagnostic criteria to establish diagnosis and then assessed a number of biomarkers. In keeping with biomarker findings in Alzheimer’s Disease, medial temporal lobe grey matter atrophy (using MRI) was characteristic of the prodromal Alzheimer’s Disease group but the researchers did not find any significant differences in regional grey matter volume between the prodromal Alzheimer’s Disease group and participants with Alzheimer’s Disease. In a moderately sized study involving people with Alzheimer’s Disease (n=202) there was found to be an relationship between performance on memory and executive functioning and ratings on IADL – a measure of daily functioning. There were also gender differences with attention predicting bathing and eating ability in women while language skills predicted food preparation in men and driving skills in women. Such associations are useful and can be usefully investigated in larger replication studies.
In one study, researchers looked at the function of a single gene SorCS1 which plays a role in Type 2 Diabetes. They looked at the effect of the gene product on the processing of Amyloid Precursor Protein. Disruptions of the processing of Amyloid Precursor Protein are implicated in the pathology of Alzheimer’s Disease. The researchers found that the the SorCS1 protein influenced where the Amyloid Precursor Protein was moved within the cell. Furthermore this location influenced how the APP was processed thus identifying a link between one risk factor for Diabetes and Alzheimer’s Disease. However both Diabetes and Alzheimer’s Disease are complex illnesses influenced by a number of factors and so further research will be needed to see how these findings fit into the broader picture. The New York Times has an interesting write-up of 3 studies showing the benefits of physical activity and exercise in ameliorating cognitive decline. In two of their studies sedentary behaviour was correlated with more rapid cognitive decline when compared to people who had even light levels of activity. A third study showed the benefits of resistance training in slowing cognitive decline. In another paper from the Alzheimer’s Disease Neuroimaging Initiative the researchers looked at data from 401 people with Alzheimer’s Disease and concluded that CSF ABeta42 levels were elevated in the earlier stages of the illness and that adjusted hippocampal volume and CSF Total Tau levels were altered later in the disease process. The researchers in a small German neuroimaging study (n=31) provided evidence of a relationship between connectivity in frontal-parietal networks and attention (assessed using the Attentional Network Task) in people with early Alzheimer’s Disease. A moderately sized study (n=239) in a sample of people over the age of 85 showed a significant inverse correlation between intracranial volume, which the researchers used as a proxy marker of premorbid brain volume and risk of Dementia and more specifically Alzheimer’s Disease and Vascular Dementia. Interestingly in the group with the largest intracranial volume, dementia risk was not associated with white matter lesions. There is a write-up of the 2010 Leon Thal Symposium which covered amongst other subjects the establishment of a registry as well as approaches to data gathering. An American group have estimated the incidence of dementia and cognitive impairment not-dementia in the USA and over a 6 year period they estimate that there are 1.4 times as many incident cases of cognitive impairment not-dementia as cases of dementia. NICE have just published their revised Technology Appraisal for drugs for Alzheimer’s Disease here.
Over at the Alzheimer Research Forum there is coverage of a small longitudinal study which shows a greater rate of atrophy in Alzheimer’s Disease associated brain regions including the parahippocampal gyrus. However it would be useful to have a larger replication of the data as well as a l0nger follow-up period (this follow-up period in this study is 2 years). Additionally while atrophy in various structures such as the Medial Temporal Lobe are good predictors of conversion to Alzheimer’s Disease atrophy doesn’t necessarily result in disease. Thus Alzheimer’s Disease conversion rates over a longer follow-up period would usefully add to these findings. There is a critical reviewof the use of a combination of Memantine and an ACHEI in the march edition of the neurologist. The researchers identified one relevant study and concluded that there was insufficient data to determine if the statistically significant improvement in outcome measures such as ADL’s was clinically significant. The researchers in a 3-year longitudinal Swedish study of people with Alzheimer’s Disease taking Donepezil (n=435) concluded that the there was an average 1.6 point deterioration in ADAS-cog points every 6 months (although there was no placebo group for comparison). Furthermore the cognitive performance predicted the scores on functioning. Functioning in turn was related to the risk of admission to a residential home. Thus the researchers were able to determine the benefits of medication using a cost-analysis with admission to a care home as one of the outcome measures. There is a write-up of the 2011 International Conference on Alzheimer’s and Parkinson’s Disease in Barcelona at the Alzheimer’s Research Forum. Feedback from the conference includes a more critical discussion of the Amyloid hypothesis as well as a consideration of multimodal therapeutic approaches.
The Lou Ruvo Center has recently opened in Las Vegas. This is a memory clinic with a large investment which impacts on the model of care. The facilities for the memory clinic are contained within a single building and these include a 3 Tesla MRI scanner, facilities for neuropsychology assessment and handheld computers for use in a streamlined process. Interestingly although the patients do not have to enrol in research their data can be compared to the Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset. Also at the Alzheimer’s Research Forum Li and colleagues review the evidence on homocysteine as a risk factor for Alzheimer’s Disease. They conclude that the evidence points to a relationship between homocysteine levels and Alzheimer’s Disease but studies investigating a role for Vitamin B have produced mixed results. In this 11 C PiB study there was found to be no association between Beta-Amyloid load and rate of cortical atrophy over time. Pittsburgh B is a compound which is used to identify Beta-Amyloid Plaque which is central to the Alzheimer’s Disease process according to the Amyloid Cascade Hypothesis. Nevertheless the findings in this study may point to independent roles for Amyloid Beta load and cortical atrophy in the development of Alzheimer’s Disease. The authors of a meta-analysis with a large sample size (n=6122) concluded that whilst there is an association between Homocysteine levels and Alzheimer’s Disease causality has not yet been established and further studies are needed.
Gantenerumab, a monoclonal antibody has joined a number of compounds which have been found to clear Amyloid Plaques in the brain. The Amyloid Cascade Hypothesis states that Amyloid plaques found in the brains of people with Alzheimer’s Disease are central to the disease process and so compounds like Gantenrumab by reducing these plaques are thought to be of great potential in Alzheimer’s Disease. However research into the cognitive effects of the plaque removal for Gantenerumab are still ongoing. The clearance of Amyloid Plaques is also associated with Amyloid Related Imaging Abormalities (ARIAS) the significance of which is still being investigated. The Picalm gene product which has been linked to Alzheimer’s Disease has been investigated in one study where the researchers found evidence that it disrupted the ability of Amyloid to interfere with endocytosis which could inform further research in this area. The researchers in this Korean study provided further evidence of differences in the rate of cognitive decline in three forms of dementia – Parkinson’s Disease with dementia, Vascular Dementia and Alzheimer’s Disease. The authors of a meta-analysis of Diffuse Tensor Imaging studies concluded that Mild Cognitive Impairment differed from Alzheimer’s Disease in that in the former there appeared to be sparing of changes in the frontal and occipital lobes whereas in the latter changes were evident in all regions of the brain. There is a review of a neuroimaging supplement in the Journal of Alzheimer’s Disease which looks at developments in this area. In the USA, the Advisory Council on Alzheimer’s Research, Care and Service is convening quarterly meetings to examine issues such as the infrastructure for research into Alzheimer’s Disease. If this model is successful it will be interesting to see if it can be applied elsewhere. The Department of Health have published their action plan for implementing the National Dementia Strategy which is available here and also published their Dementia Commissioning pack which is available here.
