A new search engine at: http://thagoo.com/ . The results in RSS feed.
Related post on this blog, a book review:
Information trapping
More information on: ResearchBuzz
Monday, October 8, 2007
Thagoo for information trapping
Lap dancers provide evidence for human estrus
Lap dancers with a normal cycle earned more during their 5 hours shift when in estrus. Estrus refers to the phase when the female is sexually receptive. Under regulation by gonadotropic hormones, ovarian follicles are maturing and estrogen secretions exert their biggest influence. They earned about US$335 per 5 hours shift, during the luteal phase they earned US$260, and US$185 per shift during menstruation. Participants using contraceptive pills showed no estrus peak earning.
This research was started to test the "hidden" estrus view. In this view the estrus phase was "lost" or "hidden" in the human female to promote male provisioning and paternal care in long-term pair bonded relationships. In contrast to this view recent laboratory studies showed that women near the most fertile point of their cycle are most attractive to males.
This was manifested by:
1. more attractive body scent
2. greater facial attractiveness
3. increased soft-tissue body symmetry
4. decreased waist-to-hip ratio
5. higher verbal creativity and fluency
How?
Eighteen professional lap dancers working in a gentlemen's club recorded their menstrual cycle, work shifts and tip earnings for 60 days on a study website. A mixed model analysis of 296 work shifts showed an interaction between cycle phase and hormonal contraception use.
Why
Dr Shock loves creative unusual research.
Other remarks
1. Economic evidence for the existence of estrus in contemporary human females
2. Real consumer spending patterns reveal human preferences more reliably than verbally stated judgments
3. Men can detect female fertility accurately but not so accurate that tips during the other phases drop to zero
4. As often in races between the sexes the outcome is not a clear victory for either sex
Limitations
1. Small sample size (n=18) hampers generalizability
2. Outcomes (earning menstrual cycle phase, hormonal contraception) were self-reported
3. The exact mechanism that influences the tip earnings is not identified (body scent, facial attractiveness etc.)
These results have clear implications for human evolution, sexuality and economics.
Article discussed:
Miller, G., Tybur, J.M., Jordan, B.D.
Ovulatory cycle effect on tip earnings by lap dancers: economic evidence for human estrus.
Evolution and Human Behavior 2007 ahead of print.
Additional information on Science Now
Information about the Estrous cycle on Wikipedia.
Sunday, October 7, 2007
10 Top Tools for presentations
Often Dr Shock has to present his work or he has to give presentations mostly on ECT and depression. Luckily he has powerpoint on his mac. Keynote has nicer lay-outs but he doesn't want to take the risk of a freezing presentation.
Lifehacker.com has some useful presentation tools and tips.
1. Dim the background
2. Zoom
3. Etc.....
Those Sweet Twenties
Elderly experience recollecting detailed memories of their lives from when they were in their twenties. People recall more events from the period when they were adolescents and young adults than from other lifetime periods.
We found that participants answered questions about events that occurred when they were between 15 and 25 years old more frequently correct than questions about events that occurred when they were younger than 15 or older than 25 years. This result supports the view that people store events better in adolescence and early adulthood.
Research is done by cue-words, participants are given a cue-word e.g. church and are asked to tell a memory associated with this word. Afterwards the date of this memory will be traced with the participant. If this is done with elderly a characteristic graph will ensue if recollections are placed against age of the participants.
Two explanations exist. The age period of your twenties is the most impressive. It's the time of your life with the greatest impact, the period in which the direction of your life is made. In these years more memorable events happened than in others
The other explanation is that in your twenties memory is at it's best. Events in adolescence and early adulthood are stored better than in other lifetime periods. From then on your memory declines.
Article discussed:
Presentation of the paper:'Reminiscence Bump in Memory for Remote Events' written by Jaap Murre and Martijn Meeter at the SARMAC VII (The Society for Applied Research in Memory and Cognition).
Abstract of the article
Related blog article:
Memory for a general audience
5 blogposts on Vagus Nerve Stimulation (Round Up)
Vagus Nerve Stimulation is an interesting development for the treatment of treatment resistant depression. In the US it is approved by the FDA but not reimbursed by Health Insurance Companies, dividing psychiatric patients in haves and have nots?
A website with a lot of information on VNS at vnsdepression.com, please read the disclosure
For a discussion about efficacy of VNS and an update on the recent literature please read this post about VNS
Besides Electroconvulsive therapy, VNS is another form of Neurostimulation for depression
Other blogs are interested in VNS as well
8 Healthy Habits Aren’t So Healthy That You Don’t Know
Not so healthy habits on Healthy Living Blog
1. Using anti-bacterial soap
2. Sitting up straight, see an article on this blog:sit up straight
3. Following a low-fat diet
4. Drinking eight glasses of water a day
5........etc
Saturday, October 6, 2007
Depression information on healthcenter.com
On healthcenter.com information about depression.
MyDepressionConnection.com was designed around three main areas: 1) Finding the information you need; 2) Managing your condition and taking actions to improve your health; and 3) Sharing & Learning experiences, ideas and inspiration with people who have "been there."
With thanks to PsychSplah
What distinguishes us from the chimpanzee?
Chimpanzees do not systematically make fair offers to their fellow chimpanzees, nor do they systematically refuse to accept unfair offers even though they could discriminate between the quantities available to themselves and their partners. Chimpanzees behave according to traditional economic models of self-interest, unlike humans, and chimpanzees do not share the human sensitivity to fairness. This is recently published in Science. It's amazing how the researchers transformed the ultimatum game for use with chimpanzees, ultimate creativity.
