Author: Dr Justin Marley

The paper reviewed here is ‘From Utopia to Science: Challenges of Personalised Genomics Information for Health Management and Health Enhancement’ by  Hub Zwart, Professor of Philosophy and which is freely available here. I thought it would be interesting to look at this paper because the sequencing of human genomes is becoming increasingly accessible as sequencing technologies improve. Zwart addresses the use of information from the genome and gene therapy. I was particularly interested in the former. Zwart broadens the initial part of his inquiry by examining various forms of biotechnology and referencing Huxley’s classic ‘Brave New World’. He raises some intriguing questions about the evolution of culture and a move away from anthropomorphism. After reading this paper, there were a number of questions that seemed to suggest themselves.

What happens if a person has access to their full genome sequence outside of the medical environment?

Speculating, there are a number of possibilities

– A person will respond appropriately to this knowledge. The appropriate response will vary according to context. Having this level of information is unprecedented and it will take some time to identify what an ‘appropriate’ response is. For instance, it might be usual for a person to have an initial period of focusing on the information followed by a sharp decline in this focus but research will be needed to characterise this response.

– A person might become overly anxious about having this information. Even if they have no known illness disease  related alleles, they might anticipate further information becoming available about their alleles. The information might be incorporated into a prior somatoform disorder. I did a quick medline search combining ‘genetic counselling’ and ‘somatoform’ which produced one reference which didn’t seem too relevant. However a more detailed search might have picked up some relevant papers.

– A person might feel a loss of control if they are found to have a predisposition to a certain illness. Indeed this has been well explored and genetic counselling has been utilised for a number of genetic conditions. Outside of a supportive medical environment if a person learns of newly identified relationships between their alleles and specific diseases they might be unable to judge the appropriate risk.

– There may be a number of reasons why the information may be more complex – genes are differentially expressed in different tissues, there may be small inaccuracies in a genome sequence, the interactions between gene products may be more important than having the disease allele.

How will Health Services respond to Personal Genomics?

While this isn’t the case at the moment, it wouldn’t be too unreasonable to suppose that in 10 years time, a sizeable proportion of the population will have access to their genome sequences. People might approach health services to help them interpret this information. Thus there might be an increasing role for geneticists in managing this aspect of healthcare although this will depend on health service configuration and responses. Additionally primary care may develop specialised services for managing this aspect of healthcare. Within mental health services there may be a role for prevention although any service responses would need to be evidence based. Various studies have identified degrees of risk associated with specific genes but also emphasise the importance of the environment.

How will this impact on culture?

If a person has information to about their genome sequence then one important question is how will this influence their relationship with others? Obviously this will become exceedingly complicated and there will be countless examples that could not have been anticipated. There are a number of broad possibilities. Many people will want to keep this information private as with other aspects of their healthcare information.  Others may advertise this information to others if they think it will be to their advantage and certain self-selected ‘types’ will be known by the genes they do or do not have and it may therefore confer an additional layer of identity.  Many aspects of an emerging genomics culture have been examined in the film ‘Gattaca‘. This information may combine in complex ways with other technologies such as the internet.

One thing is clear and that is that this field will need to be regulated and the ethical implications engaged in ongoing debate.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The paper reviewed is ‘Behavioral Symptoms and Caregiver Burden in Dementia’ by Shaji and colleagues and freely available here.

Aims: The authors write that

‘The present study examines the prevalence of BPSD in a community sample of patients with dementia and its impact on the caregivers‘

Method: The study took place in a rural area in Kerala, India. Trained healthworkers identified cases which were then screened by clinicians using DSM-IV criteria and the Clinical Dementia Rating (CDR) scale. Subjects rated as moderate to severe on the CDR were included in the study. I didn’t notice any exclusion criteria and the population might therefore be representative of a clinical population (albeit with selection bias influencing the sample population characteristics). The subjects were also included in two other studies and three outcome measures were collected

• BEHAVE-AD.

• General Health Questionnaire-12.

• Zaret Burden Interview (ZBI).

The statistical tests used for different data types are clearly stated.

Results:

• 29 people were included in the study with a mean age of 78.3 and all living at home with their families.

• The characteristics of the sample are described in table 1. 43.8% of the people received a diagnosis of Alzheimer’s Disease and 34.5% were diagnosed with Vascular Dementia. The other diagnosis or combinations are described. 79.3% of the sample were female.

• The scores on BEHAVE-AD are described in table 2 with 28 of the subjects meeting the criteria for Behavioural and Psychological Symptoms in Dementia (BPSD). I noted that the standard deviations were relatively large.

• Table 3 displays the prevalence of items on the BEHAVE-AD subscales. Particularly prominent are delusional ideation and disturbances of activity.

• In Table 4 the researchers detail the incidence of delusion types.

• Table 5 shows a comparison of vascular dementia and Alzheimer’s Disease.

• Table 6 showed the characteristics of no/mild BEHAVE-AD symptoms v moderate/severe BEHAVE-AD symptoms. Here, I thought the significant results perhaps reflected their relationship to the BEHAVE-AD total as they are components.

• Table 7 displayed the characteristics of 2 samples defined by GHQ score thresholds. There is a significant relationship between increasing GHQ scores and ZBI scores. I thought that causality might be difficult to interpret in view of the cross-sectional nature of the study.

Discussion:

The authors draw a number of conclusions. They note the absence of a relationship between BEHAVE-AD and GHQ-12 scores and suggest that a larger sample size may be helpful in exploring this relationship further.

Conclusions:

I thought this was a small but interesting study in a sample with family based care of people with moderate to severe dementia. There was found to be an association between GHQ scores in carers and ZBI scores although the direction of the link was unclear given the cross-sectional design of this study.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The paper reviewed here is ‘Safety and Tolerability of Donepezil, Rivastigmine and Galantamine for patients with Alzheimer’s Disease: Systematic Review of the ‘Real-World’ Evidence’ by Lockhart and colleagues and freely available here.

Aim: The aim of the study is clearly outlined and reflected in the title.

Method: The authors identify trials from the following sources

• Medline database

• EMBASE

• Cochrane library

The researchers used the following search terms in MESH and the text of the abstract: Dementia, Alzheimer’s disease, Donepezil, Rivastigmine, Galantamine, cohort, retrospective, naturalistic. The researchers also hand-searched a number of conference proceedings. Primary outcome measures were

• Incidence of individual AE’s reported

• Withdrawal due to AE’s

• Incidence of individual AE’s

The researchers opted for a qualitative analysis rather than a meta-analysis ‘due to potential heterogeneity in included studies’.