There was no correlation between baseline cortisol levels and subsequent Alzheimer’s Disease in the large prospective Rotterdam study. Poor self-perception of health was one of the factors that was significantly associated with fear of developing Alzheimer’s Disease in a telephone survey of 2013 adults. In one MRI study, researchers compared sequential MRI data on people with Normal Pressure Hydrocephalus (NPH), Parkinson’s Disease (PD), Alzheimer’s Disease (AD. This data was acquired from the Alzheimer’s Disease Neuroimaging Initiative) with healthy controls. The researchers were interested in factors that helped to discriminate NPH from AD and PD and the results suggested that ventricular volume and cortical thickness combined were better than ventricular volumes alone (as the latter values overlapped with the AD group). There is a very good article in the Independent on modifying lifestyle to reduce the risk of developing Alzheimer’s Disease based on a recent study examined this contribution in more detail. The long-term consequences of Traumatic Brain Injury was discussed at the Alzheimer’s Association International Conference (AAIC) in the USA and research was presented associating TBI with subsequent dementia although the relationship is complex. At the Alzheimer’s Research Forum there is an interesting write-up of a small research study which combined functional and structural Magnetic Resonance Imaging (MRI) findings. The study provided evidence of increased activity in the hippocampus being correlated with a reduction in cortical volume in a network which has been associated with changes in Alzheimer’s Disease. It will be interesting to see the results of further replication studies.
One of the questions asked in Alzheimer’s Disease research is just how important are the neurofibrillary tangles in the aetiology? This is a useful question to ask because there are a number of people who are found to have significant neurofibrillary tangles in the brain at autopsy but were not diagnosed with dementia during lifetime. The obvious inference would be that tangles do not necessarily result in Alzheimer’s Disease and there must be other factors playing a protective role. Santacruz and colleagues have tried to answer the question by looking at data from two studies – the Nun study and the Adult Changes in Thought study (combined n=821). Using the Braak staging for grading the pathology at autopsy the researchers found that people with severe Braak staging (V-VI) who were not diagnosed with dementia prior to death did have evidence of significant memory impairment. The data was consistent with the Tau hypothesis* which state that the neurofibrillary tangles play a central role in the disease process. In an interesting development, a group at Oxford have used a new scoring system for small vessel disease to show a correlation with cognitive scores. None of the people involved in the study had pathological evidence of Alzheimer’s Disease using Braak staging and the researchers used both a simple measure of cognition (the MMSE) as well as the CAMCOG. Thus the group have shown results which may contribute to a better understanding of the contribution of small vessel disease to cognition with potentially useful clinical applications. In an fMRI study comparing people with Frontotemporal Lobar Degeneration and Alzheimer’s Disease with a healthy control group the researchers found evidence of an association between an increase in activity in the right temporal pole in Primary Progressive Aphasia and aphasia. The researchers suggest that alterations in the connections of the temporal lobe may account for these findings. The researchers in a recent case-control study in Spain (n=690) concluded from their analysis that variations in the Amyloid Precursor Protein gene did not contribute to risk of Late Onset Alzheimer’s Disease (LOAD) in their sample group although effect sizes can be small.
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. A small MRI study looked at the diagnosis of Alzheimer’s Disease. The researchers found that more complex models factoring in data on multiple areas in the brain were better correlated with diagnosis than simpler models looking at the Medial Temporal Lobe and it will be interesting to see these results replicated with a larger sample size. There is a paper on Late Onset Alzheimers Disease (LOAD) outlining three new potential pathways in the disease independent of the amyloid pathways and based on Genome Wide Association Studies. There is a write-up of the new American guidelines for genetic counselling at the Alzheimer’s Forum here. The guidelines were issued by the American College of Medical Genetics and the National Society of Genetic Counsellors differentiate between susceptibility genes and genes associated with early-onset Alzheimer’s Disease. Separately an American survey of 276 first degree relatives of people with Alzheimer’s Disease showed that 60% of participants would undergo testing which included APOE4 testing even if it was paid for privately. Also at the Alzheimer’s Forum the team draw attention to a supplement in the journal Nature focusing on Alzheimer’s Disease and freely available here. In a 2-year prospective study including 211 patients with Alzheimer’s Disease the researchers found a number of factors associated with more rapid decline including higher CDR score at baseline and this is a modestly sized study.
A small cross-sectional structural 3T MRI studyshowed a significant volume reduction in the Amygdala in people with Alzheimer’s Disease compared to a control group of healthy older adult participants. A small (n=68) longitudinal study examining vascular risk factors provided evidence of a significant association between the presence of vascular risk factors and the rate of cognitive and functional decline in people with Alzheimer’s Disease and it would be interesting to see a large replication study with detailed psychometry. The researchers also found an association between the vascular risk factors and regional cerebral blood flow which differed between the groups when using SPECT. There is research suggesting that Beta-Amyloid, thought to play an important role in Alzheimer’s Disease can impair the blood-brain barrier. The researchers included a small post-mortem study of 4 people with Alzheimer’s Disease in their study and found evidence of increased revascularisation in the neocortex and hippocampus. This supports the hypothesis that increasing revascularisation would impair the integrity of the Blood Brain Barrier as this process breaks down and reforms the tight junctions between vascular cells that constitute the Blood-Brain Barrier. The researchers have suggested that Beta-Amyloid or another derivative of Amyloid Precursor Protein may be driving the formation of these new blood vessels (angiogenesis). A moderately sized American study (n=139) found evidence that a person’s beliefs about their risk of Alzheimer’s Disease is strongly influenced by the information they receive about that illness and also that in their sample the younger group perceived themselves at more risk of developing Alzheimer’s Disease compared to the older group. However the older group were more likely to report engaging in risk-reducing behaviours. In work investigating the use of Lithium in Alzheimer’s Disease, the researchers report on an analysis of a sample from a larger study in which they didn’t find a difference between the Lithium and Placebo groups in serum Glial Cell Line Derived Neurotrophic Factor after treatment. There are however other positive findings in this area and it will be interesting to see the results of the large multicentred trial when it is completed.
The elasticity of brain tissue was investigated in a group of people with Alzheimer’s Disease and compared with cognitive intact people who were both positive and negative for Pitsburgh B compound (an important marker of Alzheimer’s Disease that can be identified before the disease manifests). The researchers used a technique known as Magnetic Resonance Elastography and found that brain stiffness was increased in the people with Alzheimer’s Disease compared to the cognitively intact control groups. Research has provided evidence that Amyloid Plaques grow in the brain at around 2-3% year. These Plaques are thought to be critical to the development of Alzheimer’s Disease according to the Amyloid Cascade Hypothesis. The original press release from the Society for Nuclear Medicine (SNM) can be found here and in the report based on papers presented at the 2011 SNM meeting the researchers noted that plaques were present in
‘12 percent of those in their 60s, 30 percent of those in their 70s and 55 percent in those over the age of 80‘
The press release also mentions other research which is investigating imaging techniques to visualise the plaques. There is the potential for such investigations to transform clinical practice if the technology becomes widely available and economically viable. In the Amyloid Hypothesis as well as Amyloid Plaques, Tau proteins found within cells are thought to play an important role in the disease process. In a recent study, Professor Feinstein who has been researching Tau proteins for 30 years and his team discovered that when Amyloid was added to neurons it led to the disintegration of the Tau structure inside the neurons instead of the expected Tau Phosphorylation. Furthermore this was associated with the rapid demise of the neurons suggesting to the researchers that the Tau proteins role in forming the cytoskeletal infrastructure of the cell was being compromised. It will be very interesting to see further replication of these results. There is a write-up of preliminary findings with Leviteracetam in people with Alzheimer’s Disease but there will need to be larger replication studies. 117 single nucleotide polymorphisms at or near the locus for the Alzheimer’s Disease associated gene SOR1 was found to be correlated with hippocampal volume in a group of healthy young adults (n=936) and it will be interesting to see further research in this area. There is an interesting study in which the researchers found a quite high prevalence of depression in people with Alzheimer’s Disease or Vascular Dementia (the paper is freely available here). The researchers used the DSM-IV criteria in conjunction with the Geriatric Depression Scale in 98 consecutive patients with a diagnosis of Alzheimer’s Disease or Vascular Dementia and found a prevalence of depression of 87%. The authors emphasised the importance of screening and it will be interesting to see further replication of these findings. There is a Dutch cost-effectiveness study of Memantine in moderate to severe Alzheimer’s Disease which is freely available here.
