Dr Shock MD PhD

Discovered my learning style in a modern outfit online. From Lifehacker I did a survey on DVC learning Style Survey.
These are my results from the survey:

You learn best when information is presented visually and in a written language format. In a classroom setting, you benefit from instructors who use the blackboard (or overhead projector) to list the essential points of a lecture, or who provide you with an outline to follow along with during lecture. You benefit from information obtained from textbooks and class notes. You tend to like to study by yourself in a quiet room. You often see information "in your mind's eye" when you are trying to remember something.

Learning Strategies for the Visual/ Verbal Learner:

To aid recall, make use of "color coding" when studying new information in your textbook or notes. Using highlighter pens, highlight different kinds of information in contrasting colors.

Write out sentences and phrases that summarize key information obtained from your textbook and lecture.

Make flashcards of vocabulary words and concepts that need to be memorized. Use highlighter pens to emphasize key points on the cards. Limit the amount of information per card so your mind can take a mental "picture" of the information.

When learning information presented in diagrams or illustrations, write out explanations for the information.

When learning mathematical or technical information, write out in sentences and key phrases your understanding of the material. When a problem involves a sequence of steps, write out in detail how to do each step.

Make use of computer word processing. Copy key information from your notes and textbook into a computer. Use the print-outs for visual review.

Before an exam, make yourself visual reminders of information that must be memorized. Make "stick it" notes containing key words and concepts and place them in highly visible places --on your mirror, notebook, car dashboard, etc..

What I like about this survey is the practical and modern advice you get. I suggest all students in particular medical students should do the survey. It will deliver some new tricks and this survey is better than the surveys I did when being trained as a teacher.
These result probably also explain my interest in websites and good design as well as gadgets.

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There was no evidence of a protective effect on suicidal thinking or action with the addition of CBT to an antidepressant in depressed adolescents. In contrast to an earlier study in the United States cognitive behavioural therapy (CBT) does not improve outcome of treatment with a selective serotonin reuptake inhibitor (SSRI). On second look the US study also did not show additional benefit of CBT added to a SSRI (fluoxetine). Moreover the results of the US trial limits generalisability since it excluded adolescents with active suicidal intent, self harm, severe conduct disorder, and active substance abuse. Certainly suicidality is a core feature of severe depression. More than half of the participants were recruited from advertisement.
This trial in Great Britain is of more importance since it includes moderate to severely depressed adolescents and this randomised controlled trial had a follow-up of 28 weeks and it did not exclude suicidal adolescents nor psychotic depressed patients. They were all outpatients. CBT was offered weekly for 12 weeks, then fortnightly for 12 weeks with a final session at 28 weeks (total 19 sessions). The focus of usual care was an explanation of depression and attention to recent family or peer group conflicts. Comorbidity problems were also attended to when required, including liaison with schools and other agencies.
Overall outcome on the long term (28 weeks) was not bad at all: 7/94 (61%) of those in the SSRI alone group and 52/98 (53%) of the CBT plus SSRI group were much or very much improved. Again no significant difference but a good response for adolescents with a severe depression.

One weakness is the absence of a placebo arm, which we considered to be unethical in such ill patients, so we cannot draw any conclusions regarding overall effectiveness of treatment.

Now this is the most regrettable remark in this article about this excellent trial. Since there is such difficulty in deciding what is the best treatment for adolescents with depression as well as so much uncertainty about the benefit or harm from the use of antidepressants it is most unethical not to include a placebo arm in this kind of randomised controlled trials. If we want to get any further in the treatment of a sever illness we shouldn't choose for the easy way out.

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Acomplia (rimonabant) from sanofi-aventis has serious psychiatric side effects, namely depression. The European Medicines Agency (EMEA) recommends not prescribing this drug to patients with a depression or on antidepressants.
More information medicalnewstoday.

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This blog about depression and it's treatment especially with ECT is in the air for a while. I hope a lot of readers benefit from these scribbles. The truth be told, I learn a lot from writing these articles. Mostly I gather a lot of information for my work as a psychiatrist which end somewhere in a drawer or the "round archive" without being read at all. Since writing this blog I actually read them and when appropriate post the information on my blog. Surfing on the net nowadays is always accompanied by the question: Is this information relevant, blogable?
Now I take the privilege today to look back on my posts and make a round up of the most important sites with information about ECT relevant for interested readers in this subject, hope you like it.

1. About ECT for bipolar disorder from healthyplace.com, also more general information about ECT, the procedure, side effects.

2. Take it easy on ECT. Opinion of a patient treated with ECT about the side effects and the discussions about this topic in the media.

3. Another patient's opinion about ECT and it's side effects adding to the discussion in the media.

4. Electroconvulsive therapy (ECT): Treating severe depression and mental illness. Information by the Mayo Clinic. Very informative for patients facing the choice.

5. ECT get's a makeover. On ABC News, the opinion of patients and doctors.

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New article with proponents and antagonists of ECT, objectively written by Sibile Morency at ABC news.

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"If you have the capacity to respond to reward, then you have the placebo effect," says neuroscientist and radiologist Jon-Kar Zubieta, senior author of the new study published this week in Neuron.
In this study they used brain imaging techniques. The 14 volunteers were told they would receive painful injections of saltwater in their jaw muscles. This shot would be followed by a painkiller. Half of the volunteers would receive the painkiller and the other half would be injected a fake painkiller, so they were told. However all volunteers were injected with the fake painkiller (placebo). During this procedure they were monitored with brain imaging techniques (positron emission tomography (PET) scans).
The scans showed that half of the participants who believed they were receiving painkillers reported feeling significantly less pain than did other volunteers. Their dopamine levels were noticeably higher (than that of the others) from the moment they were told they were receiving authentic painkillers.
On another day these fourteen with 16 new volunteers were brain scanned with functional magnetic resonance imaging (fMRI) during a card gambling game. They were told they could win or lose a certain amount of money each round; they would then push a button to determine the real take.Several of the participants showed a flurry of activity involving dopamine release in the nucleus accumbens while awaiting the outcome, indicating that they were expecting a reward. These participants were also the people reporting pain relief from the fake painkiller. So there is a strong link between the reward system (dopamine, nucleus accumbens) and the placebo effect. With this result you can predict the placebo response or even develop techniques targeting the dopamine system to increase the placebo effect.

