Author: Dr Justin Marley

The book reviewed here is ‘Infotopia: How Many Minds Produce Knowledge” by Cass Sunstein and narrated by Marc Cashman. Firstly the production standards are good. Cashman delivers a solid performance and was able to hold my attention through the 7 hours and 43 minutes of the audiobook and the audio quality was clear on the 106 Mb version. Sunstein begins by looking at aspects of group psychology which influence how group decisions are arrived at during deliberation. He explains phenomenon such as reputation cascade and polarisation which have a significant influence on the outcome of group deliberation. Then Sunstein looks at some solutions to how group deliberation can be improved. Sunstein provides us with a very interesting take on future’s markets. I thought these particular insights were fascinating. He points out that future’s markets can be very accurate for the purposes of predicting events. He then takes a step back and compares this with the deliberation process to show that this is an effective means of integrating the wisdom of crowds and that this can factor in the ‘hidden’ knowledge of individuals even when using systems where there is no financial incentive. It was certainly interesting to think of the parallels between science which essentially is about making testable predictions on the basis of an understanding of phenomenon and the predictions that are inherent within the futures markets. He also goes onto give examples of companies such as google which have been making effective use of these principles. Sunstein then looks at Wikipedia and the more generic wikis and I was interested to learn that Wikis can apparently reduce project time by 50%. I didn’t see the original study but if this is the case for certain types of projects then it is certainly an area that is potentially very important for the type of information intensive work that might be involved in certrain aspects of mental health service delivery for instance. Sunstein discusses other forms of social media.

In summary I thought Sunstein’s book is a great introduction to a very important area which has maintained a relatively low profile – how groups can arrive at better decisions in the digital age. The approaches described here would benefit from further investigation in the context of healthcare delivery. In healthcare settings, there are many situations in which groups allocate time to discussing aspects of healthcare delivery on a number of levels. If the collective group time can be more effectively utilised then this would be relevant both economically and to quality of healthcare delivery. This is speculation however and the benefits could be investigated by means of small pilot research studies.

References

Cass Sunstein. Infotopia: How Many Minds Produce Knowledge. Narrated by Marc Cashman. Audible Inc. 2009.

Index

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Responses

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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 ‘Psychiatry in the Mainstream‘. This is a young blog which I first noticed on reviewing the Sport Psychiatrist blog (see review here) and I note that the author Dr Lawrence Choy has very kindly included this blog on the blogroll. On the home page, we learn that Dr Choy is from San Francisco, has a B.A in Molecular and Cellular Biology, an M.D and is currently a psychiatry resident at Stanford University Hospital.

Appearance and Design

The blog uses an effective white background throughout with black font for the text. The title pane features a picture of an inviting red sofa. At the time of writing, there are three posts on the main page. Two of the posts contain pictures complementing the articles. The articles are tagged and comments are enabled. Indeed the first article has 6 comments already. On the right hand pane, there is a chronological index and a particularly neat feature is the ability to navigate to articles using hypertext links within the calendar. There is a blogroll and the reader can subscribe to the blog posts.

Content

In the first article, Choy looks at ECT in popular culture with the now infamous misrepresentation of ECT in ‘One Flew Over the Cuckoo’s Nest’ and addresses some of the common associated misconceptions. In the second article, Choy cites characters with borderline personality disorder in films including ‘Girls Interrupted’. Film characters have been the focus of numerous articles by psychiatrists (see here, here, here and here) as they offer amongst other things a very useful opportunity for psychiatrists to demonstrate how illnesses can affect people’s lives and to be able to do this sensitively. In the third article, Choy discusses a new film (at the time of writing) ‘Shutter Island’ and uses this to discuss the subject of the leucotomy developed by Dr Walter Freeman and which has a very controversial history. There are indications for functional neurosurgery at the present time but the nature of both these indications as well as the surgical procedures has changed considerably.

Conclusions

Although this is a young blog, Choy has written some interesting articles and is using popular culture to highlight mental illnesses and their treatment and it will be interesting to follow this blog as it develops further.

Index

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Twitter

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Podcast

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TAWOP Channel

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Responses

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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 an open access article ‘Bridging the Divide Between Science and Journalism’ by Jennifer Strohm and colleagues and available here. In the abstract, the authors write that

‘…it is imperative that scientists know how to communicate their latest findings through the appropriate channels. The credible media channels are managed by working journalists, so learning how to package vast, technical research in a form that is appetizing and “bite-sized” in order to get their attention, is an art‘

The authors have written an article which reflects many of the values espoused within the article itself – it is concise, written in simple language and broken down into small paragraphs. The article contains a number of tips for scientists about how to communicate their stories to the media. At least one of the authors has a background in journalism (after I did a quick search)*. I interpreted the article as one which gives the scientist an overview of how science journalists operate and what their expectations might be.

I’ve mentioned elsewhere that the issue of how science is communicated to journalists is an area that could be addressed within the scientific community. To expand on this, I would argue that the scientists that author a paper are in the best position to do the work for the journalists. Now it might seem strange for me to say this. After all, isn’t that what the journalists are there to do? I would respond by saying that communication is a two-way process and that delegating to one party is missing the point.

Surely the body of scientific knowledge should be applied to the problem of communicating science in the first instance. If the process of discovering truth is not communicated effectively, then that ‘truth’ is effectively lost. Therefore if all the resources are put into discovering the ‘truth’ without any being allocated to communicating those results, there is a considerable possibility that most of those resources ultimately will be lost. How many papers have been published and how many articles are now collecting dust, never to be cited or indeed read again?

Indeed that leads onto another question. Of all the papers that have ever been published what percentage of them have had no impact whatsoever? Obviously this depends on the definition of ‘impact’. It could be argued that they all have an impact to some extent. People get experience from writing the papers. The editors read the papers and surely some of the readership will read even the most unpopular of papers in a journal. But just suppose we could say that a paper had no impact and that this was meaningful. If we look back through history what percentage of all papers would fit this category and is there any way we could predict which category an article would fall into? A paper might be rediscovered at a later point and the reader might then make some useful connections in which case how would we ever know that a paper has had or ever will have an impact. Obviously a line has to be drawn somewhere.

Perhaps more resources should be allocated into deciding how useful papers are. The possibility of losing valuable information by this means would be more than compensated for by using the available knowledge usefully. Returning to the earlier theme maybe a significant proportion of the journal article submission should be allocated to an easy-to-understand summary. If authors were required to do this then not only would journalists be able to understand it more easily, but so too would the reviewers, editors, readership and general public. Perhaps this has been the price that science has paid for delegating communication of science to the media.This however is beginning to change as the mainstream media with established television, radio and newspapers are being joined by the web 2.0 technologies which scientists are successfully navigating in order to communicate their work. In this environment a new relationship is being forged between science and media and both scientists and science journalists are continuing to adapt to these new changes.

*There is also a conflict of interest declaration

Index

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Twitter

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Podcast

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TAWOP Channel

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Responses

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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 ‘The Role of Theory in Increasing Adherence to Prescribed Practice’ by Hanna and colleagues and freely available here. I selected this paper as it refers to the self-efficacy construct which featured in a previously reviewed paper on determinants of healthy eating behaviour (see here). For this reason I was mainly interested in the understanding adherence behaviour and subsequent sections. However in the introduction the authors cite an important paper in which one author calculated an estimated 24.8% of patients will not adhere to medical treatment although this was a passing reference and the original paper will be interesting to look at in closer detail. Moving onto the ‘understanding adherence behaviour’ section the authors describe 5 relevant theories.

1. The Health Belief Model (Rosenstock, 1966).This is outlined in the article as a number of factors combining to influence goal-directed behaviour. These factors are the perceived vulnerability, perceived severity, ’stimulants to behaviour’, self-efficacy and what I would term a risk-benefit judgement. Essentially it seemed to be a model in which advantages and disadvantages associated with the behaviour are combined to influence behavioural outcome although I wasn’t clear on the weighting associated with each of the factors.

2. Protection Motivation Theory (Rogers, 1983). This theory incorporates threats, rewards and coping mechanisms to arrive at a judgement. While there is some overlap with the previous model there are independent factors also. It is interesting to speculate on whether these would be occurring as simultaneous or sequential psychological processes.

