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Monday, December 31, 2007

10 Fun Ways to Live longer

Eat dark chocolate, play games and have more sex to name a few of these 10 fun ways to live longer.
Now with the year 2007 closing may be a good opportunity to pick some of these fun ways to live longer as new year resolutions for 2008.

Sunday, December 30, 2007

5 Motives for Residents to Stay Late at the Hospital and Why that is a Bad Idea

Why it is a bad idea? Because they become more dominant and less patient centered the next day in their patient care especially in the afternoon as analysed from recordings on autiotapes.
By the end of an afternoon clinic session, residents who had stayed late reported feeling more distracted, less competent and less succesfull compared to those who had left on time. Even when compared with the residents who were on call. Moreover the residents that stay late feel less fulfilled than those who don't stay late.

Possible motives for residents to stay late at the hosipital:

  • Residents may lack adequate time-management skills

  • Residents may stay late voluntarily because they think they can learn more

  • Residents may feel responsible for their patients

  • Some residents work less efficiently than others

  • Residents may have difficulty in trusting others to take over patient care

  • Some residents may use the hospital as a place to fulfil social and emotional needs

Limiting on long working hours may not necessarily reduce residents' time on the job. Limits on consecutive hours as expressed in the work guidelines issued by the Accreditation Council of Graduate Medical Education (ACGME) in 2003 makes it difficult to collect data about the hours that residents actually work. The researchers used data collected in 1990 to study "staying late". At that time residents were free to report on the time they spentat the hospital or in the clinic.

Analysis of a systematic sample of 243 primary care visits conducted in 1990 by 52 paediatric residents at a teaching hospital. They reported about their work responsibilities the night before each primary care visit and their communication style was analysed from recordings made on audioptapes.


1. Old data, the experience of current residents may differ.
2. Little knowledge about what residents did when staying late, whether staying late was habitual or sporadic.

Helping residents to learn to manage their work while under clinical stress. This could promote better adherence to guidelines on working hours and have a positive impact on patient care.

Article Discussed:
Chen-Chung Liu, Lawrence S Wissow (2008)
Residents who stay late at hospital and how they perform the following day
Medical Education 42 (1), 74–81.
Blogging on Peer-Reviewed Research

Saturday, December 29, 2007

Internet Censored in Saudi Arabia and Iran

China is not the only country censoring Internet and anonymous blogging.. The leading Saudi blogger, Fouad Alfarhan, has been arrested in Jeddah on December 10, 2007 for exercising his freedom of speech on his popular blog Also in Iran 24 Internet cafés were closed and 23 people arrested including 11 women as government steps up online crackdown. This was done in a police operation in Tehran on 16 December 2007.

And I am afraid this is just the tip of the iceberg.

Related post on this blog:
Does Internet Addiction only exist in China?

Friday, December 28, 2007

How to act when you bump into a psychiatrist on a party

A guide on how to act when meeting a psychiatrist on one of the social gatherings this season or any season. Time for a laugh? Go read it and don't forget the comments.

Thursday, December 27, 2007

Electroshock treatment for Internet Addiction in China?

Journalist unhesitatingly use electroshock to draw attention to old news. has an old story about China clinic gives 'web addicts' shock treatment.

Besides it being old news e.g. compared to these articles back in 2005 on: usa today and BBC NEWS, although the best is from february 2007. They all report about the same clinic:The Internet Addiction Treatment Center in Daxing County. Moreover, in Western studies no consensus exists as to whether Internet addiction really exists.

About electroshock, my expert opinion of the scene from the video presented with the article of and information from it is not about ECT but something probably comparable to transcranial direct current stimulation.

The so-called Internet addiction is in many cases not an ailment, but just a symptom of some deeper problem. Descriptions of the deeper problems can be read on and on The Herald Tribune.
It mostly comes down to:

"The main cause of Internet addiction is that parents' expectations for their children are too high," said Xu.

With education perceived by many parents as the only means of advancement in an ultracompetitive society of 1.3 billion people, some lock their children up to study and ask teachers to assign extra homework. The pressure can be too much for some children, Xu said, especially if they fail.

"Then they escape to the virtual world to seek achievements, importance and satisfaction, or a sense of belonging."

Another explanation for Internet addiction could be a creative manner of censorship by the Chinese government. Internet is a relatively new phenomena in China, a side effect of its booming economy and technological advances, but how to control this development and how to fit it in with its communist government?

Even anonymous blogging is prevented in China

Delegates at the National People's Congress, China's annual session of Parliament, have proposed stricter criminal punishments for Internet café operators who admit minors, and have flagged restrictions on violent games.

The Internet Addiction Treatment Center in Daxing County uses a blend of therapy and military drills to treat the children with "Internet addiction". It is a government-funded center, run by an army colonel under the Beijing Military Hospital. It is one of a handful of clinics treating patients with Internet addictions in China.

Patients, overwhelmingly male and aged 14 to 19, wake up in dormitories at 6:15 a.m. to do morning calisthenics and march on the cracked concrete grounds wearing khaki fatigues. Drill sergeants bark orders at them when they are not attending group and individual counseling sessions. Therapy includes patients simulating war games with laser guns.

The center's tough-love approach to breaking Internet addiction is unique to China, but necessary in a country with over two million teenage Internet addicts, according to the facility's staff.

Wednesday, December 26, 2007

Postcards from the EDge

This simple postcard prevented repetition of hospital-treated-self-poisoning events by 50% over a 2 year period. The postcard was send 8 times during the first year. The treatment was effective in women not in men. The intervention did not reduce the proportion of individuals who repeated self poisoning. So the number of patients repeating self poisoning did not reduce significantly but the rate of repetition of hospital treated self posoining was halved in the group receiving the postcard 8 times in the first year of this 2 year follow-up. Apart from this postcard all patients received treatment as usual.