At the Alzheimer’s Forum there is a detailed discussion of a new meta-analysis on the relationship between hypertension and Alzheimer’s Disease. The study actually shows that hypertension is associated with a slight lowering in blood pressure which is the opposite of what you might expect if hypertension contributed to Alzheimer’s Disease. There are certainly studies which support a relationship between cerebrovascular disease and Alzheimer’s Disease and since hypertension raises the risk of cerebrovascular disease the results of this study do seem a little surprising to me. However the authors of the article note that there is a higher risk of Alzheimer’s Disease in people with hypertension in middle age and there is also the possibility that Alzheimer’s Disease itself may predispose to changes in blood pressure which might confound the results. They conclude that more research is needed in this area and in particular researchers need to focus on tightening up the inclusion criterion for their studies. Over at the Alzheimer’s Research Forum there is a look at new research which may shed light on early-onset Alzheimer’s Disease. Two studies are covered which look at in vitro research in murine fibroblasts comparing wild-type cells with presenilin gene knockout cells. The evidence from these studies suggests that these genes may play an important role in autophagy the process whereby a cell degrades its components. Again at the Alzheimer’s Research Forum there is coverage of an initiative to standardise the collection of metabolic data – the Metabolomics Standards Initiative. Laboratories use mass spectromoter data to describe the metabolic contents of cells but currently laboratories use widely varying methods. A standardisation of methods should facilitate a comprehensive description of metabolites in cells. In turn this information can be used with genomic and other data to better characterise disease process and investigate therepeutics.
A small (n=43) multicomponent cognitive intervention program showed benefit in people with amnestic Mild Cognitive Impairment but not Alzheimer’s Disease in this study. A small study showed preliminary evidence that not recognising difficulties with memory (anosognosia for amnesia) is present not only in people with Alzheimer’s Disease but also in people with amnestic Mild Cognitive Impairment. This was based on an assessment of 25 people with Mild Cognitive Impairment compared with 21 controls. An interesting moderately sized 5-year longitudinal study in China provides evidence that vascular risk factors increase risk of conversion from Mild Cognitive Impairment to Alzheimer’s Disease but also that treatment of these vascular risk factors decreases the risk of conversion. One research group is reporting that the use of a combination of neuropsychological, CSF and structural imaging data on Hippocampal subfields can be used in the assessment of 12-month conversion rates from MCI to Alzheimer’s Disease. There were 120 subjects in the study – using data from the Alzheimer’s Disease Neuroimaging Initiative and it would be beneficial to see these preliminary findings replicated. Were these findings to be replicated further down the line there would need to be a separate piece of work around taking this outside of specialised research centres and into the clinical setting so although interesting the next stage needs to be verification of the findings. In a moderately sized study (n=78) people with Mild Cognitive Impairment (MCI) and a cognitively intact control group were randomised to either a Growth Hormone Releasing Hormone analogue Tesamorelin (subcutaneously) or placebo over a 20-week period. The researchers found that the Tesamorelin group experienced higher subjective cognitive improvement and higher scores on executive and verbal memory tasks than the placebo group. It will be interesting to see the results of further replication studies involving other populations and longer follow-up periods. In a moderately sized cross-sectional study (n=438), the researchers looked at the relation between apathy and executive functioning in people with amnestic Mild Cognitive Impairment and Alzheimer’s Disease. They controlled for a number of variables and concluded that there was a significant correlation between executive functioning and apathy in the aMCI group but it was not possible to see this relationship in the people with Alzheimer’s Disease. The researchers suggests that additional pathology may have obscured the relationship in the latter group and a longitudinal study design would be suitable for testing this hypothesis. There is a PLOS-One paper looking at predictors of conversion from Mild Cognitive Impairment to Alzheimer’s Disease which is freely available here. Using a combination of biomarkers and psychological outcome measures the researchers were able to identify MCI cases which progressed with a sensitivity of 96.43% and a specificity of 48.28%. A Spanish group write about their experience of a 3-year longitudinal study of Mild Cognitive Impairment. Although there is a body of evidence relating amnestic MCI with conversion to Alzheimer’s Disease in their study, the researchers found this was more likely to be associated with multi-domain MCI. An American group have published research in which they identify a syndrome which precedes MCI and which they refer to as Pre-MCI. For those with Pre-MCI 28% converted to MCI or dementia at 3-year follow-up whereas only 5% converted in the Non-Cognitive Impaired group. The researchers identified Pre-MCI as
‘At baseline, Pre-MCI subjects showed impairment on tests of executive function and language, higher apathy scores, and lower left hippocampal volumes (HPCV) in comparison to NCI subjects‘
The researchers in one autopsy study analysed the results of the 1672 brain autopsies in cognitively normal adults. They found that pathology associated with a number of disease processes was present in a modest percentage of cases even though the people had been cognitively normal before death. Cerebral microinfarcts were present in 33% of cases and 6% had Braak stage V or VI for neurofibrillary tangles. Thus the findings suggest that pathology may be present in the aging brain and that this isn’t necessarily associated with cognitive impairment. Nevertheless the pathologies examined here are central to a number of disease processes which affect cognition and it will be interesting to see further research in this area which helps to better characterise the factors which influence whether the pathology does and does not impair cognition.
A small double-blind randomised cross-over study recruiting people with behavioural variant Frontotemporal Dementia (bvFTD) showed a significant improvement in carer rated Neuropsychiatry Inventory (NPI) scores on the day of administration of 24 IU Oxytocin. These early results will need to be replicated with larger numbers of subjects. Hodges and colleagues looked at representation of musical knowledge in a study comparing people with Semantic Dementia and AD with healthy controls (n=47). Using volume based analysis of the structural Magnetic Resonance images they identified decreasing right Anterior Temporal Pole volume as being significantly correlated with impaired performance on knowledge of popular melodies. Although the people with Semantic Dementia performed worse than the AD and control groups on the melody recognition task the relationship with rATP volume also held in this group. Researchers have identified long repeat expansions in the gene C9ORF72 as being linked to both Frontotemporal Dementia and Amyotrophic Lateral Sclerosis. There is a case report on REM sleep behaviour disorder in a person with Frontotemporal Dementia and the authors suggest that this may be a generalisable feature not just of synucleopathies but of degenerative conditions affecting the relevant cortical centres. In an interesting study, researchers used post-mortem and structural MRI data to assess the volume of the hypothalamus in people with Frontotemporal Dementia. They found that the volume of the posterior hypothalamus was significantly reduced in those with behavioural variant Frontotemporal Dementia. In a German study (n-104), the researchers characterised the course of the illness in people with a diagnosis of Frontotemporal Lobar Degeneration. In their study 57% of the people in the study were still living at home and 40% were receiving non-pharmacological treatment. A small 6 week study showed evidence of a significant decrease in Neuropsychiatry Inventory Scores in people with behavioural variant Frontotemporal Dementia compared to a placebo group and it will be interesting to see the results of large replication studies. Diagnostic criteria are central to the diagnostic process in modern psychiatry with multiple established diagnostic systems in place. Revisions of diagnostic criteria should be more helpful in a number of ways including diagnostic accuracy. The criteria for Frontotemporal Dementia (FTD) were recently revised and the researchers in one study wanted to see if this improved the ability to detect cases (sensitivity). In an analysis of 137 brains of people with pathologically established Frontotemporal Dementia the researchers looked at the criteria for behavioural variant FTD and compared these with the previous diagnostic criteria by looking retrospectively through the patient’s casenotes. 86% met ‘possible criteria’ for behavioural variant FTD with the new criteria compared with 53% meeting the previous diagnostic criteria.