3. The Theory of Reasoned Action (Ajzen and Fishbein, 1980). The original theory incorporated a perception of how others viewed the effectiveness of the action and also how effective the action was going to be. This theory seems to suggest that the social milieu is an important aspect of actions being undertaken.

4. Self-efficacy Theory (Bandura, 1977). The belief a person has in being able to undertake a task. These beliefs are further influenced by physiological state, ‘mastery experiences’, ‘vicarious experiences’ and ‘verbal persuasion’.

5. Social Cognitive Theory (Bandura, 1986). The mediating factors for influencing goal directed behaviours include self-efficacy, sociostructural factors (impediments and facilitators) and expectations of outcome.

The authors compare the theories and argue that the concepts including outcome expectations in social cognitive theory encompass the concepts contained within the other models. They then look at some experimental support for the theories in physiotherapy. What I found particularly interesting about the conclusions from their analysis was the need to operationalise a theory in order to facilitate the experimental investigation of that same theory. This reminds me of the top-down versus bottom-up debate. The attachment of the finer details to the top level constructs enables assessment to take place and is similar to some of the discussion that takes place in computational biology (e.g see the blue brain project).

In summary, this was a brief paper which outlines a number of theories relevant to adherence to treatment regimens and a consideration of the experimental support in a very specific area of physiotherapy. However there is also an application of this same approach to the area of medication adherence and the concepts have a wider relevance to health related behaviours. There are enough models considered here to provide a useful starting point for further reading.

Index

You can find an index of the site here. The page contains links to all of the articles in the blog in chronological order.

Twitter

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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).

TAWOP Channel

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Responses

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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 a preprint edition of ‘fMRI Reliability: How reliable are the results from Functional Magnetic Resonance Imaging’ by Craig Bennett and Michael Miller and is freely available here. MindHacks had drawn attention to this article and it is also referenced on Craig Bennett’s blog. The article, excluding references is just under 10,000 words. Bennett and Miller refer to the Vul et al paper in the introduction, a paper which critically appraised the methodology in contemporary fMRI studies (for further details see here). They then argue for the importance of reliability of fMRI studies with a number of supporting points.

I found the section on ‘What factors influence fMRI reliability’ slightly tricky to get to grips. Although the authors have explained the concepts throughout the paper very clearly, I hit a stumbling block with the CNR and SNR. The difficulty I had with the SNR is that it is defined by dividing the mean signal intensity in a volume region by the standard deviation of signal strengths of voxels in that region. The difficulty I had here however was more of a philosophical one. The ratio in itself seems to contain some implicit assumptions. How do we know for instance that the variation in signal intensity across voxels is a marker of noise. Suppose for example that the fMRI scanner performed perfectly, capturing the data without error. Would we not expect to see a wide variation in voxel activity in a region or would we see very little variation? I don’t know on what basis we could argue which of these should be more likely. If we don’t know the answer to that, then for me, it is difficult to know what the noise and the signal will ‘look’ like.

Similarly with the contrast ratio. If we were taking a photograph of a scene and displaying this photograph to convey useful information e.g a portrait, then clearly contrast is going to be very useful. If there is a difference between two pixels then ‘maximising’ this difference suggests a transformation of this data. Surely this would be dependent on the amount of information stored within the image which is effectively the resolution of the image. If the image is stored digitally then the detail within the image would be a function of both the number of pixels in each layer as well as the number of values each pixel can take. However we are talking of volumes here and would therefore replace pixels with voxels. The more voxels that are possible within the image capture, all other things being equal, the higher the resolution. So I could only see the CNR making sense if it represents the ‘range’ of signals possible within a voxel which would be a function of the equipment. This for me, means that there is a difference between the SNR and the CNR because the former is dependent on the brain activity whereas the latter might be a function of the equipment (although I might be wrong about this).

The difficulty in relying on the brain’s activity for the signal to noise ratio can be illustrated as follows. If we take a snapshot of the brain’s activity at a moment in time or across time why should the reality not be a messy blur of activity that doesn’t make much sense to us. After all our brain’s didn’t evolve to inspect fMRI scans. The bottom line in the argument is why shouldn’t the brain shift it’s activity very subtly when responding during tasks? Sure, it could do some very dramatic shifting which would be easy to pick up in the scan, but on what basis are we arguing that there should be a dramatic and not a subtle shift. A subtle shift might represent a small change in activity of individual neurons across a wide network much as might be expected in the neural networks that have been used to simulate brain functions and perform useful tasks. Here subtle shifts in the weightings of individual synapses in a network are sufficient to store complex information with little change in the overall ‘energy’ of the network.

So moving onto the remainder of the paper which utilises the earlier discussion of CNR and SNR. They cite research showing that doubling the field strength of the MRI scanner from 1.5T to 3T results in a 1.3 fold increase in the CNR. The SNR increases with a doubling of the field strength also although I didn’t fully understand the rationale as I’d got stuck earlier as described above. What I found interesting was the large number of factors that influence the image quality and the authors cite a noted example of a faulty light bulb which produced patterns in the resulting images (presumably though these would have been different from the brain activity). This was one clear example of extraneous noise that would interfere with the brain signal.

They also describe the subtle alterations in methodology that are required between different strength scanners to optimise signal-to-noise ratios. In the section on ‘SNR considerations of analysis methods’, the authors raise some very interesting points about the transformations of the data that are used. For instance, I was intrigued by the smoothing operations that are used to reduce error. Smoothing of the data sounds to me like averaging and this would effectively ‘remove’ outliers. However, who is to say that the outlying data is not important – perhaps one area drives the others. My argument here is not for nihilism but rather for an explicit elucidation of the underlying assumptions inherent in each stage of the data analysis. If any one of these steps is adopted uncritically into the wider neuroimaging culture then there is the risk that it will become a ‘ritual’ rather than a useful and relevant analytic procedure. For each hour of effort put into analysing data surely two hours should be put into the reasons for why the data is analysed the way it is (Ok entirely arbitrary but just for the sake of the argument). After all, it is a simple enough matter to automate the data analysis procedure but it is the choice of analytic procedures which is the key.

The analysis of the equipment is relatively easy (although this is extremely complex as discussed above). But on this scale of complexity, if analysis of the equipment is the easy part then when it gets to assessing the subjects, this really takes the biscuit. Start asking whether one subject varies from another and you enter the tangled web of philosophy, psychology, neuroanatomy, neurophysiology, neuropharmacology and any other discipline which bounds on this question. Take genetics for instance. Do some people experience synaesthesia as a consequence of genetics. If so, does that mean that there are subtle differences in the wiring and consequently on aspects of brain functioning and therefore activation under specific tasks. If so, then how many genetic factors are relevant. And if this is the case for synaesthesia then why not for every other brain function? How many brain functions are there? How many combinations of brain functions are there? Can a person have several gene-brain function changes relative to another person? If so, how many combinations are possible? How do you determine which combinations are present? What sample size would you need for each combination? This argument rests on an assumption of brain modularity which isn’t necessarily the case. But even here this is just one tiny part of the argument. What role does the environment play on each person? The effects of environmental insult, learning, nutrition, exercise, motivation and so on.

The section on fMRI reliability focuses on some philosophical questions which are inescapable. If you retest a person on the same task, then how do you determine if the imaging method is reliable. This is a problem common to psychometric tests. If there is perfect test-retest reliability in the same person, then something’s wrong with the test because people can change with time. This basic problem underlies the neuroimaging paradigm also. The authors describe a number of statistical methods for assessing the test-retest reliability in voxels. What I found most interesting here, was the concept of analysing the whole brain activity which the authors point out has happened infrequently. This seems a very thorough approach to the question but at the same time I would expect there to be little reliability in this approach if there is intrasubject variability in the same task with time as well as a modular approach to brain function.

The authors use three methods of assessing test-retest reliability

1. Cluster overlap. Dependent on voxels meeting a threshold in both test and retest which is a drawback of this method.

2. Voxel counting. Looking at voxels which are active in both test and retest.

3. Intra-class correlation. Matching not just the activity but the magnitude of that activity in voxels in the test/retest conditions

The authors set out their search strategy. I wasn’t able to find the search years used. They use the PubMed database and use a simple search strategy followed by a hand-search of the retrieved papers. The results are illustrated in full in tables 1, 2 and 3. From table 1, it was shown that the mean range of ICC across the tasks in the multiple papers was on average 0.58 which I thought was quite a large range. The cluster overlap varied from 0.21 to 0.865 again showing quite a large range.