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A commentary in the JAMA by Prof Max Fink. In this commentayr he sumarizes the most important recent topics in ECT.
1. Remission for depressive illness with ECT: 55%-86%, these results compare favorably to the response rates in the STAR*D trial.
2. Relapse prevention after ECT, nortriptyline with lithium is first choice, continuation ECT for patients who relapse despite this treatment and for those who may not tolerate medication.
3. ECT is a primary treatment for psychotic depression.
4. ECT reduces the acute risk for suicide.
5. Medication resistance does not bare relation to treatment efficacy with ECT.
6. He still favours bilateral electrode placement.
7. Important side effects are anterograde-, retrograde amnesia.
8. Vagus Nerve Stimulation and Deep Brain Stimulation are not comparable in efficacy to ECT.

This is in short his few about the recent achievements in ECT treatment and it's research. His preference for bilateral ECT is a topic for debate. Unilateral electrode placement is technically more complex but comparable in efficacy when done the right way. That is with supratreshold stimulus dosage after stimulus titration during the first session. Research with side effects should be done for the long term and focussed on individual differences

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These are the words of a wise old man. George W. Comstock, an epidemiologist renowned for proving both what worked and what didn’t in the prevention and treatment of tuberculosis. He died last sunday of prostate cancer on the age of 92 and he had never retired:

Comstock said of his career: “I never really thought too much of it in terms of achievement. It’s been fun. While there are people in science, of course, who are shooting for the Nobel Prize, who are shooting to be the top dog in this field, but I think most of us are just interested in learning something that will push the knowledge a little bit further ahead. And, you know, that’s gratifying.”

For his achievements you can read an article at WSJ.com Health Blog by Jacob Goldstein.
For me these words are an example of wisdom that struck me.

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This is the title of an article from a patient treated with ECT and a nuanced opinion about this treatment, wish a lot of patients would read it.
A voice from the silent majority

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The way adolescents act and react such as poor decision making, recklessness, and emotional outbursts makes many parents hopeless. At least that's what I remember from my parents although I was a very agreeable adolescents. The title of this post is by Dr. Huxtable, Bill Cosby in The Cosby Show who has the same opinion as many parents.
As a psychiatrist I am also a consultant for a adolescent unit in our hospital. The consults are very few but mostly about depressed adolescents. I find it very hard to diagnose depression in this category of patients, they do have symptoms comparable to adults but they can also differ in their symptoms.
Can adolescents be depressed, is it the same as with adults? I wonder. So I have chosen to explore this topic from a more scientific, biological view point. Are the brains of adolescents different than those from adults, can these brains become depressed or are their differences explaining a different symptom pattern and treatment needs?
Brain maturation continues into the teen years and continues even into the 20's. During the teen you get an overproduction of gray-matter. Gray matter is distributed at the surface of the cerebral hemispheres (cerebral cortex) and of the cerebellum (cerebellar cortex) mostly, but also in the deeper centres of the brain.
After the overproduction of gray matter the brain undergoes a proces called "pruning". Pruning is a neurological regulatory process, which facilitates a productive change in neural structure by reducing the overall number of overproduced or "weak" neurons into more efficient synaptic configurations. It is often a synonym used to describe the maturation of behavior and cognitive intelligence in children by "weeding out" the weaker synapses. Connections among neurons in the brain that are not used wither away. This is also called: the use it or lose it principle.
This pruning proces makes the brain more efficient by strengthening the connections that are used most often, and eliminating the clutter of those that are not used at all.
Functional magnetic resonance imaging (fMRI) research found that compared to adults teens' frontal lobes are less active during the showing of pictures of people with fearful expressions and their amygdala is more active. The frontal lobe is the seat of goal oriented rational thinking and the amygdala is involved in discriminating fear and other emotions.
Teens often misread facial expressions, the judgement insight and reasoning power of the frontal cortex is not up up to the task yet as it is in adults. Adolescents process information differently from adults.

What does this mean?
1 Adolescents are "hard wiring" their brains during this period in life, that's probably why this is the period for education
2 This explains why adolescents fail to to heed adults' warnings, they may simply not be able to understand and accept logical arguments
3 It is also possible that adolescents misperceive or misunderstand the emotions of adults, leading to miscommunication
4 Adolescence seems not to be the right time to experiment with alcohol and drugs

The question about depression and adolescence in view of brain development remains for a next article, to be continued

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Cyberonics Inc. on Monday said the United States Food and Drug Administration has approved its Demipulse and Demipulse Duo generators for commercial release. The products are used for vagus nerve stimulation, which is used in the treatment of epilepsy and certain types of depression.
In August 2006 Cyberonics saw the FDA reject the company's application to use its implantable generator to treat depression in patients who do not respond to medications. Mainly due to disappointing results of clinical trials. In the only randomized controlled trial VNS failed to perform any better when turned on than in otherwise similar implanted patients whose device was not turned on. For summary of safety and effectiveness data see this FDA rapport.
The pacemaker-like device, which is surgically implanted into a patient, has been available in the U.S. since 1997 as a treatment for epilepsy.
VNS uses a stimulator that sends electric impulses to the left vagus nerve in the neck via a lead implanted under the skin. The left vagus nerve is stimulated rather than the right because the right plays a role in cardiac function such that stimulating it could have negative cardiac effects. The exact method of therapeutic action is unknown, but VNS has been shown to affect blood flow to different parts of the brain, and affect neurotransmitters including Serotonin and Norepinephrine which are implicated in depression. Some patients experience an alteration of voice quality and loudness during the time that the pulse is being delivered to the vagus nerve. Other common side effects include hoarseness, throat pain, cough, shortness of breath.
For further eading on VNS please see Wikipedia.
For more explanations about the differences between VNS, Magnetic Brain Stimulation and Deep Brain Stimulation, please see this website from Biotele.
For more information about VNS see this page from the Mayo Clinic. And this one for Deep Brain Stimulation.
My opinion is that efficacy is not proven for these treatments for depression although there are patients that can benefit. Before you try one of these methods be sure they have been treated with all regular options including ECT or electroshock.