A systematic review examining a number of studies (with a total of 768 people with Vascular Dementia and 9857 controls) reinforced the important relationship between hypertension and increased risk of vascular dementia. A short small-sized trial looking at the use of Donepezil in females with Down Syndrome has shown promise in a number of outcomes although it will be interesting to see the results of larger longer-term replication studies. A small Magnetic Resonance Spectroscopy study (n=48) showed that brain metabolite Myo-inositol is increased in a sample of people with Down Syndrome compared to age-matched controls. There was a post-mortem study comparing brains of 4 people with Down Syndrome (average age 66) with 6 controls (average age 70). As Down Syndrome is associated with age related degenerative changes, this study was able to provide useful information in describing age related changes more accurately. The researchers were interested in the number of glial and neuronal cells in the neocortex in both groups using stereological analysis which means estimating 3-dimensional information about the brain from 2-dimensional microscopic slices. Based on their analysis the researchers estimated that in the brains of the sample group with Down Syndrome there were 30% less glial cells and 40% less neuronal cells than in the control group. Interestingly there were similar numbers of cells in the Basal Ganglia in both groups. This may represent a combination of neurodevelopmental and neurodegenerative processes and it will be interesting to how these results might be influenced by therapeutic interventions in future studies.
A post-mortem study (n=761) examined comorbid pathology in Normal Pressure Hydrocephalus (NPH). Since cognitive impairment in people with Normal Pressure Hydrocephalus is not always reversed with shunting the researchers wanted to know whether this might be due to comorbidity. Although there was a large sample set, only 9 patients had NPH and of these 5 had comorbid Alzheimer’s Disease at autopsy. The researchers conclude that irreversibility of cognitive impairment with shunting for NPH in some cases may be due to comorbidity. In a small study (n=20), cerebral acetylcholinesterase (AChE) levels were assessed using the tracer (11)C-MP4A (using PET imaging) in people with Multiple Sclerosis (MS) with secondary progressive cognitive impairment and also in healthy controls. The researchers found that there was no difference in AChE levels between the two groups but within the MS group there was an inverse correlation between AChE levels and cognitive performance including MMSE scores and it will be interesting to see the results of larger replication studies. A large study (n=13000) confirmed that anticholinergic drugs are associated with cognitive impairment. This relationship was already well established but this was a large longitudinal study (n=13003). The researchers used the Anticholinergic Cognitive Burden Scale (ACBS) to investigate the relationship. For medications with a definite anticholinergic relationship there was a small deterioration in the MMSE over the 2 year follow up (by slightly less than a point) compared to the control group. The study is well covered in an article at NHS Choices.
There’s been some interesting work from two personal genomics companies. Using a large sample size, the researchers at these companies have identified new gene associations with Parkinson’s Disease and estimate that up to 25% of the risk associated with Parkinson’s Disease is genetic. The study was published at PLOS Genetics One and the study is covered in detail at the Alzheimer’s Forum here. There is the first in a three part series on Braak’s hypothesis about Lewy Body Dementia. Braak suggests that based on the localisation of Lewy Bodies in the body in a number of studies that Lewy Body Dementia begins in the enteric nervous system before progressing to the peripheral and central nervous system. There are however critics of this hypothesis and the article presents a balanced discussion of Braak’s hypothesis. A group of Neurologists have published a study in the New England Journal of Medicine in which they examined videos of people who reported that they had Parkinson’s Disease. Based on the Neurologists’ observations of video segments and not on physical examination, the researchers concluded that many of the videos did not show Parkinson’s Disease. The study raises a number of questions.There has been a new characterisation of the 3-dimensional structure of the alpha-synuclein protein associated with Lewy Body Dementia which should contribute towards molecular research in this area (also covered here). One post-mortem study (n=23) found an inverse correlation between number of Lewy bodies in the Amygdala and Amydala volume using prior MRI but no other correlations between MRI and neuropathological findings.
In 2011 there was a Dementia Awareness Week and the Alzheimer’s Society had a report here. Dementia Awareness Week has been well promoted in the media. Carer Tommy Whitelaw toured several cities talking to carers of people with dementia and there is a video interview with him in this article. In Trafford the Alzheimer’s Society staffed an information stand in the local shopping centre and also held a concert at the local Arts Centre. In Dorchester the start of a 3-year roadshow which is a collaboration between the Alzheimer’s Society and Tesco (as the Alzheimer’s Society is Tesco’s Charity of the year) took place. They are hoping to reach 100,000 people over the 3 years. In Maltby, Lost Chord together with the Alzheimer’s Society held a ‘tea dance‘. In Twerton, there was a sponsored open day at a day centre with the aim of raising awareness and raising funds for the local Alzheimer’s Society. The Alzheimer’s Society in conjunction with Tesco held a ‘Remember the Person Photo competition‘ to raise awareness. In Harlow, there were a number of activities including a collection at a Garden Centre, a reminiscence day, an information stand, singing session and tea dance. There is coverage of the work of HOPE – a group of people living with dementia who are raising awareness in West Sussex here. In Sheffield there were a number of activities including an event featuring a children’s TV presenter, a memory tree, balloon launch and singing. In Warrington the Warrington Arts Council for the Development of Music (WACIDOM) had organised a musical recital and there was also a tea event. In Cornwall there was a tea dance organised by the Alzheimer’s Society and Cornwall Care.
In a 10-year prospective cohort study, 163 people without cognitive impairment were assessed on their dietary habits at baseline and grey matter volume was assessed 10-years later (using MRI) together with neuropsychological assessments. The researchers found evidence of a significant association between consumption of boiled or baked fish and improved working memory as well as preservation of grey matter volume of 10 years later. The researchers were careful to control for a number of well-known confounders. One of the emerging findings in Alzheimer’s Disease research is a protective role for the Mediterranean Diet. There have been various suggestions for this relationship including a reduction in Cerebrovascular Disease. In one study researchers investigated the relationship between mediterranean diet and cerebrovascular events (n=707). Participants were stratified into low, moderate and high adherence to the Mediterranean diet. The most interesting finding was that there was a significant reduction in prevalence of infarcts in the highest adherence group. The odds ratio for this group (compared to the low adherence group) was 0.64, significant at the 5% level and with the 95% confidence interval between 0.42 and 0.97.
In a small study (n=49), researchers looked at high and low fat diets in healthy people and those with Amnestic Mild Cognitive Impairment. The latter is a condition in which the person has subjective and objective memory impairments and in some but not all people can lead on to dementia. The researchers found that in both groups of people, the low diet was associated with a significant improvement in visual delayed recall. In other words switching from one diet to another improved the ability to recall visual information. Curiously the low fat did not seem to benefit some of the other skills. The researchers also found that the high fat diet changed some of the biological markers in the cerebrospinal fluid (the fluid that bathes the brain) making the pattern more like that seen in Alzheimer’s Disease. This is certainly very interesting research but it will need to be replicated in a larger sample and over a longer time period. What is most interesting about this though is the possibility that this type of research could lead to some very specific guidance on dietary changes that can affect cognition (that will complement some of the interesting findings e.g the benefits of the Mediterranean diet) but we will need to wait and see. There is further support for the benefits of omega-3 fatty acids or vitamin supplements (C, D, E and B vitamins) in minimising cerebral atrophy in Alzheimer’s Disease in this moderately sized case-control study of older adults. One of the findings from a number of studies has been that older adults (over the age of 65) have slower response times than young adults on cognitive tasks.