This behavior is tested with the ultimatum game:
In laboratory settings, social scientists have observed subjects playing the "ultimatum game," in which, say, with a total kitty of $10, Player A offers to split the cash with player B. If B accepts A's offer, they divide the money accordingly, but if B rejects A's offer, both players get nothing. "In thousands of trials around the world, with different stakes, people reject offers of 30 percent [$3 in our example] or less," says Glaeser. "So typically, people offer 40 or 50 percent. But a conventional economic model would say that B should accept a split of even one cent versus $9.99, since you are still better off with a penny than nothing." (If a computer, rather than a human, does the initial split, player B is much more likely to accept an unfair split
Humans will take into account the interest of others and are sensitive to norms of cooperation and fairness. Individuals will reject a unfair proposed division at a cost to themselves, if they perceive it as unfair. Chimpanzees however, are rational maximizers and are not sensitive to fairness.
Related information about "fairness and reason in the ultimate game"
Ultimatum Game on Wikipedia
Discussed article
Chimpanzees are rationam maximizers in an ultimatum game.
Keith Jensen, Josep Call, Michael Tomasello
Science, 2007;318: 107-109.
Friday, October 5, 2007
8 opinions from an ECT expert about 2 major studies on ECT for Depression
On psychiatrictimes.com Prof Max Fink discusses the 2 most important articles on continuation therapy after ECT for depression. ECT is very effective in the treatment of depression even if several antidepressants have failed. He discusses a large, government-supported, collaborative study led by the Columbia University Consortium (CUC), patients with unipolar major depression that had failed to respond to multiple trials of medications were treated with ECT to clinical remission and then randomly assigned to one of three continuation treatments: placebo, nortriptyline alone, or the combination of nortriptyline and lithium.
The other important trials is the multi site Consortium for Research in ECT (CORE) collaborative study that used the same populations with the same inclusion and exclusion criteria, evaluations, and time periods as the CUC study. After remission, the patients were randomly assigned to continuation treatment with the same combination of lithium and nortriptyline or with ECT.
Relapse
The six-month relapse rates for the two treatments were not statistically different from that of the lithium and nortriptyline combination in the CUC study
His conclusions:
1. Efficacy: ECT was effective in both studies. ECT compared favorably with the STAR*D study of patients with nonpsychotic major depression.
2. Psychotic Depression: 95% of the patients who had psychosis and depression remitted compared with 83% of patients who had nonpsychotic depression.
3. Suicide: In the CORE study, 29.5% of the patients expressed suicidal thoughts or reported suicidal acts at baseline. The HAM-D scores for suicidal intent were reduced to zero in 38% of the patients after one week of treatment, in 61% after two weeks, and in 81% at the end of the course. These findings are supported by comparable CUC data.
4. Prior treatment: In the CORE study, the adequacy of prior treatment bore no relation to treatment efficacy, a finding that is confirmed in other studies.
5. Elderly: older patients with depression exhibit better clinical outcomes than younger patients when treated using ECT
6. Relapse rates after successful ECT are reduced by either the combination of lithium and nortriptyline or by continuation ECT.
7. Continuation therapy: the combination of lithium and nortriptyline, both monitored with serum blood levels, is the preferred medication when continuation ECT is not available or is refused.
8. Electrode placement: bilateral electrode placement and half-age dosing estimates, monitored by EEG adequacy, ensures greater efficacy for the first treatment and overall with fewer treatments
Articles used:
1. Sackeim HA, Haskett RF, Mulsant BH, et al. Continuation pharmacotherapy in the prevention of relapse following electroconvulsive therapy: a randomized controlled trial. JAMA. 2001;285:1299-1307.
2. Kellner CH, Knapp RG, Petrides G, et al. Continuation ECT versus pharmacotherapy for relapse prevention in major depression: a multi-site study from CORE. Arch Gen Psychiatry. 2006;63:1337-1344.
Thursday, October 4, 2007
Russian Psychiatry
On the International Herald Tribune Europe an article shows a summary of top stories in Russian newspapers on Thursday, October 4 2007.
One newspaper had a story about Russian psychiatry:
GAZETA
THE STATE OF RUSSIAN PSYCHIATRY: Russia's Constitutional Court will review laws regulating psychiatric care on Thursday following several recent cases in which people complained of being forcefully confined in psychiatric facilities for their political affiliations or other non-medical reasons, a practice reminiscent of Soviet treatment of political dissidents. Tatyana Dmitrieva, the health ministry's head psychiatrist, called such complaints "speculation," and said the psychiatric field should be further developed rather than curtailed. Particularly, she said, psychiatric care should be provided to Russia's many immigrants, who often suffer depression and other psychological illnesses when they arrive.
MindHacks.com has some more information suggesting "a return to the bad old days" when it was used in part to suppress political dissidents. Alliance for Human Research Protection has some more information
Microsoft beat Google with HealthVault?
Microsoft just released a “software and services platform” that will allow people to store their health information online. WJS Health Blog had the scoop and a screen shot. Tried it myself: healthvault.com. Made my Firefox freeze at an instant, search did not work, really beta but the first.
Dozens of articles on chocolate craving
Dr Shock is amazed by the many articles in blogs and news sites such as this one, about an article in the British Journal of Psychiatry. The article is discussed on this blog as well: Chocolate craving efficient discriminator for atypical depression.
Most commentary on these news sites are very limited and sometimes completely wrong. Mostly they forget to mention that this research was done on atypical depression.
Another annoying feature of these articles is that you can't comment on them. But most striking is the quantity of articles, how do they do it? Anyone who knows the trick? Jealous? You bet
Director of the Rijksmuseum Amsterdan retires
A good friend and Professor in art history Ronald de Leeuw is retiring from his job as director of the Rijksmuseum, the most important and well known museum in Amsterdam, The Netherlands. Since many of my readers are from the United States of America this news might be of importance. Professor Ronald de Leeuw was the director of the Rijksmuseum for 11 years, before that he was the director of the Van Gogh Museum also in Amsterdam.
