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Monday, March 31, 2008

Food for the Brain

The brain needs certain ingredients to flourish or to life up to the expectations of every day problems. The brain has priority when it comes to certain ingredients. Some nutrients for the brain can't be made by the body it self. The brain is dependent on our intake of these essential nutrients. Now what does the brain need?

  • The brain needs omega-3 and omega-6 fatty acids. These fatty acids are essential to the brain. It is needed in equal quantities. An important omega-3 fatty acid is docosahexaeenacid (DHA). It is the main nutrient for neurons and their axons. For the hardware. Omega fatty acids can be obtained by eating fish but also soja, walnuts, eggs.

  • Neurotransmitters are chemicals that are used to relay, amplify and modulate signals between a neuron and another cell. Serotonin is an example. Antidepressants influence the concentration of serotonin and other neurotransmitters. Serotonin is believed to play an important role in mood. Serotonin is made of tryptophan, one of the essential amino acids. We rely on our intake of trypthophan. The human body can't make it them selfs. Foods rich with tryptophan are nuts, fruit (especially bananas), vegetables, eggs.

  • The other neurotransmitters such as dopamine and noradrenalin are based on the amino acid tyrosine. This amino acid is not an essential amino acid. Nevertheless our brains benefit from some extra supply of tyrosine as in yogurt, fruit and vegetables especially them that contain a lot of vitamin C, and Marmite.

  • Choline is the basis of acetylcholine, also an important neurotransmitter. Choline is not an essential amino acid. Choline is present in sardines, tuna, salmon, and eggs.

  • Brains also do well on vitamins such as vitamin C and E. They both also free the body of free radicals. free radicals can damage the brain.

Now that is something completely different to the food in this video. They compared the food on the package, the advertisement and the real content in this short video.

In short eating healthy for the brain means eating fish, vegetables, fruit, eggs and yogurt. Eating junk food replaces these important nutrients and are of no benefit for the brain.

Sunday, March 30, 2008

Another Gadget Pen

Recently I wrote a post about 4 Pens and my fascination with pens. There is a new gadget pen that drew my attention.
This pen is a:

  • Mini Torch

  • Laser Pointer

  • Bank Note Checker

  • Stylus

  • Ball Pen!

You can see and buy it on

5 in 1 Gagdet Pen allows you to write conveniently in the dark. It also has a stylus for you to use on PDAs, mobile phones or even to play NDS. It also consists of red laser pointer and bank note checker, too. It is undoubtedly a multi-function pen.

Thanks GearLive

Friday, March 28, 2008

Video Gene Regulation


In this video introduction, Perspective author John Mattick, Stephen Buratowski, and Science editor Guy Riddihough discuss the new and increasing understanding of how RNA regulates DNA, and how RNA may have been the original molecule of life.

Recurrence of Depression with Less Stress than First Episode?

First episodes of depression are more likely to be precipitated by severe stressful life events than are recurrences of depression in unipolar disorder.

  • This is most evident in patient samples compared to community samples. This might be explained by the fact that in community samples patients aren't experiencing clinical depression or patients in community samples may contain individuals with less episodes in the recurrence group compared to patient samples.

  • As the mean age of a patient sample increases the recurrences of depression will be more easily initiated without severe stressful life events compared to first episodes. They will be more likely be precipitated by severe life events.

  • With more women in a sample it is likely that a recurrence will be precipitated by a severe stressful life event. Women are more likely than men to experience a severe stressful life event both before first episodes and before recurrences.

It is asserted that the first episode of a depression is more likely to be preceded by major psychological stressors than are subsequent episodes. This was proposed by R. Post a well known researcher and psychiatrist specialized in bipolar disorder. This ia also known as the kindling phenomenon. In clinical practice it is observed that less and less stressful life events elicit depression across the course of the disorder. But these observations are biased since it is done on a selection of patients.

Recent studies have investigated the differential prediction by life stress of a first onset versus a recurrence. The well known odds ratio is used in these studies. According to a recent review comparing odds ratios has it's disadvantages. They did a systematic review with a new statistical method, using one statistical index to compare first episodes with recurrent episodes and triggering life events. They also looked at moderators such as age, gender and patient status.

Their literature search yielded 28 studies of which 13 could be included in their final sample for analysis.
They used published, unpublished studies, and dissertations. They excluded bipolar disorder. This theory was first used and researched for bipolar disorder as such, so manic and depressive states were included. This review includes only unipolar depression.

Overall their result provide support for the hypothesis that recurrence of depression is precipitated by less severe stressful life events. 11% more individuals in the first onset group than in the recurrence group experienced a severe stressful life event. The clinical significance of this small percentages is unclear. It doesn't explain all the variance in the stress-depression relationship. It may be only applicable to certain groups of individuals or under certain conditions. One group I can think of are the more severe depressed patients, psychotic depressed patients or inpatients. Just stressful life events alone doesn't explain the recurrence of depression.

The most important limitation of this systematic review is the small number of studies (n=13) and the probable sample overlap.

Overall conclusion is that in some patients recurrence of depression might be precipitated by lesser severe stressful life events compared to the first and previous episodes. Further research is needed into which patients and what other factors moderate this effect and what other factors contribute to recurrence.
Stroud, C.B., Davila, J., Moyer, A. (2008). The relationship between stress and depression in first onsets versus recurrences: A meta-analytic review.. Journal of Abnormal Psychology, 117(1), 206-213. DOI: 10.1037/0021-843X.117.1.206

Thursday, March 27, 2008

Upgrade Your Life

upgrade your life by gina trapani
Recently read this new book by Gina Trapani. Read the previous edition a while ago, lifehacker. This new book, upgrade your life, is a little smaller but thicker. The chapters are in a different order compared to the previous edition. This new book starts off with Control Your Email. Indeed an important chapter. In comparison with the previous edition in this chapter all the scattered information about e-mail and how to control it is put in one excellent and explanatory chapter.

