Mental health

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Published by Anonymous (not verified) on Tue, 13/01/2015 - 11:14am in

NSW Mental Health Plan Worth National Reach

Published by Anonymous (not verified) on Tue, 16/12/2014 - 9:54am in

Mental Health Funding Uncertainty ‘Alarming’

Published by Anonymous (not verified) on Tue, 09/12/2014 - 9:35am in

Govt Ordered to Release Interim Mental Health Reviews

Published by Anonymous (not verified) on Thu, 27/11/2014 - 11:00am in

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Mental health

Still 'Profiteering From Anxiety'

Published by Anonymous (not verified) on Thu, 07/02/2013 - 8:23am in


Late last year, the excellent Neurobonkers blog covered a case of 'Profiteering from anxiety'.

It seems one Nader Amir has applied for a patent on the psychological technique of 'Attentional Retraining', a method designed to treat anxiety and other emotional problems by conditioning the mind to unconsciously pay more attention to positive things and ignore unpleasant stuff.

For just $139.99, you can have a crack at modifying your unconscious with the help of Amir's Cognitive Retraining Technologies.

It's a clever idea... but hardly a new one. As Neurobonkers said, research on these kinds of methods had been going on for years before Amir came on the scene. In a comment, Prof. Colin MacLeod (who's been researching this stuff for over 20 years) argued that "I do not believe that a US patent granted to Prof Amir for the attentional bias modification approach would withstand challenge."

Well, in an interesting turn of events, Amir has issued just Corrections (1,2) to two of his papers. Both of the articles reported that retraining was an effective treatment for anxiety; but in both cases he now reveals that there was

an error...in the article a disclosure should have been noted that Nader Amir is the co-founder of a company that markets anxiety relief products.

Omitting to declare a conflict of interest... how unfortunate.

Still, it's an easy mistake to make: when you're focused on doing unbiased, objective, original research, as Amir doubtless was, such mundane matters are the last thing you tend to pay attention to.

ResearchBlogging.orgAmir, N., and Taylor, C. (2013). Correction to Amir and Taylor (2012). Journal of Consulting and Clinical Psychology, 81 (1), 74-74 DOI: 10.1037/a0031156

Amir, N., Taylor, C., and Donohue, M. (2013). Correction to Amir et al. (2011). Journal of Consulting and Clinical Psychology, 81 (1), 112-112 DOI: 10.1037/a0031157

Language That Is Person-First

Published by Anonymous (not verified) on Fri, 01/02/2013 - 7:37am in

An editorial in the Canadian Medical Association Journal by Roger Collier highlights the problem of Person-first language: Laudable cause, horrible prose

Person-first language (or language that is person-first, as it prefers to be known) is the nice idea that rather than calling someone, say, "blind", we should call them "a person who is blind", so as to remind everyone that they're not defined by their blindness but are a person first... clever, eh?

No. For one thing, it's just bad English. As Collier puts it: "There’s a reason Ernest Hemingway didn’t call his novel The Person Who Was Male and Advanced in Years and the Sea."

He goes on to quote linguist Helena Halmari who highlights a number of problems with the approach:

In English, emphasis naturally occurs at the end of sentences... so by pushing mention of a disability or disease deeper into a sentence, adherents to person-first language may actually be adding stress to those words. “What you have at the end of a sentence is the new information that gets the most attention,” says Halmari.

Worse yet...

Tucking the disability behind the noun may contribute to stigma rather than reduce it. After all, most adjectives with positive connotations precede nouns. We do not typically say a “person who is beautiful,” for instance, or a “person who is intelligent.” Sticking a word in the shadow of a noun can create the impression that there is something inherently wrong with it - that it should be hidden.

As a 'person with mental illness', I entirely agree. I am a man, a neuroscientist, a blogger; I'm not ashamed of those things, so I don't feel the need to erect linguistic fences between them and my person. I am also a psychiatric patient, a depressive, mentally ill; I'm not ashamed of that, either, and I resent the implication - however well-intentioned - that I should.

To me that's the really troubling part of this: the should aspect. The only reason you should not call someone something, is because they ask you not to.

Person-first advocates claim to be speaking on behalf of the 'group' who are harmed and offended by the current use of language - but who gave them that right? They don't speak for me, or anyone but themselves. I don't see 'the mentally ill' as a group at all, but even if it is one, they're certainly not our  elected representatives.

So non-person-first language doesn't offend me. In fact, I'm more worried by the idea that people will assume that, because I'm mentally ill, I want them to use person-first language. Now that's offensive.

Drunk Rats Could Overturn Neurological Orthodoxy

Published by Anonymous (not verified) on Tue, 15/01/2013 - 9:41am in

A form of brain abnormality long regarded as permanent is, in fact, sometimes reversible, according to an unassuming little paper with big implications.

Here's the key data: some rats were given a lot of alcohol for four days (the "binge"), and then allowed to sober up for a week. Before, during and after their rodent Spring Break, they had brain scans. And these revealed something remarkable - the size of the rats' lateral ventricles increased during the binge, but later returned to normal.