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The New York Times reveals that among specialists the psychiatrists are the one's that get payed the most by pharmaceutical industries in the USA. In the USA drug companies are required to disclose their payments to doctors for lectures and other services. Endocrinologists received the second largest amount.
Efforts to require disclosure of payments to doctors began almost by happenstance in 1993. Compliance with the law seems to be "spotty". In The Netherlands such laws do not exist. To my opinion it would be time to make them. Even with disclosures in abstracts, articles and lectures it is still hard to evaluate the objectiveness of some psychiatrists.
Well that's to posts on money and health today.

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In the biggest attempt yet to change the public perception of conditions such as depression and schizophrenia, three major charities are to run a TV campaign showing that many conditions thought of as incurable are treatable.
The amount of money involved in this campaign is about 16 million pounds, according to the Guardian.

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Side effects of ECT, the possible memory loss is a topic for debate. Not only between psychiatrists but also between patients. Here is another story of how these side effects ruined the life of a patient. Made a comment to this post but it was not published on the blog as a comment. Here is another more positive opinion about ECT from a patient.
Side effects will be a topic for discussion for a long time. On this blog two other views are described in 2 posts. First a view from Prof Max Fink and here a post about an ongoing discussion with Prof Sackeim.
I will post your comment anyway.

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An unfortunate 46 years old man had a strange side effect with a selective serotonin re uptake inhibitor (SSRI). SSRIs are antidepressants. In continuation of yesterdays post about chocolate here is another strange story. After approximately two weeks of treatment with the SSRI he noted an intense itching sensation in his scalp after eating a piece of chocolate cake.
The itch spread to the arms, abdomen and legs and the patient treated himself with clemastine and the itch disappeared. He now realised that he had eaten a chocolate cake before this episode and remembered that before the first episode he had had a chocolate mousse dessert. He had never had any reaction from eating chocolate before and therefore reported this observation to his doctor.
The skin contains a system for producing serotonin as well as serotonin receptors. Serotonin can also cause itching when injected into the skin. SSRI-drugs increase serotonin concentrations and are known to have itching and other dermal side effects.
This case report suggests that there may be individuals that are very sensitive to increases in serotonin concentrations.

"Life is a box of chocolates, you'll never know what you'll get" (Forrest Gump)

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It is claimed that chocolate has the capacity to improve mood, and make people feel good. Chocolate is made from cocoa, butter and sugar. Milk chocolate contains extra milk solids and fats, white chocolate is akin to milk chocolate without the cocoa. That's why white chocolate to my opinion is not chocolate. Attempts have been made to identify any psychoactive substance in chocolate. Several candidates were identified but their concentrations are too low to have a significant psychoactive effect and they are also present in higher concentrations in non-craved foods. Milk chocolate is the most preferred but if psychoactive substances were involved dark chocolate should be the most preferred. At least I prefer the dark chocolate.
Interaction between chocolate and neurotransmitter systems that contribute to appetite, reward and mood regulation were studied but no antidepressant mechanism of chocolate was found.
Chocolate can be the quality of chocolate graving, only chocolate will satisfy that craving. When experiencing an aversive mood state any carbohydrate will suffice in an attempt to achieve relief. This last form of behavior is also called emotional eating, food preference can be altered across a range of mood states. It is useful to distinguish between these two separate phenomena: chocolate craving and carbohydrate craving. The two phenomena can, however, co-exist in the same individual by virtue of the dual status of chocolate as being specifically desired and being more generally craved as a carbohydrate at times of emotional eating.
For most people chocolate is a substance of pleasure and extravagance. When taken in response to a dysphoric state as an emotional eating strategy it may provide a transient comforting role but it is more likely prolonging this state. It is not an antidepressant.
For an excellent review please read: Mood state effects of chocolate.
Parker G, Parker I, Brotchie H. J Affect Disord. 2006 Jun;92(2-3):149-59.

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In the last couple of years antidepressants were accused of causing suicide in patients using them. More recently a subgroup of patients, adolescents were assumed to be of increased risk for suicide when using antidepressants. This is a reference to an article on The Corpus Callosum, a scienceblog.
This blog has already dedicated a number of posts about this subject. This recent post discusses: Suicide Attempts Among Patients Starting Depression Treatment With Medications or Psychotherapy and an editorial Antidepressants and Suicidal Behavior: Cause or Cure? in the latest (July 2007) issue of the American Journal of Psychiatry.

The main finding of the article was this: the temporal pattern of suicide attempts was the same regardless of treatment modality, and it was the same regardless of the age span of patients studied. Note that the pattern was the same, although the rates were different.

The treatment modalities were antidepressants prescribed by a primary physician, antidepressants prescribed by a psychiatrist and individual psychotherapy.
The risk of suicide attempts peaks before the onset of treatment, these data show a pattern that is exactly the opposite of what one might expect if antidepressants were associated with increased suicidal risk.
This and other studies are observational studies and observational studies can never definitively demonstrate causality, prospective studies are needed for that. However, the results of both studies are consistent with a protective role of treatment against emergent suicidal behavior.