In a case of self-poisoning patients are admitted to the hospital for treatment and psychiatric evaluation. After evaluation discharge destination is determined as well as follow-up. This study was preformed in New South Wales, Australia, the Hunter Area Toxicology Service to be precise.

The investigators used an elegant study design: Zelen design or single consent version. After evaluation patients were first randomized. Those randomized to the experimental condition than were asked for consent. Only patients randomized to the intervention were asked for informed consent. The control group had 394 participants, the intervention group 378.

In the intervention group 21.1% of patients had one or more readmissions for self-poisoning compared with 22.8% in the control group 24 months after baseline.

There were 310 cumulative readmissions in the control group and 145 in the intervention group.

The control group used 422 bed-days and the intervention group 183 bed-days.
The intervention also has a substantial cost-effectiveness.

1. It is not known to what extend the population and clinical service model is generalizable to other settings
2. Only patients with self-poisoning were included not other forms of self-harm.
3. No data on mortality and suicide outcomes are available yet.
4. The mechanism for the long term benefits remains speculative.

Elegant and solid study design with excellent internal validity. Creative and simple supportive measure for patients with self-poisoning. Might have only limited applicability to comparable regions and works only for women apparently. Other comparable studies showed no reduction in the number of patients admitted for self-poisoning but they didn't look at the rate of self-poisoning.

Article Discussed:
Br J Psychiatry. 2007 Dec;191:548-53.
Postcards from the EDge: 24-month outcomes of a randomised controlled trial for
hospital-treated self-poisoning.
Carter GL, Clover K, Whyte IM, Dawson AH, D'Este C.

Earlier Article: Free Full Article
BMJ. 2005 Oct 8;331(7520):805. Epub 2005 Sep 23.
Postcards from the EDge project: randomised controlled trial of an intervention
using postcards to reduce repetition of hospital treated deliberate self
Carter GL, Clover K, Whyte IM, Dawson AH, D'Este C.

Movie with the same title: Postcard from the edge (Wikipedia)
Blogging on Peer-Reviewed Research

Tuesday, December 25, 2007

8 Benefits from Working from Home

I have the privilege to spent one day a week working at home if duty allows it. This enhances my productivity enormously. At home I can work without distraction on difficult tasks such as writing articles, book chapters, preparing lectures and presentations. All pleasant tasks for an academic.

That is why this post attracted my attention: 8 Benefits of Working from Home

At home I can work when more productive, eat healthier and have time for exercise and work more efficiently not distracted by beepers, telephone or friendly colleagues.

What are your advantages?

How does memory stick

How can we remember things facts even whole scenes. The most important part of the brain for memory is the hippocampus. This hippocampus exists of neurons or brain cells. These brain cells communicate with their neighbors by sending a chemical burst from the tips of these spines, across a space called the synapse to the tip of a spine on the next cell. If the chemical bath is strong enough, the receiving spine bulges forward — strengthening the connection between the spines. This is thought to be the fundamental process underlying learning.

In a recent article in Scientific American: Signaling Neurons Make Neighbor Cells "Want In", a recent discovery about memory is explained.

A new discovery about the function of neurons could help scientists understand how the brain assembles information during learning and memory formation.

Scientists have found that when electrical impulses are passed from one neuron to another, they not only strengthen the synapse (connection) between them, but they also give a boost to neighboring synapses, priming them to learn more quickly and easily.

In The New York Times:Brain Cells, Doing Their Job With Some Neighborly Help, it is explained how the researchers can watch a synaps in action.
The ability to watch a synapse in action is itself a scientific accomplishment. The average human brain has about 100 billion neurons, and about 1,000 times that many synapses. To zero in on a single one, the researchers used mice that were genetically engineered so their brains produced a fluorescent protein that glowed only in specific cells of the hippocampus. Peering through a high-powered microscope at a slice of this tissue, the researchers could zero in on a single synapse.

In another article in Scientific American:Sleep, Attention, and Memory it is explained why sleep is so important for memory and the hippocampus.
For years scientists have known that sleep is necessary to focus attention on a task, whether you're trying to learn something or not. Specifically, sleep deprivation leads to reduced activation of attentional networks in the frontal and parietal lobes across a range of cognitive tasks. In addition, executive function tasks, thought to be mediated by prefrontal cortex, show greater deficits after a night of sleep deprivation than do other cognitive tasks, such as perceptual and memory tests.

They showed that if you are sleep-deprived there is significantly less activity in the hippocampus.
Moreover if you are well rested there is a stronger coupling between the hippocampi and other structures normally associated with episodic memory processing, including other areas in the medial temporal lobe. If your not well rested the hippocampus will need a tighter coupling with basic alertness networks in the brainstem and thalamus. In order to remember things the not well rested sleepy subjects required activation of the hippocampus together with basic arousal circuits.

Not well rested subject need to crank up their arousal circuits along with their hippocampi. They seem to do so at the expense of other circuits that are normally involved in encoding new memories.

Monday, December 24, 2007

Searching for a Comic?

You can search the Internet for almost anything. Try searching for a comic on Oh No

Personalized comic search and transcription.
Thanks Dr Confabula.

Mood Foods and Tea

Now your at it, going to eat delicious Christmas dinners with dark chocolate after, here are some considerations before you start.

Mood Food or what is your mood today and find out what food could help your mood.

Your Mood: Depressed

Problems at home are doing you in.

Your Meal: Grilled salmon or sushi for dinner

Here's Why: A study in Finland found that people who eat more fish are 31 percent less likely to suffer from depression. And skip sweet, simple carbs­ — the inevitable sugar crash can actually deepen depression.