What I found interesting were not the answers to the bigger questions as above but rather the secondary findings. For instance, the authors note that there is greater test-retest reliability in tasks assessing motor function in comparison to cognitive function. Perhaps this reflects the relativel complexity of the cognitive tasks and/or the increased space of viable solutions. There was no consensus on what values should be used for test-retest reliability. There were some potentially interesting findings in clinical groups but I wasn’t sure how to interpret these in view of the wide variation that was found across all of the above studies. A between-centre variability of 8% in terms of the BOLD signal seemed quite good relative to the inter-subject variability.

The authors conclude by suggesting a number of improvements that could be used in research including increasing task length, the strength of the scanner, the use of genetic algorithms in task construction, quality assurance methods and a mock up of the task beforehand to ensure the subject has understood the task. They then look at where neuroimaging might go next and suggest the importance of analysis of large data sets and ‘provenance’.

I thought this was a very interesting paper and the authors have a talent for explaining complex subject matter in a way that can be understood by the interested reader who might possibly have little background in the subject. I can’t help feeling however that fMRI research really focuses on the very core of what the brain is doing and that the tool is giving yet another window onto the complexities of the brain. What I mean by this is that the solution may not be in the images themselves but rather in the understanding of the images by triangulation with other areas of knowledge. Indeed it seems to me inescapable that the fMRI data cannot be interpreted in isolation from psychology, neuroanatomy, neuropharmacology, neurophysiology, psychiatry, computational neurobiology, cellular neurobiology and philosophy. Perhaps a consensus needs to be arrived at not just within the neuroimaging community but with members of these other communities. Such a consensus would need to invoke optimal methods for deliberation within groups (see Infotopia by Cass Sunstein for further information on this subject) to ensure an unbiased consensus which maximises the use of specialised knowledge within the group settings and which hopefully would enable optimal research strategies to be devised and blind alleys to be avoided.

Index

You can find an index of the site here. The page contains links to all of the articles in the blog in chronological order.

Twitter

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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).

TAWOP Channel

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Responses

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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.

Some people with epilepsy may develop psychosis between seizures – interictal psychosis and the prevalence varies between 0 and 16% (Trimble, 1991)(Umbricht et al, 1995). In a Japanese study published in the British Journal of Psychiatry 285 people who had developed both epilepsy and interictal psychosis were assessed (Adachi et al, 2010). The researchers found that the time interval between onset of epilepsy and interictal psychosis displayed a skewed distribution (to the left i.e closer to the onset of epilepsy). The researchers were also able to better characterise the relationship between interictal psychosis and epilepsy in their sample. Thus a family history of psychosis was associated with earlier onset of interictal psychosis as were the generalised forms of epilepsy. The researchers conclude that there were independent risk factors for both epilepsy and interictal psychosis as well as possible shared risk factors.

Dimebon has been a candidate treatment for Alzheimer’s Disease after an initially promising trial reported in the Lancet (see here for further details) and is used in Russia as an antihistamine. However the results of two Phase 3 trials have been recently reported. In the CONNECT study – a double-blind, placebo-controlled trial (n=558), Dimebon did not meet statistically significant improvements on the primary or secondary points relative to placebo. There is still another trial in Huntington’s Disease underway and the company have further information on Dimebon here.

There is a report here on a recent study in Biological Psychiatry (see here) showing evidence of decreased time to remission of depression in a trial of Scopolamine compared to other classes of antidepressants. Scopolamine is a muscarinic antagonist and the tricyclic antidepressants also act on these receptors in contrast with the SSRI’s. There were 23 subjects in this double-blind placebo-controlled cross-over trial and there was both a statistically significant improvement (p=0.001) and clinically significant improvement (32% reduction in MADRS scores compared to 6% in the placebo in the first phase of the study.

There was a recent study (also covered here) in rats which found that suppression of Vasopressin secretion interfered with the ability of adult rats to recognise baby rats.

This adds to other research from the same research group which suggests that Vasopressin may be involved in the formation of emotional memories which are important for social interactions. If this is replicated in humans then it would have application in social cognition which in turn is relevant to a number of conditions.

In another widely reported study, a team have collected intestinal bacteria from a sample of 124 European subjects and sequenced the genomes of the 160 bacteria identified. The resulting genomes when combined into a ‘metagenome’ are larger than the human genome and the significance of this for human illnesses will surely become clearer with time.

There’s a write-up here of another study looking at sleep in African and Hispanic Americans (n=1107) and finding an association between sleeping either less than six hours or more than 8 hours a day and the accumulation of visceral fat. The study was published in the journal Sleep (see here) and was a longitudinal cohort study with various measurements at 5-year intervals. These findings are potentially important in view of other research showing increased mortality in groups with this amount of daily sleep compared to those who sleep between 6 and 8 hours daily. This new research is examining the pathways involved and in turn this information can be potentially useful in stratifying risk although this would require further research.

Psychiatry 2.0

Mind Hacks has two interesting articles. The first is the weekly spike activity in which he links to coverage of a recent neuroimaging study identifying an association between activity in the ventral striatum and perception of inequality. There is also a link to the research blogging awards and an article on the Vul paper on fMRI (see here for further details on the original paper) is in contention for an award. The second article is a look at a recent study published by Craig Bennett and looking at the test-retest reliability of fMRI studies. Bennett produced the tongue-in-cheek paper in which he ‘found’ activity in the brain of a dead salmon and used this to emphasise the importance of correct methodology (see here for further details). The current paper is useful for the appraisal of fMRI papers by the interested reader.

Dr Shock is ever generous with his tips and in this article talks the reader through ‘read it later’, a browser plug-in that’s particularly useful for bloggers. The Differential Biology Reader discusses crowdflower, a piece of software for organising research.  Dr D has an interesting article on transitional objects. The CogSciLibrarian has a piece on Facebook and the ‘Theory of Mind’ while Dr Deb looks at Japanese mobile software that analyses the power spectrum of infant’s cries and suggests why they might be crying. At PsychCentral, Dr Tomasolu has a piece on positive psychology and how to achieve a balance between negative and positive thoughts. Dr Brandemihl has a short piece on Transcranial Magnetic Stimulation in the treatment of depression anticipating an article that is due to be published in the Archives of General Psychiatry.  Corpus Callosum takes a look at 2 American Journal of Psychiatry articles on the relationship between diet and mental illnesses.

Evolutionary Psychiatry

There is an interesting write-up on a recent hypothesis by Professor Wheeler that cooking food may have led to an increase in brain size. The essence of the argument is that cooking reduces the amount of energy needed to digest food. In moving from Austrolopithecus to Homo Erectus and Homo Habilis there was a reduction in the size of the intestines and an increase in brain volume.

The argument is that these anatomical changes were causally related to corresponding behavioural changes which enabled a significantly higher proportion of the body’s resources (i.e energy) to be allocated to the brain. Indeed this has been the subject of a Horizon programme which is available for a limited time here. There’s another interesting write-up, this time of a conference examining the ‘Origins of Human Uniqueness and Behavioural Modernity’. Discussion took place around a number of subjects including the possible role of gifts and adornements particularly in the role of signalling social status.

References

Adachi N et al. Epileptic, organic and genetic vulnerabilities for timing of the development of interictal psychosis. The British Journal of Psychiatry. Vol 196. p212-216. 2010.

Trimble MR. The Psychosis of Epilepsy. New York: Raven Press, 1991.

Umbricht D, Degreef G, Barr WB, et al. Postictal and chronic psychoses in patients with temporal lobe epilepsy. Am J Psychiatry 1995;152:224–231.

Index

You can find an index of the site here. The page contains links to all of the articles in the blog in chronological order.

Twitter

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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).