In the Neurocognitive Outcomes of Depression in the Elderly study, researchers have published findings which show a correlation between reduced stressors and subsequent improvement in cognitive scores (n=213). Decreased social interaction was a predictor of cognitive decline and although this could have been due to confounders, the relationship still held after controlling for variables such as depression status. One of the most interesting questions about antidepressants is why they characteristically take many weeks to reach a full beneficial effect. There are a number of studies which suggest that the antidepressants act to increase the number of synapses between neurons in the hippocampus – a region of the brain involved in memory formation. A recent murine study provides evidence that a class of antidepressants – the SSRI’s act in the hippocampus to cause one class of cells known as the granule cells to revert to a more ‘immature’ form which are able to form new synapses more readily. One research group has been investigating response times in cognitive tasks across the lifespan and provide evidence that this slower response time is in part due to an effort to increase accuracy. Further by inhibiting this tendency, older adults are able to better match the response times of younger adults although aging is still associated with a slowing in response times. In a large Danish study (n=37658) researchers looked at the national registry data on patients discharged from psychiatric care with subsequent diagnoses of dementia. They found a significant reduction in incident dementia with the use of older antidepressants and although replicated with Alzheimer’s Disease was not with other forms of dementia. Large studies of this type raise interesting questions for further investigation and these results could inform smaller tailored studies aimed at further investigating these findings.
A moderately sized (n=547) longitudinal study showed evidence of a correlation between depressive symptoms (using the 15-point Geriatric Depression Scale) and Executive Control Function (ECF) as well as psychomotor speed but not memory (using the California Verbal Learning Task). A Cochrane Database Systematic Review on antidepressants for agitation and psychosis in dementia was published in February 2011. The authors concluded that there were few relevant studies although in some (but not all) of those identified the SSRI’s were associated with fewer side-effects when compared to antipsychotics as well as showing similar results on reduction in behavioural scores compared to comparator antipsychotics. However the performance of the antidepressant in comparison with placebo differed according to the behavioural scales used. The authors call for further studies in this area. In one longitudinal study over 6.8 years (n=572) AF was associated with a Hazards Ratio of 1.38 for all cause dementia with a 95% confidence interval of 1.1 to 1.73 and the researchers recommend interventional studies looking at how successful AF treatment might impact on the hazards ratio.
Obsessive-Compulsive Disorder
There is brief coverage here of a study in the American Journal of Psychiatry looking at Obsessive Compulsive Disorder where the researchers link the orbitofrontal cortex with difficulties in controlling goal directed behaviours. In a review of studies looking at Obsessive-Compulsive Disorder and eye movements the researchers found that there was an association with a subtle impairment in smooth pursuit eye movements but this was not correlated with symptom severity.
Health and Social Care Bill
The Health and Social Care Bill underwent a second reading at the House of Lords this week and there is coverage of the events at the BBC website which includes an extract of the discussion (see also here). There are a number of proposed changes to the National Institute for Clinical Excellence proposed in the Health and Social Care Bill which is currently passing through parliament where evidence is being given to the Public Bill Committee. Included in these changes is a broadening of the body’s role to encompass a number of social care policies which has previously come under the jurisdiction of the policy development function of the Social Care Institute for Excellence (SCIE). 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.
Researchers using a model of hominid migration patterns and climate events have hypothesised that climate change has played a significant role in human evolution. They argue that Homo Erectus manifested a number of behavioural traits that provided flexibility across multiple climates allowing it to persist when other hominids which had adapted to narrow climates became extinct. The possible role of climate change in the rise of humans is covered in this post. In a paper published in the Proceedings of the National Academy of Sciences (freely available here) one group of researchers have used a large dataset to analyse genetic variation in human populations in Africa. Previously it has been thought that global human populations originated in East Africa. The researchers in this study confirmed previous findings about genetic diversity in specific ethnic groups in Africa including the Khomeni bushmen of Southern Africa and concluded that human populations originated in Southern Africa. However there is an interesting commentary from Professor Chris Stringer in this article that places these findings in context. There is a very interesting finding in Science reported on here (see also supplementary material here). The genome from a lock of hair from an Australian Aborigine was analysed and compared with genome data from other ethnic groups. The researchers used a number of gene markers to estimate migration patterns. They concluded that Australian Aborigines are the oldest continuous human population outside of Africa and were the first of a wave of humans leaving Africa to populate the rest of the world. They estimate that this happened approximately 62-75,000 years ago. This was followed some 25,000 years later by a second wave of migration that populated Europe and Asia. However the evidence suggests that all groups hybridised with a Neanderthal population in the Middle East before the migration.
An interesting development is the recent publication suggesting that children were taught how to produce the cave paintings found in caves throughout Europe. These paintings are relevant to discussions about the development of symbolic thought in human evolution. Much can be inferred about the neolithic or paleolithic mind from cave art and in this regards there have been interesting findings with the Britain’s oldest example of Cave Art (circa 14,000 years ago) as well as recent findings in Germany. A look at the role of older adults in the Bronze age is covered here. The researchers looked at a 600 year period in Austria approximately 4000 years before present. They found that older adults were more likely to be buried with copper axes than younger males and as this was believed to be associated with higher social status it suggests that older adults held important positions within the community. The common understanding of the origins of language have been challenged by a recent paper. Chomsky suggested that humans have an inbuilt brain mechanism for generating the grammar of a language. A new study involved running simulations on language generation using likely geographical locations for the origins of language as well as data on commonly used terms and phonemes. The simulations suggested that language is likely to have originated in central Africa and that grammatical rules are likely to have arisen through cultural rather than innate biological mechanisms and it will be interesting to follow the subsequent debate. There is a write-up here. There is a replication study on Twitter looking at Dunbar’s number. Professor Robin Dunbar has hypothesised that 150 is the number of social contacts that people are able to meaningfully maintain. The researchers analysed the twitter conversations of 1.7 million people and concluded that the number of stable relationships was between 150 and 200. While there are many reasons for using Twitter which mean that there will be significant variation from these numbers in individual cases the key finding here suggests that people use Twitter socially in a similar way to other forms of social interaction. There is a brief report on a recent paper on the evolution of emotional expressions which take into account anthropological findings of expression across cultures. There is evidence that languages are transmitted through males.
In a paper in the American Journal of Human Genetics, Stoneking and colleagues have looked at the genomes of people from 33 populations in Asia for similarities to the genome of Denisovans. Denisovans are an extinct hominid with one specimen being identified in Siberia dating back to over 30,000 years ago. The researchers found evidence of Denisovan DNA in people living in countries including Australia and Indonesia. They have suggested that the Denisovans were likely to have inhabited a vast range from Siberia to Australia thought to be possible only for modern humans. However other researchers have suggested that hybridisation may have occured in Central Asia with the migration of subsequent generations. The Denisovan specimen was found with a necklace and is more closely related to Neanderthal (although distinct) than humans although such generalisations should be viewed with caution without a sufficient sample size. There is evidence that Neanderthals ate shellfish some 150,000 years ago in the Iberian Peninsula. The earliest evidence in humans dates back to 164,000 years ago in South Africa. The significance of these findings is that consumption of shellfish was thought to differentiate humans from other ancient hominids and to have contributed to population expansion. John Hawks has been involved in genetic analysis of the Denisovan hominin which appears to have diverged from human lineage 400,000 years ago and from the Neanderthal lineage 330,000 years ago. The significance of this is that there is evidence that humans have interbred with both Neanderthals and Denisovans on the basis of recent genetic analyses in humans. However a new specimen suggests that Neanderthals and Denisovans may also have interbred producing a complex genetic history. There is also evidence that Neanderthals were building structures using mammoth bones some 44,000 years ago.