Probably a lot of crap but funny

Drinking? Older than 70, try Tea. Tea will keep your bones stronger as you age.

Researchers know of two things in tea that help bones: polyphenols, (which include flavonoids) some of which have estrogen-like qualities; and fluoride, which helps keep teeth and bones strong. Green tea, which is a rich source of EGCG, also helps to keep bones strong by inhibiting bone reabsorption, part of the natural cycle of bone breakdown and rebuilding that is always occurring in our bodies.

Sunday, December 23, 2007

The Royal Channel

Queen Elisabeth II has her own channel on YouTube. On her or is it Her channel I saw her first appearance on television in 1957. In this broad cast she already announced that she will adapt modern developments, better late than never. The Christmas Broadcast or 'Queen's Speech' for 2007 will appear on this channel at approximately 3pm GMT on Christmas Day.

There is a lot of old and new material. A day in the life of Charles (The Prince of Wales), Garden Parties, State Banquets. Embedding alas disabled.

Couldn't resist. An elderly going with the times, always good news. What do you think?

4 times Dutch Delight and a Poll

Regularly I discuss recent articles about different subjects related to medicine, psychiatry and education among other subjects. The choice of articles is completely biased. It is because I think the subject is interesting, the research design is elegant or creative, the research question is relevant, or the results are important or any combination of these characteristics. Sometimes, also to my own surprise, these articles are written by Dutch authors.
This blog now exists for 9 months and it is almost the end of the year. Time to look back on these articles written by Dutch authors and to select the best ones. The articles I appreciated the most. This selection is completely arbitrary based on my personal preferences but nevertheless here they are:

1. The use of SSRIs and venlafaxine among children and adolescents in Dutch general practice decreased between 2001 and 2005. A point of concern is the high percentage off-label prescribing of SSRIs and venlafaxine in 2005 as compared to 2001. Not very creative kind of research but very practical with a clear message: Watch out for prescriptions of off lable drugs in children. I hope they will look into this matter in the near future.

2. A disappointing conclusion in this meta analysis: Efficacy of Internet based Cognitive Behavioral Therapy (CBT) for depression and anxiety disappointing. In a recent meta-analysis CBT for depression and anxiety was modestly effective compared to placebo, care as usual, or waiting list conditions. There was also a significant heterogeneity between trials. In short the trials are different and hard to compare.

3. Bold statements mostly done by senior staff members during grand rounds about material that is less well known occurs frequently. Such bold statements are frequently articulated with great conviction and are usually accepted and assimilated by junior staff and the likes of them.
In this article the authors found only 8 (32%) statements to be supported by scientific evidence. In 17 (68%) statements the available literature contradicted (n=13) the statement, or no literature was avalable (n=4). A lot of bull doe ushered during Grand Rounds.

4. 38 of 50 elderly patients refused randomisation beforehand in this trial because of fear of electroconvulsive therapy (ECT). An in depth interview showed that fear of brain damage by ECT played a major role. This recently published study was a feasibility study testing the efficacy and safety of ECT, prescribed in an earlier phase of treatment than last resort. This study 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). The wrong assumption that ECT causes brain damage might be a vestige of the seventy's and the dark period of the anti psychiatry in the Netherlands in that same period.

Which of these articles did you like the most, take the poll on the top right,

Regards Dr Shock.

Saturday, December 22, 2007

I have been nominated

This blog is nominated for Best New Medical Weblog (established in 2007) on

I am very honored by this.

Dark Chocolate More Flavonoids

Dark chocolate has the most flavonoids. This is the substance that improves blood flow and vascular function and diminishes clotting as discussed recently in a post on this blog: Dark Chocolate is good for the Heart.

A typical bar of dark chocolate contains an average of 53.5 milligrams of flavonoids. A milk chocolate bar contains less than 14 milligrams, while white chocolate doesn’t have any

Confectionery makers often take out the flavanols, stripping the chocolate of its main health-promoting properties because flavonols also makes the chocolate taste bitter.
Flavonols are also found in tea, red wine and some fruits and vegetables, foods also known for their heart-healthy effects.

But even if your chocolate is loaded with flavanols, it won’t be a wonder drug. Most studies show only modest benefits from chocolate, and even though it’s good for you, you still have to pay attention to calories and fat.

“If you ask me what’s more important, a little physical activity like walking or eating the chocolate, go take your walk,'’ said Dr. Shani. “I don’t think in the very near future we’re going to tell every patient go ahead and eat lots of chocolate. That would be too good to be true.'’

This disappointing news is from The New York Times

How to find documents on the FDA site

A step by step how to for finding documents on the site of the FDA.

This cheat sheet should help you find briefing documents - the reams of supporting paperwork submitted by a drugmaker when seeking FDA approval for its med. It was compiled by a professor and students at the Lake Erie College of Osteopathic Medicine’s School of Pharmacy and recently published in the letters section of The Annals of Pharmacotherapy.

On Pharmalot:How To Find Documents On The FDA Site

4 Medical Myths Untrue

Ever wondered whether reading in dim light damages your eye sight, or drinking 8 of water is good for your health, shaving legs causes hair to grow back thicker, and you only use 10% of your brain?

Read about these myths in the BMJ

Friday, December 21, 2007

Unsafe sex due to drinking

Research by the University of Southampton found strong links between binge drinking and unsafe sex.

The poll of 520 people attending sexual health clinics found 76% said they had unprotected sex due to drinking.

And this is the proposed solution:
Free condoms should be given away in pubs, clubs and taxis to reduce the levels of unwanted pregnancies and sex infections, experts say.

Read about this research on BBC News
What do you think?