Study designs were assessed using the Newcastle-Ottawa Scale which is

‘designed to appraise the methodological quality of comparative cohort and case control studies‘

The researchers include a detailed list of inclusion and exclusion criteria in table 1. The impression I got from reading the criteria is that the diagnostic criteria, trial type (essentially randomised trials) and of course treatment were the most significant factors influencing inclusion. Thereafter the inclusion criteria were fairly broad meaning that there was an opportunity to include a relatively large number of papers.

Results: There were a number of steps involved in reaching the final number of 12 papers and the interested reader is referred to the original paper linked to above. The characteristics of the 12 studies are summarised in Table 2. In the identified studies, the numbers for the different acetylcholinesterase inhibitors were

Donepezil: Retrospective analysis – n=6294; Prospective analysis n=4034

Rivastigmine: Retrospective analysis n=1842; Prospective analysis n=2143

Galantamine: Retrospective analysis n=809; Prospective analysis n=418

Table 3 shows withdrawal from the medication to GI effects. There is a wide spread within the prospective study – withdrawal due to any GI AE category although the difference in sample sizes cause difficulties in interpretation. In a number of cases p values are given. I might have missed this, but I couldn’t identify what tests were being used to produce the p-values.

Table 4 shows withdrawal due to all non-GI adverse events. My impression from inspecting this table was that there was a broad range across the studies – both retrospective and prospective and this wasn’t summarised with mean and confidence intervals for aggregated data. Looking through the data further, the figures for withdrawal due to cardiovascular events ranged from 0 to 1.2%.

Table 5 shows an aggregation of GI and non-GI adverse events and here there are a number of consistent findings across various studies particularly in the GI studies although there are outliers in the dataset. Again the data is not pooled although this is explained in the methodology section.

Table 6 shows CNS adverse events. There were a lot of categories here but there were a relatively small number of data points for each category.

Table 7 shows ‘non-CNS-related AE’s’ which covers a number of cardiac and miscellaneous AE’s (excluding GI (with the exception of weight loss)). The De La Gastine study shows a higher incidence of cardiac arrythmias for the different ACHEI’s but has smaller sample sizes than the other studies. Here again I thought the use of confidence intervals and statistical comparison between groups would be helpful.

Conflict of Interest: I couldn’t identify a COI declaration and the authors identify their institutions as Pfizer and Abacus International, a health consultancy firm.

Conclusions: I thought the researchers had gathered a large amount of useful data. It would have been interesting to see the information displayed with the use of confidence intervals and for these to be used in a between-group comparison. Even a lack of difference between groups in itself would have been interesting and I thought would have been helpful in drawing firm conclusions. The researchers discuss why they have opted for a qualitative analysis.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

• The insertion of artificially-synthesised DNA into a bacterial cell with subsequent establishment of viability has been widely reported in the media (see here, here, here, here and here) and will lead to substantial debate about the ethical implications as well as leading to a vast array of applications. An interesting soundbite from Venter’s presentation is

‘This is the first self-replicating species that we’ve had on the planet whose parent is a computer‘

• One research group has identified a novel pathway involving amyloid plaque mediated excitotoxic cell death in a model of Alzheimer’s Disease which may lead to new therapeutic approaches.

• There is evidence that build up of Amyloid Beta leads to cataracts in people with Down Syndrome as well as being associated with early onset of Alzheimer’s Disease.

• One group has identified details of Lithium mediated anti-inflammatory pathways which may contribute to an understanding of Lithium’s mechanism(s) of action.

• Further research shows an association between adult central adiposity and later life dementia in this study of community residents (n=700).

• The authors of this study have called for psychiatrists to be included in ‘disaster first-response’ teams on the basis of their findings.

• A JAMA paper outlines details of a successful suicide reduction program in people with depression. In this population, the suicide rate was reduced by 75% and over a 2.5 year period was 0.

• A group of physicists have predicted that the magnetic fields associated with ball lightning would be sufficient to stimulate phosphenes, visual experiences secondary to cortical activation which would likely influence the perception of lightning.

Psychiatry 2.0

• There’s an interesting piece on falling at ABC Therapeutics.

• In this AJNR post there are useful links to articles on neuroimaging in autism, the development of the cerebral sulci and gyri as well as the neurosurgical uses of Diffuse Tensor Imaging.

• At the Brain Disease blog there is a short piece on the closure of a hospital.

• Stephanie Allen links to online neuroscience videos in this post.

• Dr Shock links to a video of Richard Dawkins speaking on ageing genes.

• At the Neuropathology blog there is a look at a phase II study in which Nerve Growth Factor is being injected into the Basal Nucleus of Meynert in subjects with Alzheimer’s Disease.

• There is a very interesting article on a social media tool for sharing scientific research data – My Experiment – discussed at ‘O’Really‘ and the blogger has been involved in the production of the videos.

• There is a look at Telehealth at the Singularity Hub.

• There author gives a top 11 reading list at Blue to Blue.

• A study finding Thalamic D2 receptor density associations with creativity is covered at Nou Stuff.

• At Corpus Callosum there is a brief piece on how average hours of TV watching exceeds average hours of working per week in US research.

• The American Society of Human Genetics has produced an important position paper on genetic ancestry and this is discussed at the Genetic Genealogist blog. An excerpt reads:-
  

‘Leadership of the human-genetics community, diverse in its interests and its own identities, should develop mechanisms for promoting thoughtful and rigorous use of genetic ancestry estimation in academic research….Leadership of the human-genetics community, diverse in its interests and its own identities, should develop mechanisms for promoting thoughtful and rigorous use of genetic ancestry estimation in academic research’

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

I found this interesting video on YouTube after posting an earlier Meditations video when I was experimenting with introspection. One subscriber had linked to another channel with videos of  ‘Streams of Consciousness’ or SoC for short. When I looked into this, I found something that was very interesting. Essentially the video is a compilation of people from a variety of backgrounds reading prose. Each person reads a small portion. Then end result is fascinating.

Here for example is ‘The Wreck of the Hesperus‘ read by SoC. My initial impression was that I maybe couldn’t understand the flow of the poem as well as I might with a single reader as I would have to adjust slightly as each new reader was introduced. Perhaps I might not hear the initial part of the new verse as clearly on adjusting to the new readers  pitch, volume and accent. However what was really very interesting was just hearing so many different people bringing their interpretation to the prose in a very raw way. In effect the SoC is about the narrators as much as it is about the prose. In this particular piece, the background effects of wind add an ominous atmosphere to the piece. Anyway I think this is a really great idea. Here are links to a few more of the videos the group have created

• Jaberwocky

• The Raven

• The Creation of Sam

• The Last Leaf Part 1

• The Last Leaf Part 2

• The Tiger

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The blog reviewed here is ‘Bio Data Blogs‘ which is by the company BioData and focuses in particular on their research management software product BioKM. I thought this blog might be interesting to look at the blog contains various reference to web 2.0.