There is also an interesting open-access paper on Neanderthals and fire use in the Proceedings of the National Academy of Sciences here. The researchers looked at a number of sites used by archaic hominids in Europe and found no evidence of fire use by predecessors to the Neanderthals (e.g Homo Heidelbergensis) but repeated fire use by Neanderthals across sites. Although there is evidence of fire use by Homo Erectus at Koobi Fora (estimated at 1.4 million years before present) the evidence here suggests that Neanderthals were consistently using fire and this raises questions about how this consistency was achieved. For instance this may have been achieved through language. A current controversy in the literature centres around whether hominid brain size increased as a result of cooking or preceded this and so this has other implications. Indeed there is coverage of a paper published in PNAS about the origins of cooking. Cooking allowed for selective changes in the jaw and size of teeth in primates. By looking at fossil specimens and using the features of the jaw and teeth as proxy markers of cooking activity, the researchers hypothesise that cooking began approximately 1.9 million years ago. Other research suggests that cooking may have influenced the increase in brain volume that occurred in primate evolution. Contextualising these findings it’s also interesting to ask if early humans (Homo Sapiens) in Europe learnt their fire making skills from Neanderthals in order to survive in this Ice Age environment.
The findings last year of interbreeding between Neanderthals and humans were widely discussed. In another finding skulls recovered from the Iwo Eleru cave in Nigeria have been dated to 13,000 years ago and have features suggesting a hybridisation between humans and an ancient hominid species the latest specimens of which date to 140,000 years ago in Tanzania. Thus the story of human evolution becomes increasingly complicated. In terms of human evolution a very important part of understanding relates to the behaviour of archaic hominid ancestors. In a recent study, one group has dated a Homo Erectus stone tool factor to between 600,000 and 620,000 years ago. They found a large number of stone tools there which is suggests amongst other possibilities a complex social organisation. In another long term study, one group has identified several Neanderthal sites at high altitude (they were previously thought to be found only in low altitude habitats) in the Greek Mountains. What is particularly interesting about these findings is that these sites were revisited over long periods of time possibly up to thousands of years. There is preliminary evidence of hominids in Central Asia using stone throwing to hunt prey 1.9 million years ago. A new analysis of the Laetoli footprints suggest that human ancestors started walking upright some 3.7 million years ago.
Right-handedness is likely to be at least 400,000 years old. An analysis of fossil teeth from 400,000 year old hominid specimens in Spain suggests that they were most likely predominantly right-handed. The pattern of wear on the teeth indicated the most likely direction in which the tooth moved against the food and in turn the hand that was likely used for feeding. These hominids are thought to represent Homo Heidelbergensis. Recent evidence suggests that they are the common ancestor of modern humans and Neanderthals. The researchers also looked at European Neanderthal specimens and found similar evidence for right-handedness. While the researchers focused on the evidence for handedness, the significance of this is two-fold. Firstly there is an argument that asymmetry within the brain is necessary for language. The second is that Schizophrenia may arise as a result of inteference with the development patterns of asymmetry in the brain which is a theory developed by Professor Tim Crow (see review here). These findings could provide the first evidence that another species Homo Heidelbergensis had developed language as well as the possibility that some members may have been affected by Schizophrenia (assuming aberrant neurodevelopmental processes) in Europe as far back as 400,000 years ago. The authors of an Austrian study looking at human skulls concluded that the anatomy of the skull is highly integrated and that changes in one part have significant effects on the structure of other parts of the skull which has implications for considering how adaptations to the environment may have unexpected effects.
Domestication of animals has played an important part in recent human history and possibly in human evolution. The earliest evidence for domestication in dogs has been found in Siberia and dates back to 33000 years before present. Researchers have found a skull which has features of both domesticated dogs and wolves suggesting it is an ‘incipient dog’ i.e a dog in the earliest stages of domestication. However they also conclude that there are no living relatives and so this was ultimately an unsuccesful episode of domestication. What is also interesting is that based on other findings the domestication of dogs took place in many different regions possibly independently. Archaeologists in China may have discovered the first imperial palace which was built at a time of great significance in Chinese history. Meanwhile in Turkey in the eight millenium BC, archaeologists have discovered that bracelets constructed from Obsidian during this period were polished using remarkably accurate methods comparable to those used today according to the researchers and shedding light on an important phase in the history of development of modern civilisation. On Mount Aratat, archaeologists are investigating structures built during an important transition from the Pleistocene to the Holocene epochs during the Younger Dryas. Nearby archaeologists are working at the site of Gobekli Tepe to uncover the origins of agriculture which was to have a profound effect on the course of human history (see here, here, here, here, here, here, here, here and here).
Evidence that Chimpanzees have empathy is provided in this study in which their vocalisations were dependent on the audience of other Chimpanzees. There is evidence that baboones reason using analogy. In one study, the researchers presented Baboons with pairs of shapes and to complete the task the Baboons had to draw inferences about the relations between those relationships. The Baboons were able to complete the task after a learning period and were able to relearn the task much more quickly when it was presented again one year later. Researchers have used obtained evidence that Marmosets can intentionally meditate in order to receive a reward (see write-up here which also features footage). The researchers used an EEG to record brain activity. The Marmoset would appear to focus at a distance and this would correspond to a 12-16 Hz frequency of cortical activity. Once the reward was received there would be a return to waking brain activity. This raises important questions about intelligence, cognitive abilities and consciousness in New World Monkeys whose ancestors diverged from ours some 40 million years ago. There is an open-access article on primate evolution at PLOS Genetics. An international group of researchers have looked at variation in 54 genes in primates in order to produce a more accurate phylogenetic tree.
Phylogenetic Tree from (Perelman P, Johnson WE, Roos C, Seuánez HN, Horvath JE, et al. (2011) A Molecular Phylogeny of Living Primates. PLoS Genet 7(3): e1001342. doi:10.1371/journal.pgen.1001342)
The diversion of human and Chimpanzee lineages is estimated to be between 6 and 7 million years ago from this analysis. There analysis sheds light on some of the earlier and more controversial diversions particularly regarding the New World Primates. A research group from St Andrews in Scotland observed Chimpanzees in Uganda and concluded that Chimpanzees were using at least 66 gestures to communicate with each other. The use of gestures is thought to be an important step in the development of spoken language. The researchers in one study concluded that Orang-Utans are capable of using pantomiming to communicate with other Orang-Utans or with humans. The researchers watched 7000 hours of footage of Orang-Utans in Borneo filmed over 20 years and identified 18 examples where pantomiming was used including the clip shown below. The use of gesturing has been suggested as an important stage in the evolution of human language (see here).
A young orangutan pantomimes for help with a coconut from Science News on Vimeo.