ER on The WEB

On you can learn when a bullet should be removed. On this site you can even practice your ER skills with a moulage.

A moulage is a practice scenario, where you have a patient to assess and manage appropriately.

There are case presentations and lots of images, a wealth of information.

Thursday, December 20, 2007

The Brain from Top to Bottom

On this website: The Brain from Top to Bottomthere is a lot of information about the anatomy and functions of the brain. You can browse the website in several different ways:

By topic, like a wanderer with your knapsack of knowledge on your back. Enter whatever topic interests you and amble around. Sometimes you may feel a little lost, but you may also make some amazing discoveries.

By level of explanation, like a seasoned traveller exploring one of the world’s great cities from top to bottom. Since you will want to see and know everything about the topic you have chosen, you will start at the beginner level, then go on to the intermediate and advanced levels. When you are done with that, you can go on to explore the links we provide to other Web sites and all the knowledge that the Internet has to offer.

By level of organization, like an archaeologist exploring the various levels of a dig site. You can dig down to the nervous-system level, the cellular level and even the molecular level. Or if you prefer, start from the molecular level and work all the way up to the psychological and social implications of your sub-topic.

By module, like a researcher consulting an encyclopedia. The modules on this site are a gold mine of information on such subjects as the history of various disciplines, the tools used in them, the researchers involved in them, and famous experiments that can help you understand them.

By guided tour, following your guide, Right Brain, who takes you through all the levels of the site as if you were at a museum. Right Brain’s guided tours are custom-designed to answer all your questions. To teach you everything he knows, he will take you down secret paths known only to him.

It has very explanatory pictures and drawings. I tried the brain and mental disorders and how the brain develops, it is amazing. Go have a look, what do you think?

Drug Companies shift their Activities to Developing Countries

On this photo are all the gifts a Malaysian general practitioner received in a span of 5 weeks from 17 hours of promoted related interactions with drug sales representatives.
16 multinational pharmaceutical companies and 9 local generic companies and distributors approached Dr Ibrahim. Drug companies shift their marketing efforts to markets in the developing countries since strict regulations in developed countries prohibit most marketing strategies.

Our research shows that poor government regulation, weak industry self regulation and major health challenges of irrational drug use, significantly compound the impact of irresponsible drug marketing on the poorest consumers in emerging markets.

Due to lack of independent information available to medical professionals and patients, medicines can be inappropriately prescribed, dispensed or sold.

The complete report can be downloaded on the website from Consumer International called Marketing Overdose.

Marketing Overdose is:
.... a campaign organised by Consumers International.

Our aim is to expose examples of irresponsible drug marketing and campaign for effective rules and regulations to ensure doctors the public and patients have access to independent, accurate and up-to-date information.

Consumers International (CI) is the world federation of consumer groups that, working together with its members, serves as the only independent and authoritative global voice for consumers.

With over 220 member organisations in 115 countries, CI is building a powerful international movement to help protect and empower consumers everywhere.

Founded in 1960, the organisation is now needed more than ever. This modern movement is essential to secure a fair safe and sustainable future for consumers in a global marketplace increasingly dominated by international corporations.

Consumers International is a not-for-profit company limited by guarantee, registered in England

Related posts on this blog:
Direct to Consumer Advertising in Europe
4 Reasons for Drug Companies to move to China
Doctors and Drug Companies

Wednesday, December 19, 2007

Where are you during lectures?

When attending formal university class I used to sit in the back. To be sure to get out quickly when it was useless or boring. Actually I always sat in the back of a class. Is there a relationship between where students sit in lectures and their performance in examinations? This question is now answered in Medical Education.

The authors realized that students tend to sit in the same place every lecture.They believed that student's attitudes and academic drive may be reflected in their choice of seating position. They carried out an ecological study to find out if there is a relationship between seating position and examination performance.

Those who take the back row are as likely as those at the front to achieve good grades. Medical students sitting in the back is not of educational significance.

The authors distributed a questionnaire to all Year 2 medical students. The students were asked for their identification number to access their mean examination score from the last academic year. The students also had to indicate their seats in the lecture theater with their reason for choice of seat. 92% (n=264) completed the questionnaire.

By the way, when you are cramming for finals here are some good tips to remember

Med Educ. 2007 Dec;41(12):1234.
Is there a relationship between where students sit in lectures and their
performance in examinations?
Roked F, Aveyard P.

Birmingham, UK.

PMID: 18045374 [PubMed - in process]
Blogging on Peer-Reviewed Research

Tuesday, December 18, 2007

Time Lapse Photography

A year of photos from Bryant Park in New York City:

Photojojo's Time Lapse Video of Bryant Park from Photojojo on Vimeo.

All time-lapse photography is, really, is shooting a bunch of photos of the same thing, spread out over a period of time, and smushing them together into one video that plays back in a shorter amount of time.

If you want to read the guide on the ins and outs of time-lapse and start churning out your very own time-lapse videos from your photos go have a look at Photojojo.

Thanks to

3 Times Walking 50 minutes a Week for Treatment Resistant Depression

Exercise addition is an effective strategy when treatment with antidepressants is not satisfactory enough. Three times a week 50 minutes walking is enough.
Seventeen patients with incomplete remission of depressive symptoms began a 12-week exercise program while continuing their antidepressant medication (unchanged in type or dose). The severity of the depression diminished significantly with 5.8 points on the Hamilton Depression Rating Scale and 13.9 points on the Inventory of Depressive Symptomatology-Self-Report.

This lower-cost addition strategy has also numerous other health benefits:
1. cardiovascular benefits
2. improves executive functioning in the elderly (neurocognitive functioning)
3. protection from brain insults and disease
4. reduces the risk for dementia.