Appearance and Design

The blog features a grey-striped background with a central graded beige lined background for the articles. The title pane is not demarcated but features a number of social media subscription options. There is a rectangular graded brown pane beneath the title containing a search box.  The reader is able to navigate the blog using links on the right side of the central pane. The links are to recent posts as well as posts archived by month. There are also external blog links. The posts are dated, comment enabled with author details and tweet enabled with tweet counts. Posts are generously illustrated.

Content

The welcome post gives a background to the blog. I found a number of the insights in this post quite interesting – researchers apparently hanging onto 15 year old samples. There are a number of news round-ups which are quite useful including this one which looks at research on how the structure of mitochondria is attained or this one which looks at evolutionary research on guppies showing that they can adapt to their new environment in just 10 years. The blog also features interviews with scientists. There is also a link to the BioKM YouTube Channel which gives insights into the research software. There are also a number of posts of general scientific interest. This one for instance is a very impressive post linking to video sites that share research protocols – something that I’ve suggested after finding difficulty in understanding the methodologies of specific papers.  Following on from this is an interview with the founder of one such site here.  There’s a look at an article on how to organise a motivated research group here. A number of the posts feature links to interesting videos (including the above). This one for instance is a solution for the financing of research groups.

Conclusions

I found this to be an informative blog. While there is a focus on educating the reader about the company’s software product, there are a number of instructive articles of general scientific interest also.

Acknowledgements

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The blog reviewed here is ‘Beaker – A Medical Research Blog‘ which I came across from one of Boraz’s Twitter posts.

Appearance and Design

The blog features a grey background with a diagonal white lined design. The central pane containing the text has a white background. The title pane features a photograph of two scientists focusing on a task next to the title of the blog. The articles are of a good length, informative, titled with author details, comment enabled , tagged and posted in specific categories. The articles are generously illustrated with high quality and relevant photographs including micrographs. There is one caveat however. In many of the articles, the reader must click on the ‘read the rest of the entry’ link at the bottom of the summary for each post in order to read the full post. The blog can be navigated using functions in the right hand panel – according to tags, categories and recent posts. There is also a search box. There are external links as well as a link to donate to the Sanford Burnham Institute.

Content

As would be expected from a large institution, there are frequent events (e.g visits by influential figures to the institute) and reports on research studies that are being undertaken. In this post for instance, the author succinctly describes an approach to designing new molecules that is being pursued at the institute by one researcher.  This post explains the role of messenger RNA and refers to a symposia on mRNA being held at the Institute.  As the blog is relatively young there are 15 posts at the time of writing.

Conclusions

This is a young blog which demonstrates how an institution can effectively represent itself through the use of social media. Indeed with a large number of employees and students, an Institution has a marked advantage if it is able to efficiently leverage its resources through the medium of social media. For the reader, the posts are well written and offer insights into the interesting research that is being undertaken at the Institute. This blog would particularly appeal to those interested in working or studying at the institute, readers with an interest in research or those interested in representing their institute through social media.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The paper reviewed here is ‘Learning from Experience’ by Jerry Tew, Colin Gell and Simon Foster and freely available here. This is a 66-page document which outlines material useful for course instructors in higher education mental health courses to enable the involvement of service users and carers in service development. The intended audience is somewhat wider however and this is explained more fully in ‘The Purpose of the Guide’. The authors then discuss how students typically learn about mental health subject matter in courses such as medicine and psychology. Forming a partnership with service users and carers is then contextualised in ‘Setting the scene’ where it is identified as one of the ten essential shared capabilities by the National Institute for Mental Health in England. They go on to write that

‘Service users and carers have a unique contribution to make to training in core professional skills, such as listening, communication, empathy, advocacy and offering counselling or advice‘

They further write about the experience of involving service users in the teaching thus

‘Also it requires a humility that allows teaching staff to give up any vestiges of a superior ‘expert’ status based on ‘knowing best……..Teaching staff may learn new knowledge, skills and ideas from the service users and carers with whom they are working, and benefit from ongoing and constructive challenges to their value base‘

Potential benefits for service users are also discussed including the contribution that this can make to recovery.  The authors include a useful section ‘Pointers to good practice’. In the third section, the authors present the multiple ways in which service user contribution has been realised. These approaches range from inclusion in training through to e-modules, drama and experience sharing. There is also a discussion of how service users can contribute to course planning with examples as well as for student selection, student assessment and course participation. The authors then discuss some of the practical aspects of implementing these suggestions identifying possible barriers as well as presenting a template. They look at issues such as capacity, infrastructure and employment or contracting. The authors then include a section on evaluation with some useful feedback forms included. The document finished with the conclusions and appendix.

This is a useful document for organisers/trainers of mental health courses. Some of the suggestions here would be suitable for application in service development also.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The paper reviewed here is ‘Differentiating the Cognitive Profile of Schizophrenia from that of Alzheimer Disease and Depression in Later Life’ by Mulsant and colleagues and freely available here. In the abstract the authors conclude that

‘Patients with LLS (Late Life Schizophrenia) have a different cognitive profile than patients with AD (Alzheimer’s Disease) or DEP (Depression in later life). Particularly, memory impairment in LLS seems to be more pronounced in learning than recall‘

Method

• All cases referred to a memory service for consultation were analysed. I wasn’t absolutely clear if this was done retrospectively or prospectively but from the wording it seemed to be retrospective.
• People referred to the service underwent psychiatric and neurological assessments and DSM-IV criteria were used for the diagnoses
• All people referred to the service underwent the following neuropsychological test battery as routine and these test scores were included in the analysis

1. Animal Fluency
2. Boston Naming Test
3. Clock Drawing Test – Freedman Scale
4. California Verbal Learning Test II – Short Form (CVLT)
5. Dementia Rating Scale-2 (DRS)
6. FAS Letter Fluency (FAS)
7. Luria Alternating Diagrams
8. Mini-Mental Status Examination
9. Trail Making Test A and B
10. Wisconsin Card Sorting Test – 64