TAWOP Channel

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Responses

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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 podcasts reviewed here are the 18th and 19th episodes in the series of Mind Podcast by Arjen ter Hoeve. In the 18th episode in the series (available here) Hoeve talks about classical conditioning. He takes the audience through the process of classical conditioning explaining terms such as the conditioned stimulus and response, extinction and stimulus generalisation. He gives examples to illustrate these concepts. As I was listening I thought it was interesting to think about the possible clinical significance of this material. The application in treatment of phobic disorders is well established. Similarly there is experimental evidence for a possible role of classical conditioning in depression although many other explanatory models are also used.  Expanding upon this it could be speculated that perhaps nidotherapy may be a useful approach for certain disorders if in the process it involves a minimisation of exposure to conditioned stimuli or objects which are associated with stimulus generalisation.

In the 19th episode (available here), Hoeve looks at operant conditioning and modelling. Operant conditioning involves a modification in behaviour with the stimulus following this behaviour. This is in contrast with the classical conditioning discussed in the previous podcast where the stimulus occurs prior to the behaviour. There are various methods for delivering the stimulus as well as a number of observed phenomenon such as extinction that occur. There is a short musical interlude and Hoeve also introduces a section about influential figures in psychology. He then covers modelling or observational learning giving his own examples from the cinema and then commenting on wider culture(s). Hoeve has more relaxing music in the background and provides the listener with further interesting material with both of these episodes providing a broad overview of three well characterised forms of learning.

Twitter

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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).

TAWOP Channel

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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 ‘The Sports Psychiatrist‘ by Dr Zaakir Yoonas. I had become aware of this blog after Dr Yoonas had very kindly commented on one of my earlier posts and I was interested to learn more about this blog. Other psychiatrists have played an important role in sports. For instance psychiatrist Dr Steve Peters has been involved in the preparation of the extremely successful British cycling team at the last olympics (for further details see here).

Appearance and Design

The blog is hosted at blogspot and uses a white background throughout. The articles lie in the central pane, are single columned with black font, orange headers with dates and generous use of high quality illustrative photographs. The title pane contains a photograph of a suited man in a running pose with the caption ‘Thoughts on the mental aspects of athletes and competition’. Immediately below the title pane is a disclaimer while to the right an About section informs us that Dr Yoonas is a psychiatry resident at Stanford. The right hand pane contains useful links to Dr Yoonas’s twitter account, links to external blogs and a navigatable chronological index of the site. The latter index is extremely convenient for rapidly accessing articles.

Content

The blog is relatively young. The first article is dated August 2009 and there are 22 articles in total at the time of writing. The articles are several paragraphs long and focus on various aspects of the intersection between psychiatry and sports. A number of articles examine news stories about sports people and expand on psychiatric aspects of these stories. So for instance there are articles on angry outbursts and how these can be managed, the effects of chronic stress, as well as a piece on traumatic brain injuries. Dr Yoonas also covers a number of interesting research studies such as this one on an association between depression and injuries in athletes. I also found an article on ‘where do winners go next?’ quite interesting. Dr Yoonas cites research which suggests that maintaining success is associated with a focus on process rather than the expectations of others. This perhaps is not just applicable to sports but to other areas of human endeavour.

Conclusions

This is a relatively young blog with some very interesting articles on the intersection between sports and psychiatry. I thought that Dr Yoonas is able to effectively bring an emotional element into the articles which helps him to connect with his readership and highlight common and treatable mental illnesses. There are other articles on improving human performance which are important for the emerging area of mental well-being and so this blog will have a broad appeal.

Index

You can find an index of the site 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).

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 audiobook reviewed here is ‘20th Century European Philosophy’ by Professor Ed Casey and narrated by Lynn Redgrave. Redgrave narrates quickly and with an authoritative style and is also supported by a male narrator (who I couldn’t find in the credits of my version of the book) who impersonates the various philosophers complete with a french or german accent as appropriate. Having had no training in philosophy but having listened to a number of other audiobooks on philosophy, I thought Casey explained the material well communicating tricky concepts which I was able to understand on first listening to the book. He discusses Husserl, Heidegger, Derrida, Sartre and Foucalt amongst others.

There were a number of points of interest that I came across. Firstly Husserl had apparently suggested that logic had psychological underpinnings rather than logic being derived de novo and had been involved in arguments with a prominent logician of the time over this who had reviewed his book on the subject. The relationship of maths and psychology for instance has been written about elsewhere and is interesting to know that the subject can be traced back to Husserl. I was also interested to learn that a figure Brentanao had influenced both Husserl and Heidegger and so it would be interesting to learn more about this man who had perhaps had a significant effect on 20th century European history.

Moving from Husserl to Heidegger the emphasis of existentialism changed from a consideration of intentionality and consciousness to that of being and the importance of considering time. What I also found interesting was how Sartre had essentially argued against some of Heidegger’s concepts and had also been awarded the nobel prize in literature (although he declined this) both of which argue against my ill-informed preconception of philosophy as a progressive body of knowledge arrived at through reasoning. I was also intrigued by the concept that the brain would actively produced ‘nothingness’. Merleau Ponty’s emphasis on the body was also interesting and something that I will probably need to read a little further on. Much of the material here I thought would be relevant to psychiatry, most notably the phenomenological movement and the philosophers described in this book have influenced many aspects of qualitative research.

In summary, I thought that this was a good introduction to the works of some of the most prominent European philosophers in the 20th century with the material being very clearly explained and well presented.

References

Professor Ed Casey. 20th Century European Philosophy (Unabridged). Narrated by Lynn Redgrave. Blackstone Audiobooks. 1996.

Index

You can find an index of the site 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).

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 a Department of Health document  ‘Impact Assessment of Autism Strategy’ and freely available here. An impact assessment is used to assess the likely consequences of a policy. A good description of what an impact assessment means is found here. This impact assessment examines the likely consequences of the Autism Strategy (details of the autism strategy can be found here). The Autism Strategy is an important policy which has multiple aims including achieving an increased awareness of autism as well as ensuring that people with autism gain access to the services that they need. While i’m familiar with impact assessments, this is the first one i’ve seen. The document is fairly brief and if the reader moves to the end of the document there is a ’specific impact test’ checklist. This summarises some of the information that has been used in the assessment. There is a long column of no responses in the evidence base column for this checklist.

On returning to the main document and reading through this, there are lots of very sensible suggestions about the costs and benefits of different parts of the strategy. These were made, I thought, using a top-down approach which I would contrast with the bottom-up approach associated with evidence-based approaches. I thought perhaps that some of the more detailed assessments of the impact would become apparent if pilot programs have been completed for instance. There are undoubtedly many approaches to increasing awareness which would be expected to have different effects. I was impressed by the structured approach which follows from the strategy in trying to improve the quality of life of people with autism in the population.

Society and culture are complex entities. To what extent does a population continue along a ‘natural’ trajectory and to what extent can the ’ship be steered’ in a particular direction? This question is applicable not just to the autism strategy but also to social interventions in other conditions. So if we take one extreme. Suppose somebody puts up a sign outside a shop which says think about employing people with autism. Suppose also that this was repeated in every city, town and village in the UK. This would be costly but I would also say that this is ‘passive’. People walking past can see the sign but they do not necessarily have to respond. Maybe a small percentage of people in a position as employers will go on to employ people with autism on the basis of seeing these signs. I’m not sure what percentage it would be. A percentage of people with autism would be employed who might not previously have been employed, members of the general population would have increased exposure to people with autism and also those people with autism would have increased exposure to the general population. Thus inclusivity is increased. For argument’s sake, let’s say that 5% of all people with autism who can be employed but are not presently, receive work through this means. That means that the population has ‘moved’ very slightly in the desired direction and optimistically we might say there has been a slight improvement in the overall quality of life of people with autism (there are a lot of assumptions in this last statement).

However  because the job market is a competitive market, even with the increased awareness, people with autism will face competition for jobs. One assumption could be as follows. If awareness needs to be raised for people with autism, then without this people with autism might be at a disadvantage in getting jobs. Why would this be so? Perhaps through stigma in the general population – after all would there be a need for an autism strategy if inequalities did not already exist? But where does stigma come from? Autism is a relatively recent diagnosis that has been around for some 60 years. There is a likelihood that the stigma arises not just because someone has been given a label of autism but from something independent of labels and diagnoses. This something else is typically what would lead to the pathway to diagnosis in the first place. Without the formal pathway, it is left to members of the general population to make their own judgements which is what people tend to do. People with autism cannot be stereotyped. They can be highly individual. However they can have difficulties with communication – for instance non-verbal communication. So perhaps members of the general population might make a note of these difficulties and make a judgement. This in turn might play a role in the job market and may or may not put the person with autism at a disadvantage.

