Archive for June, 2007

New study shows five subtypes of alcoholics: young adult, young antisocial, functional, intermediate familial, chronic severe. This seems to be getting a fair bit of media attention.

Here’s a 1983 study with six subtypes. Here’s a 2006 review finding as many as four subtypes. Here’s a 2004 study with four subtypes. There’s also a type 1/type 2 distinction from 1988, and a type A/type B distinctions. This is just from a quick google search and a non-exhaustive search on PubMed.

Ahistorical science news is pretty common – everything’s a big new finding, a new development, the first of its kind. I’m not sure how much this has to do with science writers not having much background, how much it has to do with news not selling unless it’s new, and how much it has to do with the fact that if you don’t have to give people historical perspective it makes you able to do your job – writing stories people will want to read – much more efficiently.

I still wish that science news would come with more information on what this has to offer over similar previous findings, and more information on how those previous findings (for work with applied implications) were useful or not useful. Is this really a shiny new finding, or just another variation? That kind of thing. (At least it’s not yet to the point where people are still reporting it as news months from now.)

I’m agnostic about whether this specific study in a shiny new finding or not – it may be a useful improvement on previous studies, it may not; I don’t know enough about that area of research to tell. The point I want to make, though, is that a lot of science-related stuff hyped as news isn’t, and it often gets oversold because it’s presented without the research context.

I’m probably going to switch to posting longer, higher-quality stuff once a week or so, and post news stories or tidbits the other days of the week. Attempting to do topics justice while still posting frequently doesn’t go so hot with a full-time job. (I’m having a lot of fun, though. Here and at the job. But not, you know, too much fun.)

Here is a sampling of topics I’d like to write about at some point (not in any order). If anyone votes for anything, I’ll bump it up in the schedule. If anyone wants to propose a topic, I’ll drop it in the list as long as it’s vaguely appropriate.

  • medication for youth (this has a vote already)
  • antipsychotics for youth
  • worries about personality and perceptions of self with regards to medication
  • relapse rates in bipolar
  • kindling
  • violence rates/types (both by and against the mentally ill)
  • creativity and medication
  • firearms (second amendment, deaths by suicide)
  • transient mental disorders (like hysterical fugue, that was once popular and is now almost gone)
  • more on culture and mental disorders because I <3 culture
  • evolutionary psychology/biology of mental disorders (because I <3 evolution)
  • culture and evolution with regards to mental disorders (because I <3 the interrelationship of culture and evolution more than almost any academic topic)
  • approaches to decreasing stigma and stereotypes
  • weird crap I find on the internet
  • multiple personality disorder, soulbonds, and theory of mind (i.e., lots of speculation)
  • otherkin, and fringe religious beliefs: I don’t believe you’re really an iridescent winged fox like you think you are, but I don’t think you’re mentally ill, either
  • these weird things you have to get differentially diagnosed with and that almost no one has (like cycloid psychosis and brief psychotic disorder): what the hell are they?
  • inaccuracies in science reporting
  • symptom clusters in unipolar depression: withdrawal vs. support-seeking
  • Munchausen’s (people faking disorders including mental illness for personal gain)
  • dumb things people say – not the standard dumb things like”depression means you’re weak” but new fun wacky stuff
  • Is schizoaffective disorder a form of schizophrenia, a form of bipolar, its own thing, or something else?
  • spectrum disorders, public perception, and identity politics
  • other identity politics stuff
  • legal stuff (I don’t know enough about this yet to break it down into subcategories)

I was in the second of two all-day meetings today. The first I got through by being actively interested plus taking adderall, but by today I was so tired of paying attention that the adderall wasn’t much help. (It doesn’t fix not wanting to pay attention, luckily; the first add medication I tried caused me to pay attention to everything anybody said no matter what even if I really wanted to think about something else.) So tonight is Random Facts From Goodwin & Jamison (2007) Night, instead of semi-coherent post on something substantive night.

  • People first developing bipolar disorder are, on average, 22.2 years old. In 1990 that figure was six years higher for studies with similar inclusion/exclusion criteria. Why? They mention a couple hypotheses: more people are being diagnosed bipolar instead of schizophrenic (and psychotic features appear to show up earlier), and antidepressants and stimulants are kicking off episodes earlier than they would naturally have occurred.
  • A few entries from a long list of conditions and drugs reported to precipitate manic episodes: influenza, Syndenham’s chorea (movement disorder caused by infection), bromide (a sedative used in the late 19th and early 20th centuries), and Q fever.
  • Apparently lithium during pregnancy isn’t anywhere near as likely to lead to a heart defect as we used to believe. (But you still shouldn’t breastfeed on it.)

