Welcome to the Forty-Sixth Edition of Encephalon, a neuroscience blog carnival.
The best neuroscience posts of recent on The Neurocritic
Welcome to the Forty-Sixth Edition of Encephalon, a neuroscience blog carnival.
This is my 5th time to host (Thanks, Nick!) and I have not stopped enjoying the privilege of hosting this wonderful weekly anthology of the best posts of the medical blogosphere. Since FIVE is the lucky number for me today, I am opening this round with five of the best posts submitted to me this week...
Welcome to the 32nd edition of Gene Genie, a blog carnival devoted to genes and genetic conditions. This edition includes some excellent articles on genes and gene-related diseases, genetics, genomics and personalized genetics.
The next three weeks Dr Shock is on vacation. This blog has been updated daily for more then a year. Since blogging is fun I will probably keep on blogging during these three weeks but maybe not daily and the long posts your used to.
No cold turkey to prevent withdrawal symptoms from blog addiction or is it Internet addiction? Won't need shocktherapy for this I hope. But blogging is good for your health, at Living the Scientific Life
By the way there another stupid thing people believe you can get addicted to. Here is a good one: internet dating. Thanks Pure Pedantry
After these three weeks I will probably start with a new design, maybe I will need your help with that, looking forward to all this.
Apart from a transient mild decline in manual motor speed, there seems to be no
adverse cognitive effects associated with chronic Deep Brain Stimulation (DBS) in Cg25 for Treatment Resistant Depression (TRD) in this sample of 6 patients with a follow-up of 12 months.
Another important conclusion from this research:
Several areas of cognition that were below average or impaired at baseline improved over follow-up, and these changes were not correlated with improvements in mood.
Moreover, in contrast to the memory deficits consistently reported with
ECT, no consistent declines in memory for either verbal or visual material were noted after onset or maintenance of DBS over baseline.
Posted by Dr. Shock at 8:02 AM
It is a pretty neat concept and, as a big fan of Google myself, I can say that it maintains Google standards for easy maneuverability and is extremely friendly for the user. If you use a Google Reader as an aggregator - this is far easier to negotiate. You put in a few details about yourself, including your medications and already can gain access to a good deal of interesting information.
The new portal, created by Practice Solutions, a CMA company, allows physicians to register their patients with any or all of the online tools the portal offers - asthma tracker, blood pressure tool and weight tracker and a personal health record. Designed by physicians, the portal also provides secure messaging, ensuring a private channel of communication between patient and doctor.
"This service really shows the role of technological innovation in raising the standards of health care delivery in Canada," said Dr. Brian Day, President of the CMA. "The mydoctor.ca Health Portal provides a new way for physicians to give each patient the care and attention they deserve while also empowering patients to become active participants in their care."
Peer review means reviewing the research of other scientists in your field for publication in a scientific journal. This procedure is confidential. Reviewers should abstain from peer review if there is a conflict of interest not only financial but also scientifically.
Pfizer subpoenaed the New England Journal demanding that the Journal produce peer-review and other editorial documents on all manuscripts concerning Pfizer's cyclooxygenase-2 (COX-2) inhibitors, valdecoxib (Bextra) and celecoxib (Celebrex) specific articles that they had published and any others that we had rejected for publication. Pfizer wanted the peer-review documents, including the critiques prepared by reviewers for the authors, to help defend itself in product-liability litigation, the company was not looking for specific information. Pfizer was hoping to use the Journal's expert reviewers and their critical commentary in an attempt to challenge scientific aspects of the articles, adding what Pfizer's attorneys called the "significant imprimatur" of the Journal to their case.
the judge decided that while the materials Pfizer sought were relevant, their probative value was limited. As Sorokin concluded, even though the information sought was relevant, "the NEJM's interest in maintaining the confidentiality of the peer-review process is a very significant one, especially in light of its non-party status, and tips the scales in favor of the NEJM."
Screening for depression through the Internet is feasible and is acceptable to large groups of adolescents. Furthermore, the Major Depression Inventory (MDI) and the Center for Epidemiological Studies-Depression scale for Children (pdf, small) (CES-D) are reliable and valid instruments that can be used for this screening.