Renovation
The Rijksmuseum is undergoing a massive renovation. The renovation will probably be finished by 2010. The renovation started in 2003. A small sample of the collection can be seen during the renovation, other objects can be seen in 11 other museums in The Netherlands.
An important purchase was a painting by Jan Steen:
16 Medical Games
Games are fun. Dr Shock loves computer games. Thanks to DigiCMB he found a lot of medical games on Deirdre's Wiki.
Deirdre Bonnycastle is a member of Classroom 2.0 blog:
I have been a teacher for 36 years; I've used personal computers in my classroom since 1980 and I currently help faculty in the College of Medicine to move to a more student centered approach.
Classroom 2.0 is:
the social networking site for those interested in Web 2.0 and collaborative technologies in education.
My favorite game is DoomEd, what is yours?
PsychAntenna, information search tool for mental health
PsychAntenna is an ever-growing showcase of psychology-related websites, blogs, podcasts and journals that utilize RSS (Really Simple Syndication) to broadcast their content. The goal is help clinicians, researchers and students in the field of Psychology utilize RSS more efficiently and locate the best resources to help them keep up-to-date in their respective areas of interest. PsychAntenna is the work of Dr Gareth Furber
PsychAntenna is an excellent collection of blogs, podcasts, websites, and journals about mental health care:
1. search blogs with keywords or have a look at the most popular, at random, or the latest.
2. clear description of the blog
3. You can rate, comment, subscribe and preview the results of your search
4. you can subscribe your blog
Wednesday, October 3, 2007
10 causes of low performing in medical students
Causes for low performance of 21 medical students from high socio-economic background and high scores on their entrance examination:
1. stress resulting from language problems (8/21)
2. adjustment problems to life away from home (6/21)
3. lack of self-confidence (12/21)
4. fear of failure (8/21)
5. worry about the future (10/21)
6. difficulty in managing study time (17/21)
7. lack of concentration (10/21)
8. inability to retain what was studied (10/21)
9. examination anxiety (8/21)
10. inability to write examinations (5/21)
Dr Shock doesn't think these causes only apply to med students. So parents if your kid is not performing well during his study these are probable causes to look at.
16 of these 21 students took part in a regular individual counseling regarding their personal problems. The counseling focused on the problematic issue revealed by a questionnaire.
The sample of students was derived from 115 students who sat a first internal assessment examination in pathology. The selected 22 scored less than 30%, 1 student did not fill in the questionnaire.
At follow-up after 6 months the 16 students improved significantly in the post-programme performance, the 6 students not participating did not improve their results significantly.
The majority of the students participating in the program felt that the sessions had helped to improve their performance.
Conclusion
Poor performers can benefit from individually tailored remedial programs which include counselling and training in study skills, along with good mentor support.
Article discussed:
Facilitating learning in low performers.
PMID: 17883379
Authors: Mysorekar VV, Joshi MA
Journal: Med Educ: , 2007
Tuesday, October 2, 2007
What is cognitive therapy
Dr Shock is in to some obsessive blogging this evening, would some cognitive therapy help?
Dr Shock found an interesting article about cognitive therapy on About.com:Depression.
Cognitive therapy recognizes 10 common patterns of faulty thinking, which are known as cognitive distortions.
* All-or-Nothing Thinking: Failing to recognize that there may be some middle ground. Characterized by absolute terms like always, never, and forever.
* Overgeneralization: Taking an isolated case and assuming that all others are the same.
* Mental Filter: Mentally singling out the bad events in one's life and overlooking the positive.
* Disqualifying the Positive: Treating positive events like they don't really count.
* Jumping to Conclusions: Assuming the worst about a situation even though there is no evidence to back their conclusion.
* Magnification and Minimization: Downplaying positive events while paying an inordinate amount of attention to negative ones.
* Emotional Reasoning: Allowing your emotions to govern what you think about a situation rather than objectively looking at the facts.
* Should Statements: Rigidly focusing on how you think things should be rather than finding strategies for dealing with how things are.
* Labeling and Mislabeling: Applying false and harsh labels to oneself and others.
* Personalization: Blaming yourself for things that are out of your control.
Another Grand Round of English Medblogs
This weeks Grand Round of Medblogs is hosted by Musings of a Distractible Mind.
Stay tuned and go read all about it.
Information from the Royal College of Psychiatrists about electroconvulsive therapy
A whole page with information in a Q&A format about electroconvulsive therapy on the website of the Royal College for Psychiatrists.
BioWizard, PubMed in a web 2.0 dress
This site offers an incredibly easy way to find and discuss the most relevant medical and scientific literature. In addition, BioWizard offers an array of tools and features, including PubMed search capability, a comprehensive products search, the latest scientific news, the table of contents from major journals, and blogs from some of the most prominent minds in science and medicine today.
ScienceRoll has an article about it's features.
Monday, October 1, 2007
Doctors reactions to memorable patients deaths'
Between 5-17.5% of doctors reported sadness of moderate to severe intensity following the death of a memorable patient. Fatigue, problems in sleeping, changes in appetite, anger and relief were particularly reported. There were no significant associations between the intensity of the responses and gender, seniority or specialty, except that female doctors were more likely to have cried.
How?
Doctors who attended 12 lunchtime seminars and teaching sessions in a hospital between 1 May and 1 August 2005 were invited to participate in a study. They had to fill in a questionnaire on their own. Questionnaire responses were anonymised as far as possible.