An Origin for Language?: Some remarkable research hinting at the origins of language has been carried out by a UK group with the Bonobos at Twycross Zoo and has been published in PLOS One (see also a write-up of the study here). At the time of testing the Bonobos form two groups each with their own enclosure. The 2 groups are released from their enclosures separately to forage for food. Kiwi is favoured by the Bonobos but they also receive apples and these fruits were stored at specific locations. Bonobos communicate with a series of calls – barks, yelps, peep-yelps and peeps. The researchers recorded the calls that were made when Kiwis or Apples were found. The researchers then varied the food that was presented as well as the recorded calls that were played prior to the groups being released from the enclosures. They found that calls that were associated with Kiwis were more likely to result in Bonobos searching at the Kiwi sites. However there was a small catch in that the Bonobos were more likely to search at the Kiwi sites even without prompting. However after hearing the apple associated calls the Bonobos were more likely to visit the apple sites and so this provided evidence that the calls were likely to represent foraging signals to other group members. There was also a similar result in terms of the time spent foraging at the respective sites when the kiwi or apple associated calls were played back. The researchers suggested that in Bonobos rather than Chimpanzees the combination of different calls is turned into a sequence which has meaning. This ability to combine calls which then have new meaning expands the possibilities for communication and is a significant finding if confirmed. Our ancestors diverged from the Chimpanzee lineage some 6 to 8 million years ago. Since the Bonobo lineage diverged from the Chimpanzee lineage after this, we are related more closely to Chimpanzees than Bonobos in the evolutionary timeline. However if this ability is not present in Chimpanzees then it suggests that this ability to combine calls in humans and Bonobos would be an example of convergent evolution *(1). There was also another interesting finding. One call sequence associated with the Kiwi fruits seemed to be a very strong signal which was associated with the Bonobos searching the apple site twice as often as usual instead *(2). If the Bonobos are distinguished from Chimpanzees through the use of combination calls then this might explain other differences between Bonobos and Chimpanzees *(3) and would contribute to our understanding of the origins of language *(3)
A Mandrill was observed to create a pedicuring tool in this study adding another example to the extensive evidence base of non-human primates using tools. An interesting argument over copyright has developed in the case of an Indonesia Black-Crested Macaque which took a photographer’s camera and photographed itself. The photographs were used by a magazine without asking for permission from the News Agency that employed the photographer. However since the monkey took the photograph of itself it was argued that the photographs were in the public domain. The argument however isn’t that the Macaque itself is the copyright holder. An MRI study of Chimpanzees in captivity and humans showed that there was no brain atrophy in Chimpanzees in contrast with humans. However in cross-sectional studies, the researchers have to rely on comparisons between individuals rather than tracking the atrophy in individuals as in a longitudinal study. If longitudinal data confirms the hypothesis that cerebral atrophy has evolved in humans then we would know to look for corresponding gene differences between Chimpanzees and humans which account for this. In humans though the additional decades of life-expectancy mean that there are many years of environmental stress that would differentiate humans from Chimpanzees making it difficult to distinguish between the effects of genes and environment. In research published in the Open Access journal ‘Mobile DNA’ , the researchers compared human and Chimpanzee DNA and found that the main differences resulted from the so-called junk DNA. The researchers conclude that this is consistent with the theory that the genetic differences between Chimpanzees and humans are mainly differences of gene regulation rather than gene differences. 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.
Did monkeys gain big brains by ‘shrinking guts’? is the question asked in one paper. The researchers looked at New World Monkeys and after controlling for a number of factors concluded that there was no evidence of an inverse correlation between brain volume and decreasing volume of gastrointestinal tracts (GIT). They used the digestibility of the diet as a proxy measure of GIT size and energy investment in digestion. Nevertheless as Professor Dunbar points out this does not necessarily generalise to humans where the relationship between diet and brain volume is debated. In one study there was a finding of the earliest appearance of nails in primates in T.Brandfi (55.8 million years ago). It had been previously hypothesised that nails appeared with an increase in body size in primates but this finding contradicted the hypothesis. There are various connections between nails, the central nervous system and behaviour. The connexin26 gene for instance relates sensorineural deafness to nail dystrophy. It has also been suggested that nails were selected in place of claws for foraging food on small branches. The nails can also be used for specialised actions including plucking (Thus it might be expected that the utilisation of nails in extending the movement/behaviour repertoire should be accompanied by changes in the Motor Cortex). A large study looked at 125 baboons in the wild in Kenya. The researchers stratified them into 5 social groupings and analysed for two stress-related hormones testosterone and glucocorticoids. Essentially they found that the alpha males, those with the highest social status, were constantly exhibiting the highest levels of these two hormones. The researchers suggest that these results may be translatable to humans. However the alpha male baboons get into frequent physical altercations with other baboons which may contribute significantly to the stress hormone levels and does not translate easily into human settings.
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 another article on Austrolopithecus Sediba here. This is important archaeological work going on in South Africa to uncover some of our earliest ancestors that could be called human (i.e part of the genus homo) circa 2-million years ago. They have identified articulated skeletons, are able to gather data on some of the characteristics of the skin of these hominids and have also identified cerebral asymmetry. Debate continues over the nature of the Homo Floresiensis specimens – are they really another species or a human group with microcephaly? Perhaps the genetic analysis underway will settle the matter. A 20-million year old ape skull has been found in Uganda which usefully contributes to the narrative of primate evolution.
There is a very interesting resource on human origins which includes evolutionary and primatology material. Professor Hawks review an interesting paper in PLOS Biology in which the authors discuss several hypotheses about the evolution of human cognition. There is also an interesting Nature piece on human evolution here. The authors of a letter in Nature present a model of the evolution of ‘overconfidence’ which they suggest from their findings leads to an increase in individual fitness although it is also associated with a number of problematic outcomes. There has been a recent computer simulation of human cooperative behaviour the results of which have been published in PNAS. The researchers conclude based on the simulation of their model that people are inherently altruistic and that this results from adaptations to cooperative behaviour. In other words, even if our distant ancestors had started off cooperating for purely selfish reasons the very act of this cooperation over long periods of time creates an environment where altruism emerges as an adaptive trait. There is coverage here of a recent finding of a 160 million year old placental mammal specimen. Hawks also has coverage of the paper here. There are various implications including the possibility that gene mutation rates in hominoids are much lower as well as the interpretation of lineages of early primates. There is coverage of a PLOS-one paper here (via sandygautam) correlating increasing brain volume with maximal oxygen uptake in different species. Again there are various implications and in this context it is particularly interesting to note that Brain Derived Neutrophic Factor is secreted during exercise.
*(1) There is an exception to this. This would not be the case if the Chimpanzee-human concestor was able to combine calls but the Chimpanzee lost this ability after their divergence from Bonobos
*(2) This seemed to me to raise the possibility of deception. There are cases of New World Monkeys specialising so that one member watches for predators while the others eat food. Sometimes this group member will raise a false alarm. When the others move away from the area, this member will then take the food. In the example above it might be possible that the Bonobo on finding the Kiwi fruit attempts to send the other Bonobos to the Apple site so it can secure more Kiwi fruits. What is even more interesting is the strength of this signal as it suggests that the motivation of the signaller before generating the signal might produce a more significant change in group behaviour (i.e it would not just be a function of the motivation of the responding group). If this were the case there may be an interesting correlation between the motivation of the signallers and the effect of the signal.
*(3)As speculation if the line of reasoning given here holds then the combination calls could be as a result of increases in working memory. However working memory capacities of Chimpanzees and Bonobos should be tested directly.
The Royal College of Psychiatrists has started up a YouTube Channel here. The Royal College of Psychiatrists YouTube Channel features a number of interesting videos on their channel including tributes to psychiatrists Professor Sir David Goldberg, Professor Sir Michael Rutter and Professor Hamid Ghodse. There are aslo a series of videos by a group of trainee psychiatrists which are very interesting. In the UK there has been a shortage of doctors going into psychiatry recently. There has been a lot of discussion about how to solve this recruitment problem. I think these two videos could signal a new and profound development in the relationship between psychiatrists and society. In the first video, a group of trainee psychiatrists tell us why they like what they’re doing. During the course of the video we get to see the ‘human side’ of the trainees.
They are a group of young people who share with us a passion for what they are doing. They are relaxed and friendly in their manner and challenge some of the stereotypes that have been developed over the years. Indeed there are very strong stereotypes that have to be challenged. It’s difficult to know where these stereotypes have come from but certainly in the cinema psychiatrists have a very useful role in plot devices leading to well publicised caricatures. This has been well explored in the literature and the interested reader is directed to several resources (see here, here, here and here). Trainee psychiatrists have been engaging with society in other media (see reviews here and here). However the important development here is for the psychiatrist to be shown not as an agent observing and influencing society from the outside but as part of society. In other words people who just happen to be psychiatrists. In this way people will not need to overcome stereotypic assumptions in the simple act of relating to someone who is a psychiatrist. This in turn might contribute to career choices (although research is needed in ths area). In the second video Dr Kamran Ahmed does a brilliant job of tackling these issues.