By the age of 18 about one in every four adolescents has had at least one
depressive episode, and most adults with recurrent depression have their initial depressive episodes as teenagers
A total of 1,392 adolescents, recruited through high schools and the
Internet, filled in the online questionnaires. Of these, 243 (17%) were interviewed with the MINI diagnostic interview to assess the presence of a mood disorder.
Posted by Dr. Shock at 9:43 AM
The New Grand Round of this week is up on Musing of a Dinosaur.
Grand Rounds has become the contemporary weekly portrait of medicine through the eyes of the medical bloggers.
The Efficient MD Wiki is designed to help healthcare professionals and medical students discover clinical pearls, useful resources, life hacks, and strategies to improve the practice of medicine.
But Dr. Hussain, who entered his profession at a time when Iraqi doctors were among the most sophisticated and highly trained in the Middle East, is caught in a time warp in a war-torn land where knowledge and sophistication have been largely overwhelmed by third-world decay, and ancient equipment has plunged some treatments into a “One Flew Over the Cuckoo’s Nest” barbarism, despite the best intentions.
In Google Health you can now add your health information. You can add your diseases and medication use. The systems alarms when dangerous interactions appear with your different medications. You can also add allergies.
You can even add medical records from sources of which a few of are shown in the next figure
When you link a website to your profile, you may authorize that website to read your Google Health profile or to automatically send and update information in your profile (such as medical records or prescription histories). You decide which permissions to grant when you sign up with each website.
If you're willing to hand over your medical profile to the big G in the name of convenient info, Google Health is for you. The more privacy-minded, of course, may refrain.
Supportive therapy in psychiatry is mostly done by unexperienced psychiatric residents during their training. Most residents as well as psychiatrists think that supportive therapy is just providing a sense of safety, support self esteem and hope, alternated by advice how patients should live their life, structure their day, get to work and behave. Psychiatrist the least qualified usually apply for the supervision of residents doing these therapies based on these premises.
To my opinion these kind of therapies are the hardest to do, need the most experienced and psychotherapeutic best qualified psychiatrists. Yes psychiatrists because this kind of therapy is mostly done with the most vulnerable patients with sever psychopathology and usually with several diagnoses. Sure residents can be trained in supportive therapy and they should be.
What makes supportive psychotherapy besides the patients in need for it so difficult?
Posted by Dr. Shock at 6:16 AM
Iceland, the block of sub-Arctic lava to which these statistics apply, tops the latest table of the United Nations Development Programme's (UNDP) Human Development Index rankings, meaning that as a society and as an economy - in terms of wealth, health and education - they are champions of the world.
Bass-Krueger wanted to test how large this effect was. He had some of his several dozen subjects play Tetris for 15 minutes. Then he gave everyone a spatial reasoning test similar to those used in IQ assessments. The results were staggering: Tetris players scored more than 55% higher than the control group. “Even in 15 minutes it can still have an effect,” Bass-Krueger told us here in Atlanta at the Intel International Science & Engineering Fair, where he presented his results.
Watch this video and you will know why.
Alisa Miller, head of Public Radio International, talks about why -- though we want to know more about the world than ever -- the US media is actually showing less. Eye-opening stats and graphs.
The answer is: in the stress system. Stress reactivity might be an important link between a genetic variant of the serotonin transporter gene, stressful life events in early years and depression.
There is evidence of interaction between a functional genetic variant of the serotonin transporter gene and life events. Depression is not based on a simple gene or a cluster of genes. But on a gene and environment interaction. So the risk of getting a depression is higher when a certain genetic variant of the serotonin transporter gene is present in the presence of life stress, especially in early life. But how does this genetic predisposition and life stress lead to depression?
Cortisol, a reliable indicator of hypothalamic pituitary-adrenocortical (HPA) axis functioning and stress reactivity has a hereditary component and is also elevated in 40%–60% of adults diagnosed with depression.
How was this research done?
