Tag Archives: the amazing world of psychiatry: a psychiatry blog

The Moral Sense

The Morals Sense is an audiobook (and paperback) by James Q Wilson. Nadia May narrates the book with an effective use of prosody which I found engaging. Wilson’s thesis is that there is an innate moral sense that is pervasive and which he supports with evidence throughout.  In parts his use of biology to persuade us of underlying principles reminded me of another book with an underlying biological thesis (see review here). Wilson argues that we should look at dispositions rather than universal rules and that the family provides us with the foundations for our moral senses. He covers a significant number of subjects throughout the course of his argument, too many to effectively summarise in a short space. I found his discussion of empathy and sympathy particularly interesting and he argues that sympathy is a fundamental component of our ability to develop morals effectively. He explores many other variables which contribute to these including community values, demographic variables as well as developmental variables.

At one point in the book, Wilson gives an example of the prisoner’s dilemma in which two friends face a  tiger. If they face it together then they will  overcome the creature but if one or the other runs the other will perish. If they both run then one of them will perish. If they want to survive therefore, the solution is for both of them to stay and fight. However he drops in the statement that they should do so after talking it through with each other in order to anticipate each other’s actions. At this point, it became obvious to me that Chimpanzees had already solved the prisoner’s dilemma without any obvious recourse to language. The clip here demonstrates this. This shows one of the chimpanzees using a branch to fend off the ‘leopard’ while the others in the group do not run away but face the creature also. They did not noticeably communicate with each other beforehand and their ‘supportive’ action suggests either that the  chimpanzee-human concestor was able to solve this dilemma also or else that this is a case of convergent evolution. Nevertheless it is only when he frames the classic dilemma in this way that the connection becomes obvious.

Wilson provides us with abundant evidence to suggest that the moral sense is universal in a cultural tour de force. He also delves more deeply into matters with an examination of the insights of philosophers throughout history and encourages the use of a ‘thought experiment’ to further the discussion. Wilson has an extensive knowledge of sociobiology, an interesting thesis and the listener will learn a great deal about human nature after listening to this audiobook.

Reference

James Q Wilson. The Moral Sense. Narrated by Nadia May. Blackstone Audio. 2000.

Index: 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.

Alzheimer’s Disease Neuroimaging Initiative

There is a progress report on the Alzheimer’s Disease Neuroimaging Initiative titled ‘The Alzheimer’s disease neuroimaging initiative: progress report and future plans’ by Weiner and colleagues and freely available here.  Although the authors don’t focus on the history of the ADNI in detail, they refer to another useful source for this and discuss it in passing. The ADNI was established to identify biomarkers for conversion from mild cognitive impairment to dementia and also to establish outcome measures for treatment. The reader interested in the pathophysiology of Alzheimer’s Disease is referred to section 1.2 which outlines the elegant model which has informed the study. The model uses the Amyloid hypothesis in which ABeta peptide builds up in the brain leading to a chain of events which eventually causes synaptic dysfunction and neuronal loss. What’s particularly here is that a model has been used to build a real-world experimental paradigm which has generated data to modify the model and the researchers in this initiative have investigated large numbers of variables from that model. Nevertheless as the authors point out the underlying amyloid hypothesis isn’t essential for the studies from the initiative and indeed there are several pieces of evidence that argue against this hypothesis in its simplest format. What is most interesting about the initiative is that the data has been made available to scientists around the world and for this reason there has been a large amount of research completed using these datasets. The operational details of the initiative are outlined in the methodology section of the paper including the policy for gatekeeping access to the dataset. The results section is by far the most interesting part of this paper highlighting the achievements of the initiative. These include the development of protocols for different neuroimaging approaches, the identification of biomarkers which predict structural and functional changes in the brain. The development of similar initiatives in other parts of the world is encouraging and appears to be another direct effect of this initiative. Finally the authors look to the future and hint at ADNI 2, which in one sense is a renewal of the grant for the study but in another takes the initiative in a different direction whilst building on the firm foundations of the ADNI. This is a useful paper summarising the ADNI which has advanced an understanding of Alzheimer’s Disease and laid the foundations for a series of further projects which should hopefully contribute towards both a better understanding of Alzheimer’s Disease and also improved treatment options.