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A new candidate drug for bipolar disorder is being designed by researchers in Chicago and New York. It works as well in mice as do the currently prescribed drugs. They hope that it will ultimately provide relief without the side-effects of present treatments.
Bipolar disorder, which afflicts about 1% of adults, is typically treated with drugs called mood stabilizers, especially lithium is used. Lithium is thought to act by blocking the function of an enzyme called glycogen synthase kinase-3beta (GSK-3beta) in the brain.
Kozikowski and colleagues did two things. First, they looked for a way to improve binding to the enzyme. They also altered the enzyme so that it could get from the blood into the brain, which involves passing through a water-resistant membrane.
They made a whole family of molecules, and tested how well each of these blocked the enzyme's chemical behavior. They identified the best of them and looked at whether it would work in animals. In a mouse model of 'mania', hyperactive mice were calmed and moved around much less when given the new candidate drug. The new compound looks promising, but a lot of work remains to be done before it will be ready for human trials.
References

1. Kozikowski, A. P. et al. J. Am. Chem. Soc. 129 , 8328-8332 (2007).

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Activity scheduling is an attractive treatment for depression because it is relatively uncomplicated, time-efficient and does not require complex skills. Activity scheduling is a behavioral treatment of depression in which patients learn to monitor their mood and daily activities, and how to increase the number of pleasant activities and to increase positive interactions with their environment. This treatment was developed about three decades ago because it was evident that depressed patients find fewer activities pleasant, engage in pleasant activities less frequent and obtain therefore less positive reinforcement than other individuals.
Researcher form the department of clinical psychology of the Vrije Universiteit in Amsterdam, The Netherlands did a meta-analysis to examine the effects of activity scheduling on depression, on the relative effects of activity scheduling compared to other treatments and on the longer term effects. Their literature search produced 16 studies with a total of 780 subjects. In four studies subjects were recruited from clinical settings. In only five studies the participating subjects had to meet diagnostic criteria for depressive disorder, the other studies included subjects who scored high on a severity rating scale for depression or used other definitions. Activity scheduling was compared to other psychological treatments. Activity scheduling was compared to cognitive therapy in 10 studies.
They concluded that activity scheduling is effective in the treatment of depression and equally effective as cognitive therapy also at follow-up periods up to 6 months.
The limitations of this review were:
1. number of studies was small
2. studies used very small sample sizes
3. only one study compared with antidepressants
4. the quality of the studies was not always optimal
5. few studies used clinical samples

It is remarkable that activity scheduling received so little attention. Since activity scheduling is as effective as other psychological treatments for depression it is possible that the effects of treatment are achieved by common factors such as the intensive relationship between patients and therapist, the expectation of the patient of being cured, the ritual of the therapy, and the presentation of a rationale. Advantages of activity scheduling is that it is simple and easy to understand, no need of complex skills, and time efficient.

If you want to know what activity scheduling is and you don't want to waste to much time before starting some exercise or looking for a therapist, please have a look at this excellent blog on Finding Optimism. There is also a recent article in cooperation with zen habits about Top 42 Exercise Hacks. Besides there is much more about fighting depressed mood in different ways on this blog.
Informative links on this subject:
More Evidence for Antidepressant Properties of Exercise

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Nearly 30 million Americans suffer from some form of depression. Many people with depression do not seek help, even though most of those with severe cases can be helped. Kidney disease patients are at an increased risk of suffering from depression. Understanding Depression in Kidney Disease and When Your Loved One is Depressed, gives readers an understanding of what depression is, what may cause it and how it is treated.

The American Association of Kidney Patients (AAKP)has published a brochure in the AAKP Understanding series. To download an electronic copy of this brochure, please visit the AAKP site.
It is an excellent brochure with an accurate account of what a depression is and how it is treated. Different treatment options are explained.
It is stated on this website that kidney disease patients are at an increased risk of suffering from depression. Since we did some research about depression and chronic inflammatory liver disease I am a little reluctant about scattering around this diagnoses. Would need to do a thorough literature search before answering this important question. With patients with liver disease a high prevalence of depression was only found by using a depression severity scale. Using severity scales to screen for depressive disorders in chronic somatic patients yields a prevalence that is too high. With a structured psychiatric interview prevalence is usually less and comparable with the prevalence in the general population for patients with a chronic inflammatory liver disease. It is possible that patients with a chronic somatic illness have some features of a depressive disorder, but lack all the features required for the DSM-IV diagnosis.
In conclusion patients with chronic somatic illness can have "psychiatric complaints" sometimes due to a psychiatric disease but most of the times due to their somatic illness.

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The European Committee supports the request of the pharmaceutical companies for "direct-to-consumer-advertising". The International Society of Drug Bulletins warns against this legislation. It is wrong to confuse information with advertising.
The dangers of "direct-to-consumer-advertising" are:
1. advertisements from drug companies are mostly limited to those drugs with the highest profit
2. efficacy is often exaggerated
3. risks are usually obscured
4. it confuses patients when suggested another drug by their physicians
5. it forces physicians to use the advertised drug
6. advertisements by drug companies lack comparison with drugs from other companies or other treatments, making it hard for consumers to compare different drugs or other treatment options

Another objection is the impartiality of the Pharmaceutical Forum preparing this proposal. This is done by the Pharmaceutical Forum. This forum is not elected and not less than 5 drug companies are part of this forum. Moreover the patients are represented by The European Patients' Forum sponsored by the Drug Companies.
There are only two countries allowing "direct-to-consumer-advertising": USA and New Zealand.

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Another short but concise introduction to ECT for patients can be found on this page of webMD. It is short but on this blog more posts about sites with information on ECT for patients can be found. Use the tags on the right column.
The information is reviewed by the department of psychiatry from the Cleveland Clinic.