Girls at high (n=25) and low (n=42) risk for depression by virtue of the presence or absence of a family history of this disorder were genotyped and exposed to a standardized laboratory stress task. Forty-two girls had biological mothers with no current or past Axis I disorder (low-risk daughters), and 25 girls had biological mothers with a history of recurrent episodes of depression during their daughter’s lifetime (high-risk daughters). Cortisol levels were assessed before the stressor, after the stressor,and during an extended recovery period.
The two groups of daughters did not differ significantly in their genotype distribution.
And the results?
Daughters who are homozygous for the s allele showed a marked increase in cortisol production during and following exposure to the stressor. In contrast, daughters with at least one copy of the l allele exhibited a slight decrease in cortisol production over the course of the stress session.See the figure.
Biological stress reactivity is a plausible mechanism underlying the association between genotype and exposure to life stress in predicting the onset of depression.
Serotonin is an important neurotransmitter believed to play an important role in depression. The transport of serotonin during reuptake in the neuron from the synaps is done by a protein. The production of this protein is dependent on certain genes. The variant of this gene affects how much serotonin transporter protein is produced. Individuals with the short allelic form of this variant showed an increased risk of depression compared to those carrying the long allele but only when exposed to adverse life events or maltreatment. There have been some nonreplications, but these have been outnumbered by the number of replicated findings. The original science abstract of the article on influence of life stress on depression is freely available
Posted by Dr. Shock at 8:41 AM
This is a call for cases to be submitted to this new journal. Not only the extraordinary exciting cases but all cases. The intention is to form a database with thousands of cases and a search function so that physicians as well as patients can look for e.g. male 52 years with COPD and non smoking. The focus is on outcome of these cases, that is what they want to know from the authors
Are we in need of this new journal? Don't think so.
Let me know in the comments
I wanted to be a psychiatrist before I went to Med School. Fascinated by the work of Jung and especially Freud, psychiatry seemed the ultimate goal for Med School. Encountered these pioneers while reading literature and a new goal was formulated. Before that my hart was set on social geography, thank god I changed my mind.Other factors such as the encounter with people out of the ordinary during my earlier years most certainly did help my career choice but I found out after finishing Med School during residency in psychiatry.
During Med School I only once doubted my choice. It was during my clerkship of internal medicine. The head of the department, it was hematology, seemed to appreciate my interest in patients and internal medicine. He asked me to apply for a residency in Internal Medicine. Shortly thereafter he was diagnosed with oat cell tumor, lung cancer and died within 6 months and that was the end of my uncertainty about my specialty after med school.
Factors that are associated with choice of specialty based on earlier research are:
Posted by Dr. Shock at 6:36 AM
I like the music of Neil Young, not everything but this love for his music started way back in the seventies. Heart of Gold got me hooked. A fan of Neil Young discovered a new spider and named it after Neil Young.
A sneaky spider has been named in honor of rock musician Neil Young.
Jason Bond, a biologist at East Carolina University, named a newly discovered arachnid, Myrmekiaphila neilyoungi. It is also known as a trapdoor spider.
"There are rather strict rules about how you name new species," Bond said. "As long as these rules are followed you can give a new species just about any name you please."
He added, "With regards to Neil Young, I really enjoy his music and have had a great appreciation of him as an activist for peace and justice."
Dr Crippen is a blogging doctor from the United Kingdom, his posts are of interest even if you don't have to deal with the lousy health care system of the British Empire and full of humor. In a recent post about new treatments for menopause he exposed Jennifer Harper-Deacon who proudly proclaims that she is “Health Journalist of the Year” and who advocates "Hormonal Balance"
includes the plant essences Dioscorea villosa (wild yam), which possesses oestrogen- and progesterone-like properties and acts as a hormonal regulator; Agnus castus, a progesterone-like essence considered to be a master hormone regulator that helps with night sweats, hot flushes, reduced libido, oedema (swelling) and vaginal dryness; and salvia, an essence that helps the body to adjust to hormonal changes, inhibits perspiration and calms the mind, body and spirit. It also contains pulsatilla, known as the remedy of choice for sensitive women, as it impacts on both the psyche and ever-changing hormonal symptoms. Take three drops three times daily for the first month, gradually increasing the dosage up to seven drops, three times daily. Ideally, you should take this remedy for six months.