• It didn’t look as though a single specific hypothesis was being tested. Instead the demographics and cognitive test results from the different groups – DEP, AD, LLS and control group were being compared.
• In the first phase of the statistical analysis, ANOVA was used.
• When differences between groups were identified using the ANOVA, a Bonferroni correction was made for multiple comparisons
• Cohen’s D was used for differences between the LLS and other groups

Results

• LLS (n=25)
• AD (n=15)
• DEP (n=15)
• NC (n=12)
• I thought Figure 1 was a very useful summary of the data and quite intuitive. The Late onset Schizophrenia group are acting as the reference group. In this diagram, group differences at p<0.001 are highlighted with ***. From looking at differences of this significance I noted the following
• The LLS group were significantly better on a number of memory tasks than the AD group
• The control and DEP groups were significantly better than the LLS group on the FAS, DRM memory, WCST categories, CVLT short and long delay free recall
• I wondered if the latter findings were tapping predominantly into frontal lobe function and the AD group findings into medial temporal lobe function

Discussion

• In the discussion, the authors comment on the hierarchy of memory impairment across groups
• The researchers note that the groups have small sample sizes which would reduce the power of the study
• They note the memory impairment of the LLS group compared to the DES and control groups on a number of memory tasks

I thought this was a neat study, showing how service data can be effectively utilised to examine group differences in cognition. This research approach should be reproducible across other services although the components of the test battery will vary. Even so, examination of group differences including vascular dementia and frontotemporal dementia using different test batteries would be valuable.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The paper reviewed here is ‘Effects of Rivastigmine in Alzheimer’s Disease Patients With and Without Hallucinations’ by Jeffrey Cummings and colleagues and freely available here. In the abstract, the authors write that

‘Hallucinations predicted greater treatment responses to oral Rivastigmine‘

In the introduction, the researchers cite evidence that a cholinergic deficit is associated with hallucinations in Lewy Body Dementia and Parksinons’ Disease with Dementia. The  evidence of this association between cholinergic deficits and hallucinations forms the rationale for the current study where the researchers are investigating the effects of Rivastigmine on hallucinations in people with Alzheimer’s Disease.

Method

• The researchers pooled data from two clinical trials although I wasn’t clear on how these studies were selected. There may be a bias towards a positive effect as unpublished negative studies may not have been included in this analysis.
• The 2 studies were randomised and placebo-controlled
• The ADAS-cog was used as a primary outcome measure
• The Clinician’s Interview based impression of Change plus Caregiver impression was also used as a primary outcome measure
• The presence of hallucinations were identified using the BEHAVE-AD (Behavioural Pathology in Alzheimer’s Disease Rating Scale) and confirmatory analysis was undertaken on the change from baseline at 26 weeks
• Physical illness was not an exclusion criteria unless severe
• Participants continued on medication for comorbid physical illness and thus the populations better approximated that which would be expected in clinical practice
• Use of psychotropic medication was an exclusion criteria (albeit with a small number of exceptions)
• Both trials were of 6 months duration
• Rivastigmine capsules with flexible dosing up to 12mg/day in 2 divided doses were used
• The lower target dose of Rivastigmine was excluded from this analysis although I wasn’t clear on the reason for this
• The ANCOVA and ANOVA were used in the statistical analysis

Results

• 1424 subjects were included in the analysis
• Mean age was 73.2 years
• Mean duration of dementia was 39.1 months
• 23% of patients on Rivastigmine reported hallucinations at baseline
• 19% of patients on placebo reported hallucinations at baseline
• The researchers write that ‘At 6 months, a mean improvement of 0.5 points on the ADAS-cog was seen in patients with hallucinations at baseline treated with rivastigmine, while patients without hallucinations at baseline showed a 0.3 point decline’. The improvement in ADAS-cog scores in the AD group with hallucinations was significant at below the 5% level.
• There was a greater decline in the placebo hallucinator group compared to the placebo non-hallucinator group

Discussion

The researchers note a small and statistically significant effect of Rivastigmine in improving ADAS-cog scores in people with AD and hallucinations. They also note an increased decline in ADAS-cog scores in the subjects with hallucinations at baseline and they speculate about the role of the basal forebrain acetylcholinergic projections. In order to further test the cholinergic hypothesis of hallucinations, I thought it would be interesting to include all acetylcholinesterase inhibitors in all forms (e.g capsules) to further explore the hypotheses generated in this paper.

Acknowledgements

The diagram above is by author Ju and denotes the chemical structure of Rivastigmine. The image is in the public domain and further details can be found here.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The blog reviewed here is ‘Spread the Word. EMDR transforms trauma‘. In the about section, the philosophy underlying the blog is explained. The blog draws on the contributions of the wider EMDR community to highlight aspects of  EMDR ranging from successful application through to practical tips.

Appearance and Design

The background for the blog is dark blue with a central white pane. The title pane features a blue flower design with the title of the blog. Immediately beneath the title pane there are links to the home page and the about section. On the right hand side of the central pane lie the categories index, a search bar and links to external EMDR sites. The categories index features a limited number of categories and communicates the simple and effective organisation of the blog. Posts are comment enabled, dated and include category tags. They are typically text-based and a paragraph or several paragraphs in length.

Content

At the time of writing there are 13 posts in total. The introductory post stipulates that contributions should be a minimum of 200 words in length. This post by Dana Terrell sheds light on the origins of the blog and how she was introduced to EMDR. Several posts detail people’s experience of EMDR. For instance this post is about the use of EMDR for improving success at job interviews while this one describes an application in pain management.

Conclusions

This recent blog about EMDR contains 13 posts but already effectively conveys a lot of the enthusiasm of the posting EMDR practitioners. The posts are generally fairly brief but effectively convey useful information such as the application of EMDR in specific situations. This will be a useful blog to follow for EMDR practitioners or those with an interest in this area

Conflict of Interest

The author has undergone training in EMDR.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The article reviewed here is ‘BioTorrents: A File Sharing Service for Sharing Scientific Data’ and available at Plos One as an open access article. This is a brief article which outlines the features and potential benefits of BioTorrents and is written by the authors of the software.

There is a clear introduction which outlines why BioTorrents is needed. Essentially in a network, relying on a single node (or server/computer) to distribute data to all of the other nodes in the network is less efficient than using many nodes in the network to distribute that data. This BitTorrents approach works because there is a successful protocol which involves labelling the data so that nodes in the network ‘know’ what data the other nodes have. This approach was developed for BitTorrents initially and was used for distributing generic data. However due to copyright issues of the distributed material on these generic networks, servers were shut down and hence these networks were to some extent unreliable due to the pragmatics of their operation rather than the underlying technology. Hence the BioTorrents variation on the theme in which only legitimate scientific data is transferred across the network thus avoiding the reliability issues described above. The result is that BioTorrents is a useful approach for sharing large scientific datasets across networks and the authors cite large genomic datasets as an example of the data that can be usefully transferred in this way.