Index: 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.

News Round-Up: September 2010 3rd Edition

Two interesting papers have been published by the Proceedings of the National Academy of Sciences (see here and here). Taken together they provide evidence which suggests that a specific region in the brain known as the default mode network is more likely to develop Alzheimer’s Disease associated pathology due to peculiarities in the way energy is produced in this region. There’s been a good write-up at the Alzheimer’s Forum on this (see here). The researchers are telling an interesting story with many twists and turns.

When we need energy to do various activities we use one of two mechanisms to get that energy. Glycolysis is the process by which glucose is broken down to produce energy. This can take place through anaerobic or aerobic means. When we suddenly sprint over a short distance we need to get energy very quickly if there isn’t much oxygen available. The term used for this type of energy release is anaerobic glycolysis. The schematic diagram below illustrates this process in which glucose is broken down through several steps releasing the energy-producing molecule ATP as well as lactic acid which leads to muscle fatigue.

In the second case, when we are jogging over a long distance, there is more time to get oxygen to the muscles and we are able to make use of another process known as aerobic glycolysis.

The process of glycolysis is linked to another important energy producing pathway known as oxidative phosphorylation. In this reaction, electrons are transferred between molecules involved in the pathway and the end result is that a large number of energy producing ATP molecules are created. This pathway is very good at creating energy.

These two processes – glycolysis and oxidative phosphorylation have been well described and are found in introductory texts in biology and physiology. The researchers in these studies were interested in aerobic glycolysis – that is the process by which glucose is broken down to produce energy in the presence of oxygen. The energy produced by oxidative phosphorylation is so great in comparison with that produced by glycolysis alone that it has often been overlooked when looking at energy use by the brain. This is just one of the ways in which the researchers have been quite innovative in these studies.

If we turn to where energy is needed in the body, we find that the brain uses approximately 20% of the body’s energy consumption. Therefore the issue of how the brain uses energy is critically important. Needless to say the methods by which the brain consumes energy are extremely complex and may involve a sophisticated interplay between the brain’s support cells – the glial cells and the neurons. In order to investigate aerobic glycolysis, the researchers used measures of glucose consumption and oxygen consumption in the brain. By calculating the expected oxygen consumption for the given glucose consumption, the researchers were able to estimate the extent of aerobic glycolysis in different parts of the brain. It was here that there is another interesting twist in the story.  The researchers found that a part of the brain known as the default mode network appeared to account for more of this type of activity than other parts of the brain. The default mode network involves several regions of the brain that are active during ‘wakeful rest’. The network is characterised by a synchronous firing activity of these different regions at roughly once every ten seconds. The network is thought to be associated with introspective activities in contrast with the brain’s responses to events in the environment. Below is a diagram illustrating the default mode network at different stages of development.

There is some evidence to suggest that the plaques that build up in Alzheimer’s Disease are more likely to be found in the regions in this network. So next, the researchers turned their attention to a component of the plaques found in Alzheimer’s Disease – ABeta peptide. Using a radiolabelled isotope which shows up this peptide in the brain, the researchers used PET scans to examine both people with Alzheimer’s Disease and people with high levels of ABeta peptide in the brain but who were cognitive normal. They found that in both groups, the ABeta peptide was more likely to be found in the regions in the default mode network. Furthermore it was more likely in those people with Alzheimer’s Disease than in those without.