194 of 239 invited doctors participated, 7 did not complete the questionnaire.
Coping strategies of doctors
83.5 respondents revealed that "talking with others" was their preferred method.
Other popular forms of coping were:
1. having time alone (64.4%)
2. socializing (36.2%)
3. exercise (26.6%)
4. seeking religious guidance (21.8%)
In general support for doctors is provided in equal measure by other doctors, nurses and others: friends, family, loved ones.
What is a memorable patient death?
A patient death that had occurred within the previous few months which the doctor recollected for any particular reason. This has it's limitations. Doctors good describe their responses to a specific incident, rather than describe their general or typical responses.
Other limitations of this study were:
1. modestly sized convenient sample of doctors
2. adaptation of the questionnaire
3. recall bias as a result of the delay between the memorable death and the questionnaire
Additional important finding
Over half of doctors recognized the need for improved training in dealing with patient death.
Article discussed:
"Memorable patients deaths'": reactions of hospital doctors and their need for support
Moores, TS, Castle, KL, Shaw, KL, Stockton, MR, Bennett, MI.
Medical Education 2007;41: 942-946.
Sunday, September 30, 2007
13 questions about depression answered by OrganizedWisdom
OrganizedWisdom has excellent information on depression. The information delivered is divided in:
1. 5 great resources
2. what is depression
3. what are the symptoms and complications of depression
4. what are the types of depression
5. what are the treatments of depression
6. what Are The Holistic and Alternative Treatments for Depression
7. how do you prevent depression?
8. wisdom, stories and blogs about depression
9. foundations and support groups on depression
10. message boards, chat and discussions about depression
11. scientific and medical journal articles on depression
12. clinical trials on depression
13. related searches
There is no WisdomCard for electroconvulsive therapy yet.
About OrganizedWisdom:
It shouldn't be a time consuming process to quickly find links to the very best resources when searching for health information. So, we are solving this problem by adding the wisdom of trained expert search guides and physician reviewers to the power of algorithmic-only search tools and social bookmarking sites. This human-powered model helps us deliver far superior health search results by eliminating search index spam from low-quality websites, links to duplicative libraries of licensed health content or potentially dangerous web sites.
Saturday, September 29, 2007
Chocolate craving efficient discriminator for atypical depression
Chocolate reduces irritability and rejection sensitivity in patients with atypical depression. The question about chocolate craving succesfully allocates two third of particpants with three or four symptoms of atypical depression.
How?
3000 participants reporting clinical depression completed a web-based questionnaire when visiting a website (http://www.blackdoginstitute.org.au). Respondents were required to have experienced depressive episodes lasting at least 2 weeks and requiring treatment. The questionnaire was used to investigate self-reported benefits of chocolate during a depressive episode and examine for any specificity of personality style to such chocolate craving.
More results
When depressed 1465 (54,4%) reported food cravings, with 1210 (44,9) specifically being chocolate cravers (50,7% of the women, 30,9% of men).
Of the chocolate craver group, the 736 (60,8%) who rated chocolate's capacity to improve their depressed mood as moderately to very important were more likely to rate it as making them feel significantly less anxious and less irritated.
What is atypical depression?
Criteria for atypical depression (DSM IV):
A. Mood reactivity (i.e., mood brightens in response to actual or potential positive events)
B. At least two of the following:
1. Significant weight gain or increase in appetite
2. Hypersomnia (sleeping too much, as opposed to the insomnia present in melancholic depression)
3. Leaden paralysis (i.e., heavy, leaden feelings in arms or legs)
4. long-standing pattern of interpersonal rejection sensitivity (not limited to episodes of mood disturbance) that results in significant social or occupational impairment
C. Criteria are not met for Melancholic Depression or Catatonic Depression during the same episode.
In general, atypical depression tends to cause greater functional impairment than other forms of depression. Atypical depression is a chronic syndrome that tends to begin earlier in life than other forms of depression — usually beginning in teenage years.
Atypical depression is more common in females — nearly 70% of the atypical population are women
Good to know
The author Gordon Parker is an excellent researcher from Australia. In his work he states that mood reactivity as the main criteria for atypical depression should be abandoned. He pleads for another feature as the main criterion: personality style with emotional dysregulation.
Article discussed:
Gordon Parker Joanna Crwford
Chocolate craving when depressed: a personality marker
British Journal of Psychiatry (2007) 191: 351-352
Friday, September 28, 2007
8 Effects of TMS on Brain Function but how does TMS work?
Dr Shock is skeptical about the possibilities of Transcranial Magnetic Stimulation (TMS) influencing the neural networks involved with depression. TMS can influence the cortex on the surface and probably a few centimeters beyond. In research TMS has been used to disrupt neural activity experimentally in studies of human cognition but relatively little is known about how TMS works.
Effects of TMS on brain functions:
1.Single burst TMS instead of repetitive TMS applied to the visual cortex interferes with visual imaging (repeated stimulation=rTMS has a longer lasting effect than a sinle burst)
2. Stimulation of the right spot in the motor cortex causes the tumb to twitch (intensity calibration of the TMS stimulus, this is used before repetitive stimulation to other parts of the scalp (rTMS))
3. Low frequency stimulation (1-5 pulses per second) depress brain activity, higher frequency stimulation (25 or more pulses per second) increases excitability.