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In a recent systematic review it is suggested that antidepressants, more specific the selective serotonin reuptake inhibitors (SSRIs) begin to have observable beneficial effects in depression during the first week of treatment. This conclusion is debated by the authors of a recent letter in the same Journal: Archives of General Psychiatry.

We argue that the criteria of including only studies reporting outcomes for at least 2 points in the first 4 weeks of treatment might have systematically selected positive trials, that is trials showing significant differences between placebo and active drugs during the early phases of the trial. In other words, it is possible that the authors of primary studies reported more often early outcome data suitable for reanalysis when differences emerged.

They also argue that probably most of these trials with the positive outcome were sponsored by the drug companies. And it is not unusual for these companies to not publish negative trials comparing SSRIs with placebo. The authors plead that scientific journals should require, before accepting reports of clinical trials, a statement in which authors agree that data may be accessed by organizations involved in research synthesis. Reports of clinical trials should not be accepted without such a statement. Only in this way would the damage of publication bias be mitigated.

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Memory complaints after ECT a somatoform disorder . This needs some explanation. It is the title of an article by Prof M. Fink. A very distinguished physician with a tremendous amount of experience with ECT. In this article he summarizes the complaints of two patients treated successfully with ECT. They both have expressed their memory loss with great detail in the media and even psychiatric congresses. He also mentions Kitty Dukakis and her new published book and DVD: Shock.
The author doesn't deny memory loss can occur after ECT but not to the extend as noted by the examples he mentions in this article. In his article he makes a case for defining these extraordinary cases with extensive personal memory loss as a somatoform disorder. This is a disorder consisting of unexplained physical complaints, inconsistent with known anatomy, physiology, or biology. According to the author:

The rare complaints of persistent loss of personal memories as a consequence of ECT are well within the family of these syndromes.

The demographic features of the complainants according to the author are well educated women, often nurses, with histories of prolonged depressive illness marked by somatic features and suicidal episodes. ECT was the last resort, reluctantly advised and administered, that resulted in relief of depression. The loss of personal memories is a new focus of illness making return to work impossible, however these patients function well in new roles as critics of psychiatry.
I don't know, I can recognize his arguments but the problem is as stated in an earlier article that we do not know enough about the possible causes of memory loss. By that I mean the possibility that some patients are more vulnerable for this side effect. Vulnerable in a biological sense and the patients he describes could well be the ones we are looking for but we need better understanding of the etiology for discovery of high risk groups.

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I have recently written a post about food and depression and how healthy eating might help. Here is another interesting site for help on healthy eating.

The Diet Plate ® system, invented by Kay Illingworth, centres around a portion control plate that literally takes all the guesswork from maintaining a healthy, balanced diet. That means there's no counting calories, points or fat grams and no denial of essential food groups, so it doesn't rely on having to eat starchy carbohydrate one day and protein the next.

They have studied the use of this plate with patients with type 2 diabetes in clinical trials. The results off this study are promising so they say. The article is being reviewed, but they already mention the effects being very positive. As stated earlier:

Research in this area is still underway so it is not possible to draw any firm conclusions but the evidence does suggest that it is worth trying to follow a healthy diet in order to protect our mental health.

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Google has recruited big names to advise the company on health care. The rumour is that this could be the start of a new service. Google might be working on a way for people to store their medical records online, according to the Wall Street Journal health blog

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I use scenes form movies very often when teaching medical students about psychiatry. The benefit of those scenes are that you can see psychiatric symptoms and patients in a very condensed form. Not all movies or scenes can be used. For instance it is hard to use "A beautiful mind" for teaching on Schizophrenia because you'll have to show a very long excerpt of the movie to make your point. Shine is also an example of a movie which you'll need to show at considerable length in order to show the students psychiatric disorder. There is even an entire website about Movies and Mental Illness.
With clear instructions some scenes can be used to demonstrate psychiatric symptoms. "As good as it gets" is one of my favorites. All ready in the beginning of the movie the first scenes paint a clear picture of someone with obsessive compulsive disorder (OCD). Showing "As good as it gets" during a lecture a student asked me if "The Aviator" is also about OCD. I hadn't seen that movie so I purchased the DVD. There are some scenes that clearly shows symptoms of OCD and as such can be used for instructing medical students about psychiatric symptoms. On the other hand seeing the movie also raises the question whether it is OCD or compulsions and obsessions as part of Schizophrenia and that is more difficult to show during a lecture. It requires to show a considerable part of the movie.
Now back to Shine. It is one of the most impelling movies of a psychiatric patient struggling with his illness and overcoming for a great deal his illness. He has also been treated with electro convulsive therapy which can be seen in a short scene. He is doing well these days. In this article in The Japan Times. He is doing a tour in Japan this year."I have tours of New Zealand and Europe this year and again two European tours in 2008, as well as concerts in Australia and Asia, so my itinerary is rather full," he says. "But then I enjoy playing very much. I just play and let the music tell the story."
Good for him
Not only movies but also television shows have psychiatric topics. For instance Brook Shields talking about her post partum depression with Oprah Winfrey. For another comment about psychiatry and movies or television have a look at this article from Lancaster Online: How the media looks at the mind.

Discussed movies:
"A beautiful mind"
"As good as it gets"
"The Aviator"
"Shine"

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Finding optimism is a great blog. A lot of information about depression. I cannot beat that blog. The recent post is 94 resources on treating depression. An excellent collection of links. Also informative links about ECT with one of them I hadn't seen before. Another I did find a while ago

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In my Google Reader it keeps coming up that elderly men and women have Low Bone Mineral density with Selective Serotonin Reuptake Inhibitor (SSRIs) Use. SSRIs are the most used antidepressants. Other antidepressants such as tricyclic antidepressants (TCAs) do not have this effect according to the abstract of this article in the Archives of Internal Medicine.
The problem is that depression also causes bone density loss, so is it due to the drug or the disease? Other antidepressants such as tricyclic antidepressants do not cause this diminishing of bone density, at least according to this article.Needs to be continued.