While it’s tempting to draw some general conclusions about what this might mean in terms of introspection and response to external events, it is far too early to do so. Indeed it is far too early to even draw conclusions about energy metabolism and Alzheimer’s Disease. The total sample size in both studies was 58 people and so really what these studies are doing is telling us about what areas in the brain are likely to be affected in Alzheimer’s Disease, which mechanisms might be making them vulnerable and how all of this might tie in with the way the brain creates and uses energy. However there is a need for further studies to reproduce these results with a larger group of people and also to test these theories in different ways to see if they stand up to close scrutiny. If these theories do stand up to close scrutiny then they will give us exciting new insights into some of the mechanisms producing Alzheimer’s Disease and offer the possibility of novel therapies based on this understanding. So this will certainly be an interesting area to follow.

Other News in Brief

Mind Hacks has a very good round up of Spike Activity here as well as coverage of the first man diagnosed with Autism who is now 77 years of age and very well travelled as well as an intriguing study using mirrors and giving valuable insights into how the brain processes visual information (mirror, bright light and dark room required). There is also a very interesting video here demonstrating the use of programmable gloves that can apparently train a person’s to use specific movements of the hand. The researcher in the video talks about how this is being used in rehabilitation and although there’s certainly a ‘wow’ factor in seeing these gloves in action this should be interpreted with the published findings particularly given the possible clinical uses discussed.

Index: 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.

Review: Geriatric Island – Japan

I came across a company called Journeyman Pictures that distributes video footage including documentaries. One of the documentaries is ‘Geriatric Island – Japan’ available on YouTube here. The video gives a broad overview of a number of important issues about an aging population in Japan. As longevity in Japan increases and the birth rate decreases there are economic consequences. The documentary makers argue that this is leading to people saving rather than spending and the possibility of looking to immigration to increase the working population. As other countries are expected to have similar demographic changes there is global interest in how Japan adapts to these changes. There were a number of issues which the documentary quickly moves through which perhaps don’t have easy and immediate solutions. The narrator persuades us that there is an increasing homeless population due to the changing dynamics of society. This in turn they argue is due to the diminishing influence of confucian doctrine. Although we see a Japanese island where the average age of the population is 71, I thought the narrative was a little anxiety provoking leaving the audience with a number of problems to solve.  I would have liked to have seen a closer look at the many benefits of these demographic changes. For instance society is defined not by the working population but by all members of the society. Although there may be economic problems for the working age population, what about the older adult population? After a lifetime of working they are now able to enjoy the benefits of retirement, wisdom, extended families and insights into the problems of society. Perhaps the changing demographics of Japan will lead to a new societal structure which will show the rest of the world how older adults can take a more central role.

Index: 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.

Review of the Geriatric Pharmacotherapy Blog

The Geriatric Pharmacotherapy Blog was created in April of this year and at the time of writing there are four posts. The blog is written by Thomas R Clark, Director of Clinical Affairs at the American Society of Consultant Pharmacists Foundation. The blog was created on a Mac as indicated at the bottom of the page. The home page is simply structured with abstracts of the four posts located in the central panel. The reader must click at the bottom of each abstract to read the full article and is able to make comments on the posts. Clark summarises two studies on adverse drug events in this post. Although the blog has only a few posts, the reader can easily get to further useful material by following the links. For instance if you follow the links in this post, there are various useful resources including the ASCP foundation website which features amongst other things an electronic newsletter. In conclusions this is a fairly recent blog with only a few posts but which links to other useful resources and is relevant to those with an interest in pharmacotherapy in older adults.

Index: 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.

Book Review: The Essentials of Neuroanatomy

The book reviewed here is from 1973 – ‘The Essentials of Neuroanatomy’ by G Mitchell. On reviewing this book, I came across issues not just about neuroanatomy but also about how knowledge changes with time. Firstly it is a relatively short book at just over 100 pages. In the introduction Mitchell writes about how it started as a private text he had produced for his students. I was interested to learn a little more about the author and came across this obituary here which describes Mitchell as a surgeon and anatomy lecturer who inspired his students and practised surgery around the world. On reading through the book it dawned on me that every work on neuroanatomy is an interpretation much as orchestras will produce their own distinctive interpretation of a classical symphony. The book is divided broadly into three parts. The first part concerns itself with a discussion of the neuroanatomical structures and this is interspersed occasionally with physiology. The second part is a brief introduction to embryology whilst the third part is even briefer and provides the student with an overview of the dissection process.