Control rats, given lots of sugar instead of alcohol, did not show these changes.

This is really pretty surprising. The ventricles are simply fluid-filled holes in the brain. Increased ventricular size is generally regarded as a sign that the brain is shrinking - less brain, bigger holes - and if the brain is shrinking that must be because cells are dying or at least getting smaller. So bigger ventricles is bad.

Or so we thought... but this study shows that it might not always be true: alcohol reversibly increases ventricular volume over a timescale of days. It does so, the authors say, essentially by drying brain tissue out; like most things, if you dry the brain out, it gets smaller (and the ventricles get bigger) but when the water comes back to the tissues, it expands again.

As you can see here in Figure 2...

Maybe. I admit that just eyeballing this, it looks more like the ventricles are getting brighter, rather than bigger, but I'm not familiar with the details of water scanning. Maybe some readers will know more about it.

If it's true, this is big - maybe it's not just high doses of alcohol that does this. Maybe other drugs or factors can shrink or expand, the ventricles, or even other areas, purely by acting on tissue water regulation, rather than by anything more 'interesting'.

Take the various claims that some psychiatric drugs boost brain volume while others decrease it, just for starters...could they be headed for a watery grave?

Of course, this is in mice - and it might not translate to humans... we need to find out, and I for one am keen to apply for a grant. Here's my draft:

Participants: 8 healthy-livered neuroscientists.
Materials: 1 MRI scanner, 1 crate Jack Daniels.
Methods: Subjects will confer to pick a Designated Operator, who will remain sober. If no volunteers for this role are forthcoming, selection will be randomized by Bottle Spinning. All other participants will consume Jack Daniels ad libitum, and take turns being scanned. Once all Jack Daniels is depleted, participants will continue to be scanned until fully sobered up (defined as when they can successfully spell "amygdalohippocampal").
Instructions to Participants: i) what happens in the magnet, stays in the magnet. ii) If you 'dirty' the scanner, you clean it up. iii) Bottle caps are not MRI safe!

Er... seriously though, someone should check.

ResearchBlogging.orgZahr NM, Mayer D, Rohlfing T, Orduna J, Luong R, Sullivan EV, and Pfefferbaum A (2013). A mechanism of rapidly reversible cerebral ventricular enlargement independent of tissue atrophy. Neuropsychopharmacology  PMID: 23306181

DSM-5: A Ruse By Any Other Name...

Published by Anonymous (not verified) on Sun, 13/01/2013 - 8:45pm in

In psychiatry, "a rose is a rose is a rose" as Gertrude Stein put it. That's according to an editorial in the American Journal of Psychiatry called: The Initial Field Trials of DSM-5: New Blooms and Old Thorns.

Like the authors, I was searching for some petal-based puns to start this piece off, but then I found this "flower with an uncanny resemblance to a MONKEY" which I think does the job quite nicely:
Anyway, the editorial is about the upcoming, controversial fifth revision to the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (APA).

A great deal has been written about the DSM-5 over the past few years, as "the rough beast, its hour come round at last / Slouches towards Bethlehem to be born" (see, I can reference early-20th-century poetry too).

But now the talk has moved into a new phase, because the results of the DSM-5 'field trials' are finally out. In these studies, the reliability of the new diagnostic criteria for different psychiatric disorders was measured. The new editorial is a summary and discussion of the field trial data.

Two different psychiatrists assessed each patient, and the agreement between their diagnoses was calculated, as the kappa statistic, where 0 indicates no correlation at all and 1 is perfect.

It turns out that the reliabilities of most DSM-5 disorders were not very good. The majority were around 0.5, which is at best mediocre. These included such pillars of psychiatric diagnosis like schizophrenia, bipolar disorder, and alcoholism.

Others were worse. Depression, had a frankly crap kappa of 0.28, and the new 'Mixed Anxiety-Depressive Disorder' came in at -0.004 (sic). It was completely meaningless.

The American Journal editorial was written by a group of senior DSM-5 team members. I'm sure they wanted to write a triumphant presentation of their work, but in fact the tone is subdued, even apologetic in places:

As for most new endeavours, the end results are mixed, with both positive and disappointing findings...Experienced clinicians have severe reservations about the proposed research diagnostic scheme for personality disorder...like its predecessors, DSM-5 does not accomplish all that it intended, but it marks continued progress for many patients for whom the benefits of diagnoses and treatment were previously unrealized.

Remember: this is the journal published by the organization responsible for the DSM and even they don't much like it.

But the real story is even worse. The previous editions of the DSM also conducted field trials. These trials had a system to describe different kappa values: for example, 0.6-0.8 was 'satisfactory'.

However, the new DSM-5 studies used a different, lower threshold. They simply moved the goalposts, deeming lower kappa values to be good. At one point, they wrote that values of above 0.8 would be 'miraculous' and above 0.6 a 'cause for celebration', yet this wasn't the view of previous DSM developers.