I wasn’t clear on the aims of the paper and this is perhaps reflected in the absence of a methodology section. In effect, I think the article is to some extent is a description of the journey of the authors from the identification of the needs through to the construction of BioTorrents and their subsequent observations of the BioTorrents in action. However the structure of the paper is a fairly minor point and instead the technology that is being presented is fascinating and extremely useful.

Screenshot from the website (http://www.biotorrents.net/)

I navigated to the site (see address above) and found it was well organised and easy to understand. There is a FAQ section and the data is hosted on a server at the laboratory of Jonathan Eisen a coauthor of the paper. At the time of writing I could identify 26 datasets. There were a few points I was unclear about. The first was about the ethical aspects of hosting data on these servers. For human data, research should pass through a research ethics committee and data storage is a point for clarification. There is usually an endpoint after which the data must be destroyed. Having data distributed in this way means that potentially the data cannot be destroyed as it may end up on a server somewhere indefinitely. Thus this approach might have implications for ethics protocols. There were two associations that sprang to mind when thinking about BioTorrents. The first was the Alzheimer’s Disease Neuroimaging Initiative which involves a large dataset that can be analysed by researchers from around the world and this might be well suited to BioTorrents. The second was the wayback machine which stores a small percentage of the ‘internet’ indefinitely and two questions I had were whether this would be included in the archived material*

In any case, this has potential applications for research in psychiatry providing such data storage methods have been given ethics clearance and collaborators are located at multiple sites either within LAN’s or at different geographical sites.

* or whether the BioTorrents approach was a useful alternative and distributed method for archiving material of historical interest – a kind of distributed system for storing the internet equivalent of world heritage sites.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The paper reviewed here is ‘Theory of Mind Deficits in Patients with Acquired Brain Injury’ by Martin-Rodriguez and colleagues. As the title suggests, the researchers are looking at how adult acquired brain injury influences ‘Theory of Mind’ (ToM). ToM is an important component in various models of social cognition. For those not familiar with ToM, this concept refers to the model that a person has of another person’s mind. In other words it is about empathy, the insight into either one’s own or another person’s mind. Disorders of ToM have been associated with Autistic Spectrum Disorders (ASD). However, we can say that ToM is a function of mind which in turn is a function of brain. Indeed in the introduction, the researchers refer to three regions associated with ToM

• Prefrontal Cortex

• Posterior Cingulate Cortex

• Bilateral Temporo-Parietal Junction

If this is the case then we can also say that an adult without an autistic spectrum disorder could acquire a disorder of theory of mind after developing a brain injury affecting the relevant brain region(s). This could occur for instance after traumatic brain injury or in the course of a neurodegenerative disease (for instance there is discussion and emerging evidence of altered empathy in frontotemporal dementia e.g see here and here).

In the abstract the authors write that

‘The severity of ToM impairment was influenced by ratio of patients with frontal lobe lesion, ratio of patients with right hemisphere injury, type of belief task, and heterogeneity of the sample’s etiology‘

Method

The researchers used the PsychInfo and Medline databases between the years 1995 and 2008. I didn’t look through all of the returned results but on using the search term “Theory of Mind” in  PubMed for the years 1900-1998, 537 abstracts were retrieved. Although these were not all relevant, there might have been additional useful references if the search period had been extended. The researchers combined ‘Theory of Mind’ as a search term with ‘brain damage’, ‘brain injury’ and ‘head injury’. I looked at some alternative search terms such as trauma and accident but these didn’t seem to produce distinct results although this was only a brief inspection. Studies that used the following tests were included

• ‘FOTOM’ (first order ToM)

• ‘SOTOM’ (second order ToM)

• ‘Understanding IS’ (indirect speech e.g sarcasm)

• Detecting faux pas

Studies needed to compare subjects with demographically matched healthy controls for inclusion. The number of correct responses on the above tasks provided a simple quantitative measure of ToM. The mean difference between controls and subjects was standardised using Cohen’s D. The researchers applied a Hedge’s D correction to produce an unbiased estimator. They coded a number of other variables including other demographic variables as well as subcomponents of the tasks described above. The analysis was performed using ‘Comprehensive Meta-analysis Version 2‘ as well as macros for SPSS. The statistical analysis was more involved than described here and the researchers also calculated the number of unpublished studies that would be needed to nullify the statistically significant published results using Rosenthal’s approach and a specified threshold.

Results

Unbiased effect sizes for the four types of tasks were as follows

• FOTOM – Unbiased d = 0.52

• SOTOM – Unbiased d = 0.60

• Faux pas – Unbiased d = 0.70

• Understanding IS – Unbiased d = 0.87

The results of a meta regression analysis for the subtest components and demographic variables were tabulated. From this table I could identify three results that were statistically significant at below the 5% level

FLP ratio – R-Squared 0.86 slope 0.93 for Faux Pas (p=0.02)

RHP ratio – R-Squared 0.85 slope -0.92 for Faux Pas (p=0.04)

RHP ratio – R-Squared 0.68 slope 0.82 for IS (p<0.01)

Results for additional variables were also included. Sample sizes required to nullify the effects within the different subtest components were all over n=100.

Discussion

From these results the researchers drew a number of conclusions as per the abstract excerpt quoted above. The researchers acknowledge that they could not factor in the effects of other variables that influence outcome after brain injury. Indeed one point I was not clear on was the longitudinal nature of the performance on the ToM tasks. For instance, premorbid performance would have been useful although there are comparator groups for the included studies. There was no mention of whether a period of stability had been achieved for performance on ToM tasks and whether this was cross-sectional data. There were differences in the effect sizes for FOTOM and SOTOM tasks and these effect sizes were increased with the use of the false belief tasks. The moderating effect of frontal lobe lesions on faux pas tasks weren’t too surprising but in their discussion the researchers focus on specific regions within the frontal cortex.

In conclusion, this is a complex paper with more involved results and conclusions than are discussed here although a number of the more interesting findings are described above. The involvement of the frontal cortex in performance on ToM tasks such as the faux pas task are consistent with other parts of the research literature and I found the relationship between the ratio of right hemisphere involvement in participants to Faux pas and IS tasks quite interesting. It would be interesting to take some of these findings and use them to generate hypotheses in a longitudinal assessment of fronto-temporal dementia.