The chapters about: Organize Your Data, Trick Yourself into Getting Done, and Clear your Mind rely heavenly on Getting Things Done by David Allen. The selection of hacks are very useful as well as the mentioned software and web based solutions. Remember the Milk (online todo list and task management)is thoroughly explained, I tried it for a while but I like Omnifocus better. Unfortunately omnifocus is not web based and can't be synchronized with the iPhone yet.

After these chapters a lot is to follow. Firewall your attention was an eyeopener to me, especially the tip to shut down your e-mail program when working is terrific.
In Streamline Common Tasks a lot of tips and tricks follow. Saving website pass words, a way to learn your self new pass words based on one basic pass word, text messaging efficiently all in this chapter to name a few.

If you want to get all your data to go or learn how to master the web in these chapters there is a lot of information on just to do that.

There is an accompanying website with errata and links related to the subjects, even links to articles on Gina Trapani is the founding editor of this software and productivity blog.

This new book doesn't add a lot of new information to the old version.

Over all the book has certainly matured. The new order of chapters is more "natural" or logical. The text is well written. It doesn't need a high ranking on the nerd-o-meter to comprehend even the most difficult tricks.

Ever wondered how a computer can be of benefit to your life? Buy this book and you will know how.

For Dutch readers wondering what lifehacking is read this post by Martijn Aslander

Related post on this blog: interview with Gina Trapani

Wednesday, March 26, 2008

The Bleeding Edge of Deep Brain Stimulation

Interview with the Deep Brain Stimulation team of the Ceveland Clinic.
The team exists of a small group of neurosurgeons, psychiatrists and neurologists.

It is being studied as a treatment of last resort for disorders such as depression, Tourette's syndrome, obesity, anorexia, stroke recovery, traumatic brain injury, epilepsy, cluster headaches, chronic pain and addiction.

Nice insight into the history of this new treatment.

The U.S. Food and Drug Administration in 1997 approved deep brain stimulation for treatment of Parkinson's and essential tremor, a much more common disorder that causes trembling. It now also is approved to treat dystonia, a rare movement disorder that involves disabling muscle spasms

One of the fear's is that tinkering with emotional centers of the brain may alter a person's personality.
"I think I've become less concerned because what I've seen is these people returning to how they felt before depression. In other words, we don't seem to be turning on some kind of happy circuit that overrides their depression," said Dr. Donald Malone, the psychiatrist who cares for all the patients in the Clinic's trials.

A nice infographic about deep brain stimulation
for them that find this short video from YouTube on top of this post to heavy.

Related posts on this blog:
Deep brain stimulations for Alzheimer
6 Different locations for DBS in depression
Deep Brain Stimulation resolves coma
The switch that lifts depression

Thanks Neuromodulation blog

Tuesday, March 25, 2008

16 Factors that could Make a Portfolio Succesful in Medical Education?

A couple of weeks ago I was invited to participate in a task force for the development of a web based portfolio for psychiatric residents. I still had two articles about this subject in my "To Blog" drawer.

In medical education the focus has shifted from the acquisition of knowledge to the achievement of competence. Competence has been defined as the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individuals and communities being served.

One of the instruments to support the development of competence in an integrated coherent and longitudinal fashion is the portfolio.

In portfolios the student reports on the work done, feedback received, progress made, and plans for improving competence. An advantage of portfolios can be the stimulation of reflection, trying to structure or restructure an experience, knowledge or a problem.

These factors can make a portfolio successful:

  • Portfolio's should be introduced with a hands-on introduction with a proper briefing of students and teachers: a thorough introduction of the portfolio and its intended use

  • Purpose and procedures should be clearly explained. Both students and mentors should receive clear guidelines and support for their use

  • Portfolio design should be centered on informing, training and gaining commitment from both trainers and trainees

  • The portfolio should be part of other educational activities

  • The maintenance of the portfolio should not be time consuming, some have the perception that maintaining a portfolio costs a lot of time, the portfolio should be smart and efficient

  • Students should have proper IT skills

  • Downloading software and the usage of the software should be user friendly

  • An effective portfolio should have a clear and flexible structure, when learners are given a certain amount of freedom to determine their content the portfolio is more appreciated

  • Clear instructions, they want to know what kind of information they were expected to provide

  • Portfolios should be used both for the formative promotion of learning and the summative assessment. They both ensure that portfolio learning maintains its status alongside other assessments

  • The portfolio assessment should be combined with an interview, adding a mentor to support the portfolio also helps

  • It should be integrated with other educational activity

  • Mentors need to support their students in using their portfolio

  • The portfolio's should be assessed with global criteria, portfolio assessment has no effect on students' openness. When not assessed the use of portfolios will tail off

  • Assessment should be part of institutional asesments with a small group of skilled and trained assessors

  • A flexible learner centered format, too much structure implies a greater risk than too little structure

The most important step to make the use of portfolio in medical education useful is to know the following before you start:
purpose, content, mentoring and assessment.

These factors are based on a systematic review published in Medical Education

Should the portfolio be web based or paper based?
In a recent study, it was shown that students spent more time on the web based portfolio and showed a greater sense of ownership of portfolios in this format with respect to both form and content. The students added more personal touches to web based portfolios content and form. Students enjoy presenting their web based portfolio, which motivates them and enhances their sense of ownership. Both ownership and motivation are crucial factors in effective portfolio use.