The indispensable 1boringoldman blog has a nice graphic showing the results of the DSM-5 trials, with the kappas graded according to the old vs. the new criteria. As you can see, the grass is greener on the new side.
The fact is that the DSM-5 field trial results are worse than the results from DSM-III, the 1980 version that's served mostly unchanged for 30 years (DSM-IV made fairly modest changes.) The reliabilities have got worse - despite the editorial's claims of 'continued progress'. It's true that the DSM-5 field trials were a lot bigger and conducted rather differently, but still, it's a serious warning sign.

Finally, there was great variability in the results between different hospitals - in other words the reliability scores were not, themselves, reliable. Some institutions achieved much higher kappa values than others, but it's anyone's guess how they managed to do so.

Still, there's great news: the DSM-5 is just a piece of paper (well, a big stack of them). Any psychiatrist is free to ignore it - as the creator of the more reliable DSM-IV (not III, oops) is now urging them to do.

ResearchBlogging.orgFreedman R, Lewis DA, Michels R, Pine DS, Schultz SK, Tamminga CA, Gabbard GO, Gau SS, Javitt DC, Oquendo MA, Shrout PE, Vieta E, and Yager J (2013). The Initial Field Trials of DSM-5: New Blooms and Old Thorns. The American Journal of Psychiatry, 170 (1), 1-5 PMID: 23288382

Smart People Say They're Less Depressed

Published by Anonymous (not verified) on Sat, 12/01/2013 - 8:26pm in

The questionable validity of self-report measures in psychiatry has been the topic of a few recent  posts here at Neuroskeptic.


Now an interesting new study looks at the question in issue from a new angle, asking: what kind of people report feeling more or less depressed? Korean researchers Kim and colleagues found that intelligence and personality variables were both linked to the tendency to self-rate depression more severely.

The study involved 100 patients who'd previously suffered from an episode of depression or mania and who, according to their psychiatrist, had now recovered and were back to normal. Kim et al looked to see what the patient thought about their mood, by getting them to complete the Beck Depression Inventory (BDI) self-report questionnaire.

This was compared to the clinican-administered HAMD scale (another Neuroskeptic favourite) which is meant to be independent of self report.

It turns out that the BDI and HAMD scores were only weakly correlated - with a coefficient of just r=0.32. That's really not very good considering that, in theory, they both measure the same thing: 'depression'. Many people reported being considerably depressed when their clinicians rated them as fine.

But more interestingly, certain characteristics of the patients were correlated with their self-report/clinician-rating discrepancy. Specifically, patients with a lower IQ, who were more impulsive, and less conscientious, tended to self-report more severe depression.

Now, the uncharitable interpretation of these people is that they were just too sloppy to complete the form properly... the uncharitable interpretation of the psychiatrists is that it's their fault for underestimating depression in people less inclined to express themselves in 'the right way'. There's no way to know.

Either way, it's a serious problem because it shows that self-report and observer-report measures of depression aren't just poorly correlated, they're actually measuring different things for different people.

It could be even worse than it appears because the HAMD, although supposedly not a self-report measure, does in fact heavily rely on the patient's cooperation. So a 100% clinician-rated scale might be even further removed from self-report.

ResearchBlogging.orgKim EY, Hwang SS, Lee NY, Kim SH, Lee HJ, Kim YS, and Ahn YM (2012). Intelligence, temperament, and personality are related to over- or under-reporting of affective symptoms by patients with euthymic mood disorder. Journal of affective disorders PMID: 23270973

Artwork During Recovery From Encephalitis

Published by Anonymous (not verified) on Sun, 06/01/2013 - 9:37pm in

I recently wrote about anti-NMDA receptor encephalitis, a neurological disorder that often manifests with psychiatric symptoms, such as depression and hallucinations.

The latest American Journal of Psychiatry features a strange series of four drawings made by a 15 year old girl during an episode of the disease, which presented as psychotic symptoms but later progressed to severe insomnia and epilepsy before it was diagnosed and treated.


"As she gradually recovered we asked her to draw something. She did not know what to draw, so we suggested an animal, such as a dog, but she did not know how to start.

When we told her that a dog has four legs, a tail, two ears, two eyes, and a mouth, she drew an abstract figure that consisted of a head with four legs (A). Her next drawing, of a cat, looked exactly the same, apparently since they share the same basic features.

Two weeks later the dog now looked more recognizable but like a human, standing upright, with two arms and four legs...All body parts were listed beneath the figure in the same color as they were drawn (B).

Two months after the patient was transferred to a local rehabilitation center, the cat was catlike for the first time; it had four legs, was normally proportioned, and was correctly positioned. Colors were used adequately. However, this drawing still looked like one by a primary school child instead of a 15- year-old girl (C).

Finally, after 5 months of rehabilitation her drawing had a normal composition. She still had the urge to write down what she drew, she did not encircle the figures anymore (D)."

ResearchBlogging.orgEsseveld MM, van de Riet EH, Cuypers L, and Schieveld JN (2013). Drawings During Neuropsychiatric Recovery From Anti-NMDA Receptor Encephalitis. The American journal of psychiatry, 170 (1), 21-2 PMID: 23288386

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