The end result is that while the general population might move in a certain direction passively with advertising campaigns, there will still be a lot of people who don’t know what autism is. Maybe some people who are educated about this might forget. Or they might remember and still their prejudices remain. So returning to the original question, can social engineering succeed? The formal and reasoned process outlined in the document meets society which can respond explicitly and formally but also implicitly and covertly.  What would be interesting is to see how the two are differentiated. There have been advertising campaigns to raise awareness of different illnesses. How much exposure to the messages do people need? I would argue that a subtle marker of how much awareness there is in society is reflected in figures of high status. For instance how many people with regular programs on the television or radio have autism? Why are people with autism not included in society as much as they should be? There will probably be many reasons that people would give for this and perhaps that people with autism themselves might give.

What would happen if there was explicit legislation for autism? So for instance, what if employers were required by law to include people with autism in the interview process at least or perhaps would employ people with autism in a certain percentage of positions in large organisations? As with the arguments above, this might lead to an overall improvement in the quality of life for people with autism (again with various assumptions). Employers who are unfamiliar with autism might need to learn about autism. Or they might not. Would employers need additional skills and therefore need training? What skills would they need? People with autism might need routine and might become distressed if this is not present. However everyone is different and so it would be dependent on the individual. These types of questions though are quite useful to ask, particularly in a research setting. What percentage of employers think they require additional training? What percentage of employers actually do need it in practice? How does this vary from one job to another? What additional training might people with autism need to help them manage better in different environments? How does the type of training interact with their individual qualities? Obviously there are lots of questions. Quantitative responses to these types of questions are useful beyond impact assessments and apply to the development of services and effective integration of people with autism into society.

So in summary, I thought this impact assessment gives a broad overview of how the autism strategy might impact on practice. There are lots of interesting research questions that can be asked about this. Each question can take us in a different direction and provides us with many possible interpretations of how to act on the knowledge gained. Hopefully, like the dementia strategy, the autism strategy will have many benefits for the people that it is designed for.

Index

You can find an index of the site 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).

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 a brief round-up today.

An fMRI study provided evidence of different regions involved in learning new verbs (left posterior temporal gyrus and left inferior frontal gyrus) and nouns (left fusiform gyrus) as well as a relationship between hippocampal activity and the efficiency of learning new nouns. This information could be of relevance to a number of conditions which involve disorders of language and memory. For more information on the study see here.

A study involving neural prosthetic devices in people provided evidence of the function of the beta and delta oscillations identified in the EEG. Based on their findings about the timing of the oscillations, the researchers concluded that the beta oscillations were strongly associated with anticipating commands for initiating movements. For more information see here.

Discover reports on some experimental evidence to suggest that smells and sounds are perceived together as hybrid ’smounds’ – at least in a murine model. These conclusions are based on the activity of cells in the olfactory tubercle which respond not only to smells but also auditory tones presented alone or in combination with smells*.

Vaughan Bell has a good round-up of Spike Activity where he looks at the recent findings on the XMR virus in Chronic Fatigue Syndrome amongst other studies.

Brain-Derived Neurotrophic Factor has been suggested as a possible therapeutic intervention in dementia. The authors of a new study reported on here found that slow versus rapid application of BDNF to cell cultures had different effects and this is discussed further in the report.

* Since smells are closely related to taste it is tempting to speculate that this could even be relevant to Pavlovian conditioning if confirmed in other species.

Index

You can find an index of the site 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).

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 podcasts reviewed here are the 17th  episode in the Mind Podcast series by Hoevens. In episode 17 (freely available here) Hoevens discusses sleep, hypnosis and psychoactive drugs in an episode lasting over 50 minutes. When looking at sleep, Hoevens describes the stages of sleep and the nature of the circadian rhythm. Although not delving too deeply into this very complex subject, Hoevens discusses dreams with a passing reference to Freud and also some interesting facts about sleep. Hoevens then covers hypnosis briefly while linking in with previous material on filtering of sensory information in the perceptual process. He finishes of with a look at psychoactive drugs. He emphasises the associated health risks. There is a lot of material covered here and I found it to be at a slightly more basic level than in previous podcasts which perhaps reflects the amount of material that was covered.

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).

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 book reviewed here is ‘Delete’ by Victor Mayer-Schonberger and narrated by Dennis Holland. Holland narrates at a moderate pace and with an upbeat style.  In the book, Mayer-Schonberger argues that the digital age has created a permanent store of memories which now poses a challenge to society. At several points he discusses individual memory in more detail, for instance outlining some of Baddeley’s ideas on how memory works. He compares the permanence of digital memory with the impermanence of biological memory and with the impermanence of cultural memory through the ages due to the absence of large-scale methods of storing memories. The large scale methods of storage later appear in the form of books and I was intrigued to hear of the output of scribes in the early middle ages in contrast to the capabilities of the printing press.  Mayer-Schonberger argues that the permanence of memory in the digital world has arrived suddenly:

‘A world without forgetting is difficult to predict‘

He provides the audience with some case examples showing how these memories have been problematic but argues speculatively that people will doubt their own memories if presented with ‘perfect’ digital memories of their life, many of which they themselves will have ‘forgotten’. Mayer-Schonberger also argues that our memories are impermanent because we ‘become’ someone different with time, learning from our mistakes. I thought these were perhaps existential themes and it was interesting to see them being considered in relation to the use of information technology.

The essence of Mayer-Schonberger’s argument is that we should have some degree of control over our personal information and he suggests digital rights management as a possible solution which he then further expands upon. He even suggests that such information can be monetised and I was somewhat bemused to think that the concepts of some of the existential philosophers might form the basis for a digital economy.

Going off at a slight tangent, Mayer-Schonberger’s arguments made me consider Jung’s writings on archetypes. If as Jung suggested, we have a collective unconscious that is stored within culture then how would this be affected by the advent of our present age of digital permanence? Would such archetypes, if they exist, be affected by the abundance of cultural memories stored without decay in our digital world? Would they become distilled within the ever expanding cultural heritage that is available on demand, where society is in the process of creating subculture upon subculture?

It would be interesting to see the results of general population-based surveys to see if people would want to manage their personal information in this way and perhaps a small pilot study to see if it is feasible and is capable of producing the expected outcomes. Even if all of this pointed in the right direction there would still be the matter of making it work economically which is obviously an important test of any technology.

Mayer-Schonberger has tackled an important issue in the digital age and it will be interesting to see how things develop in this area.

References

Viktor Mayer-Schonberger. Delete (Unabridged). Audible Inc. Narrated by Dennis Holland. 2009

Index

You can find an index of the site 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).

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 ‘The social origins of folk epistemology’ by Hugo Mercier and available here. The paper is one of a series in the journal ‘Review of Philosophy and Psychology’ and I thought it interesting because Mercier develops an evolutionary argument for some of the properties of ‘reasoning’. Mercier presents his arguments very clearly and includes any additional material that might be needed by the reader thus avoiding the need to refer to additional papers (except perhaps for the explanation of the tests which are used to examine reasoning). In the introduction, Mercier presents two views of the function of reasoning. In the first, reasoning is to be used in discussion with others (or more specifically in arguments and persuasion) and in the second is used in rule-based systems to compensate for the innaccuracies that can sometimes result from intuition. The definition of reasoning is important for the discussion and he refers to tasks such as the Wason Selection Task which essentially tests the subject’s ability to use deduction (see here). Mercier cites the arguments of others who have proposed how reasoning might have developed in the progression from animals to humans. I thought perhaps it was entirely possible that non-human species are capable of reasoning. There certainly seems to be some evidence emerging in that direction particularly in chimpanzees. If that were so, then some of Mercier’s arguments would need to be amended since they are contingent on the assumption that reasoning has evolved specifically in humans and that it must be consistent with other unique properties of humans (strictly speaking this is not entirely true as Mercier does argue that reasoning does not take place in ‘most’ other animals although the explanation of ‘most’ is not expanded on at a later point). If considered in this manner, then it could be argued for instance that the process of deduction or more general features of logic are in turn dependent upon cause and effect (I have argued this elsewhere). These in turn are evident in the physical world and a ‘knowledge’ of how the physical world works is a necessary part of survival for most species (this statement is contingent on the definition of knowledge and I have used it here to exclude simple organisms without a nervous system which is capable of storing knowledge although even here it could be argued that ‘knowledge’ about the world is stored in the ’successful’ genes contained within DNA).