Mentors were more pleased with the web based portfolios. They are easier to navigate via hyperlinks. They didn't have to leaf through when they were looking for specific information. Paper based portfolios take more time to read or to find specific information. Web based portfolios are more user friendly for the mentors.It can aslo be accessed at different locations. Some mentors prefer accessing the portfolio from their home. To them web based portfolios are easier and quicker to read.

The quality of both types of portfolios didn't differ. So web based portfolios are preferred.
Erik Driessen, Jan van Tartwijk, Cees van der Vleuten, Val Wass (2007) Portfolios in medical education: why do they meet with mixed success? A systematic review
Medical Education 41 (12) , 1224–1233 doi:10.1111/j.1365-2923.2007.02944.x
Driessen, E.W., Muijtjens, A.M., van Tartwijk, J., van der Vleuten, C.P. (2007). Web- or paper-based portfolios: is there a difference?. Medical Education, 41(11), 1067-1073. DOI: 10.1111/j.1365-2923.2007.02859.x

Monday, March 24, 2008

New Disease: Dysphoric Social Attention Consumption Deficit Anxiety Disorder

This new disease is somewhere in between attention deficit disorder, depression and anxiety disorder. It is only treatable with Havidol. This drug has side-effects:

Side effects may include mood changes, muscle strain, extraordinary thinking, dermal gloss, impulsivity induced consumption, excessive salivation, hair growth, markedly delayed sexual climax, inter-species communication, taste perversion, terminal smile, and oral inflammation. Very rarely users may experience a need to change physicians.

The disease as well as the drug (Have it all) are fake.
Australian artist Justine Cooper created the marketing campaign for a non-existent drug called Havidol for Dysphoric Social Attention Consumption Deficit Anxiety Disorder (DSACDAD), which she also invented.

From Reuters interview with the artist:Fake drug, fake illness
"The thing that amazes me is that it has been folded into real Web sites for panic and anxiety disorder. It's been folded into a Web site for depression. It's been folded into hundreds of art blogs," he added.

The parody is in response to the tactics used by the drug industry to sell their wares to the public. Consumer advertising for prescription medications, which are a staple of television advertising in the United States, was legalized in the country in 1997.

Now why should I write a post about it? For two simple reasons:

Sunday, March 23, 2008

8 Facts about Toblerone Chocolate

When I was a kid flying was still for the happy few. It was surrounded with luxury excitement and "going places". When someone from our family made a trip he or she would always return with a toblerone bar from the duty free shop of the airport.

Did you know that:

  • Toblerone is with us for 100 years this year

  • The recipe was never changed and is secret. It is a mix of almonds, nougat, honey and chocolate invented by Theodor Tobler in 1908 together with his nephew Emil Baumann

  • It is available in 122 countries

  • It is the last chocolate bar still produced in Switzerland, all other Swiss chocolate is made in the developing countries

  • The name is a conjunction of the last name of Theodor Tobler and the Italian for nougat: torrone.

  • 25% of all their chocolate bars are sold in duty free shops

  • The shape of the bars the triangle is inspired by the mountain Matterhorn. It is an unique design for chocolate bars, and patented. Some say they can see a bear in the logo of the matterhorn

  • Just before world war 2 and in the eighties of the previous century the factory almost went bankrupt

It is even used as a nickname for a moving operation of yahoo from London to Switzerland: operation Toblerone
Yahoo (NSDQ: YHOO), which had been threatening its European operations for the last year to shape up or they would be shipped out, has done just that: it is moving its European headquarters from London to Switzerland, with 70 of its top managers in the UK told to relocate or lose their jobs, reports FT. The move, nicknamed Operation Toblerone, was made for corporate tax reasons, the story says citing a source.

About the video found on YouTube:
this late 90s Toblerone ad was designed to run in the surreal style of some of the Beatles songs. Featuring the confectionary made from Triangular Almonds from Triangular Trees, and Triangular Honey from Triangular Bees! That's a lot of Triangles!

Besides their dark chocolate no conflict of interest here.

Thanks NRC

Saturday, March 22, 2008

15 Ways to De-Stress

Some of these ways to de-stress your life have been discussed on this blog. Exercise everyday, there are 21 reasons why exercise is good for your health, not only mental health.

Exercise can be of help when suffering from depression. I wouldn't go that far that exercise is an antidepressant but it is to my opinion a valuable adjunctive treatment to several other treatments such as antidepressants or cognitive behavioral therapy.

Exercise addition is an effective strategy when treatment with antidepressants is not satisfactory enough. Three times a week 50 minutes walking is enough. Says recent research.

For the other 14 ways to de-stress your life go to ego development

Friday, March 21, 2008

38 Bookmarks for Photos

Recently I posted some links for free photos. On the author of Beyond Bullet Points saves bookmarks for free photos. Up until now 38 bookmarks. The best collection I have ever seen. Got this photo from stock.xchng, had to register that was all.

Related posts: Presentation Zen

10 Ways They Fail

I particularly liked this one, go seee the other 9 on Wacky Archives: 10 Ways They Failed

Probably all photoshopped but who cares.

Thursday, March 20, 2008

SSRIs Effective in Depressed Adolescents and Children?

Little attention is being payed to the efficacy of SSRIs for depressed children and adolescents. Most of the attention is on suicidal ideation and attempts due to these antidepressants.