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Med-Source
Although it is difficult to see how often this blog is updated it hosts a lot of information for medical students. For instance links to sites with free medical text books, useful websites and reference material.

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The American Medical Association’s is thinking about recommending the inclusion of “Internet/video game addiction” in the Diagnostic and Statistical Manual of Mental Disorders (a.k.a. DSM), the standard-setting catalog of mental illness.According to an article in the Wall street journal online.
Luckily the final decision will be up to the American Psychiatric Association, which oversees the DSM. To my opinion a lot of research has to be done to proof it even exists. Is there proof of withdrawal symptoms?
You might have guest this author plays a lot of games, on and offline.
Maybe we shlould make a poll which games are played by which medical specialism?

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The eye opening story about one of the most controversial medical treatments in history.
At this site from the publisher of the film you can view a trailer and buy the DVD. Through candid and intimate interviews with patients, doctors, and other experts, the film explores the myths, mysteries, and realities surrounding electroconvulsive therapy, a medical procedure used, most effectively, in treating severe clinical depression. ECT works by inducing seizures in a patient through electrical impulses to the brain. One of the interviewed is Kitty Dukakis, wife of the three-term Massachusetts governor Michael Dukakis.
I bought the DVD, will review it when I've seen it.

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ECT for bipolar disorder is underused to my opinion. This article on HealthyPlace.com is an excellent description of the use of ECT with bipolar disorder

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A call for vistors to this nice blog to reveal there inspiration for blogging
I hope it grows fast!

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Healthy eating and depression. A publication from the Mental Health Foundation, a UK charity for everyone's mental health. You can also read it online. Research in this area is still underway so it is not possible to draw any firm conclusions but the evidence does suggest that it is worth trying to follow a healthy diet in order to protect our mental health.

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This is a non commercial website with practical information about depression

Beyondblue is a national, independent, not-for-profit organisation working to address issues associated with depression, anxiety and related substance misuse disorders in Australia. Beyondblue is a bipartisan initiative of the Australian, state and territory governments with a key goal of raising community awareness about depression and reducing stigma associated with the illness.

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Shrink Rap: L.A. E.R. Tragedy . . . Emergency Mental Health Care If this is true, psychiatry in the USA is in a deplorable state.

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Always thought John Travolta was an intelligent actor, kind to others and understanding the less well todo, alas.
Travolta Echoes Cruise On Psychiatry, Travolta Says No To Psychiatric Medication - CBS News

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How to make up your mind about choosing psychiatry as a speciality in medicine. An excellent introduction

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Sure, ranomized controlled trials are better than naturalistic trials, but what we need is better memory tests, study other types of memory (everyday memory and semantic memory), longer follow-up and basic research to the question why some of the patients treated with ECT get memory deficits.
In his letter to the editor Prof Sackeim defends his findings of a naturalistic 7 centre trial to the side effects of ECT. He also used a biographical memory test. These tests are at the least not the best tests to examen retrograde amnesia. We should develop more specific and sensitive test for retrograde amnesia. Last month I made a post about better memory tests especially for retrograde anmesia. W're doing a trial with a new test with ECT for retrograde amnesia. Patients are still incuded in this trial.
Moreover as stated in his letter the impact on every day living of retrograde amnesia is still to be researched. Besides everyday memory, semantic memory is of interest.
Also most research on side effects of ECT have a short follow-up. Randomized controlled trials control for such things as late onset depression and the side effects but with longer follow-up w're able to look at the patients in which the depression is the first symptom of cognitive decline.
We now know a lot about dosage, electrode placement and cognitive side effects of ECT, but what we don't know yet is how do these side effects appear, where do they originate. How can we adapt our techniques and devices to lessen cognitive side effects. More important, which individual factors of the patient makes him more or less prone to these cognitive side effects.

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I read this interesting post on ECT.org will comment on it as sson as possible. Now on vacation in Italy.

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A clear and concise desription about ECT

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According to this study and article Yoga may help treat depression and anxiety. Even some data on brain scans and evidence for changes in neurotransmittors after Yoga

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This article by Laura D. Hirshbein is a clear description how depression became a specific disease category with concrete criteria. I thought depression was one of the most clearly described categories in human history. Depression was not a classification in the DSM I (1952). Depression as we know it today became only a diagnostic category in DSM III in 1980. There were certainly descriptions of melancholia in physicians writing throughout human history but the author states that depression as we know it is a twentieth-century phenomenon.
As a psychiatrist working on a depression unit I can most of the time clearly recognize depression. But many patient also present with depressive complaints which are clear depressions in terms of DSM IV criteria but differ from those patients in which a diagnosis of depression can't be missed at least to my opinion.
The author has strong arguments for this 20th century phenomenon.Depression became topic of research in the 1950's. In those days the inpatients mainly consisted of young women.The large number of women in clinical trials for depression in those days appeared to be a reflection of the hospital population of that time. Before the 50' in pre world war 2 period the inpatients of a psychiatric hospital were mainly older men.
In the develoment of DSM III, groups of researchers developed specific diagnostic criteria for depression. They looked at populations of patients in hospitals.Symptoms were counted and analyzed to see which best characterized depression.Patients with drugs or alcohol abuses were excluded as in medication trials. Researchers tested those criteria in hospitalized depressed women. The question whether women were depressed more than men was never raised. The connection between women and depression has been a closed circle. This article gives some food for thought.