The first part of the book is arguably the most important. Broadly speaking this consists of both the technical descriptions of the neuroanatomy and the insight laden explanations. I found the former quite hard going particularly as the illustrations are grey scale line drawings which are relatively sparse in the text. As an example

On transverse section the pons is seen to consist of a dorsal part which resembles the medulla and of a ventral part which contains both longitudinal and transverse fibres intermixed with small masses of grey matter (the nucleus pontis)

Of the latter, the following is an example (on the subject of the thalamus)

In .. animals with relatively simple bodies no elaborate sensorium is necessary and the cortex is practically non-existent. In these the thalamus is represented by a few small nuclei. As the body increases in size and complexity the ordinairy special sensory mechanisms become increasingly important. This is associated with a proportionate increase in the thalamus and by the development of cortical areas connected anatomically and functionally with it

Along the way, I found myself reminded of the underlying ‘logic’ of the central nervous system that must ultimately underlie the psychological phenomenon that we experience as well as the corresponding psychopathology.

In any interpretation there are constraints and for Mitchell he operates within the constraints of both the knowledge of his time and the medium through which he is interpreting the neuroanatomy.  There are sufficient advances in neuroanatomy for entire volumes to be concerned with single neuroanatomical structures that may take only a paragraph in Mitchell’s book. The methods of investigating the function of the neuroanatomical areas have increased considerably examples being functional Magnetic Resonance Imaging, intraoperative electrode recording and magnetoencephalography. Nevertheless even with these developments there will always be some basic features of neuroanatomy which will remain to be learnt and understood when first approaching the subject and Mitchell is able to communicate these with enthusiasm. However in the very technical areas the deficiencies in the medium become apparent. Text would be improved by more line drawings.

Even if this were addressed, the argument could be taken further. Grey scale line drawings would be improved by introducing colour. Colour drawings would be improved by labelled photographs. Labelled photographs would be improved by silent videos of the structures. Silent videos would be improved by videos with labels and a narrative. Ultimately this would be combined with the ability to rotate the structures through a software interface while accessing the narrative. The reason for this is that neuroanatomy is about 3 dimensional structures and relationships and while an elaborate language has developed to communicate relationships – one picture speaks a thousand words – and a video speaks ten thousand words. Ultimately the video would avoid any misunderstandings and help the audience to get close to the essence of nature. The neuroanatomical text evolves with technology to enhance the learning process.

So is this text redundant? Has it been surpassed by a whole new generation of bright gleaming technologically enhanced neuroanatomy texts. It seems a pity for this to be the case. Mitchell would no doubt have influenced many doctors in training and the book is thus not just a collection of pages but part of a wider system of people. Part of the culture of that period. Also Mitchell’s lifetime experience of surgery and anatomy is bound up within the book and here too there are deeper aspects to the book. Can a lifetime of learning condensed into a single work be easily replaced by technological and technical advances? After all, the student is a person who learns best by experiencing, problem solving and insight rather than an empty vessel waiting to be filled with a river of technical information. Will Mitchell’s text cease to influence medical culture with each successive year that passes as its last edition fades further into history? Does such a book serve a specific function within its era or does it depend upon other factors as with Gray’s Anatomy? In any case, I’m not going to throw my copy of the book away. As it sits on the bookshelf, testimony to the life of an author dedicated to an understanding of the theory and application of neuroanatomy, I expect at some distant point I will develop a flash of insight into a value that this book contains which is absent from colourful and technically advanced contemporary texts.

References

G.A.G Mitchell. The Essentials of Neuroanatomy. Second Edition. Churchill Livingstone. 1973.

Index: 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.