A book I’ve been mentioning (and will continue to use in my entries) is:

Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression by Frederick K. Goodwin and Kay Redfield Jamison (Hardcover – Mar 9, 2007)

If you like research on bipolar disorder and/or recurrent depression, this is the freaking awesomest book ever – a huge collection and summary of available research on every aspect, with commentary. If you like it enough to consider getting it, I encourage you to get it through the link above, which will benefit crazyboards, the support and education boards that I help moderate and that have helped me a whole hell of a lot.

If you can’t afford the price tag, you may be able to get it through inter-library loan. The current one is the second edition.

Some terminology used for states in bipolar disorder:

mania: euphoria and/or irritability. People who don’t know much about it sometimes think it’s the same thing as being extra-super-happy, and would like to have it.

hypomania: somewhat less euphoria and/or irritability. People who don’t know much about it usually don’t know that it’s mania to a lesser degree, and therefore not as destructive, but if they did, they’d probably pick hypomania out as the fun mood state to be in, and pay more for this than mania. (I’d sure pay a lot personally to trade out what I actually get for these happy, productive hypomanias.)

mixed state: a lot of people know something more about bipolar disorder aren’t familiar with this term. It involves having symptoms of mania and depression at the same time. Anybody who paid for this would want a refund.

dysphoric mania: Not a DSM term, and as far as I can tell, accounted for by the fact that even euphoric mania can suck, and the fact that mania with depression mixed in gets termed a mixed state. Maybe someone will rescue it but I think this might be a red-headed stepchild.

depression: real depression (as opposed to fake-ass glamorous depression) is probably not worth much to anyone who isn’t in a mixed state.

First, mania and hypomania
I’m going to leave out all the objectively bad things for you that can happen during hypomania/mania – damaging relationships, losing jobs, spending yourself into debt, etc. – and instead concentrate on the subjective-type-stuff that happens during mania (data from table in Goodwin and Jamison):

percentage and symptom

76% flight of ideas / racing thoughts

75% Distractibility / poor concentration

29% confusion

54% delusions
29% persecutory/paranoid delusions

Hallucinations: 18% auditory, 12% visual, 15% olfactory

19% thought disorder

By definition you can’t get delusions or hallucinations in hypomania (if you do, it’s considered mania instead), but you can certainly get racing thoughts and crappy concentration (I don’t know how common confusion is, but I’ve seen the first two mentioned a lot).

I have no doubt that some people with bipolar disorder get the euphoric kind of mania without the subjectively unpleasant stuff, and that some get the euphoric kind of hypomania that is also useful and productive and doesn’t even screw up their life and people write books on it about how hypomania is great and how to prolong and maintain it.

But man, let’s have a little recognition of those of us who can barely read through a paragraph or write an email while we’re so pointlessly overenergized, and who can’t sleep or calm down or do anything because we can’t slow down or stop our speeding thoughts, etc. All bipolar disorder sucks ass, but things suck especial ass when there’s a perception that there’s a good side for you that helps make up for the bad side, when it’s mostly just different kinds and degrees of painful.

And that’s mania and hypomania, the more positive side of bipolar disorder. Later I’ll write about mixed states, which were what I actually wanted to write about, since there is some damn nifty research and theory on them. And since they are also under-recognized, particularly popularly.

A meta-analysis of 55 published research studies found that social skills programs for autistic kids were poor overall, though better if the programs were held in the normal classroom setting rather than a pull-out one. They were more likely to use and to maintain the new skills, and more likely to use them in other settings. The researchers recommend greater amounts of programming, targeting programs towards kids’ skill deficits, and checking to see whether the program was actually carried out as designed.

No commentary on this one – just general surprise that they were found so solidly poor.

Manic mice

Mice engineered to lack a specific gene showed behaviors similar to human mania in a study funded in part by NIMH; they were hyperactive, slept less, appeared less depressed and anxious, and craved sugar, cocaine and pleasure stimulation. The rodents’ behavior was more normal after lithium treatment or restoration of a functioning CLOCK protein, which the knocked-out gene codes for.

The article says this is similar to human mania, and it sounds like it’s similar enough to tell us useful stuff, although the mice don’t sound bipolar, just, as they say, behaving similarly to some aspects of manic humans.