The number of patients needed to be treated to gain an additional improvement was 9 for all SSRIs compared to placebo. For fluoxetine only it was 5. A number needed to treat of 9 is high and comes close to no use. A number of 5 tough sounds promising and is comparable to those reported for SSRIs in adults. Sertraline and citalopram showed only a moderate degree of efficacy and the other SSRIs a weak degree of efficacy.

This conclusion is based on a meta-analysis of 11 randomised controlled trials on the effect of SSRI treatment in children and adolescents with depression.
The randomised controlled trials were different in methodological approaches: enrolled population, sample size, diagnostic and outcome measures, and applied treatment schedule.

Nevertheless, with all these limitations SSRIs especially fluoxetine might be of benefit for severe or resistant depression in children and adolescents. Moreover, combination therapy with cognitive behavioral therapy in adolescents with moderate to severe depression is superior to medication or CBT alone. To my opinion this combination is the optimal treatment for severe or treatment resistant depression in adolescents and children.

The FDA black box warning for paroxetine in October 2004 resulted in a nonsignificant decline in antidepressant treatment of adolescents, including a significant deceleration in the rate of treatment with SSRIs other than paroxetine.

This outcome of a recent study published in the Archives of General Psychiatry of January 2008 neutralizes the concern expressed mostly by drug company supported publications about putting depressed youth at risk due to excessive decline in antidepressant prescribing.

USALA, T., CLAVENNA, A., ZUDDAS, A., BONATI, M. (2008). Randomised controlled trials of selective serotonin reuptake inhibitors in treating depression in children and adolescents: A systematic review and meta-analysis. European Neuropsychopharmacology, 18(1), 62-73. DOI: 10.1016/j.euroneuro.2007.06.001

Internet Addiction

A couple of weeks ago I posted on Internet Addiction in the DSM V?

Medicalize problems again. In an editorial in the American Journal of Psychiatry Internet Addiction is proposed as a new diagnosis in DSM V. Now the American Journal of Psychiatry used to be a serious peer reviewed journal although some of us doubt this feature for a while now.

On Mind Hacks there is another post about this editorial.
Why we have to describe this as an addiction still completely baffles me.

Wednesday, March 19, 2008

4 Ways to Store your PDF's

As blogger but also as doctor I am the proud owner of a lot of pdf's. Mostly scientific papers printed or downloaded from the University Library. Now that pile can grow to an enormous height.

How to save these files without being able to find them again when needed?

There are two ways off-line and two ways on line. The advantage of an on line library is that you can share the articles and read them anywhere with a computer or laptop. Real paper is easily scanned into a PDf in one step.

You just want to save tax documents on your computer, you want a quick and easy way to do it. While most scanner workflows require several steps to digitize documents, the Fujitsu ScanSnap transforms paper into PDF with a single button press.

Ways to store PDF's

  • On a Mac I use Yep. Yep is software comparable to iTunes and iPhoto. You can store or let the program scan your hard drive for pdf files and tag them.
    Start Yep for the first time and it automatically shows you all your PDFs tagged based on where they were found on your hard disk. But the real fun begins when you start adding your own tags. You'll never go back to a hierarchical filing system again.
    You can search for files in yep based on tags. You can save these searches when you need them on more than one occasion. Comparable to play lists.
    Instead of having to decide which folder to store documents in, a simple, powerful tag mechanism we call the ‘ Yep Tag Cloud’ allows you to tag and retrieve documents with ease. In addition to tagging, there is a collection organizer similar to iTunes or iPhoto that lets you make ‘smart collections ’.

  • On a windows computer I use endnote. You can download references from PubMed directly into endnote. You can than attach pdf's to their reference.
    The “Link to PDF” field is renamed to “File Attachment” for organizing up to 45 files per reference. Your custom reference types can now be exported and imported between computers easily. And, you can control the display font for the “Search” window and reference field labels.
    Via search you can retrieve the pdf files.

  • An on line solution is Connotea.The advantages being that you can tag the articles and retrieve them from any computer as long as your on line.
    You will have to register. You can easily share your references with your colleagues. You can export the references for any reference database such as endnote, bibtex, and reference manager.
    You can install a simple button on your browser to import thereference into your library. The only disadvantage is that you can't link to a pdf file.
    Saving references in Conntoea is quick and easy. You do it by saving a link to a web page for the reference, whether that be the PubMed entry, the publisher's PDF, or even an Amazon product page for a book. Connotea will, wherever possible, recognise the reference and automatically add in the bibliographic information for you. In Connotea you assign keywords (or 'tags') to your references. These can be anything you like, and you can use as many as you like, so there's no more need to navigate complicated hierarchies of folders and categories. Connotea shows you all the tags you've ever used, so it's easy to get back to a reference once you've saved it.

  • The other on line solution is CiteULike. It is comparable with connotea but here you can save your pdf with the reference which is clearly an advantage compared to connotea. You can share your library with others, and find out who is reading the same papers as you. In turn, this can help you discover literature which is relevant to your field but you may not have known about.This system is also based on tags. You can import and export references.
    CiteULike is a free service to help you to store, organise and share the scholarly papers you are reading. When you see a paper on the web that interests you, you can click one button and have it added to your personal library. CiteULike automatically extracts the citation details, so there's no need to type them in yourself. It all works from within your web browser so there's no need to install any software. Because your library is stored on the server, you can access it from any computer with an Internet connection.

My choices are yep and citeulike, any other suggestions, please let me know in the comments

ECT Treatment Number 2

A short description and a correction in this second post on The Angie by someone undergoing ECT treatment.

During ECT you are normally not intubated, this procedure only applies to pregnant women in their third trimester. They need to be intubated due to risks of regurgitation of gastric content.