However we can be certain that humans are able to reason as defined above and so it does seem like a sensible starting point. He argues that reasoning doesn’t necessarily replace other cognitive functions and as such would have an additional ‘cost’ – meaning that additional resources have to be allocated to the reasoning process (presumably genes, neurotransmitters, electrochemical energy in nerve transmission, time for neuronal firing and so on). I would argue here though that just because there is cost, it does not necessarily mean that it serves a necessary function for survival. Adaptation to the environment particulary in more complex organisms may not necessarily be an entirely ‘efficient’ process. He goes onto discuss communication and suggests that it is more complex than at first glance. Quite specifically he refers to deception and suggests that people have evolved mechanisms for detecting deceit.

The next stage in Mercier’s argument is quite interesting. He essentially argues that persuasion is an important part of communication and for this to take place, the person has to have an understanding of the other person’s beliefs and knowledge. It is the process of gauging these as the starting point for communication which requires a specific cognitive process which he suggests is reasoning. He then goes onto look at how reasoning has been used in groups and how in some situations the group may arrive at better decisions than the individual and in others worse decisions.

In summary, I thought Mercier’s paper was clearly argued and that he developed a particularly interesting argument around a role for reasoning in persuasion. If this holds then it would have implications for social cognition.

Index

You can find an index of the site 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).

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 ‘Determinants of Healthy Eating: Motivation, Abilities and Environmental Opportunities’ by Johannes Brug and freely available here. I thought was a useful topic to examine as patterns of eating behaviour can influence outcomes in a wide-range of mental illnesses and are indeed used in the diagnostic criteria of a number of illnesses. So it seems reasonable to ask what models are there relating to eating behaviour. Brug presents a very broad psychosocial model and I was particularly interested in the intentionality aspect of the psychological component of this model. He outlines a structure proposed by M Rothschild in which motivation, ability and opportunity provide an explanatory framework. The article is relatively brief and consists of an overview of a model of healthy eating determinants together with a precis of some of Brug et al’s  systematic analyses of intervention or observational trials relating to eating and modifiers of eating behaviours. He cites a model in which four determinants of intention are outlined – these are

1. Attitudes. The evidence base here points to a weighing-up of short-term and long-term outcomes – benefits and risks. Short-term outcomes are prioritised. Thus for instance short-term factors such as a pleasant taste would outweigh long-term health risks.

2. Self-efficacy. The extent to which a person believes that they have control over their behaviours will influence these same behaviours.

3. Self-identity. Apparently there isn’t much evidence in this area.

4. Social influences. According to the ANGELO framework these are divided into Axis 1 and Axis 2. Axis 1 consists of micro-environments – immediate locations for food e.g shops and macro-environments which consists of informal infrastructures which influence eating behaviours. Axis 2 consists of physical, political, economic and socio-cultural factors.

In terms of the trials, Brug tells us that the data could be stronger but draws conclusions about the importance of parental influence, modelling and social support, accessibility and availability of healthy/unhealthy foods and socioeconomic factors. In summary Brug presents us with a simple model of determinants of eating behaviour but a knowledge of this model can be used to offer another perspective on relevant illnesses.

Index

You can find an index of the site 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).

TAWOP Channel

You can follow the TAWOP Channel on YouTube by clicking on this link

Responses

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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 ‘Roles of the Insular Cortex in the Modulation of Pain: Insights from Brain Lesions’ by Starr and colleagues and freely available here. This is of relevance to a model of the insular cortex and emotions which i’ve been working on (rather slowly!). The researchers have identified two subjects who had developed middle cerebral artery strokes with resulting right sided insular lesions. They compare these subjects with a healthy control group and examine how pain is processed using a number of different methodologies.

Methodology

The methodology is complex as the study consists of multiple components – assessments of pain intensity, the unpleasantness of the pain, a characterisation of the individual responses to the pain and a between group comparison. 2 subjects with strokes involving the left Insular cortex were identified. They were compared with 14 healthy controls with a mean age of 59. The subjects themselves were aged 53 and 59. If the control group were healthy then I interpreted this as meaning that there was no significant medical illness. However conditions such as hypertension and diabetes are more prevalent with increasing age and it could be argued therefore that since the controls are reported as ‘healthy’ then they may not be representative of the general population. Additionally there might be expected to be evidence of white matter lesions however small in at least some of the control group although these are not reported although if they did exist they might not be too important for the current paradigm.

Subjects were administered a visual analogue scale for pain intensity and pain unpleasantness. Short and long duration noxious stimuli were applied to the calf (as this was unaffected by the lesions in the two subjects). Tactile and thermal thresholds were also identified in all subjects. fMRI was used to investigate brain activation during presentation with stimuli. There were parts of the methodology I didn’t understand even after looking for further information. The difficulties I had were with the ’statistical analysis of regional signal changes within the brain’. For ‘pain-related activations’, the researchers used ‘boxcar activations’. Boxcar functions are described here. This much is reasonably straightforward. The researchers are modelling the pain activations (presumably in the brain regions) as signals of finite duration with a specific and constant amplitude meaning that if graphed against time it looks like a rectangle with no activity on either side of the signal. The use of activations suggested to me that they were referring to brain activations, after all this part of the study is concerned with fMRI. They then refer to the regressor and here I wasn’t entirely clear which variable they were referring to. They add that

‘the regressor was convolved with a gamma-variate model for the hemodynamic response … and its temporal derivative‘

I hadn’t come across the term convolved before but it appears to mean that two functions are combined (there’s a good illustration here). I presume that the gamma-variate model is equivalent to a gamma-distribution which would be determined by the relevant parameters. The individual components make sense but I couldn’t put it all together. The regressor (what is the regressor in this case?) is combined with a model of the hemodynamic response. The hemodynamic response is the change in blood flow to the region of interest representing a proxy marker for cerebral activity but why is the regressor being combined with this response? Why for instance would they not be using a correlation between the VAS responses and the hemodynamic response (approximated with the gamma-variate model)?  They further add that they are using a temporal derivative of the hemodynamic response. Presumably this would then refer to a change in change in blood flow (if the derivative is being used in the calculus sense) but why would they be interested in this? So, I couldn’t understand this section although the remainder of the paper was reasonably straightforward and in effect I had to then accept the results for this part of the paper without fully understanding the process. I have argued elsewhere that there is a place for having an accompanying video with papers (for instance that could be freely hosted on YouTube) and I suspect that a 5-minute video could save the reader at least 30 minutes of reading around the subject (or more) particularly when multiple methodologies (some esoteric) are being used. The end result is that when presented with the noxious stimuli, the researchers have used fMRI on the 2 subjects who have had a stroke and also the healthy control group to image where the activation is taking place. The methodology is more involved than that but I thought these were the most salient points.

Results

With a complex methodology there were lots of results. The ones I found most interesting were as follows

1. Patients 1 and 2 had involvement of the Sensory Cortex and Basal Ganglia as well as the Insular Cortex from the strokes.

2. Subjects 1 and 2 differed subtly in the regions that were affected

3. Subjects 1 and 2 had increased pain intensity (on the affected side) but lowered pain unpleasantness in response to the noxious stimuli in comparison to the control group

4. In the subjects, the affected insula was not activated in response to pain which the researchers reasonably suggest is due to the damage resulting from the stroke

5. In response to pain, in one of the subjects the prefrontal cortex is activated in contrast with the control group which the researchers suggest is being additionally recruited in processing pain without the insula being active.

6. Without going into the details too much, the researchers have identified somatosensory cortex activation on the side where the insula is not active which wasn’t present in the control group. They interpret this as meaning that this activity is not reliably picked up when the insular cortex is active. Does this mean that some areas mask others in fMRI studies?