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Forgetting May Be Part of the Process of Remembering - New York Times
Interesting article in Nature Neuroscience.
In all, this research suggests that memories are more often crowded out than lost. An ideal memory improvement program, Dr. Anderson said, “would include a course on how to impair your memory. Your head is full of a surprising number of things that you don’t need to know.”

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Dr Shock is attending a symposium in Bolzano, Italy about ECT. On one of his days off he was hiking the mountains of the Dolomites in north eastern Italy were he met a 77 years old men Dr Ugo Bebetti. During a pranzo (lunch) in a lovely hotel in Bulla where they met, both on there way to the Alpe di Siusi he told Dr Shock about Dr Ugo Cerletti. The old man met Dr Cerletti during his resedency at the University of Rome.

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Kevin, M.D. posted a link to a press release about the dutch kidney show by the Dutch broadcasting company BNN. The founder of BNN had several kidney transplantations before he died. Read the comment whether it is a hoax or a serious problem in the Netherlands

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This is one of the hardest questions to answer especially if your working on a inpatient unit with depressed patients. They are mostly severely ill for a long time and demoralised when they get admitted. To get a clear picture of what is wrong we usually get rid of all psychopharmacological drugs for diagnostic purposes. That's why i find this article of major importance, clearly written by experienced clinicians. The table offers clinical features that may help differentiate chronic depression from personality disorder.
Guidelines:
1. avoid unsupported conclusions based on nonresponse
2. bear in mind that depression is likely to make personality traits look more like full-fledged PDs by exaggerating a range of personality traits such as avoidance, dependence, and interpersonal sensitivity. Always consider what evidence exists that these were more than traits at any point when a patient was less markedly depressed
3. use multiple informants (family members, close friends, primary care doctors, psychotherapists) as well as other collateral information (eg, performance evaluations from work) to gauge the highest and usual levels of occupational and psychosocial functioning when less depressed. For example, even if the patient is in the middle of multiple struggles with his treatment team, a history from family and coworkers of the patient's typically satisfying stable work and personal relationships before a first episode of MDD in his mid-20s should lead a diagnostician to question the hypothesis of borderline PD.
4. systematically assess personality pathology with specific questions about onset, quality of relationships, mood fluctuations, and patterns of coping. In this respect, clinician-rated, semistructured interviews that inquire about specific symptoms and behaviors and associated impairment may be helpful as a supplement to global clinical impressions. This may be even more reliable than patient-rated questionnaires, which may be more sensitive but less specific.

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This excellent book by Tara Calishain is worth every penny. She is the autor of ResearchBuzz, a website with news about search engines, databases and other information collections.


When I walked in to this book I remembered her name from other excellent books so I had a look inside. Immediately I was seized by her examples of how you could use information trapping. In my case I just started a blog about depression and electroconvulsive therapy and related psychiatric subjects. I was wondering how to keep up with all the information on the web. For my job as a psychiatrist, teacher and researcher keeping up with all the new articles, websites, scientific papers is an every day struggle. Since I am very interested in getting as much information with the least effort for my work and now my blog this book seemed to me an excellent introduction in how to use the computer to gain these goals.
After the first introductory chapter about information trapping the book starts of with three other important chapters in which RSS feeds, page monitors and e-mail alerts are explained and how they can help you finding information in different ways.

These chapters are full of examples with their advantages and disadvantages. After explaining how you can find RSS feeds and which websites are of help she continues in explaining the two different types of feeds and more important which feed to use and when. This chapter ends with a description of the most important feed readers and their characteristics.

The next chapter about page monitors was new to me. The most important web based and client based page monitors are described including their costs. Chapter 4 is about e-mail alerts and useful e-mail alert services.
The next chapter is about building queries. This surprised me since I already tried all the services she explained before this chapter. Building a good query is usually the starting point after which you can decide to gather the result by RSS feed or e-mail alert. She explains this order of chapters by pointing out that you first need to know the tools of the information trapper's toolbox before you learn what to trap, where to trap it and when. To me that was a little confusing, already started working. Maybe in the next book a note in the first chapter about this order of chapters. The chapter about building queries is again very well written with important tips and tricks as can be expected from this authority on search engines and their use. Made me curious about her book about search engines.
Chapter 6 is an important chapter about "Who's linking to your site". Information about who's linking to your blog or website is internal information, external information is anything else. Knowing who is linking to your blog can enhance your content and services. Knowing what people think of your website can improve your writing and if know who is linking you can approach sites like these and ask them to link to your blog as well.This chapter discusses Google and Yahoo for finding out which inbound links are there to your blog. Technorati and the new kid Icerocket are discussed as well.
Chapter 7 is the core chapter of this book, it is also the largest chapter in comparison with the other chapters.It is all about trapping information from external sources, mainly search engines. This chapter desribes a lot of different kind of search engines.General search engines, news search engines, blog search engines, commercial search engines, trapping government information, monitoring international sites and some more. All engines are descrbed with how to build your query for that typical search engine , trapping information and possibilities. Kebberfegg is a special kind of power search tool, delivers a lot of information, is not yet very user friendly. It is developed by Researchbuzz. Chapter 8 is about trapping podcastst, video and images. Chapter 9 discloses the use of tags and conversations. A lot of information about flickr, del.icio.us and others. Chapter 10 addresses the issue of organizing all the information that is filling your inbox. This is an excellent howto for the use of Gmail. Chapter 11 has two examples in two case studies as well as how to get rid of information if it's not to your liking.Chapter 12 is a very useful chapter about organizing all the information. Organizing the information on a single computer with google or yahoo desktop. The organization tools in browsers and online organizing options. Some of the software is not vailable anymore but using the keywords bookmark managers or information organizers in Google or Yahoo will keep you up to date with the newest possibilities in this field. The last chapter is about publishing your information.