The misunderstanding results from the mouth guard to protect your teeth during stimulation. Due to direct stimulation of the masseter your teeth are clenched. Like in the picture accompanying this post. The stimulation duration is only 4-8 seconds. After that the mout guard can be removed.

Tuesday, March 18, 2008

What electroconvuslive therapy is like

I recently made the decision to try and battle a lifelong struggle with depression with ECT, or electroconvulsive therapy. Because it’s such a hot-button issue in the field of psychiatry and there are many conflicting reports out there on the internet, I thought I would write, from the patient’s point of view, what getting an ECT treatment is all about.

In the interest of full disclosure, I would like to mention that I’ve only received one treatment so far. I’m hoping to use this blog to talk about my experiences as I go through them in the next few weeks while I’m getting the remainder of the treatments.

This is description of ECT by someone undergoing this treatment, I hope she or he will keep us informed about the ECT course on: The Angie, What electroconvulsive therapy is like.

Australian and New Zealand Clinical Practice Guidelines for the Treatment of Depression

While working on a new Dutch Guideline for ECT I discovered this guideline: Australian and New Zealand Clinical Practice Guidelines for the Treatment of Depression.

You can download the complete guideline (pdf 1.1 mb) or a summary. ECT is the fourth option in the treatment of depression in this guideline. They suggest to start with unilateral treatment unless the patient's prior response or urgency dictate otherwise. They even state that long-term maintenance ECT is not proven benefit. This made me wonder when this guideline was installed: 2004. We in The Netherlands are not doing that bad at all when considering our guidelines for the treatment of depression and ECT. Far more eye for the wish of the patient and symptoms, severity of illness of the depressed patient. In case of severe or psychotic depression ECT can be performed as first option

Monday, March 17, 2008

Interview with Gina Trapani on Tim Ferriss Blog

Gina Trapani
Tim Ferris is the author of the book: The 4 Hour Work Week. Read his book but beside some advice about avoiding to much meetings I found his book far less to the point and of relevance than the book by David Allen: Getting Things Done. But maybe that is an age thing, a generation gap. Not everyone shares this opinion.

Tim Ferriss has a blog and he recently interviewed Gina Trapani, the founding editor at Lifehacker and author of the brand-new book, Upgrade Your Life. I read her first edition of this book called Lifehacker, you can see the link on the right sidebar in the recommend books section of this blog. I ordered it special delivery but I am still waiting, will review it when I have read it, hopefully soon. In this interview they covered from morning routine to top downloads and more, they were able to cover a lot of topics in just 8 questions.

I liked this one:

4. What are some common “time management” tactics or approaches that you disagree with or don’t follow, and why?

To some degree, I reject the super-structured, old school of time management thought, the type of rigid planning where you say “from 10AM till 10:45 I’m going to work on TPS reports. From 10:45 to 11:15 check email,” etc. As a “web worker,” by nature I embrace serendipity and tangents, and like to keep myself open to working on unexpected things that excite me, even if they’re not in the plan. For example, a few years back, during some web surfing, I happened upon a tutorial on how to build Firefox extensions. I let myself go down the rabbit hole, so to speak, and now extension development is a big part of what I do.


Bipolar Disorder, Hands On Lecture

Dr. Kay Redfield Jamison, psychiatry professor at Johns Hopkins University School of Medicine, lived every day with the mania and severe depression that she had studied for years. She talks openly of the challenges she faced with the treatment and disclosure of her mental illness.

How Easter can Help depression

easter eggs chocolate
One of the 5 ways how easter can help with depression is chocolate.

Well we all know by now that chocolate isn't an antidepressant.
Chocolate craving might be a feature of atypical depression.
There is even doubt about the presence of flavinoids in most of the chocolate. Dark chocolate holds the higher concentration of flavinoids, these might be good for the heart.

Ah well just enjoy it because you like it is the advice of Dr Shock, but not to much.

Thanks Dr Confabula

Sunday, March 16, 2008

Free Photos

Loch Awe Scotland
Beautiful pictures accompanying a post draws attention to the message or vice versa. Finding a good picture that emphasizes the message of the post is hard to get. Sometimes if I am lucky I can use one of my own. For presentations I have a set self made photo's about ECT.

Luckily there are few free photo sites such as:

  • The site uses the following categories: USA, Business, Europe, Nature, Transport, United Kingdom, and other.
    Our on-line images are covered by the Creative Commons license for non-commercial, no derivatives, attribution license ( This provides for use in any media providing it is not for commercial purposes and they are not making a derivative image or gallery.ANYONE, by which we mean commercial and non-commercial alike, can use images in an online setting, providing they provide attribution to the image and a link back to (either the image or the main site).

    You will have to give your e-mail address, but than you can start the download. The picture is presented in a separate window were you can right click and save as.. The image above and below are from FreeFoto. It is Loch Awe in Scotland

  • A better site is All you have to do is join the mailing list and credit the source when using the image. I didn't join the mailing list but could still use the images with a simple right click and save picture as....

  • On you can only get photos with their name on it,
    Every photograph used must retain the domain name: when used on the Internet, in a web page, in printed publications, or in any product, advertising, or packaging. This credit, however, may be cropped out or digitally removed from the photograph if it is included in readable type near each photograph, group of photographs, in the text, or in the credits.
    Downloading them is easy. Just use right click with save picture as...

Did I mis any? Thanks

Saturday, March 15, 2008

Stroke Insight

Neuroanatomist Jill Bolte Taylor had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened -- as she felt her brain functions slip away one by one, speech, movement, understanding -- she studied and remembered every moment. This is a powerful story about how our brains define us and connect us to the world and to one another.