With treatment resistant depression there are several strategies to follow. An important one especially with partial recovery on an antidepressant is an addition strategy. The most common addition strategies are the addition of lithium or thyroid supplementation. Disadvantages of these strategies are: side-effects increase withe number of medications used, complexity of use and monitoring.
Patients included were on an antidepressant for at least 6 weeks with adequate dosage. Age between 20-45 years and physically inactive (exercising< 3 times a week and < 20 minutes each time).

The 12-week intervention consisted of both supervised and home based exercise sessions. In the lab patients could use a treadmills or stationary cycles or a combination of both. At home participants could use a treadmill, stationery cycles, a combination of both, or overground walking. Intensity of the exercise was self selected and held constant during a session but be changed between sessions according to the preference of the patient. The exercise energy expenditure was 16 kcal/kg/wk, a public health dose. Participants were allowed to choose frequency between 3-5 times a week.

What exercise?

Participants mostly walked as form of exercise. On a treadmill or overground walking on average of 50 minutes three times a week.

Limitations of the study:
1. not randomized
2. lack of placebo group
3. small sample size
4. low completion rate (47%)
5. selected patient group young of age (39 years)

Article discussed
J Psychiatr Pract. 2006 Jul;12(4):205-13.

Exercise as an augmentation strategy for treatment of major depression.

Trivedi MH, Greer TL, Grannemann BD, Chambliss HO, Jordan AN.

University of Texas Southwestern Medical Center at Dallas, Mood Disorders
Research Program and Clinic, 6363 Forest Park, Dallas, TX 75235, USA.
PMID: 16883145
Blogging on Peer-Reviewed Research

Related posts on this blog:
5 features of pseudo treatment resistant depression
Treatment Resistant Depression and Genes

Monday, December 17, 2007

The 2007 Medical Weblog Awards

The fourth annual Medical Weblog Awards on

The categories are:

-- Best Medical Weblog

-- Best New Medical Weblog (established in 2007)

-- Best Literary Medical Weblog

-- Best Clinical Sciences Weblog

-- Best Health Policies/Ethics Weblog

-- Best Medical Technologies/Informatics Weblog

-- Best Patient's Blog

Nominations are now accepted in the comments section of this post on

Mental Health Unit for Personality Disorders Closed in UK

The Henderson Clinic in Sutton does intensive work with people who have a moderate or severe personality disorder. These patients have enduring emotional and behavioral problems which can involve them harming themselves or others.

A consultant psychiatrist, Dr Diana Menzies, said: "These are people who, if not treated, tend to come back through the revolving door and on to acute wards in psychiatric hospitals.

There is also the opinion of a patient Vicky about the closure of this important and unique mental hospital on BBC News Health

Royal College of Psychiatrists' Centre for Quality Improvement (CCQI) statement on the closure of the Henderson Hospital in Surrey

According to Mad World:
The story says the unit has not been full over the past year but it seems surprising given that the government is supposed to be treating personality disorder services as a priority and had launched a National Personality Disorder Program.

Use of SSRIs and Venlafaxine Decreasing among Dutch Children and Adolescents

The use of SSRIs and venlafaxine among children and adolescents in Dutch general practice decreased between 2001 and 2005. A point of concern is the high percentage off-label prescribing of SSRIs and venlafaxine in 2005 as compared to 2001.

In 2001 the general practitioners (GPs) prescribed an antidepressant 732 times to 194 patients under 18 years of age. In 2005 this was 458 prescriptions to 124 patients. Patients who used antidepressants received on average nearly 4 prescriptions a year in 2001 as well as in 2005. More informative is the over all prevalence of antidepressant use decreased from 2.3 per 1000 children and adolescents to 2.0 in 2005.

In 2001 patients under the age of 12 received SSRIs mainly for anxiety disorders and patients above 12 years of age for depression. In 2005 SSRIs were prescribed most often for depression in the younger age group and other psychiatric problems. Other psychiatric problems were mainly hyperactivity and other worries about the behavior of the child. In the older age group (above 12) antidepressants were less often prescribed for depression and more often for anxiety disorder compared to 2001. In the older age group a shift of prescription for other indications than depression and anxiety could also be found. In this age group the same off-label indications appeared more often in 2005 compared to 2001 for the same indications as the younger group.

The off-label prescriptions of SSRIs was almost twice as much as in 2001. The difference was a significant increase (16.7% to 34.4%). For venlafaxine this was also the case, a significant increase in off-label prescription, but mostly for anxiety disorders.

Especially the increase in off-label prescription for hyperactivity and worries about behavior are worrying because the efficacy of SSRIs for ADHD is not established. Another problem with this is that ADHD is to my opinion mostly used for children and adolescents with lack of structure during their upbringing. The decrease of prescriptions of antidepressants for depression is probably due to the recent warnings and attention in the media about possible increase in impulsive behavior and suicidality in adolescents.

Off-label use is the practice of prescribing drugs for a purpose outside the scope of the drug's approved label, most often concerning the drug's indication. In the United States, the Food and Drug Administration (FDA) requires numerous clinical trials to prove a drug's safety and efficacy in treating a given disease or condition. If satisfied that the drug is safe and effective, the drug's manufacturer and the FDA agree on specific language describing dosage, route and other information to be included on the drug's label. More detail is included in the drug's package insert. However, once the FDA approves a drug for prescription use, they do not attempt to regulate the practice of medicine, and so the physician makes decisions based on her or his best judgment. It is entirely legal in the United States and in many other countries to use drugs off-label.