The CLOCK protein is involved in circadian rhythms. And so here is some interesting stuff on circadian rhythms in bipolar disorder, and on how lithium works, from one of my favorite bipolar disorder sites, Jim Phelps’ Psych Education. Lots of science, lots of high-level information that isn’t very widely spread, and an excellent site for info on bipolar II in general and on anxiety in bipolar.

My best friend is psyched enough about my blog that he surprised me with a domain name for a present (thank you!):

http://empiricalinsanity.net

It redirects to here, so going to empiricalinsanity.wordpress.com still works. I think the .net address is cooler though.

Yesterday I went to the Chattanooga aquarium almost all day, and it was awesome. When I got home I was too tired to think straight, and briefly posted something on psych meds and creativity that was inaccurate – oops. It may make another appearance later on. In the meantime, here’s something more off-the-cuff.

First, the media and anecdotes:

People with serious mental illness have problems using glucose efficiently in the brain

Okay, I find this completely fascinating and intuitively plausible. When I was around twelve – the first time I remember having mood problems, although probably not the first time I started having them – I started eating sugar excessively. Not just at dessert, but during the day. I’d take powdered sugar from the cabinet and put it in a tupperware and hide it in a drawer in my room and eat it straight. Among other things. I felt awful about it, but just stopping never seemed to work, even though I tried frequently. (If you can get addicted to video games, why not a substance that has immediate lifting effects on mood and energy, followed by a crash?)

When I was seventeen and working in a bookstore, I ran into a book with the badly-chosen title “Potatoes Not Prozac” which argued that sugar could be addictive, that it was related to alcoholism (I have alcoholism running on both sides of my extended family, and there’s a plausible evolutionary argument related to this I’ll share some other time), and that you could go off of it and get a drastic improvement in mental and physical health through a diet that can be summed up as sufficient protein and whole grains (similar to what later became very popular as the South Beach diet). This worked very well for me; it was like suddenly getting a stable personality, and was very similar to the first time I went on an antidepressant. Neither of those effects lasted, but they were amazing and gave me hope that life didn’t have to be the way it was most of the time.

Interestingly enough, when I’m stable on medication I can have a relationship with sugar that’s about what regular people have – it’s nice sometimes but I can drop it without a problem (unless I start eating dessert more than occasionally; I still have to watch for that).

Further anecdotal information: When I mention to psychiatrists that sugar affects my mood, they’re never surprised, although I don’t think any psychiatrist has ever suggested this as a factor up front. It’s pretty common in the patient literature, though.

So that’s the media and the anecdotes. Here’s some stuff to notice about the article (and the anecdotes):

1. There’s no mention of a published article. If it had been published, that would have almost certainly have been mentioned. That strongly suggests that this research has not been peer reviewed. (The list of articles on the lab’s website does not appear to refer to the research mentioned in the article. There’s something about glutamatergic dysfunction in schizophrenia that may be a precursor to this work.)

2. This is the only reference to that research I can find on google news or on google. I don’t have a way to cross-check the accuracy of the reporter’s take on what’s going on (I’ve seen enough errors in science reporting that I don’t want to trust an individual article, and this one appears to confuse “inefficient glucose processing” with “not enough glucose” and “lack of sugar” with “not enough glucose in the brain”).

3. I’m telling this anecdote where I’m linking my own personal screwed-up relationship with sugar to this brain glutamate thing, but I’m not sure they’re even related. I’m not sure what the relationship between ingested sugar and glucose in the brain is, but I doubt it’s all that straightforward, and anyway the article is suggesting it’s lack of sugar that’s the problem, right? And I actually felt better when I stopped, even though there was probably a reason I was eating it to begin with. (I’m pretty sure the “lack of sugar” thing doesn’t actually mean “go eat more sugar, it’ll make you feel better”, though, even if it’s possible to take that away from the article.)

4. Anecdotes aren’t data. Lots of anecdotes collected in a careful, systematic way using random sampling are data, but my telling you this stuff off the cuff isn’t data. I could be wrong about a connection between my craving sugar and my mood problems. I’ve been flat-out wrong about myself before – I thought some major issues I have following lectures and other extended verbal information would turn out to be due to an auditory processing problem, but they turned out to be due to ADD and disappeared with stimulants. (This is what we have highly trained medical professionals for – to save us from some of our best guesses.)