4. Stimulation of the left prefrontal cortex with rTMS relieves depression in some patients who haven't responded to other antidepressant treatments
5. Low frequency rTMS to the temporoparietal cortex (above the ear) reduces auditory hallucinations in Schizophrenia
6. rTMS treatment on speech areas of the brain can make people name picture at a faster rate
7. rTMS applied to motor regions of the brain facilitates lightening fast movements
8. rTMS applied to the prefrontal cortex compared to sham rTMS enhances solving of analogy puzzles, rTMS might facilitate thinking. (Try rTMS before an exam). rTMS may raise baseline level of neural activity just enough so that neurons don't have to work hard to retrieve memory or problem solving strategies.
What is TMS?
rTMS influences neurons indirectly. It is a non invasive technique to stimulate brain tissue. Anesthesia is not required. Repeated pulses of electric current are sent through a metal wire, which is usually round or figure eight shaped. This electric current generates a perpendicular magnetic field. This magnetic field in return, generates another electric current in nearby material, in this case the current runs through brain tissue just below where the coil is placed on the scalp
How is it applied in Depression?
A depressed patients receives rTMS over the left prefrontal cortex for 20-30 minutes once a day for 2-4 weeks. It is unknowm if this is the right and effective combination of stimulation frequency, intensity, timing, and location.
In a recent article in Science: TMS elicits coupled neural and hemodynamic consequences, a more detailed look on how TMS might affect the neurons is presented.
TMS was applied to the cat visual cortex and the neural and hemodynamic consequences were evaluated.
Short TMS pulse train elicited initial activation (to 1 minute) and prolonged suppression (5-10 minutes). Oxygen concentration and hemoglobin levels were tracked simultaneously with the stimulation and the recordings. Oxygen consumption and hemoglobin are metabolic markers. Both mirrored the pattern of increase in firing (about 1 minute) by the neurons followed by a decrease in firing for several minutes after a stimulation by a TMS pulse train of a few seconds.
Neural activity elicited by flashes of white and black bars on a computer screen which can influence even anesthetized animals, had an altering effect on neural activation by TMS. Neural firing dipped sharply after TMS on the visual cortex and remained suppressed for several minutes during this challenge.
These findings can have important implications for the use of TMS in depressed patients:
The findings have implications for designing TMS therapies, says George. For depression therapy, for example, "we may need people to become sad in the chair while stimulating [them]," George says (Mark George, a psychiatrist at the Medical University of South Carolina in Charleston). "Alternatively, we might have them engage in formal cognitive therapy, thinking positive thoughts." Such considerations are important, he adds, as the Food and Drug Administration is considering approval for daily TMS of the prefrontal cortex to treat depression.
The new findings also suggest why the effects of TMS often vary, says Alvaro Pascual-Leone, a neurologist at Harvard Medical School in Boston. Pascual-Leone suggests that TMS results could be made more consistent by monitoring the physiological state of the brain using electroencephalography or functional magnetic resonance imaging.
Picture used:
The picture at the top of this article is from a website about neurostimulation in all it's forms
Articles used:
Boosting Brain Activity From the Outside In
Laura Helmuth
Science 18 May 2001:
Vol. 292. no. 5520, pp. 1284 - 1286
DOI: 10.1126/science.292.5520.1284
Uncovering the Magic in Magnetic Brain Stimulation
Greg Miller
Science 28 September 2007:
Vol. 317. no. 5846, p. 1846
DOI: 10.1126/science.317.5846.1846a
Transcranial Magnetic Stimulation Elicits Coupled Neural and Hemodynamic Consequences
Elena A. Allen,* Brian N. Pasley,* Thang Duong, Ralph D. Freeman
Science 28 September 2007:
Vol. 317. no. 5846, pp. 1918 - 1921
DOI: 10.1126/science.1146426
Thursday, September 27, 2007
How does short-term memory work in relation to long-term memory?
Interesting question in relation to Electroconvulsive therapy (ECT). Retrograde amnesia and anterograde amnesia can occur during an ECT course. The memory of some recent events can be lost due to ECT, some patients complain of forgetting recent events. This retrograde amnesia extends from shortly before ECT to events that occured during the illness episode.
That is why this is an interesting question. How is it possible that some memories are not consolidated. It takes time for a short-term memory to become long-term memory. The passage of time allows it to become resistant to interference from competing stimuli or disrupting factors such as a ECT treatment. Consolidation is the time-dependent process of stabilization, whereby our experiences achieve a permanent record in our memory.
This consolidation is explained on ask the expert from ScientificAmerican.com
Just a tip of veil:
Memory consolidation can occur at many organizational levels in the brain. Cellular and molecular changes typically take place within the first minutes or hours of learning and result in structural and functional changes to neurons (nerve cells) or sets of neurons. Systems-level consolidation, involving the reorganization of brain networks that handle the processing of individual memories, may then happen, but on a much slower time frame that can take several days or years.
More in dept information about changes on a molecular and neuron level can be found on the site of Chemical and Engineering News.
Forgetting is also discussed. Where did you park your car? Were are your keys?
BUT WHAT happens to memories that last for a while but aren't permanently retained?
Understanding of the process of forgetting is murky, and the proposed mechanisms are controversial. Some researchers believe certain parts of the brain employ "long-term depression" to clean the slate, so to speak. In the hippocampus, for example, long-term depression weakens connections between synapses that are only rarely stimulated. Under these conditions, glutamate binding to NMDA receptors on the postsynaptic membrane brings only a small number of calcium ions into the neuron. This small amount of calcium activates enzymes that dephosphorylate the receptors, making them less responsive to glutamate.
Long-term depression also reduces the number of AMPA receptors in the postsynaptic membrane. It also might alter the structure of synaptic connections between the neurons. The net result of these steps is to return the neuron to a state in which it's ready to receive new information.