Attention-Deficit Hyperactivity Disorder (ADHD), or Hyperkinetic Disorder as officially known in the UK (though ADHD is more commonly used), is generally considered to be a developmental disorder, largely neurological in nature, affecting about 5% of the world's population.[1][2][3][4] The disorder typically presents itself during childhood, and is characterized by a persistent pattern of inattention and/or hyperactivity, as well as forgetfulness, poor impulse control or impulsivity, and distractibility.[5][6] ADHD is currently considered to be a persistent and chronic condition for which no medical cure is available. ADHD is most commonly diagnosed in children and, over the past decade, has been increasingly diagnosed in adults.

Article Discussed:
Pharmacoepidemiol Drug Saf. 2007 Sep;16(9):1054-62.
Antidepressant use and off-label prescribing in children and adolescents in Dutch
general practice (2001-2005).
Volkers AC, Heerdink ER, van Dijk L.
PMID: 17551992
Blogging on Peer-Reviewed Research

Sunday, December 16, 2007

10 Ways to Un-bake your Brain

Excellent tips to cool your brain when your stressed or down. Top 10 ways to un-bake your brain at Besides exercise, games to de-stress. I fully agree.

Feeling stressed, anxious, overwhelmed or fatigued? Having trouble making decisions, falling and staying asleep and solving problems? A bit low on energy, just all-around baked? Life does that to us sometimes. The good news is…there’s a short list of simple practices that, done regularly, can pretty quickly un-bake your brain…and your body!


Saturday, December 15, 2007

Medicine 2.0 in 2015

A futuristic view on medical treatment in 2015 enhanced by computer and Internet. It is called Medicine 2.0. Nice post with a lot of links on the topic of how computers and internet can be and probably will be used in the future. On in English.

Early morning april 7th 2015 I wake up because my son cries. I go to his room and he looks ill. He is coughing and has a fever. Do I need to alert a physician? Or can I wait a little longer? I touch the screen in the room to enter the symptoms my son shows into an online application. Luckily my son’s condition is not serious and I just need to give him some medication. But what medication is right? Do I need standard proven medication or should I try new medication that is still in trial? I can easily understand the information since most public accessible health information is written according to clear guidelines.

Why pregnant women don't tip over

Women have some reinforcements in their backs that men lack. This is to compensate for the forward shift of the trunk's centre of mass (COM) above the hips during pregnancy.
Isn't nature beautiful?

reinforcements in their backs that men lack, including a lumbar (lower back) curve that spans three instead of two vertebrae and spinal joints that are 14 percent larger and positioned differently.

From Scientific American

bipedalism poses a unique challenge to pregnant females because the changing body shape and the extra mass associated with pregnancy shift the trunk's COM anterior to the hips. Here we show that human females have evolved a derived curvature and reinforcement of the lumbar vertebrae to compensate for this bipedal obstetric load.

From Nature

Friday, December 14, 2007

4 Depression Hacks

4 tips to overcome depression. Only one of them, using omega-3 fatty acids is not evidence based I think. What do you think?

One of the byproducts of our contemporary isolated life is depression. Depression can have devastating effects on our mind and body, the activities that we used to enjoy with friends and family could become lifeless.

I do not agree with their pessimistic observations about antidepressants. Their suggestions about exercise and sleep as well as brainswitching are OK.

Thursday, December 13, 2007

Glad or Sad, emotion recognition software

The University of Amsterdam, The Netherlands has developed a website on which you can have your photos analyzed.

You can have your own photo's analyzed by sophisticated emotion recognition software, and the mystery of emotions will be explained to you.

Try it!

Glad or Sad in English

Malinconia or Melancholia

Malinconia, by Venezuelan artist Javier Rodriguez, deals with one of the most prominent mental health issues of recent times: depression. Malinconia is the Italian word for melancholy. Depression and melancholia can be viewed as one and the same thing.

The piece is a collage based on the Jan van Eyck painting Portrait of a Man with a Turban, a famous work of the Northern Renaissance. From the mouth down the picture is untouched retaining the classic Renaissance pose and stoic expression. But from the nose up the picture is a distortion: a confused jumble of images. This image of the Renaissance and all it entails – discovery, progress and a greater understanding of the universe – is juxtaposed with images of confusion and doubt, perfectly encapsulating the milieu that so often leads to melancholy: that greater knowledge leads not to greater understanding and certainty, but instead to more questions and uncertainty.

The most powerful part of the piece is the man's eyes. Slightly off-centre, they are where the face first becomes distorted. His eyes are the windows to his melancholia, their downward slant conveying his angst.

Peering from within the folds of the turban are four eyes, indicating a strong influence of the surrealist movement, who themselves were influenced by psychoanalysis.

Rodriguez's works are intricate compositions made from antique books. This mixture of old materials and modern technique perfectly encapsulates his sensibility of classic ideas in a contemporary context. Please visit to see his work.

British Journal of Psychiatry

5 Reasons to be Cheerful with Self Help for Depression

The factors that determine effectiveness of self help in the treatment of depression are:

  • Self help interventions have better effect when volunteers enter these form of treatment for depression. Intervention with patients recruited from clinical settings had a smaller effect. The evidence base used for the NICE guideline for self-administered treatments for depression is almost entirely conducted in volunteer populations.

  • Self-help interventions are more effective with actual existing problems. The preventive capacity of self-help treatment can be less efficacious. The capacity of self help in populations at risk may be smaller compared to those with even mild problems. In populations at risk but without symptoms it can be difficult to show additional benefit from any intervention.

  • Self-help interventions should be based on cognitive behavioral therapy principles rather than education.

  • "Guided interventions" are superior to "pure" self-help treatments. Guided here means the presence of therapist contact as part of the intervention. Therapist being either a professional or paraprofessional (no graduate mental health qualification) care taker. The guidance could be by face-to-face or telephone, e-mail and written contact.