References

Martin-Rodriguez J F and Jose Leon-Carrion.Theory of mind deficits in patients with acquired brain injury: A quantitative review.  Neuropsychologia. Vol 48. Issue 5. April 2010. pp1181-1191.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The reviewed article is  ‘Differences in hippocampal metabolism between amnestic and non-amnestic MCI subjects: automated FDG-PET image analysis’ by Mariani and colleagues and freely available here at the time of writing. In the abstract, the researchers conclude that

‘Comparison between the two MCI subtypes showed MTL hypometabolism in aMCI subjects possibly reflecting the fact that most had prodromal AD‘

In the introduction, the researchers outline some of the previous evidence showing a deficit in glucose metabolism in the Medial Temporal Lobe and providing a context for the current study. The aim of the study is clearly described  in the abstract

‘The aim of this study was to assess whether 18F-fluorodeoxyglucose positron emission tomogrpaphy differentiates amnestic (aMCI) from single-non-amnestic mild cognitive impairment (snaMCI) with executive dysfunction‘

Methodology

• The study included 30 right-handed MCI subjects who had been referred to the University of Milan neurology department.
• 85% were referred by the GP
• 15% were self-referred. The self-referrals are interesting as this might be different from the usual referral routes in other healthcare systems.
• The diagnostic criteria are clearly stipulated – 6/12 of subjective/objective evidence of cognitive impairment, normal ADL, MMSE >= 24, CDR of 0.5, performance of 1.5 SD below norms on >= 1 cognitive dimension on neuropsychological testing.
• There was an extensive list of exclusion criteria and here I thought that the subjects might differ significantly from a routine clinical population with MCI e.g Hachinski ischemic score > 4, thyroid disorders, kidney or liver disorders, history of alcohol dependence as well as a number of other criteria.
• Subjects underwent a battery of neuropsychological investigations.
• Petersen’s criteria for amnestic MCI were used and those for single non-amnestic MCI are stipulated in the paper.
• The protocol for PET imaging and analysis of the images was clearly described.
• PET images were compared to a control group of previously acquired images on 7 subjects

Results

• The average age in both MCI groups was roughly 73 years (see paper for exact figures)
• There were significant differences between the two MCI groups on a number of neuropsychological tests which might be expected. I wasn’t clear on whether there was an adjustment for multiple comparisons
• 13 aMCI subjects went on to develop dementia
• Compared to the controls both MCI groups showed hypometabolism in the posterior Cingulate gyrus
• Compared to the single non-amnestic executive dysfunction MCI group the Amnestic MCI group had hypometabolism in the Medial Temporal Lobe
• I couldn’t see the data on the control group (I might have just missed this)

Discussion

The researchers draw some interesting conclusions. They caution on the small sample size while noting that the posterior cingulate gyrus hypometabolism might be a result of a disconnection from limbic areas since it is not usually affected by Alzheimer’s pathology in the early stages of the disease while also adding that a number of the subjects with aMCI went on to develop AD. They suggest that the executive dysfunction group exhibiting hypometabolism in the PCG might mean that this area is also disconnected with this pathology.

It will be interesting to see if these findings with the posterior cingulate gyrus are replicated with larger sample sizes as this might suggest a potentially important location for pathology in both executive and amnestic MCI as well as associated pathologies such as Alzheimer’s Disease.

Acknowledgements

Public Domain PET image by Jans Langner (see here).

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

Dementia

• A new gene association with late-onset Alzheimer’s Disease has been found using a GWAS (genome wide association study). The gene is MTHFD1L and is located on chromosome 6.

• A small phase II trial (n=24) of intravenous Gamma Globulin has shown evidence of reduced ventricular enlargement and brain atrophy in people with Alzheimer’s Disease compared to the control group. It will be interesting to see the results of the Phase III study when completed.

• The American Academy of Neurology have updated their guidelines on driving advice for people with dementia

• Loss of muscle mass was associated with Alzheimer’s Disease in one study and a suggested explanation was an association with reduced activity

• In another study there was found to be a strong association between ABeta oligomers in the CSF and performance on memory tasks in people with Alzheimer’s Disease

• A prospective study (n=2148) looked at risk of Alzheimer’s Disease according to dietary patterns and identified one diet associated with a clinically and statistically significant reduced risk. See here for further details.

Miscellaneous

• A widely reported neuroimaging study provided evidence of frontal cortex activity being divided between hemispheres for two tasks compared to one. Additionally the authors concluded that there was a deterioration in allocation of resources for more than two tasks.

Psychiatry 2.0

• Shrink Rap write about depression in pilots as well as linking to a news video on this subject.

• At the EMDR International Association blog there is a discussion of an EMDR newsletter that is being launched as well as a blog which describes successful applications of EMDR.

• At PsychCentral there is an article on the complex relationship between marriage and health.

• Zivkovic has a useful post linking to some of his favourite articles on science journalism and blogging at ‘A Blog Around the Clock’. I found this one on twittering quite interesting as Zivkovic differentiates between two twittering approaches which he refers to as life casting and mindcasting (social networking versus dissemination of information).

• In another edition of Spike activity at Mind Hacks, evidence of reduced racial bias in people with Williams Syndrome as well as the effects of Botulinum Toxin on emotional experience are just some of the topics discussed.

• There is an archived interview with Elisabeth Kubler-Ross over at ‘All in the Mind’.

• At Nou Stuff, there is a discussion of a case study looking at the effects of resection of the right inferior dorsolateral prefrontal cortex.

• The Neurocritic has an amusing post on mirron neurons.

• Over at the Mouse Trap there is an interesting review of a paper about energy usage in the brain and reflexive versus intrinsic functions based around the default mode network.

• At Singularity Hub, there is a look at a recent experimental intervention in a newborn with oxygen deprivation which involved cooling the body and using xenon gas.

• Somatosphere link to a special issue of Ethos on autism.

• Dr D has a funny post on buying a book for her child and finding that the plot of Little Red Riding Hood has been completely rewritten.

Evolutionary Psychiatry

• In an podcast/article at the Guardian there is a look at a new book looking at the inner lives of animals. There is a brief description of tree snagging – the tendency of orang-utans to jump from a falling tree at the last moment which has been likened to ‘thrill-seeking’.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

Just taking a short break from blog posts. Back shortly.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

More Depression and Apathy in Alzheimer’s Disease than Amnestic MCI

A small study (n=245)  finding clinically and statistically significant increases in both apathy and depression in Alzheimers’ Disease compared to Mild Cognitive Impairment.