Efficacy or effectiveness
What is the difference? Dr Shock forgot. He received a review of a manuscript. Fortunately it will be accepted if...... And one of the mistakes Dr Shock made was confusing the two, using them both for efficacy. After a search on the web Dr Shock will remember the difference, once and for all. He found a clear explanation on medicinescomplete.com. Mind you English is not his native tongue.
Efficacy is: Whether or not an intervention can work under ideal conditions relates to efficacy.1 If the conditions of a trial are optimised, the measurement of the outcome variable may detect even relatively small effects of the treatment. In such a trial, bias is excluded as far as possible, for example by including only patients who are likely to cooperate fully with the medical advice.2 In such a trial, patients should not be treated with concomitant medication and other co-interventions should be avoided. A treatment is efficacious when it proves to be superior to (usually) placebo or another treatment of known efficacy.
Effectiveness is: The pragmatic question of whether an intervention works in routine clinical care relates to effectiveness.1 In this setting, the inclusion criteria for patients are more relaxed. In such a trial, the question is whether the treatment does more good than harm among those to whom it is offered and patients are allowed to accept or reject the treatment, much as would be the case in real-life situations.
Wednesday, September 26, 2007
Translucent frogs made for science
Gearlive has it. Scientists developed a translucent frog so they can see the organs and blood vessels during experiments with diseases.
Papayas what are they good for in medicine
No Dr Shock is not going into herbal remedies nor acupuncture or any other expensive crap. Papayas are used to introduce Year 3 medical students to uterine anatomy, endometrial biopsies, intrauterine contraception, and uterine aspiration. They sure learn a lot more than we did in the "Old Days".
During the second week of the Year 3 obstretics and gynaecological clerkship students participate in a "Papaya Workshop". The Gynaecologists pokes holes in the stem ends to mimic the cervix. On these papayas the students practice intrauterine contraception (IUC) placement with two different IUC's. They learn to dilate and aspirate and curette their papayas, mimicking the case of a women with a missed abortion.
During 1 year the students were surveyed before and after the workshop and at the end of the rotation. 90% of those asked rated the workshop as highly valuable. Before the workshop a score of 75% correct answers was achieved by 48% of the students, after the workshop this had increased to 98% and it remained fairly steady to the end of the rotation (91%).
The papaya workshop is a fun, inexpensive and easily replicable model for teaching intrauterine procedures.
I hope that the University of California San Francisco, San Francisco General Hospital will keep including this workshop in the ob-gyn clerkship and may they come up with more fun workshops with educational profits.
Article discussed:
Steinauer J, Preskill F, Robertson P.
Med Educ. 2007 Sep 20; [Epub ahead of print]
Training medical students in intrauterine procedures using papayas.
Tuesday, September 25, 2007
What Internists and everybody else should know about ECT
How commonly prescribed medications and medical conditions affect ECT is written in a recent article in Cleveland Clinic Journal of Medicine. This article: Electroconvulsive Therapy: What the Internist needs to know, can be downloaded for free. It is an excellent clearly understandable written article. Even patients can benefit from the presentation of all this knowledge and discuss some points made in this article with their psychaitrist and consulting internists.
It starts with an accurate description of the history of ECT, indications, but more important which medical assessments are needed and when. Comprehensively the authors divided the medical conditions that may require more extensive workup in three categories:
1. Patients with autonomic sensitivity
2. Patients with anesthesia sensitivity
3. Patients with cognitive sensitivity
These conditions that require special considerations are summarized in a table
Another important topic for extra workup and considerations before ECT are medication use. These medications are also summarized in a clear table.
Article discussed:
MAYUR PANDYA, DO LEOPOLDO POZUELO, MD DONALD MALONE, MD Electroconvulsive therapy: What the Internist needs to know
CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 74 • NUMBER 9 679-685 SEPTEMBER 2007
Monday, September 24, 2007
Doctor Superman is almost history
Part-time work and office hours are important factors for recent graduated medical students. These factors influence their choice for becoming a general practitioner and public or occupational health specialist. So not long from now 60-80 working hours per week as in the "Old Days" will be history. A larger percentage women choosing medical education enhances this trend. 
Enthusing medical students for your specialism also works. The main factor for medical students for choosing a medical specialism is enthusiasm for that particular specialism. The second important factor is their experiences during their education and third their experiences working in that specialism e.g. as an intern.
1091 physicians who graduated between July 1999 and June 2002 from the (Vrije Universiteit) VU university in Amsterdam or the University Utrecht were sent a questionnaire in 2002. Among other information they were asked about the extent to which certain factors have influenced their career choice. Respondents were divided in three groups: clinical specialists, general practitioners and public or occupational health professionals.
The response was 70%, 68% were working in a specialty, 23% in general practice, 9% in public or occupational health, and 2% in another occupation. Of the respondents 64% was female and 36% male.
There were some differences between the three groups. For clinical specialist training the three most important factors influencing their choice was enthusiasm and interest in the specific field (98%), experiences during education (68%) and work experience after graduation (mostly internship)(46%).
For general practitioners also interest in the specific field was the main criterion (97%) and experiences during education (79%) second, but the third factor was the possibility for part-time work (64%).
For public and occupational health professionals the most important facor was working in office hours (88%) followed by possibility to work part-time (68%) and interest in the specific field (59%) was the third factor.
These factors influence career choices. Most important working during office hours and the possibility to work part-time. This will probably increase the coming years, something to consider for Universities and medical specialists and educators.
Article discussed:
Nederlands Tijdschrift voor Geneeskunde
Carrièrewensen en beroepskeuze van recent afgestudeerde artsen
Soethout, M.B.M., Wal, G. van der en Cate, Th.J. ten
2007; 151(38); 2118-23
Sunday, September 23, 2007
Health tips for Bloggers and other Mortals
Blogging addiction is a serious condition. Dr Shock is 64% addicted to blogging which is very high according to his wife. Before looking for marital counseling fortunately Dr Shock found a blog with 23 health tips for bloggers. If you're not a blogger you may try them as well.