So what does this mean? Well, it doesn’t mean the researcher’s conclusions are incorrect. The article has some problems, like the “lack of sugar” bit giving the false impression that not getting enough sugar in diet = lack of glucose in brain, and that in turn giving the impression that the problem is lack of glucose in the brain when the research appears to implicate inefficient glucose processing.
But it doesn’t mean they’ve hit the status of widely accepted fact. It’s more of a back pocket kind of finding – very interesting, tuck it away, pull it out again later when you hear more – like another article mentioning a publication (or a publication itself), or another researcher’s work.

Is game addiction a mental disorder? (article)

In the interest of being very clear about what’s been empirically tested and what has not, the following is speculation on my part, albeit speculation I had a lot of fun with.

Here are some immediate answers people might give:

1. No, of course not. People don’t get addicted to video/computer games.

2. No, of course not. That’s stupid.

3. No, of course not. Mental illness can cause game addiction, though.

4. Yes. My son/friend/husband/cousin/I was terribly addicted.

To clear up a misunderstanding:

Let’s talk about #1: “It’s not a real mental disorder because people don’t get addicted to video/computer games.”

Well, they do; people will get addicted to damn near anything. It’s kind of amazing, actually. Does that mean it’s a Real Mental Disorder, though?

The ancient roots of video gaming

#2: “It’s not a mental disorder, that’s stupid.”

Social-cultural-cognitive psychologists (not that there are that many of us, and I’m not even one anymore, but I still) love that crap (regardless of its truth or falsity) because it reflects something very interesting about the way we think. We consider some things deeper and more real than others, more grounded in the natural world. It’s interesting to explore how we make these determinations and what they mean to us. Of course, some things really are more grounded in nature, but that doesn’t mean it’s not worth studying how we reach conclusions about that (the same way that our senses tell us about things that exist in the real world, but how our senses function is still an important field of study).

Psychologists call this process essentialism. Essentialism has a lot of different effects; one is to help children bootstrap their learning about the natural world (this is a complicated argument I may write more about later), and another is to attribute peoples’ surface characteristics – appearance, behavior, etc. – to their inner nature to the degree that a category they belong to is essentialized. For example, a category like “mentally ill” is essentialized pretty highly.

But a category like “video gamer” or “computer gamer” is not. That’s what I think’s (partly) going on above in #2 – video gaming badly mismatches the heavily essentialized category of mental illness. It sounds absurd.

But.

Video and computer games are incredibly popular and they are incredibly popular for reasons. Some of those reasons involve careful, well-tested calibration to peoples’ reward systems: You want to keep coming back for more. That’s most of the addictive part, I imagine. I’m willing to bet that it’s grounded in other very old parts of the psyche, like the ones that get rewards from foraging and from hunting.

That might make it look more essentialized, although you may want to keep in mind that doesn’t necessarily make it more real.

What’s causing the addiction?

3. “Mental illness causes game addiction, not vice versa.”

In this view, game addiction is a symptom, or maybe better stated, the content of an addiction or of an obsession. People get addicted/obsessed because they have the same kinds of (essentialized, incidentally) mental illnesses we’ve always had.

To continue the bit about about reward systems and hunting and foraging, people might be getting addicted because the same mental illnesses we’ve always had are disrupting/dysregulating the same mental systems we’ve always had – what changes is that culture is symbiotic with those systems, and culture changes (in some ways), and so the content of addictions and obsessions will be different (in some ways), in different times and places.

Does any of this matter?

4. “My son/friend/husband/cousin/I was terribly addicted.”

I am really sorry to hear that, and I hope that you/they are getting help. Don’t get stressed out over anything I’ve said; ignore it unless it manages to be useful in some way.

Is game addiction a real mental illness?

I don’t know. What do you want to call a real mental illness?
I’m not being facetious. This is a tricky problem. It’s absolutely true that mental illness exists and that it’s damaging to sufferers and those around them. It may not be true that mental illness is discretely bounded from mental health. It may not be true that individual mental illnesses are separable from each other – it may all just be a bunch of spectrums. Our current symptom-based criteria for mental illnesses may not describe all the people affected by an illness, or may describe people who are actually affected by a different illness. Some of our mental illnesses may disappear; nobody sees hysterical fugue anymore (and was it a real mental illness? or an expression of an illness that’s always existed?). Others may show up (maybe videogaming addiction is one, although my money’s not on that).

I wouldn’t worry about that too much, though. Our current categories usually work pretty well, with tweaks here and there. It’s just something to keep in mind when weird stuff happens.

Oh, but just so I don’t leave off being all pomo, yes, I think video game addiction is pathological and needs treatment, and given the popularity of videogames, I’m sure someone will do the research to give us actual answers eventually.