In conclusion it's a very good book, sometimes overwhelming with all the possibilities that are mentioned but on the other hand a lot of suggestions to try and see what fits your needs. So far the best book written about this subject. I tried to find the author on internet but she was hard to find. Finally after reading her book and using her advice a could finally trap a picture of her. I thought someone so famous as author who is hard to find on the internet besides her books, probably doesn't want to be found. So buy the book and go search for yourself!

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Give Your Mind A Workout on Finding Optimism
This is an article on one of my favorite blogs. It is a review of a website. This site offers selfhelp with depression based on Cognitive Behavioral Therapy. This review descibes how this website works as well as the pros and cons.
Article in British Medical Journal about psychotherapy on the internet.
The reviewed website: http://www.moodgym.anu.edu.au/

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VNS for Depression “New”? No, But Don’t Tell Wired - World of Psychology
Nuanced comment in this blog about Vagus nerve stimulation (VNS). As it states the FDA has approved this treatment 2 years ago. It is mostly used with pharamcotherapy- and ECT resistant depressed patients.
Since recently the treatment is not covered as a treatment for Medicare recipients since may this year. The effectiveness of this treatment is not clear, we need some good research but the trouble is how can you design a trial with a control or even a placebo condition?

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This is a small book fits in your pocket nicely. It is written for medical students, junior doctors and general practitioners. It starts with a clear and concise introduction in psycho pharmacology. It explains pharmacokinetic and pharmacodynamic principles. Next drugs are discussed in the main categories of psychopharmacological drugs: antipsychotics, mood-stabilisers, tricyclic antidepressants, mono amine oxydase inhibitors, selective serotonin re uptake inhibitors, other antidepressants and a chapter for other drugs used in psychiatry such as benzodiazepines, drugs for Alzheimer disease, drugs used in substance dependence.
Every category starts with an introduction and a summary of the drugs. Next every drug is briefly descibed. Chemical structure, receptor binding, dose, laboratory testing, routine examinations and investigations and side effects are all mentioned for each drug if applicable. The descriptions are very up to date, nice book to have for introduction

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This is a wonderfull book about blogging. It is mainly an introduction. The book starts with some general information about blogging. Next it explains the different kind of blogs, were to host your blog or use a server side blog. It also guides you how to write a blog, how to earn money with your blog. The last part of the book consits of a list per category of the most important blogs. It is not a book to read from cover to cover. I used it for inspiration and examples as well as instruction book. What I did was read a chapter and followed the links it provided. The design of the book is very pretty, well done a pleasure to read and a excellent introduction.
It doesn't go into details how to maintain a blog or how to do research for your blog e.g. using e-mail alerts, website monitors etc.

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Magnetic brain stimulator touted as treatment for depression - Engadget
As it said in the article this device is introduced during the American Psychiatric Association meeting in San Diego this year. It employs transcranial magnetic stimulation.The mistake in this article is the notion that previously you had to have anesthesia for it, they probably mean with ECT. There is no hard evidence that transcranial magnetic stimulation is actually working as a treatment for depression.
See also:about depression.com

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Biomedical philanthropy State of the donation-Wealthy philanthropists and private foundations are supporting biomedical research on a grand scale. Meredith Wadman asks what they get for their money.

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About To Have ECT? Fine, but Don't Watch It in the Movies: The Sorry Portrayal of ECT in Film
An excellent overview of ECT in movies. This article is a summary of an article by G. Walter an Australian psychiatriust. This summary is made by Prof. Max Fink from the U.S.A.
This summary discusses all movies since the beginning of the 20th century. Movies from Hollywood as well as European and Australian movies. It shortly describes the place of ECT in the movie. In this study by Walter et al. (2002) one third of medical students decreased their support for the treatment after being shown scenes from movies.

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ScienceDaily: Mice On Prozac Help Scientists Find Better Depression Treatments
Scientist discovered in mice a probable new mechanism for developing new antidepressants. They suggest that chemicals that selectively activate the serotonin receptor 5-HT6 might represent a new class of antidepressants.

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ECT online, a very nice website. It's author has the view that ECT does have a place in modern medicine. Critical standpoints are also mentioned.

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This site from the University of Amsterdam has several memory tests. You can do as many as you like. The tests are in several different languages such as English, Italian, Japanese. Polish and Portuguese. The're different memory test e.g about your favorite movies, daily news test and a training course for your memory capabillities.
I tried the Daily News Memory Test, scored 78,6% of the man with same age and interest in news and education. What did you score on this test?
Visit: www.memory.uva.nl

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In this recently published review we summarized the results of the placebo-controlled randomized clinical trials with beta-blocking adrenergic agents during electroconvulsive therapy (ECT), and review the effect on seizure duration and cardiovascular variables.

Esmolol can have a significant effect on seizure duration during ECT, it shortens seizure duration, and this effect is probably dose dependent.

Since the relation between seizure duration and efficacy of ECT is dependent on electrode placement it seems advisable to use bilateral electrode placement with patients with cardiovascular risk factors and use of esmolol during every session before seizure induction. One should take into account the possible negative effect of esmolol on seizure duration in these cases and adhere to the guidelines for ECT that advise at least 10 treatment sessions with bilateral ECT before one can conclude that ECT is not efficacious.

In the absence of cardiovascular risk factors but with prolonging hypertension or tachycardia during ECT sessions, esmolol also is again preferred. Labetalol is an alternative although, especially in high dose, the longer half-life can be considered as a disadvantage. Experiences with landiolol are limited but the short half-life, greater degree of cardioselectivity and more potency makes it a promising alternative.

Please read the article here: articles on ectweb wiki

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In rodents ECT stimulates nerve growth. The suggestion is that this growth of new nerve cells is necessary for recovery from depression. These brain changes were not a response to tissue damage due to the electroconvulsive therapy.
Antidepressants stimulate new nerve cells in adult monkeys, may have implications for humans

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