The Corpus Callosum in Amnestic MCI and Alzheimer’s Disease

A small study finding involvement of the anterior corpus callosum in Amnestic Mild Cognitive Impairment extending to the posterior corpus callosum in Alzheimer’s Disease.

Diffuse Tensor Imaging in Alzheimer’s Disease, MCI and healthy aging

Small study using Diffuse Tensor Imaging to focus on white matter changes. The authors write that

‘Present findings suggest that most DTI-derived changes in AD and a-MCI are largely secondary to gray matter atrophy‘

There were some white matter changes noted however.

4 Factors Associated with Discontinuation of AChEI’s

Findings from a 2-year prospective multicentre study.

Extra Funding for War Veterans

The UK government has set aside an extra £2 million for funding mental health services for war veterans to be allocated to a range of services including community psychiatric nurses, GP training and helplines.

Psychiatry 2.0

Health 2.0 Conferenence

Link to opening video of Health 2.0 conference.

What’s does Social Media Mean for the Communication of Science and Science Journalism?

There have been a number of interesting pieces recently on the changing or unchanging (depending on perspective) face of science journalism with the advent of social media. Helen Jaques from the BMJ writes on a recent conference where many of these issues were discussed including the new roles of the science journalist. Cameron Neylon has an interesting piece on aggregating science communication in which he comments on the development of the semantic web:-

‘We need the authoring tools that help us build and aggregate these objects together and tools that make forming these citations easy and natural by using the existing ideas around linking and referencing but if we can build those we get the semantic web for science as a free side product – while also making it easier for humans to find the details they’re looking for‘*

Government Guidelines on Social Media

The US government has released guidelines on the use of social media.

Wolfram-Alpha for Education

At the Wolfram-Alpha blog there is a link to a piece on using Wolfram-Alpha for education. Wolfram-Alpha is a tool that is able to process requested information before returning it mainly through mathematical algorithms. Here there is a look at how this tool can be used in education.

Supertaskers, Chomsky on Anarchy and Aging Cognition

It can only be another Spike Activity from Mind Hacks.

Mental Health Crisis services and the Police

Michael Anestis looks at a study from 2000 looking at crisis assessments compared  to police intervention.

Happy or Not?

Dr Grohol looks at 5 emerging trends from the positive psychology movement on happiness including the importance of experiences and relationships. He also deals with some of the criticisms of this movement.

Scotland, Vikings and Multiple Sclerosis

At Stu’s Views and MS News there is a piece linking Vikings, migration and Scotland to areas of increased prevalence of MS.

The Skull is Moulded to the Brain

Not for those who are squeamishbut Dr Moore has a piece on how the skull adapts to the shape of the brain during development.

Malcolm Gladwell on Social Media – It’s all about trust

Allan’s Library links to a video featuring the author Malcolm Gladwell who thinks that social media won’t be paradigm changing as he argues that effective communications are built on trust.

A Neuro Film Festival run by Neurologists

The Neurocritic has an article on a film festival run by the American Academy of Neurology. There is an accompanying YouTube channel.

Finding Genes in Milliseconds

The Singularity Hub reports on new technology which enables researchers to search through a database and identify gene candidates for complicated cellular processes within milliseconds.

Colourfully Presenting Data

At Citation Needed there is a look at a piece of software – the corrgram package which converts tables of data into a more presentable form.

4 Minutes of Medicine for your Mobile Courtesy of Nature

Dr Shock links to a Nature video on the emerging trend of mobile phone medicine including a medline database for the mobile.

Light Bulbs and Creativity

Another link between light bulbs and creativity has been described by Jonas Lehrer at the Frontal Cortex blog.

First Words

Dr D describes the experience of hearing her baby A’s first words.

Evolutionary Psychiatry

A New Species or Not?

A finding of general interest for human evolution is the skeleton of a child in a cave in South Africa which has been named as a new species – Australopithecus Sediba and is estimated to have lived between 1.78 to 1.95 million years ago . Although there is suggestion that this species may be intermediate between Austrolopithecus  and Homo Sapiens, critics have argued that further work remains to be done to examine a number of standard morphological features before conclusions can be drawn.

I was pleasantly surprised to find that my Lemur video (see this post for an explanation of the video) has proved relatively popular in Japan. Not sure why.

Attributions

* Creative Commons 1.0 attribution

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

The blog reviewed here is ‘Exploring Psychology’. In the About section, the author David Webb tells us that he has a Masters degree in Occupational Psychology and that he resides in Spain where he is a ‘distance learning tutor and research dissertation supervisor’. The aim of the blog is described thus

‘The exploring psychology blog is the place where I highlight and explore the most fascinating and compelling psychology related news and research‘

Appearance and Design

This is a blogspot blog, with a simple white background throughout. Posts occupy the central pane and there are several to each page. They are demarcated, dated and comment enabled. The title pane includes a description of the aims of the blog and includes the above quote. Posts are generously illustrated with enticing pictures. There are adverts above the first post and to the right, there is a link to the Psych 101 twitter account, external links, videos of interest as well as a chronological index.

Content

There were lots of interesting posts in keeping with the aims outlined above. I rather liked this idea of a ‘gratitude journal‘ from the ever creative positive psychology movement. Webb had found TED back in 2007 rather more quickly than I have (although pleased to be now be up to speed on this valuable resource!). Linking to slideshare was also quite helpful – a place for sharing presentations online. There is a very neat illustration of inattentive blindness in the video linked to in this post and I completely missed the giant mouse walking through the group of people. There is very good coverage of the ‘Little Albert’ study here. I was suprised to learn of the memory enhancing associations of doodling in this post.

Conclusions

This is an easily accessible blog with ‘bite-sized’ posts explaining useful psychological research. There are also a number of book reviews and links to useful learning material and I enjoyed reading this blog.

Call for Authors: If you are interested in writing an article or series of articles for this blog please write to the e-mail address below. Copyright can be retained. 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 [email protected]. 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.

Change to Schedule

Just to let readers know that I have changed the schedule of the blog. A regular feature of the blog has been a book review and podcast/video review each week. On reflection, although I’ve reviewed lots of very good podcasts I didn’t think these posts were as useful as others in the series. Henceforth I will only include podcast reviews if there is one of particular interest. Similarly with book reviews although there have been a number of very good books reviewed, books often benefit from a rereading particularly when complex material is covered. For this reason I would prefer more time to review books and reviews will appear intermittently.

Call to Authors

It would be great to have other authors writing psychiatry-related posts for the blog. Authors are invited to write one-off posts or a continuing series on an area of special interest or where they feel there is a need to address issues which need wider exposure. Authors would be able to retain copyright or write under a creative commons license. For further information please write to the e-mail address below.