Conclusions

On reading this paper, I thought that there were some obvious limitations which the authors acknowledge. Thus there are only 2 subjects and there are multiple areas involved – not just the insular cortex. However, the researchers were selecting for subjects that would have reasonably localised involvement of the insular cortex and the small sample size reflects the practical reality of recruitment for these very specific criteria. The involvement of multiple areas is characteristic of this paradigm and the evidence should be triangulated with evidence from elsewhere (which the researchers have done in the discussion). What I thought was slightly more tricky from the modelling perspective is that the subjects have separate responses both in terms of activation and also in terms of their responses to stimuli. However this could be a direct result of the above. In other words it they have slightly different patterns of injury then it is not unreasonable to suppose that they would have different consequences both in terms of conscious experience and therefore of the measurement of that experience. What is interesting from the modelling perspective is that some fairly broad conclusions can be drawn from this. There is some good evidence from this study that the insular cortex might be involved in gauging how unpleasant a pain stimulus is. Thus the subjects rated the pain as more intense on some occasions and yet they didn’t have a corresponding increase in the unpleasantness of that pain. This might also be described as a dissociation of the cognitive description of that pain and the emotional experience of that pain and elsewhere the insular cortex has been described as a region which is involved in the labelling of pain and emotional experiences. However that is not to say that the somatosensory cortex and basal ganglia might be involved in this process instead. The researchers though have arguments against these possibilities from their data. What is also interesting from a modelling perspective is the apparent collateral network that is invoked when the insular cortex doesn’t appear to be working properly. Thus the prefrontal cortex appears to be involved in one case suggesting that if one region is inactive there is possibly an automatic ‘redirect’ to an alternative region. Could the insular cortex be directly involved in tolerance of pain on the basis of these results? If so, then it might suggest that an understanding of the neurotransmitters used in this region might be of relevance to therapeutics in pain management. Additionally there may be implications for chronic illnesses where pain is a feature. Pain also has a complex relationship with depression. This part of the discussion is necessarily theoretical but this area thus has many possible ramifications.

Index

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Twitter

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Podcast

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TAWOP Channel

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Responses

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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.

Index

You can find an index of the site 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).

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 summary of the blogs that have been reviewed to date. To go to a more detailed review  just click on the main links below and for the blogs themselves just click on the link at the end of the summary. If you think there are any blogs that should be included, you can add your suggestion as a comment.

Psychiatry

Ars Psychiatrica. Psychiatrist Dr Neil Scheurich looks at the intersection between the arts and psychiatry. There are lots of interesting articles (blog link here).

Buckeye Psychiatry LLC. Blog by psychiatrist Dr Adam Brandemihl covers a variety of topics including tips on lifestyle and news updates (Blog link here).

Carlat Psychiatry Blog. Blog by psychiatrist Dr Dan Carlat examining the relationship between pharmaceutical companies and medical education (blog link here).

CorePsych Blog. Psychiatrist Dr Charles Parker focuses on the science of psychiatry with interesting insights into inestigations and management (blog link here).

Corpus Callosum. Blog by Psychiatrist who writes on a variety of topics with interesting posts on medication  (Blog link here).

Dr Dymphna’s Diliberations. Blog by psychiatrist Dr Elizabeth Courdes with a focus on pscyhotherapy and pharmacotherapy (Blog link here).

Dr Shock. Blog by Assistant Professor of Psychiatry Dr Walter Van Der Broek covering a variety of psychiatry related topics including the intersection of psychiatry and the internet and developments in psychiatric treatment. (Blog link here).

In Practice Blog. Blog by Dr Peter Kramer with a focus on depression. (Blog link here).

Dr Jeff and Dr Tanya’s Blog. Psychiatrists Dr Jeffrey Speller and Dr Tanya Korkosz write about psychiatry and also provide useful information on common conditions and treatments (Blog link here).

Mark’s Psychiatry. Blog by psychiatrists Dr Tracey Marks on a variety of psychiatry related topics (Blog link here).

Movies and Mental Illness. Blog by a team of a psychiatrist, psychologist and nurse examining mental illness in the movies in preparation for a book on the subject (Blog link here).

Practice What I Preach. A child psychiatrist becomes a mother and describes her experiences (Blog link here).

PsychBabel. Blog on psychiatry by Dr S Cho (Blog link here).

Shrink Rap Blog. Engaging psychiatry blog by three psychiatrists with lots of interesting articles (Blog link here).

The Psychiatrist Blog. Blog by Dr Michelle Tempest looking at the intersection between psychiatry and politics (Blog link here).

Psychotherapy

Beck Institute Blog. Blog about CBT from the Beck Institute (Blog link here).

EMDR International Association Blog. Blog about EMDR with frequent updates (Blog link here).

Jung Currents. Blog about Jung by psychologist Sparky (Blog link here).

Jung at Heart. Blog by psychotherapist on Jungian psychoanalysis. Cheryl Fuller (Blog link here).

Modern Psychoanalysis. Blog about psychoanalysis although last article is dated 2008 (Blog link here).

Sara Roizen. Fine art muralist. A creative blog by artist Sara Roizen who is training to become an art therapist (Blog link here).

Psychology

Advances in the History of Psychology.   (Blog link here).

Clinical Psychology and Pscyhiatry. A closer look. Blog providing a critique of psychiatry and psychology research (Blog link here).

CogSci Librarian Review. This is a blog by a librarian with an interest in cognitive neuroscience. Lots of useful insights into the resources librarians offer as well as cognitive neuroscience links (Blog link here).

Dr Deb. A psychology blog with articles covering many different areas and which are accessible for a general audience (Blog link here).

F.A.B.L.E – Fictional Aut0biography of Life Experience. Blog about the intersection of literature, neurobiology and psychology by Cole Bitting (Blog link here).

Mind Hacks. Popular long-running blog looking at psychology and neuroscience issues (Blog link here).

PsychCentral. Heavyweight longstanding psychology blog by Dr John Grohal who also runs a forum at his website (Blog link here).

Psychotherapy Brown Bag Blog. Blog with insightful analysis of psychological research by Michael and Joye Anstis (Blog link here).

We’re Only Human. Blog by Wray Herbert on psychological research appearing in the journal ‘Psychological Science’ (Blog link here).

Anthropology

Linguistic Anthropology. Interesting blog about linguistic anthropology relevant to a wide variety of subjects including human evolution (Blog link here).

Somatosphere. Science, medicine and Anthropology. Looking at medicine and science from an anthropological perspective (Blog link here).

Blogs about Life with an Illness

Aethelread the Unread. Insightful blog by Aethelread who has recurrent depression and writes engagingly about a number of issues (Blog link here).

A Survivor’s Guide to Huntington’s Disease. Blog by Angela F who has been diagnosed with Huntington’s Disease and whose mother also has Huntington’s Disease (Blog link here).

Bipolar Mo. Blog by a nurse with Bipolar Illness who is also a musician writing about aspects of his life (Blog link here).

Dementia

The Tangled Neuron. Blog by a lady, who’s father with dementia passed away, learning about and discussing dementia (Blog link here).

Evolution

Origins – A History of Beginnings. Blog featuring discussion of and essays about Charles Darwin (Blog link  here).

Why Evolution is True. Blog by Dr Jerry Coynes and colleagues looking at evolution (Blog link here).

Genetics

The Genetic Genealogist. Blog by a geneticist covering genealogy and related topics in genetics  (Blog link here).

Medical Ethics

Medical Ethics Blog. Interesting blog about medical ethics issues by Canadian Journalist Stuart Laidlaw (Blog link here).

Informatics

Allan’s Library. Blog about informatics (Blog link here).

Health Informatics blog. Blog on health informatics by Dr Chris Paton (Blog link here).

Mobile Healthcare Blog. Blog about mobile healthcare technology (Blog link here).

New Media Medicine Blog. Blog with useful links to health informatics resources (Blog link here).

Open MRS. Blog about the development of an open health database (Blog link here).

Science in the Open. Blog about open science Cameron Neylon (Blog link here).

Significant Science. Blog by Hope Leman about the open science movement (Blog link here).