Two tips:
If you're in a healthy relationship, have sex at least once every 3 days. I'm dead serious about this. It can be critical to both mental and physical stability.
If you're addicted to IMing, porn, RSS reading, movie watching, shoe shopping, music searching or whatever else dominates your time.... TAKE BACK CONTROL OF YOURSELF and YOUR TIME ... addictions of any kind are not healthy - a healthy person has full control over him or herself.
Saturday, September 22, 2007
Secrets, good or bad?
Adultery, a child from another man, HIV infection, abused as a child, suicidal ideation, all secrets often revealed to Dr Shock by patients during their depressive episode. Depression is often accompanied by pessimistic thoughts, guilty thought, self-blame and ideas of personal failures. That's why Dr Shock usually tries to comfort these patients and advises them to express these secrets only to him or other members of the treatment team not the ones they were hiding their secrets from. Wait until you're depressive episode has gone and then reconsider what to do. Not that they listen. Paternalistic? Maybe. There is no evidence how to handle secrets in depressed patients, no evidence based medicine on this topic yet.
Questions about Secrets and Depression
1. Is keeping a secret because of shame or anxiety harmful?
2. Can a secret become a leaden weight resulting in depression?
3. Might revealing this secret prevent becoming depressed, improve you're mental health?
Gopubmed doesn't help, only 9 articles, not one relevant.
While searching a little bit further the search with "secrets" revealed several articles not very relevant except a recent article in the Dutch Tijdschrift voor Psychiatrie on the second result page of his search. Dr Shock reads this journal every month but hadn't noticed this article. Secrets going bad is explained by the paradox that the attempt to suppress a secret thought leads to thinking more about this secret amplifying the thought to an obsession.
Disadvantages of Secrets:
1. secrets can lead to obsessive thinking and to psychiatric complaints and diseases
2. secrets can lead to somatic illness. An example is the study off HIV positive homosexuals. Those who had to keep their homosexuality as a secret progressed faster to AIDS than those who didn't have to keep it secret. The difference was 1 to 2 years. Another proof was published with non HIV infected homosexuals. Those who had to keep their homosexuality a secret were significantly more prone to infections.
3. Keeping a secret because anxiety for being excluded from their social environment
Advantages of Secrets:
1. Having secrets and sharing them with others requires social skills
2. Prevention from exclusion of social environment
Secrets
So secrets or having a secret has disadvantages and only a few advantages. Dr Shock found the search term: secrecy and disclosure the best for this topic on gopubmed. Scientific interest in this subject is increasing as can be seen on this graph:
Good instructions for revealing secrets during a depressive episode are lacking so Dr Shock will stick with his regimen until instructed otherwise.
Articles used:
Wismeijer AA, Vingerhoets AJ. Tijdschr Psychiatr. 2007;49(6):383-9. The emotional burden of secrets. Consequences for somatic health and implications for health care
[Article in Dutch] PDF
Departement Psychologie en Gezondheid, Prisma-gebouw, Kamer, AB Tilburg.
NRC W&O 23-9-2007
Friday, September 21, 2007
iPod Stethoscope
An unusual story but it seems that the old stethoscope could be replaced in the future by the ipod. Unusual subject for Dr Shock as well but he has an iPod and loves gadgets to.
Gearlive has an article about this new development although unclear.
iPod are already in use to teach medical students all kinds of heart murmurs and sounds:
Barrett produced a CD that mimicked the sounds of six abnormal heart conditions and gave it to a group of medical students, who promptly uploaded the recordings to their iPods.
Found an earlier article of the use of ipod as a stethoscope on turbogadgets
Anyway the iPod Stethoscope package combines a diagnostic stethoscope with compatible software that is able to record and playback sounds, the stethoscope has a fifty times amplification, which enables it to be used under many difficult circumstances, yet can still get excellent readings from faint heart beats to obese patients and in a very noisy environments, this makes the package a useful tool for other professions which would require the use of recording and amplification.
Anyone with more information on this development?
Thursday, September 20, 2007
This Week's Grand Round along Dutch Medblogs
This grand round for Dutch Medblogs was started by Jan at medblog.nl. He is on my blogroll.
On his blog there is an extensive article about evidence based medicine. He also links in his article to several other recent medblog articles in english.
Dr Lutser worries about the Dutch health care system. He fears that due to more market orienting health care a clear division between haves and have nots will evolve.
A funny English song explains what anesthetists do when their patients are a sleep on Martijnhulst.nl .
Admitted patients are more severely ill in comparison with say about 10 years ago, hospital stay is shortened since then, turn-over increased, medical technology and regulations increased as well as "paper work", all explanations for the increased safety risks for patients. Especially since the number of nurses and nursing staff has not increased proportionally. This was established in a recent research by a non-profit research institution in The Netherlands. Nurses have less time to take care for their patients. Writes 100% Mike.
Nurse Klivia is in Iceland, with nice pictures. Another funny travel story with pictures from Greece on manager zorg verteld
On Hotline to Home their is a interesting discussion on anonymous blogging by physicians.
Wireless LAN harmless in Hospitals on MedLog.nl.
Are patients more often depressed after myocardial infarction and is this a reason not to prescribe beta-blocking agents? Two important questions raised in an article on ecgreetje
If you want an automatic translation of e.g. for a blog please see DigiCMB. This blog is written in English, unfortunately there is no Dutch translation.