  • There was no clear advantage associated with contact that involved supportive guidance beyond monitoring. With monitoring is meant: checking that patients had used the materials, assisting with queries about use, or whether there was a specific statement that therapeutic techniques such as counseling were not used. When the intervention involved more than simple monitoring, which might include advice from the therapist about specific problems, motivation or support.

Implications of this publication:
The appropriate self-help treatment for depression should be based on Cognitive Behavioral Therapy with guidance from a health professional, although the length or nature of that guidance are less clear.

What has been done?
This recently published study is a systematic review of the randomized controlled trial literature to determine intervention, population and study design factors that moderate the treatment effect of self-help interventions for depression.

The researchers found 34 published studies reporting 39 relevant comparison. they included more and more recent studies compared to earlier reviews.

They used complicated statistical methods for their calculations: meta-analysis, meta regression with multivariate and secondary analysis as well as analysis of publication bias. I won't trouble you with the ins- and outs of these complicated statistical methods mostly because I find it difficult to grasp or explain anyway.

These results should be viewed with cautions since they may reflect statistical confounding. The reason why I have written this post about the publication is that their findings sound very rational and recognizable. This is also a well done review worth mentioning in the absence of other comparable meta-analysis.

What is Self-Help for Depression?
In general, the interventions of interest were designed to assist patients in the treatment of their depressive symptoms, using a health technology such as written information, audiotape, videotape or computer presentation. Interventions were designed to be conducted predominantly independent of professional or paraprofessional contact.

Examples of self-help for depression:
Self Help for Depression: Depression Learning Path Recovering from Depression

Article Discussed:
Psychol Med. 2007 Sep;37(9):1217-28. Epub 2007 Feb 19.
What makes self-help interventions effective in the management of depressive
symptoms? Meta-analysis and meta-regression.
Gellatly J, Bower P, Hennessy S, Richards D, Gilbody S, Lovell K.
Blogging on Peer-Reviewed Research

Wednesday, December 12, 2007

20 Most Popular Health Websites 2007

On Constructive Medicine:

the 20 Largest Health Websites ranked by a combination of Inbound Links, Google Page Rank, Alexa Rank, and U.S. traffic data from Compete and Quantcast.

Thanks HEALTH Highlights

Learning from Errors

Dopamine D2 receptor reduction seems to decrease the capability of learning from errors. The sensitivity to negative action consequences is diminished. This may explain an increased risk for developing addictive behaviors in certain individuals. Addictive behavior can be seen as risk taking behavior. Individuals with A1-allele of the D2 dopamine receptor gene polymorphism are at risk. These carriers have a reduced dopamine D2 density in their posterior medial frontal cortex. They learn to avoid actions with negative consequences less efficiently. Many studies have found relations between a reduced dopamine D2 receptor density and addiction, obesity, or compulsive gambling.

Normally we learn from our mistakes. Positive outcome is a reinforcer and negative outcome should lead to avoidance of the erroneous behavior.

The performance monitoring system consists of:
1. Posterior medial frontal cortex (pMFC) signals the need for adjustment
2. The rostral cingulate zone (RCZ) of this location is involved in learning from errors
3. Dopaminergic neurons from the midbrain into this cingulate zone is involved in judging a situation as better or worse than expected
4. The basal ganglia in particular the nucleus accumbens (NAC) plays a role in reward based learning
5. Interaction with the hippocampal formation enables learning of stimulus-reward associations.

26 healthy males grouped by 2 different genotypes of the polymorphism (A1 allele carries, n=12 and the non A1 allele carriers, n=14)under study were recorded with functional magnetic resonance imaging (fMRI). A learning task sensitive to dopaminergic manipulation was used.

The group with the A1-allele avoided the negative outcome significantly less, they also showed a reduced negative feedback related fMRI signal in the rostral cingulate zone.
The reward related activity increase in the nucleus accumbens was related to positive feedback as compared to negative feedback. This reward related increase was reduced in the A1-allele group in the right nucleus accumbens.

Article discussed:
Science. 2007 Dec 7;318(5856):1642-5.
Genetically determined differences in learning from errors.
Klein TA, Neumann J, Reuter M, Hennig J, von Cramon DY, Ullsperger M.
PMID: 18063800

More on NatureNews

Blogging on Peer-Reviewed Research

Tuesday, December 11, 2007

Beste Gifts for Bloggers and other Geeks

Since I would like to have at least some of these gifts here is the Lifehacker Gift Guide 2007

gifts small and large—from under $10 to the over $50 set—perfect for the life-hacking loved one on your list (even if that's you). To make things a bit easier, our gift guide is sorted by price range so that you can browse gifts depending on what you're looking to spend (from office gift to special someone), and if you're quick, most of these gifts should make it to your doorstep well before the 25th.

Also found a extraordinary gift for women. High Heels are dangerous when driving a car or even a bike. These High Heels however are convertible to flat shoes.

Antidepressant Medication Treatment Failure Does Not Predict Lower Remission With ECT

ECT electroconvulsive therapy electroshock Depression Unipolar Treatment-resistant-depression

Treatment resistance or better treatment failure with antidepressant medication does not predict acute remission status with ECT for nonpsychotically depressed patients.
The influence of antidepressant treatment failure and response to subsequent ECT has been a point of discussion in the international scientific literature for the last decade. The research group of the Columbia University New York has found that depressed patients who have been exposed to at least one adequate antidepressant trial without response have markedly lower remission rates with ECT compared to those without such a trial.
Other studies did not find such a difference in response between medication resistant and non medication resistant depressed patients. With depression the unipolar form is mostly meant.These reports are mainly from the "old continent", Europe.