Ahmed enlists some talented people to work on the animation and sound producing a trendy video that readily connects with the audience. However the most important part of the video is that Ahmed reveals his own thoughts and feelings about his experiences as a psychiatrist. To do this requires a lot of courage but it is an important part of engaging with society because this is exactly what other people are doing regardless of their profession as part of the conversation that is happening in society. There is one point about the video made by commentators and that is the scene with the psychologist. One of the most important aspects of psychiatry is working within the multidisciplinary team. The work of the nurses, occupational therapists, physiotherapists, psychologists, psychotherapists, pharmacists, social workers, support workers and speech and language therapists is essential in getting people better and each of those roles is critically important in this work. However the video is geared towards challenging some of the assumptions that people, particularly doctors have about psychiatrists and so this video necessarily focuses on the experiences of the psychiatrist. There is a very significant exchange between psychologists and psychiatrists and both fields have become enriched because of this exchange. Again though it is a little difficult to easily discuss the differences between a Clinical Psychology Doctorate and a Medical Doctorate in the context of a short video which is fast-paced and geared towards generating wider debate. I hope that this develops into a wider movement with psychiatrists increasingly using social media to engage with society and joining with members of the other professions to do so. I think these videos are a promising and inspiring start for the profession.
The Centre for Disease Control in the United States has released epidemiological data on mental illness and there is coverage at PsychCentral. There is an interview with the author of a new book ‘The Secret Language Code’ at Scientific American. The author Dr Pennkbaker has been using computerised analysis of text to investigate the content and has produced some interesting findings on the use of pronouns. There is a write-up by Professor Wray Herbert on research on survivors of Hurricane Katrina looking at why some people stayed while others moved out and finding a role for communality. There is a write-up here of a recent study in which the researchers identified a gustatory map in the brain to add to the other sensory maps. There is an article (via sandygautam) challenging the interpretation of recent neuroscience findings. A PLOS-One study suggests that there is room for improvement in release of raw data from research studies and this includes release of data to the Journal that groups submit to. Open data is one of the principles of the Science 2.0 movement. In another study, researchers favoured publishing in Open Access Journals.
There is a piece in the Guardian about prescription of antidepressants. The figures have been compiled using a combination of data from a prescription database as well as census data. The figures show interesting trends across the UK although there are a number of factors which influence antidepressant use and there are various reasons why the actual use may differ. A mixed methods approach would be useful to investigate the trends identified. I received a message on Twitter about a new online magazine by United Academics which is freely available here. The articles are very accessible and in the September issue there is an interesting piece on Biogerontology – the study of the biological processes of aging. The UK government is planning to implement copyright exemptions for data mining and there is further coverage here. The Neuroscience Information Framework 2.0 has a list of over 2200 neuroscience databases here (originally via a MindHacks reference to a Wiki on neuroscience databases). There is an interesting video on the Semantic Web below.
Web 3.0 from Kate Ray on Vimeo.
There’s an interesting open letter regarding the use of blogs in research in which the authors compare the use of blogs with the traditional peer review process (via @EvoMRI). There is a new Wiki site – CognoPedia where you can ‘learn more about the brain, cognition, neuroscience and brain health’. More articles are being contributed to the site. Research into a wave of protests in Spain has focused on Twitter usage and how this related to the subsequent protests. The researchers analysed a very large number of Tweets over the relevant time period and found that the large wave of Tweets resulted from initial tweeting by ‘recruiters’ apparently randomly spread through the network followed by well-connected ‘spreaders’ who were able to connect with a large group of other people. Students in one study preferred in-class teaching to video based presentations giving increased attention in the structured class environment as one of the reasons for this preference (via PsychoBOBlogy ). JSTOR are making archived material before certain dates depending on geographic location freely available. There is a talented psychiatrist Dr Peter Gordon who is producing thought provoking films about psychiatry. The video below is a response to a wake-up call to British Psychiatry by Professor Craddock and colleagues.
Awoken from Peter J. Gordon on Vimeo.
There are also a number of Science 2.0 resources which are relevant to Psychiatry 2.0 including: A Frontiers in Neuroinformatics Article on datamining in the Human Connectome Project, NIH Video and Journal of Visualised Experiments. Video and podcast material on science is indexed at this site. At the time of writing there were 7090 indexed videos, MRI educational resource, MR Connected Automated Pipeline – Linking structural MRI data with diffuse tensor imaging data to build connectomes, O’Reilly Open, Source Developers YouTube Channel, The Open Connectome website.
Diagnostic Systems Including DSM-V/ICD-11
The draft DSM-V criterion for a mixed depressive episode are being expanded to fit more closely with clinician’s experience and there are further details here. The new version of the World Health Organisation Classification of Disease (ICD-11) is displayed in draft version here. This is a work in progress with daily updates and it will allow people to comment from July 2011 onwards. I checked out the Mental and Behavioural Disorders section and there was just a little information there (relating to indexes for mortality) at the moment. The World Psychiatric Association have a very interesting paper on the use of the ICD-10 diagnostic system by psychiatrists. The researchers surveyed 4887 psychiatrists across the world using an internet based survey tool. The use of ICD-10 varied from 0% in Kenya and 1% in the USA to 100% in Kyrgyzstan, FYRO Macedonia and Slovenia. 71% of the psychiatrists surveyed used ICD-10 as their main diagnostic system. DSM-IV was the main diagnostic system for 23% of the psychiatrists surveyed (unweighted). 14.1% (unweighted) of the sample set ‘sometimes’ used a diagnostic system and 1.3% used the older versions of ICD-10 – ICD-9 or ICD-8 for diagnostic purposes. There is also a critical look at DSM-V at ‘Boring Old Man’ which highlights the wider debate in society.
Positive Psychiatry
Have they found a happiness gene? A headline in the media suggests that a happiness gene has been discovered. However I think this is an oversimplification of a complex phenomenon. First of all the researchers have surveyed 2500 adolescents in the USA and assessed their satisfaction with life. They then sampled their serotonin genes (5HTT) and divided these into the long and short forms of the genes. The longer allele of the gene results in more receptors in the neurons and is described as being more ‘efficient’. They found a large increase in satisfaction with life in those with the long form of the gene compared to those with the shortened form. Since serotonin is associated with mood, there is a justification for looking at the relationship between satisfaction and serotonin genes. However there are at least two caveats to these conclusions. The first is that this study has been undertaken in adolescents in the Unite d States and it would be interesting to see if these results vary across age groups. The second point is to look at what role the environment is playing in this. For instance there is a relationship between economic factors and ‘happiness’ in previous studies (although slightly more complex than would be expected) and so it would be interesting to see how economic variations in the environment influence these results as well as other factors which influence the social milieu.
There is coverage of the Second World Congress on Positive Psychology here and here. There is an interesting article on resilience and recent neuropsychiatry findings at Psychology Central. There is coverage of a study showing that laughter was associated with an increase in a measure of blood flow (brachial artery blood flow) compared to when people were watching stress provoking movie clips. There has been a recent consultation on the differences between well-being and happiness which will be useful for the ‘mental health and wellbeing’ movement.
References
Harrison P J et al. No Psychiatry Without Psychopharmacology.British Journal of Psychiatry. Vol 199. No 4. p263-265.
Butters et al. Changes in neuropsychological functioning following treatment for late-life generalised anxiety disorder. The British Journal of Psychiatry. 2011. 199. 211-218.
Komuravelli A et al. Stability of the diagnosis of first-episode drug-induced psychosis. The Psychiatrist. 2011. 35. 224-227.
Perecherla et al. Older Psychiatric inpatients knowledge about psychotropic and non-psychotropic medications. The Psychiatrist. 2011. 35. 220-224.
Appendix
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.
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