I was however very taken by her second recommendation for menopausal symptoms. Ladycare from Magnopulse is only £19.95
It is a small, discreet static magnet that you attach inside your underwear, which can help alleviate a number of symptoms, including mood swings and hot flushes. Do not use it if you or your partner has a heart pacemaker, defibrillator or insulin syringe driver.
This made me very happy.
Feeling menopausal ladies? Stick a magnet in your knickers. May I just add to the caveats that users of Magnopulse may have some explaining to do at airport security.
Are the recent claims to fame from a SSRI and rTMS correct for treatment of vascular depression or just treatments seeking new markets? I think the latter. rTMS is of dubious efficacy in the treatment of depression and new "me too" SSRI's are struggling for a share.
Vascular depression is in the news, especially due to the latest annual meeting of the American Psychiatric Association in Washington DC. Claim has been made that Several Therapies Show Promise for Vascular Depression meaning a SSRI and rTMS. See also Anxiety Insights.
But does the diagnostic entity of Vascular Depression really exist?
The relationship between vascular disease and depression cannot solely be explained by current established risk factors or the effects of treatment for depression. Other mechanisms must apply, and there is some evidence for common genetic factors.
Cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes. The "vascular depression" hypothesis is supported by the comorbidity of depression, vascular disease, and vascular risk factors and the association of ischemic lesions to distinctive behavioral symptoms. Drugs used for the prevention and treatment of cerebrovascular disease may be shown to reduce the risk for vascular depression or improve its outcomes.
Just as vascular disease and vascular risk factors are associated with increased rates of depression, so depression has also been shown to be an independent risk factor for cardiovascular and cerebrovascular events.
Posted by Dr. Shock at 10:01 AM
As some of you will know I took part in Adbusters’ Mental Detox Week last week. This meant I stopped doing screen and computer based stuff as much as possible. I was at work so there were obviously times when I had to check email and things. But I did manage to cut it right down to a bare minimum. Outside of work it was a total no computer, no TV, no iPod existence for me. Which is quite a big thing in my ordinary daily life.
Major depressive disorder is unremitting in 15% of cases
Major depressive disorder is recurrent in 35%.
About half of those with a first-onset episode recover and have no further episodes.
53% of those with a lifetime episode of depressive disorder either do not recover at all or have at least 1 recurrence.
What is new in this research?
The focus of this analysis is the group of 92 participants who experienced an episode of depression (meeting criteria for DSM-IV) for the first time in their life during the follow-up. Seventy-one first lifetime episodes occurred between the baseline and 1993 follow-up, and 21 occurred between the 1993 and 2004 follow-ups. The comparison group for onset consists of the 1739 participants followed up through the 1993 wave who also had the opportunity for onset but for whom onset did not occur.
Our speculative explanation is based on the notion that depressive disorder has multiple causes which
endure in varying degrees throughout the course of life.Individuals with the protective genetic configuration sometimes are exposed to other causes whose force is sufficient to break through this protective effect, and presumably these other causes are stronger than in individualswith first episodes and a less protective genetic constellation. After the occurrence of the first episode, these causal forces remain
in place, producing longer episodes andmore difficult recovery.
There is evidence of interaction between a functional genetic variant in the serotonin transporter gene and life events.
Serotonin is an important neurotransmitter believed to play an important role in depression. The variant of this gene affects how much serotonin transporter protein is produced. This protein is involved in reuptake of serotonin in the synaps. Individuals with the short allelic form of this variant showed an increased risk of depression compared to those carrying the long allele but only when exposed to adverse life events or maltreatment. There have been some nonreplications, but these have been outnumbered by the number of replicated findings.
The authors emphasize these common themes:
1. Medical/clinical knowledge - obviously this is a sine qua non
2. Competence and clinical reasoning
3. Positive relationships with students and supportive learning environment
4. Communication skills
Posted by Dr. Shock at 9:58 PM
Columbia University Medical Center has used conventional transcranial magnetic stimulation (TMS) to reduce the deficits in working memory associated with sleep deprivation.
Does my Old World origin bare fruit in my work? Read it in this Perspective of the New England Journal of Medicine: Etiquette Based Medicine.