This is one of the first US publications with results in the line of the latter group.

This research was part of the CORE study (The Consortium for Research in Electroconvulsive therapy).
They recorded treatment failure with antidepressants used during the index depressive episode with the Antidepressant Treatment History Form (n=345)before ECT.
Response to ECT was assessed with the 24-item Hamilton Rating Scale for Depression. Baseline medication treatment failure was analyzed as a possible predictor of remission status.Remission was defined as an at least 60% reduction of baseline on the HRSD and 2 consecutive ratings of less than or equal to 10.Patients were divided in a resistant and a non resistant group. Antidepressant resistant means a score of 3 or higher on the ATHF. You can score a 3 when you have had an adequate dosage of an antidepressant for at least 4 week.

66.4% of patients were treatment resistant (ATHF 3 or higher), No statistical significant relationship was found between remission and resistance status.Adjustment of the analysis for moderating effects of demographic and clinical data as well as adjustment for interaction terms to evaluate effect modification with Bonferoni correction did not influence outcome.

1. Not all patients had an ATHF completed
2. Arbitrary definition of treatment resistance
3. Retrospective collection of information on doses and durations of medications used.

I strongly believe based on these trials and the limitations of the studies from the Columbia University group that medication treatment failure doesn't influence the efficacy of subsequent ECT. The biggest challenge however is to keep these patients well after the acute treatment effect. To my opinion we should focus more on the longer term of ECT and develop treatment programs specific for his group after the first success. Day programs with running therapy, cognitive therapy focused at dealing with memory complaints at first followed by eclectic interventions such as Interpersonal psychotherapy, family therapy, relapse prevention.

Article discussed:
J Clin Psychiatry. 2007 Nov;68(11):1701-6.
Antidepressant medication treatment failure does not predict lower remission with
ECT for major depressive disorder: a report from the consortium for research in
electroconvulsive therapy.
Rasmussen KG, Mueller M, Knapp RG, Husain MM, Rummans TA, Sampson SM, O'Connor
MK, Petrides G, Fink M, Kellner CH.
PMID: 18052563
Blogging on Peer-Reviewed Research

Monday, December 10, 2007

"Hands-on" Expert writes about her Experiences with ECT, electroconvulsive therapy

ECT electroconvulsive therapy electroshock
A written account on Vicarious Therapy about her experiences during an ECT course.

I did not create a video when I went through my ECT treatments, but I did the next best thing; I wrote about my experiences with ECT on a Bipolar/Depression Discussion Board as I was going through the 8 treatments I received.

A compelling story about the ECT and how she experienced the treatment.
My 1st treatment was Friday. As my brain is super important to me I had all sort of concerns about the procedure and its effect on my intellectual abilities. I read tons. The document on this website: has lots of info. The Drs told me that I may have some short term memory loss for around the time of the treatments, but that most of those would come back within a few weeks of the treatments ending. The literature and studies I have read say the same thing.

2.6 Increase in Serious Adverse Drug Events in the last 7 years

Serious Adverse Drug Events (ADEs) reported to the FDA increased all most three times in the last 7 years. Reported deaths increased 2.7 fold, from 5519 in 1998 to 15.107 in 2007. The overall relative increase was 4 times faster than the growth in total US outpatient prescriptions, which grew in the same period from 2.7 billion to 3.8 billion.

What are Serious Adverse Drug Events (ADEs)?
Serious event according to the FDA definition is an adverse event that:
1. resulted in death
2. a birth defect
3. disability
4. hospitalization
5. was life threatening
6. required intervention to prevent harm.

In this research, to prevent double counting, the health outcome was recoded into the following mutually exclusive categories in the following order of priority:
1. death
2. disability
3. all others mentioned above
Reports without serious outcomes were excluded.

Which drugs were included in this survey?
1. prescription drugs
2. biological products except vaccines
3. over-the-counter drugs

Excluded were: medical devices, vaccines, dietary supplements, or illegal drugs. Only the principal suspect drug was used not the secondary or additional drugs used in concomitant therapy.

Data were obtained from excerpts of reports of serious ADEs that were received by the FDA from January 1998 through December 2005. The voluntary reports are submitted either directly to the FDA or to drug companies. The drug companies are required to forward these reports to the FDA if new serious, and unexpected adverse events occur.

More results

  • The increase was largely explained by the increase of reports from drug companies of new serious events not on the drug label.

  • The proportion of serious events with a death outcome was relatively constant over time: 1998: 15.8% and 2005: 16.8%.

  • A disproportionate share of adverse events occurred among elderly not among children younger than 18 years. Even after adjustment for more medication use.

  • Among the 15 drugs most frequently named in fatal outcome, 7 were pain killers, 4 had primary effects on the immune system

  • The change and overall increase can be atributed to a minority of drugs, 80% of the consequences come from 20% of the causes

How come?
In the comments the authors suggests some explanations for this nearly 3-fold increase:

  • Increasing population and intensive use of drug therapy as measured by prescription volume (25% of the increase)

  • a disproportionate contribution of pain meds and drugs that modify the immune system

  • 13 prominent new biotechnology products (anti-tumor necrosis factor, interferon alfa and beta) (15% increase)

Limitations of the study
1. It is a collection of voluntary reports not of systematic collected data
2. Only a relationship between drug and effect can be assumed not causality.
3. Reported events also included medication errors, accidental and intentional overdoses, and production problems.

Blogging on Peer-Reviewed Research
Article discussed:
Arch Intern Med. 2007 Sep 10;167(16):1752-9.
Serious adverse drug events reported to the Food and Drug Administration,
Moore TJ, Cohen MR, Furberg CD.
PMID: 17846394