And last but not least Psych-Leiden***Club-Confabula with a couple of interesting articles from which it is hard to choose. In one of them the dangers of internet are discussed: internet-stress, infomania, and internet addiction. Luckily some tips to treat them or prevent them are also given. Loneliness is in your genes and is accompanied by lower immunity and higher risk of infections. By the way her RSS feed is working again.
Wednesday, September 19, 2007
Transcranial Direct Current Stimulation (tDCS) electrifying?
Another new form of Neurostimulation for the treatment of depression came to my attention: transcranial direct current stimulation (tDCS).
What is transcranial direct current stimulation?
With tDCS a weak electrical current of 1 or 2 m Ampere is applied to the head with an electrode. The electrode is a non-metalic conductive rubber electrode, covered completely by saline soaked sponges.It is a noninvasive brain stimulation technique that utilizes low amplitude direct currents applied via scalp electrodes to inject currents in the brain and thus modulates the level of excitability. It doesn't elicit seizures and it doesn't require anesthesia. For comparison in ECT current of 9 m Ampere is used to elicit seizures during narcosis.
A recent article about this "treatment" was published: A randomized, double-blind clinical trial on the efficacy of cortical direct current stimulation for the treatment of major depression.
The abstract describes a double blind parallel placebo controlled trial. In other words, depressed patients were divided in three groups, one that received the actual treatment, one group that received an active control treatment and a group that received a placebo treatment. Active control was stimulation of the occipital cortex which is assumed to be without antidepressant potential. The placebo group received the treatment without the actual stimulation, active treatment was anodal tDCS of the left dorsolateral prefrontal cortex.
Mood was evaluated by a blinded rater using the Hamilton Depression Rating Scale (HDRS) and by a self evaluation scale the Beck Depression Inventory (BDI).
The reduction in severity score on the HDRS was significantly larger for the active treatment compared to occipital and sham tDCS. Again although significant the question remains how clinical relevant. More clinical outcome such as response ( 50% or more reduction on HDRS compared to baseline) and remission (absolute HDRS score below 7) are not provided. This makes the clinical relevance of the data hard to compare. The beneficial effects of tDCS in the DLPFC group persisted at least for 1 month after the end of treatment.
On ClinicalTrials.gov 17 studies with tDCS are recorded. Two of them are recruiting depressed patients for efficacy and safety of tDCS. One study in New York State Psychiatric Institute USA the other in The University of New South Wales, Australia.
A PubMed search for tDCS and depression results in 19 publications.
A website of The Center for Noninvasive Brain Stimulation has more information about tDCS and also rTMS.
This picture is from tmslab.org:
Dr Shock's opinion
This treatment has something magical about it. This increases the placebo effect. Moreover side-effects were minimal. It is hard to understand how local excitation of the cortex could influence serious alterations of the hypothalamic-pituitary-adrenal axis (HPA axis) present in some depressed patients or other neurobiological alterations for that matter.
Tuesday, September 18, 2007
Elderly regain vocabulary better after ECT than younger patients
Electroconvulsive therapy (ECT) has a negative effect on word fluency shortly after a course of ECT. This improves during follow-up. Elderly have a greater improvement compared to younger patients. More precise the scores on word fluency tests were significantly influenced by age. The effect of age changed from a negative influence directly after ECT to a positive effect during follow-up. The negative effect for older patients is what you expect. The change to a more positive effect is unexpected.
What is word fluency
Word fluency is tested by a simple test, the word fluency test, right. In this research , patients were tested before ECT, shortly after ECT and at 3 months and 12 months after discharge. The word fluency tests consist of naming as much animals and professions as possible during 1 minute.
What is Semantic Memory
Semantic memory is tested with the word fluency tests. Semantic memory are all those acquired facts, concepts and skill you gather during your life. We can learn new facts or concepts from our experiences with semantic memory. Episodic memory represents our memory of events and experiences in a serial form from which we can reconstruct events that took place at a given point in our lives.
Long-term memory
Semantic memory and episodic memory are both part of long term memory.
Why do elderly regain their vocabulary, their semantic memory better than younger patients?
We don't know. This effect could be due to more life experiences or more mental reserve. Another possible explanation could be that stimulation of the neural system results in restorative plasticity, especially in the elderly. Because elderly are at a disadvantage for disturbances of other kinds of memory (such as short-term memory), restorative plasticity may adhere to specific brain regions.
Article discussed:
Changes in Everyday and Semantic Memory Function After Electroconvulsive Therapy for Unipolar Depression.
PMID: 17804988
Authors: Schat A, van den Broek WW, Mulder PG, Birkenhäger TK, van Tuijl R, Murre JM
Journal: J ECT, 23 (3): 153-157, 2007
You can read the whole article on my PBWIKI
Monday, September 17, 2007
SSRI prescription drop associated with suicide increase in children?
Now Dr Shock had the feeling that this association between prescription drop for SSRIs and an increase in suicide rates amongst children, wasn't that simple. He feared that it was all jumping to conclusions. But he didn't feel like going at it. Fortunately a lot of critical bloggers had the same hunge and had a closer look. All were astonished.
Here are some excellent critical minds at work:
1.The Last Psychiatrist
2. Clinical Psychology and Psychiatry: a closer look
3. Furious Seasons
BPR3 Academic Blogging
I have written an earlier article about BPR3.
They have asked for the creation of icons for their initiative.
Design the icon that bloggers will use to identify peer-reviewed research and win subscriptions to Nature, Seed, and more!
I have tried to place the javascript on the left sidebar so you could vote, but alas the script doesn't work so here is an image of three designs and a link for voting, go do it, I voted for Kevin Z’s entry but he is not winning yet.
Sunday, September 16, 2007
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