The O’Really Blog. Blog by Duncan Hull on bioinformatics written in an accessible style (Blog link here).

Wolfram Alpha Blog. Blog about Wolfram Alpha search engine (Blog link here).

Miscellaneous

Brains on Purpose. Blog with a focus on conflict resolution and related areas in neuroscience (Blog link here).

Dream Journal. Blog about submitted dream content with analysis (Blog link here).

Singularity Hub. Blog with a focus on emerging health technologies (Blog link here).

Stu’s News and Views. Frequent news and information updates about Multiple Sclerosis (Blog link here).

Neurology

Brain Disease’s Weblog. Blog by Assistant Professor of Neurology Dr Nitin Sethi looks at the neurological literature (Blog link here).

Neurology Minutiae Blog. Blog featuring details of neurological cases and insights  (Blog link here).

Neuropathology

Neuropathology Blog. Interesting blog on neuropathology by Dr Brian Moore (Blog link here).

Neuroradiology

AJNR. Blog of the American Journal of Neuroradiology (Blog link here).

Neuroscience

All in the Mind. Blog by science journalist Natasha Mitchell who also features in the radio show of the same name (Blog link here).

Brain Stimulant. Blog looking at many interesting neuroscience articles including neural prosthetics and computational neuroscience (Blog link here).

Citation Needed. Blog by neuroscientist Tal Yarkoni (Blog link here).

Dharmendra S Modha’s Cognitive Computing Blog. Blog looking at IBM’s Blue Brain project and other developments in cognitive computing (Blog link here).

The Frontal Cortex Blog. Blog by Jonas Lehrer about a variety of neuroscience subjects (Blog link here).

The Mouse Trap. Blog by polymath Sandeep Gautam on neuroscience topics as well as interesting theories that he is developing (Blog link here).

Neurocritic. Nice blog with critiques of neuroimaging studies and insights into neuroscience (Blog link here).

Nou Stuff. Blog by neuroscientist Maria Page covering lots of interesting research in neuroscience (Blog link here).

On The Brain. Blog by neuroscientist Professor Michael Merzenich who focuses in particular on neural plasticity (Blog link here).

Small Gray Matters. Insights into fMRI by a neuroscientist (Blog link here).

Nursing

Mental Nurse. Enjoyable blog by a group of mental health nurses with a range of perspectives on mental health issues.

Occupational Therapy

ABC Therapeutics Weblog. Fascinating and at times poignant blog about occupational therapy with heavyweight analysis (Blog link here).

Palaeontology

Palaeoblog. Interesting blog by Dr Michael Ryan covering a wide array of material relevant to palaeontology (Blog link here).

Pharma

Furious Seasons. Blog by journalist Philip Dawdy who has Bipolar Illness and writes about a number of issues relating to psychiatry and pharma (Blog link here).

Pharma Blog. Blog looking at pharmaceutical news giving a broad overview of developments in the field (Blog link here).

Primatology

Differential Biology Reader. Blog by genetics and psychology student Mark Adams comparing humans and other primates (Blog link here).

Primatology.net Blog. Interesting blog about primatology (Blog link here).

Sociology

Everyday Sociology. A blog on sociology by a group of sociologists giving insights into contemporary events (Blog link here).

The New Social Worker’s Blog. Insights into social work by a social worker student (Blog link here).

Statistics

Social Science Statistics Blog.  Engaging articles on social science statistics of particular relevance to those involved in social science research  (Blog link here).

Index

You can find an index of the site 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).

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 first podcast reviewed here is a preview of a documentary of the first year of the Blue Brain project (available here). This is a 15 minute video which looks at the Blue Brain project. The sound in the video is clear, the images clear and there are interesting views of graphical representations of the computer modelsThe podcast features an interview with Henry Markram, the neuroscientist heading the European Blue Brain project. The BlueBrain project aims to simulate the human brain and in the interview Markram tells us that he is looking at a 10-year goal of achieving this aim. Markram is convincing in his discussion. Computer modelling of neuroanatomy is often criticised on the grounds that we really do not know enough to produce realistic models. However, Markram is quite emphatic in stating that we do know enough to do this and here I suppose is the point behind this project. The point is that a computer model gives you a very sharp focus, honing down the possibilities, making a bold assertion and then testing it to see if it makes any sense. These models can be compared with contemporary experimental results and learning can take place. What are we left with, without this approach. The answer is that we are left with a simple understanding that is limited to that which can be communicated in discussion or else to statements (mathematical or otherwise) about abstract parts of neuroanatomy. The computer model on the other hand defers the task of holding many interactions in memory and performing the calculations to the computer. A human would not be capable of performing these types of tasks with billions of calculations and functions being manipulated in virtual space. It is then up to the human to work with the computer to interpret the results, refine the model, communicate with other groups and find testable applications. It’s difficult to see how else an understanding of the brain could proceed satisfactorily. Such is the complexity of each part of the brain, that neuroscientists can spend an entire lifetime focused on a single area. Yet as we know, the brain is a function of all of the areas acting together and so even a profound expertise in one single area needs to be complemented by an understanding of all of the other brain regions. Markram is confident that an understanding of the brain can be arrived at within the next 10 years. Quite what this understanding means is open to discussion.

The second video reviewed here is another in the series of ‘ideas worth spreading’ in the TED series and available here. In this episode, neuroscientist Rebecca Saxe gives a short (about 16 minutes) presentation on how people understand each other. While this is a difficult task to undertake in so short a space of time, Saxe gives a relaxed and accomplished performance. The essence of her presentation consists of demonstrating that some children are delayed in being able to give a reasonable account of what other people might be thinking. She suggests that some of these abilities might lie in a region around the right temporoparietal region and then proceeds to demonstrate the use of transcranial magnetic stimulation before summarising some of the results of stimulating the right TP region on moral judgement. The implication is that moral judgement is impaired. It should be noted that the TMS will not only have a localised effect but will influence some wider regions also and so it is difficult to attribute causality to the temporoparietal region alone. Nevertheless within the space of 16 minutes Saxe has delivered an engaging narrative in an attempt to persuade the audience of a role for this region in moral judgements and understanding others.

Twitter

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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).

TAWOP Channel

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Responses

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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 book reviewed here is ‘Human Evolution:A Very Short Introduction (Unabridged)’ by Bernard Wood and narrated by Gayle Hendrix. Hendrix narrates clearly and slowly conveying a relaxed approach to the interesting material in the book. I was impressed by the very clear objectives outlined in this audiobook which are obviously very helpful but not ubiquitous.

Wood starts with a brief look at the ancient Greek and Roman understanding of human origins together with later developments in the rennaissance. What I found particularly interesting was the discussion of Vesalius the anatomist. Vesalius wrote a textbook on human anatomy which became very influential although it was intriguing to hear that at the time other anatomists were diversifying their study of anatomy into humans, dogs and monkeys as opposed to focusing on human anatomy alone. Wood goes on to outline some of the methods that are used to date samples – direct and indirect methods. The direct methods use radioisotope dating methods, something which I have understood rather crudely. Here however Wood explains the pragmatics of this approach and I got an impression of how a palaeoanthropologist might begin to approach an excavation. With indirect methods use is made of identifying similar remains of animals and plant fauna and  at sites. The resulting impression was that these approaches involved attention to the tiniest of details and that a wide knowledge base and multiple methodologies are used to derive conclusions. Wood takes the listener through the fossil record looking at candidate hominin species and then working through early and later hominins. He succinctly conveys the controversies in a number of  areas and I was left with a better understanding of the subject while at the same time appreciating that it is a very complex area of study.

I thought this was a very good introduction to human evolution. I struggled at times in trying to follow the thread as I was focusing on the abundance of terms new to me with rather long names. However I would prefer this to having too little detail as it’s not too much trouble to listen to the book again. Wood covers a vast amount of material and succinctly places the listener into the world of the palaeoanthropologist. Human evolution is relevant to the emerging area of evolutionary psychiatry although it is too early to say what impact this area of study will have on the theoretical underpinnings of psychiatry.

References

Bernard Wood. Human Evolution: A Very Short Introduction (Unabridged). Audible Inc. 2009. Narrated by Gayle Hendrix.

Index

You can find an index of the site 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).

TAWOP Channel

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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.