I would propose a similar approach to tackling the problem of patient satisfaction: that we develop checklists of physician etiquette for the clinical encounter. Here, for instance, is a possible checklist for the first meeting with a hospitalized patient:
1. Ask permission to enter the room; wait for an answer.
2. Introduce yourself, showing ID badge.
3. Shake hands (wear glove if needed).
4. Sit down. Smile if appropriate.
5. Briefly explain your role on the team.
6. Ask the patient how he or she is feeling about being in the hospital.
Rapid Transcranial Magnetic Stimulation (rTMS) to the left prefrontal cortex is not more effective than sham rTMS for depression. This was the result of a recent published randomized controlled trial with 4 month follow-up.
rTMS is a non-invasive method to stimulate the brain. Weak electric currents are induced in the cortex of the brain by rapidly changing magnetic fields (electromagnetic induction). This way, brain activity can be triggered with minimal discomfort, no need for anesthesia, and no cognitive side-effects. Side effects of rTMS are: discomfort or pain from the stimulation of the scalp and associated nerves and muscles on the overlying skin and hearing from the loud click made by the TMS pulses.
The most recent Cochrane review concluded that there is no strong evidence for benefit from using transcranial magnetic stimulation to treat depression, although the small sample sizes do not exclude the possibility of benefit. Since then (2002) 8 randomized controlled trials were published about rTMS and depression, you can read about these trials here.
After the review only one other randomized sham controlled trial was published about rTMS for depression.
Considering the outcome on the time point at week 4, Dr Shock is not very impressed by the results. For significant difference with the primary outcome 6 patients had to be excluded from the analysis. The mean difference between active and sham on the severity scales is in the range of 2-3 points, significant but hardly clinical relevant. Absolute figures on response and remission at week 4 are not given in this article. Remission rate at 6 weeks on the HAMD-17 was 15.5% increasing to 22.6% at week 9 with open labeled therapy. Not very impressive.
Research physicians administered TMS at 110% resting MT (motor threshold) at frequency 10 Hz, in 5-second trains. Twenty trains were given each session with inter-train intervals of 55 seconds. Thus a total of 1000 TMS pulses were given per session and 10 000 per course.
Overall, Hamilton Depression Rating Scale (HAMD) scores were modestly reduced in both groups but with no significant grouprtime interaction (p=0.09) or group main effect (p=0.85) ; the mean difference in HAMD change scores wasx0.3 (95% CIx3.4 to 2.8). At end-of-treatment time-point, 32% of the real group were responders compared with 10% of the sham group (p=0.06) ; 25% of the real group met the remission criterion compared with 10% of the sham group (p=0.2) ; the mean difference in HAMD change scores was 2.9 (95% CI x0.7 to 6.5). There were no significant differences between the two groups on any secondary outcome measures. Blinding was difficult to maintain for both patients and raters.
A study by a group out of the University of Cologne in Germany has demonstrated that rTMS over the unaffected motor cortex of patients that have had a stroke will make their use of the affected hand more efficient and quicker.
Most studies to date have shown beneficial effects of rTMS or tDCS on clinical symptoms in Parkinson’s disease (PD) and support the notion of spatial specificity to the effects on motor and nonmotor symptoms. Stimulation parameters have varied widely, however, and some studies are poorly controlled. Studies of rTMS or tDCS in dystonia have provided abundant data on physiology, but few on clinical effects.
This specific technology can excite or inhibit more areas of the brain than conventional TMS. Regular TMS is basically limited the brain's outer layer, the neocortex, and can only reach about 1 to 2 centimeters into the brain. So it is limited in its ability to affect many brain areas. The new deep tms can stimulate inner brain areas without inducing unbearable electromagnetic fields cortically. This device currently has almost magical properties and it is somewhat difficult to distinguish company hype from real clinical benefit. I'm not sure at this point how selective this targeting technique is. I think it will be fairly difficult to selectively turn on or off specific brain areas without having unintentional effects.
Researchers have developed a better way to manipulate a person's brain functioning. They have created a new type of transcranial magnetic stimulation (TMS) device (called controllable pulse width TMS or cTMS for short) that will allow rectangular pulse shapes of the magnetic fields. This device will enable researchers to control the width of the magnetic pulse that passes through the subjects skull.