Besides explaining left and right brain function she also reveals her thoughts and feelings during a stroke. It is also an example of a nice educational presentation.
No lectern, no walls. Her slides are simple but serve a necessary role. She also uses another powerful visual aid (but I won't give it away—watch it).


Talking of strokes, here are 4 simple signs to recognize stroke and probably save lifes

Friday, March 14, 2008

6 Reasons why Female Doctors won't Reach Senior Ranks

The suggestion is that feminisation of the medical workforce will degrade professional leadership, status and influence because women will compromise career aspirations for parenthood.

Since recent decades women comprise 60-75% of medical school entrants, at least in the UK and The Netherlands. However, only 1 in 10 medical clinical professors are women in the United Kingdom (UK). No female professor was employed in 6 medical schools. The presence of women in high ranking management and scientific jobs in Medicine has not increased.

How does gender affect aspirations in the medical workforce?

  • Female medicals students were more prepared than male students to sacrifice high professional aspirations to the realities of parenthood. Men held to their high aspirations assuming their partner would care for the children

  • There is a lack of female professional role models. Successful women are fewer in number

  • Assumptions of female medical students are influenced by stereotypes. Women are portrayed as followers and part-timers. Men as leaders and full-time workers

  • The dominant social picture is that of women being mothers and men being breadwinners

  • Women are portrayed in humbler medical specialties, such as psychiatry, while men are portrayed in prestigious specialties, such as surgeons

  • Lack of professional career advice to counterbalance these influences

These are the conclusions of a recent study published in Medical Education. This study involved students in their first clinical experience in Year 3 and 4. The design was to include a wide range of medical students with a wide spectrum of opinions. These students were interviewed with audio recording with a semi-structured, in-depth exploratory interview on which quantitative analysis was carried out by a female medical student researcher.

The authors concluded based on their results that more flexible work opportunities are needed as well as better career advice.

The question is how an increasing female workforce can be encouraged to seek career progression and an appropriate work-life balance.

But then, why should women want to adhere to demands placed on them by male dominance? What is your opinion, let me know in the comments

Related post on this blog:
Women Doctors more often wear White Coats in Media Portrayals
Drinkwater, J., Tully, M.P., Dornan, T. (2008). The effect of gender on medical students̢۪ aspirations: a qualitative study. Medical Education, 42(4), 420-426. DOI: 10.1111/j.1365-2923.2008.03031.x

Thursday, March 13, 2008

Getting Things Done

When surfing the Internet and reading all kind of geeky, nerdy blogs I often stumbled upon Getting Things Done (GTD). From the posts I discovered some important parts of GTD. The first lessons I learned from these posts was the handling of e-mail. As a doctor, researcher and teacher I get a lot of e-mail each day. Adapting the workflow from GTD in Thunderbird with different folders for Action, Waiting On, Someday, and Archive I became a master in handling e-mail. No overcrowded Inbox anymore.

See also how e-mail can ruin your life

I even bought a labeler for files. But when getting used to my efficient mail handeling I started to wonder about the book. At first I kept telling myself that you could read about GTD online and using good software would do the trick. One of my recent acquisitions was Omnifocus. But in the end I decided to buy the book, Getting Things Done by David Allen.

And I am glad I did. I read it in a weekend. It is very clearly readable written. It is very practical. It takes you by the hand to get organized. Not only online but also in your office and home office. The practical advice is really worthwhile.

The book starts with an explanation of the mind set for GTD. One of the first chapters is about projects. Projects in the view of GTD are anything that you want to or have to do that takes more actions than one. That way a lot of things to do are actually projects. In these first chapters he discusses the essence of projects with why what how and when.

Next he takes you by the hand and tells you how to collect all your projects to do, how to organize your office and how to collect files, deal with your calendar etc.

An important task with Getting Things Done is to set aside a couple of hours a week for a weekly review. In this weekly review you have to take some time to collect all loose paper , notes, and lists. Life has a nice recent post about the weekly review in GTD from the David Allen

Since their are a lot of excellent blogs about I will not bother you further with a description of the book. Read about GTD online and buy the book, it is worth your while.

Improtant blogs about GTD are:
43 Folders

Dutch readers should visit and try the tag slimmerwerken instead of gtd.

Wednesday, March 12, 2008

New Anxiety Disorder Discovered: Disconection Anxiety

Cyberspace takes it tole. After Internet addiction, Video Game addiction there is now a new anxiety disorder discovered: disconnection anxiety.

The American consumer is more connected and has more instant access to people and information than at any time in history. Losing that access creates disconnect anxiety.

What is disconnection anxiety?
Disconnect Anxiety refers to various feelings of disorientation and nervousness experienced when a person is deprived of Internet or wireless access for a period of time.
Overall, our research finds that 27% of the population exhibit significantly elevated levels of anxiety when disconnected. In terms of profile, 41% of this group are 12-24, 50% are 25-49 and 9% are over the age of 50.

So "elderly" experience less or no disconnection anxiety (duh)

Teens feel deprived form their friends, they suffer mostly from the social consequences of their disconnection. Afraid to be cut-off from their friends
Young adults also fear their disconnection from work. Afraid they will miss opportunities.
Boomers also use their gadgets for safety, without it they miss their "lifeline" or a "safety net". They feel safer when carrying it

Who discovers this crap?
Solutions Research Group (SRG) is a consumer research firm with special expertise in media, technology,wireless, leisure, youth and multicultural markets.
Based in Toronto, the firm is best known for its syndicated quarterly tracking studies of consumer behavior, including Digital Life America in the U.S. and Fast Forward in the Canadian market.