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 [email protected]. 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.

Here is a list of articles that i’ve included under the heading of social psychiatry. Broadly speaking they include reviews of policy documents, cultural psychiatry and epidemiology (strictly speaking it could be included under biological psychiatry but i’ve included them here because the data is considered at the population level). Where the titles are self-explanatory there isn’t an accompanying description.

DOH Documents Reviewed

Attitudes to Mental Illness 2010 DOH document

Annual Report of the Chief Medical Officer 2009 DOH document

Autism Strategy – Impact Assessment – DOH document

NHS Operating Framework for 2010/2011 – DOH document

New Horizons. Towards a Shared Vision of the Future DOH document on new 10-year plan for mental health services

Estimating Future Numbers of Adults with Profound Multiple Learning Disabilities in England DOH document based on research

Modernising Mental Health Services for People who are Deaf DOH document

Developing Services for Carers and Families of People with Mental Illness DOH document

Topic Selection Process for Technology Appraisals DOH document

Consultation Response and Analysis. National Dementia Strategy DOH document on National Dementia Strategy

Mental Health Advocates Supplementary Guide DOH document

Mental Health Ten Years On DOH document reviewing progress on the National Service Framework for Mental Health

National Service Framework for Mental Health 1999 DOH document outlining 10-year plan for mental health services

Commissioning and Access to Psychological Therapies – DOH document in IAPT services

The Journey to Recovery – The Government’s Vision for Mental Health Care

The National Institute for Mental Health in England (NIMHE) – Establishing a Mental Health Network DOH document on the MHRN

Mental Health Review Tribunal Report – Review of aspects of mental health tribunal administration over a specific time period

Mental Health Taskforce: An Introduction DOH document overviewing the mental health taskforce.

Choosing Health DOH document on supporting the physical health needs of people with mental illness.

Making the CPA Work for You DOH booklet explaining the CPA to service users.

Breaking Down Barriers DOH document looking at changes in mental health services.

Mental Capacity Act 2005. Deprivation of Liberty Safeguards. DOH Consultation Document on the Deprivation of Liberty Safeguards.

Medicines Management: Everybody’s Business. DOH document by service users on medication issues.

DOH Guidance on cCBT. DOH document on use of computerised CBT.

ECT Survey in England – January-March 2002. Survey of ECT practice in the UK.

Best Practice in Managing Risk. DOH document on managing risk.

Action on Stigma. Department of Health’s campaign against mental health discrimination in the workplace.

Transforming the Quality of Dementia Care Consultation on a National Dementia Strategy

Capabilities for Inclusive Practice DOH document looking at a component of the National Social Inclusions Program (NSIP)

Global Perspective

Global Mental Health Series – Commentaries. Global Mental Health Series.

Barriers to Development of Services. Global Mental Health Series.

Mental Health Systems in Countries. Global Mental Health Series.

Treatment and Prevention in Low and Middle Income Countries. Global Mental Health Series.

Scarcity, inefficiency and inequity. Global Mental Health Series.

No Health without Mental Health. Lancet Global Mental Health Series.

Prevalence of Schizophrenia in China. Large epidemiological study in China.

Developing Mental Health Services in Nigeria. Paper about developing mental health services in Nigeria.

The Influence of Culture on Psychiatry in China. This post looks at a paper on prevalence of depression in China.

Mental Health Perspectives from the Carribean Diaspora – Article on factors influencing mental health in the Carribean Diaspora

Mental Health Services in Mexico

Dementia and Related Conditions

Risk Factors for Dementia

Physical Activity and the Risk of Neurodegenerative Disease

Dementia and It’s Implications for Public Health

Social Networks and their Role in Preventing Dementia

Religious Education, Midlife Observance and Dementia. Longitudinal study looking at religious education and lifestyle interactions with dementia.

Comparability of the Diagnostic Criteria for Vascular Dementia – Article reviewing diagnostic criteria for VaD

The Genetic Epidemiology of Neurodegenerative Diseases

Accuracy of Prevalence Rates in Multiple Sclerosis

Huntington Disease in County Donegal Epidemiological Study

Mental Health Informatics

Prescriber Attitudes Towards PDA-Prescription-Assistive Technology

Ubiquitous Healthcare Service Using Mobile Phone Technology

The Use of Health Information Technology in Seven Nations

The Alignment of Information Systems with Organisational Objectives and Strategies in Health Care

YouTube and Neurological Knowledge

Mobile and Fixed Computer Use by Doctors and Nurses on Hospital Wards

Why is there Paper in the Paperless System?

Junior Physician’s Use of Web 2.0 for Information Seeking and Medical Education. A Qualitative Study

Can Wireless Text-Messaging Improve Adherence to Preventive Activities?

Web 2.0 Tools in Medical and Nursing School Curricula

Software Support for Huntington’s Disease

Health 2.0 and Medicine 2.0: Tensions and Controversies

Using the Internet for Health Related Activities

Epidemiology

The Social Origins of Folk Epidemiology

Selection Effects in Psychiatric Epidemiology

Liaison Services

Comparison of Psychosomatic Clinic with Community and Inpatient Liaison Services

A Primary Care Psychiatry Program Australian paper on Primary Care Psychiatry

Comparison of Consultation-Liaison Services in the United States and Japan

Health Impact of Social Connectedness

Social Buffering Relief from Stress and Anxiety

The Social Connectedness of Older Adults: A National Profile

History of Psychiatry

Research in the Field of Psychiatry Article from 1969

What Should Psychiatrists Be Doing in the 1980’s? Interesting look back in time

A History of Human Brain Mapping Interesting article on the history of the field of human brain mapping

Miscellaneous

Bridging the Divide Between Science and Journalism

Vocational Services for People with Severe Mental Health Problems

Factors influencing children being taken into care. A large Swedish registry study looking at factors influencing children being taken into care.

Unemployment, social isolation and psychosis. Study looking at the interaction between unemployment, social isolation and psychosis.

Modelling Disease Frequency in Schizophrenia Epidemiology. Paper looking at building mathematical models for use in epidemiology of schizophrenia.

The Growth of PTSD in Anxiety Research. Study looking at the number of research articles published in this area over time.

Exposure to ‘the Troubles’ in Northern Ireland influences the presentation of Schizophrenia. Paper looking at the interaction between traumatic exposure and presentation of schizophrenia.

Community Treatment Orders. Review of a debate about Community Treatment Orders.

Demoralisation Syndrome. Review of a study examining the construct of a demoralisation syndrome.

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 [email protected]. 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.