Posted by Dr. Shock at 7:42 AM
A failed randomized controlled trial of Fluoxetine versus placebo in elderly stroke survivors due to reluctance and subsequent informal discussions by their treating physicians. Also due in part to high community prescribing rates of antidepressants by general practitioners. In a recent research showed that 15% of adults aged over 75 years are in receipt of an antidepressant prescription from their general practitioner, half of them for more than 2 years and many without formal review.
So adolescents your not alone. Elderly are not alone as well, in The Netherlands it was hard to find elderly for a study that would test the efficacy of ECT versus nortrityline among depressed elderly (> 59 years) who had not responded to sertraline, a selective serotonin reuptake inhibitor (SSRI).
Now I am a strong supporter of placebo controlled trials. An important factor for success is the believe physicians and other health workers have in the importance of the trial. If the health workers are ambivalent you can forget it.
Why is a placebo controlled trial important for stroke survivors?
However, the evidence that antidepressants are effective is surprisingly weak, and although there is some indication that they produce improvement in mood symptoms we know little about speciﬁc indications or about complications of treatment. The latter are especially important since if treatment of depression is to have an impact on rehabilitation outcomes, then it needs to be given early at which time complications
may be more likely.
I am not a football fan but even I knew Paul Gascoigne was one of the great talents. He has not coped with the money, and the fame, and the alcohol. But what is to be done?
Posted by Dr. Shock at 11:39 AM
More than half the 28 new members of writers of the next edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) have ties to the drug industry, according to the Center for Science in the Public Interest’s Integrity in Science Watch.
The conflicts of interests were posted online by the APA last week (look here). They ranged from small to extensive.
Posted by Dr. Shock at 7:17 AM
Computer game players with more physical-aggressive personality manifest more violent behaviors in game playing with more violent interactions, more frequent punching and kicking actions, and more frequent shootings. This research is one of the first to show that personality is an important factor in how a game is played.
The most important contribution of this study is that it investigated the individual experience of game playing. Most of the existent studies, especially experimental studies, simply compare a group of people playing a violent game and another group playing a nonviolent game without taking into consideration that the violent content people are exposed to can vary to a great extent even when playing the same game. This study is the first that goes beyond contextual variables and actually considers the unique experience of each individual player.
Gadgets are nice, but are they worth all the trouble? Syncing, updating, charging, bloated software, to many features? Or should we go back to good old easy and fast notebooks of paper? Let me know in the comments.
After years spent tracking the latest gadget trends, handing over my credit card for a PDA upgrade every 4-6 months, and receiving odd glances in public for reading The Gawkish Geek’s Guide to Gadgets (monthly), I gave up my fancy gizmos and electronic organisers for good.
In recognition of the intense effort it takes for a self-confessed gadget geek to drop his ‘habit’, I hope you won’t mind when I admit to replacing it with another: the love of Moleskine notebooks. These simple notebooks are both beautiful and relatively gentle on the wallet.
My Mind is Green
Of all the mind types, yours has the most balance.
You are able to see all sides to most problems and are a good problem solver.
You need time to work out your thoughts, but you don't get stuck in bad thinking patterns.
You tend to spend a lot of time thinking about the future, philosophy, and relationships (both personal and intellectual).
Posted by Dr. Shock at 9:13 AM
Dr Shock appears in a grand round at Doc Gurley.
This week here at Doc Gurley is the Grand Rounds Smack Down edition, where the best contenders of the health care blogosphere wrestle down and dirty with tough, scary topics. Just like being in the ring, there’s no orderly progression of characters here – this ain’t ballet, folks. At any moment, something huge and impressive could come flying out of left field and hit you (ka-pow!) right between the eyes! There’s no first, no last – we’re here to entertain (and take out a few bad guys while we’re at it). We’ve got a lot of contestants, oops, I mean, submissions, vaulting into the ring. One thing’s for sure - if you hang with it to the end of this week’s match, right up to the point when the lights dim in the arena, you’ll be entertained.
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