Medicalizing adaptation to new developments again. I won't be surprised if they come up with cognitive behavioral therapy for disconnection anxiety.

Thanks engadget
You can download the report on engadget.

Making Music with Only Windows 98 & XP Sounds

This is a video of some music a guy made using only sound effects from Windows. The video is of the music playing in ModPlug Tracker, the program he used to put it all together. The music only lasts for 1:31, then he starts going through all the different sounds he used.

It is amazing what he can do with these simple sounds.

Related posts with music:
Spill the Wine
Gotta Digg, Digg This

Tuesday, March 11, 2008

Long Term Side Effects of Electroconvulsive therapy in Bipolar disorder

Patients with bipolar depression treated with ECT in the past (on average 45 months ago with a standard deviation of 21 months) only performed significantly worse on the Californian Verbal Learning Test compared to patients with bipolar disorder not previously treated with ECT.

These bipolar patients previously treated with ECT also had significantly more subjective memory complaints.

These two conclusions were drawn from a recent study in which 3 groups of subjects were compared. A group with bipolar disorder previously treated with ECT at least 6 months before memory assessment, a group of patients with bipolar disorder with an equal past illness burden but that had never received ECT and a group of healthy controls. All groups were matched for sex and age.

Now why was this research done?
Cognitive effects of ECT is largely studied in unipolar depressed patients, seldom solely in bipolar patients.
Unipolar and bipolar disorder differ from each other not only in demographic and clinical features but also in treatment and medications.
Some studies suggest that people with bipolar disorder are generally more likely to have cognitive deficits when euthymic than people with unipolar depression. This might be due to the disease it self or due to medication or both.
Extrapolating results from research with unipolar depression and cognitive side effects of ECT to bipolar patients might for these reasons not be very reliable.

Up until this reasoning I can follow the importance of further research into this matter of side effects of ECT and bipolar disorder. But the method used in this trial doesn't remotely answer this question alas.

The researchers didn't focus on the most important side effects of ECT such as retrograde amnesia and anterograde amnesia. They used memory tests not very specific for the cognitive side-effects of ECT.

Confounding factors such as medication used prior to testing and during testing as well as other important clinical variables influencing outcome could not be excluded due to small sample size. The differences found could be explained by these variables instead of ECT treatment.

Patients were not randomized to ECT or no ECT.

So what is the bottom line then?
It is still possible that patients with bipolar disorder will have a different long term outcome after ECT than unipolar patients. This research shows that although not very focused on the usual side effects of ECT the cognitive changes are small and are unlikely to influence the risk-benefit ratio of ECT.

In a recent post I mentioned the opinion that some subjective memory complaints can be considered as a somatoform disorder
A post about a memory test for retrograde amnesia
Everyday memory not affected by ECT
Bipolar disorder and ECT
MacQueen, G. (2007). The long-term impact of treatment with electroconvulsive therapy on discrete memory systems in patients with bipolar disorder. Journal of Psychiatry and Neuroscience, 32(4), 241-249.

Monday, March 10, 2008

Maintenance ECT does not produce cognitive side effects

Electroconvulsive therapy (ECT) for depression is the only treatment that is usually stopped when the patient has recovered. After successful ECT antidepressants are prescribed to prevent relapse. Since the widespread use of antidepressant pharmacotherapy, the indication for Electroconvulsive therapy (ECT) is often a medication resistant depression. Patients usually were treated with several antidepressants before ECT. Even with medication treatment failure for depression ECT is still very efficacious.

Depressed patients with pharmacotherapy treatment failure may benefit from the prophylactic effect of the same (class of) drug during maintenance therapy after response to ECT. Some patients relapse during adequate treatment with antidepressants after successful ECT. These patients usually will have another ECT course after which maintenance ECT is an option when antidepressants before and after ECT have failed to prevent relapse.

Maintenance ECT is effective in preventing relapse and recurrence in patients who have shown an initial response to ECT. During manintenance ECT the frequency of treatments is lowered. During a course patients are usually treated twice or three times weekly. During m-ECT this frequency can be lowered to once every 4 weeks. ECT frequency is lowered in small steps, from once a week to once every fortnight. In the first four months the frequency is lowered any further than once every two weeks.

During the course of ECT the most important side effects retrograde- and anterograde amnesia. To my opinion these cognitive side-effects do not increase and even might decrease during m-ECT. Cognitive side-effects during m-ECT are hardly studied because of small sample size and lack of control group.

In a recent study 12 patients receiving maintenance ECT were tested before and 90 minutes after an ECT treatment. Twelve other patients were tested at arrival in the hospital and 90 minutes later before receiving their maintenance ECT. The experimental group, tested before and 90 minutes after ECT did not show significant learning, attention or frontal decline in the second assessment after the ECT session, in comparison with the control group. However their visuospatial ability was lower than it was in the control group after after the second assessment. ECT sessions may cause some acute, mild dysfunction of visuospatial function.

Limitations of this study
Small patients samples (12 in each group).
No long term memory assessment

From this study we can not state that there are no adverse cognitive effects after one m-ECT session. But a lower frequency of treatments with a longer interval between treatments is probably to long to increase cognitive side effects. m-ECT does not produce clinical significant adverse cognitive side effects in contrast to an acute course of ECT

This research agrees with my clinical impression, anyone another opinion?

Related posts on this blog
Cognitive side-effects of ECT in adolescents
Everyday memory not affected by ECT on the long term
Side-effects of ECT how do they work out

Sackeims letter to the editor about memory loss due to ECT
RAMI, L., GOTI, J., FERRER, J., MARCOS, T., SALAMERO, M., BERNARDO, M. (2008). Cognitive functions after only one ECT session: A controlled study. Psychiatry Research, 158(3), 389-394. DOI: 10.1016/j.psychres.2007.01.005

Games with Electroshocks

Sure, your games are thrilling and all, but they don't exactly cause actual pain, do they? Well, that's all going to change thanks to the two twisted dreamers who started the company Mindwire, and their electroshock feedback device, the V5. That's right, next time you get fragged in Unreal, sacked in Madden, or robbed in GTA -- you get shocked in real life. Just the sadistic thrill you've been after, right? The device works by splitting your controller input to the "brain" of the V5 and your console, then sends electric jolts via electrode pads on your skin. Right now the company has a model tested and working with the PS2, Xbox, GameCube, and PCs, though they appear to be making preparations for current gen consoles in the next iteration of the device. If you're content with the choices at hand, this self-torture can be yours for £99.99 (or around $201). Check the totally awesome video after the break to see the V5 in action.

You can watch a video while someone is playing with this device attached on Engadget: The Mindwire V5 turns gaming into pure electroshock torture

Sunday, March 9, 2008

Dr Shock Went Hiking

The brand on the flag is pure coincidental, no conflict of interest there.

Why Can't We find a Gene for Depression?

The estimated heritability of depression is 40-50%. This is based on twin studies and family studies. Than why is it we can't find the gene?

  • There are different subtypes of depression such as melancholic type, Seasonal Affective Disorder, Bipolar depression. These different types of depression will not be explained by one gene or set of genes, or polymorphisms of genes.

  • Research until now may have varied in inclusion criteria and diagnostic criteria

  • Genes responsible for depression may differ with ethnicity. Chines might have different gene locations responsible for depression than Caucasian depressed patients

  • Besides ethnicity, gender may also play a role in genetics, depression is twice as common in females than males.

  • Depression is a complicated disease. Different systems could affected. A variety of different neurotransmitters and hormones can be involved. In some patients the cortisol stress system is involved with depression in others not. In some patients SSRIs are effective, others need other kind of antidepressants or treatments.

  • And last but not least, depression can have many causes of which heritability is just one and it doesn't have to be present at all.

There was some hope when Caspi et al showed that the 5-HTT genotype (serotonin transporter gene)moderates the depressogenic influence of stressful life events. It moderated the effect of life events that occurred not just in adulthood but also of stressful experiences that occurred in earlier developmental periods. Consistent with the Gene x Environment hypothesis, the longitudinal prediction from childhood maltreatment to adult depression was significantly moderated by 5-HTTLPR. Childhood maltreatment predicted adult depression only among individuals carrying an s allele but not among l/l homozygotes.

Since then some research and meta analyzes revealed contradictory results of this G x E interaction. Sometimes a modest association of the short allele and depression was shown and sometimes no association could be found.

This could be due to the aforementioned reasons in this post. In a recent publication of research with the serotonin transporter polymorphisms the authors investigated in 340 Caucasian patients with a major depressive episode the influence of the subtype of depression (melancholic depression versus atypical depression) and gender.

They found support for an association of genetic variation increasing serotonin transporter activity with the melancholic subtype of depression as well as evidence for a potential female-specific mechanism underlying this effect. The longer more active L allele of the serotonin transporter gene is significantly associated with melancholic depression, particularly in female patients. A L allele increases serotonin transporter activity and/or density

This contradicts the earlier finding by Caspi, they showed an influence of the short allele and early life stress and depression.
The authors argue that the short s allele increases the risk of neuroticism , harm avoidance and a depressogenic effect of neuroticism. The long allele increases the risk of melancholic type of depression without prior neuroticism. This remains entirely speculative and brings us back to the previous mentioned reasons why we can't find a gene for depression.
Baune, B.T., Hohoff, C., Mortensen, L.S., Deckert, J., Arolt, V., Domschke, K. (2007). Serotonin transporter polymorphism (5-HTTLPR) association with melancholic depression: a female specific effect?. Depression and Anxiety DOI: 10.1002/da.20433

Saturday, March 8, 2008

4 Blog Posts about ECT: pregnancy, a love letter, and is ECT the treatment for you?

The first post on PsychCentral about a letter from James Potash, a well-known researcher from Johns Hopkins who has made his career by studying the genetic basis of mood disorders and schizophrenia and possible overlaps. This so called love letter for ABC News is to postive about ECT to the taste of the author: John M. Grohol, Psy.D.

Don’t get me wrong — I know people who have successfully underwent ECT. Most say they are thankful for the option. But it is not the cure-all this article makes it out to be. It is still an extreme procedure requiring a lot of forethought prior to accepting it, and the research is far from clear as to its long-term effectiveness and efficacy.

The other blog post over at: Center for Women’s Mental Health Blog is about pregnancy and ECT
Despite evidence that electroconvulsive therapy (ECT) is a safe and effective treatment for many psychiatric illnesses during pregnancy, many clinicians and patients are still reluctant to pursue this option, concerned that it will harm the fetus or incur extra risk for the patient. Ultimately, the clinician must weigh the risks to both mother and fetus involved in not treating a woman who suffers from severe psychiatric symptoms against the risks involved in ECT treatment, and facilitate the most appropriate clinical intervention for the individual patient.

Related post on this blog:
ECT and pregnancy: a case report

Another excellent explanation of ECT from the department of psychiatry from the Michigan University: ELECTROCONVULSIVE THERAPY (ECT):

Why electroconvulsive therapy works on brainblogger