Archive for July, 2007

Ten people found my journal yesterday by searching for “bonobos”.  It probably wasn’t what they were looking for, but I hope they saw the cute picture and read about the female-female coalitions that let female bonobos mate with the males they want to mate with and not the unpleasant aggressive ones.

Go bonobos!

(The real entry for today is below)

This guy thinks that heeled footwear causes schizophrenia. Lest you ascribe reasonableness to this, be aware that the association between colder places and schizophrenia has been much more plausibly hypothesized to be due to vitamin D deficiency.

I found that link via MindHacks, which mentions it at the tail end of reviewing a stupider and more offensive paper arguing that Asians and people with Down Syndrome might be genetically similar because they like similar sorts of arts and crafts, MSG, and like to see several dishes on the table at the same time. Apparently the founder created the journal that published both studies (Medical Hypotheses) because he wanted to encourage creativity in medicine by letting them publish any ideas, no matter how far-out.

So I went and looked them up. For more information on their review and publication process, see below.  But first, some other amusing and offensive articles that probably got rejected all the way down the journal food chain:

Latex causes autism (if we could just get all future parents to switch to lambskin!)

Symptoms of schizophrenia are an attempt to compensate for lack of life skills
She claims her paper is an attempt to “situate the actions of those with schizophrenia clearly within the normal range of human behaviors and, as a consequence, it diminishes the stigma that attaches to severe mental illness”. The abstract gives the impression that she thinks if we tell people that when schizophrenics act bizarre it’s because they’re electing to deal poorly with their social and cognitive deficits, then people will stop discriminating against them.

We might be able to treat some chronic fatigue symptoms with aspirin! PubMed doesn’t give the abstract, but (like most of these articles) there wasn’t actual research involved.

The evolutionary function of labor pain is to create emotional bonds between a mother, her husband, the midwife, and the baby.
Did this person ever come across (for example) the very basic evolutionary theory that newborns’ head size is a compromise between a bigger brain for better survival, and a smaller brain (and head) that will just barely fit through the birth canal? More importantly, do they realize that when the mother is in pain, the father and midwife are not also in pain? (Unless they’re in that one place where the husband has to sit up in the rafters above the wife and every time she gets a labor pain she pulls on a rope tied to his balls.)

Finally, a bit more about the journal, from its home page:

Medical Hypotheses takes a deliberately different approach to peer review. Most contemporary practice tends to discriminate against radical ideas that conflict with current theory and practice. Medical Hypotheses will publish radical ideas, so long as they are coherent and clearly expressed. Furthermore, traditional peer review can oblige authors to distort their true views to satisfy referees, and so diminish authorial responsibility and accountability. In Medical Hypotheses, the authors’ responsibility for the integrity, precision and accuracy of their work is paramount. The editor sees his role as a ‘chooser’, not a ‘changer’: choosing to publish what are judged to be the best papers from those submitted.

Papers in Medical Hypotheses take a standard scientific form in terms of style, structure and referencing. The journal therefore constitutes a bridge between cutting-edge theory and the mainstream of medical and scientific communication, which ideas must eventually enter if they are to be critiqued and tested against observations.

Authors are required to pay page charges.

We had the manic mice; now, the schizophrenic mice! Or, more accurately, the mouse model of mania and the mouse model of schizophrenia, since they’re unlikely to be exactly the same thing as what humans gets, just things that involve some of the same systems. But even that will buy you a whole heck of a lot…

Coming soon: a mouse model of videogame addiction. You give them a mini-Nintendo controller, and they punch the “A” key to get a pellet. If you keep reinforcing them, they start punching it really fast. (Maybe we should refer to the human model of mouse pellet addiction instead?)

sz mouse link via confused.

A friend asks: do you know if there’s been any progress informing the public about the difference between “psychopathy,” “psychosis,” and “psychotic axe-murder?” which should probably be “psychopathic axe-murderer,” now that I think about it.

I don’t know, but it’s probably similar to when other terms have been adopted by the public and used pejoratively (like “idiot,” “imbecile,” and “moron,” originally specific technical designations). Then we switch to different terms like “mentally retarded” which the public then starts using as an insult, and move on to “developmental delay,” “developmental disability,” “intellectual disability,” etc.

All of these terms have been used to refer to very similar things, which interested parties want to destigmatize, some people merely wish to describe accurately, and many people want to mock and insult. Linguist Steven Pinker calls this the euphemism treadmill.

I think it’s virtually certain that words for mental illnesses and symptoms will continue to be turned into words that mean “completely unresponsive to social norms, and violent” or “SUPERDANGEROUSWILLKILLYOU”.

So what if instead we gave them a word or phrase to name the kind of person they’re trying to name: the kind of person everyone is afraid of, someone who is not merely malevolent and physically dangerous, but so mentally unbound from laws and rules and social demands that nothing you can do will stop them?

Such as “horror movie killers”. Or “Jasophrenics” (after Jason of the various horror movies, but with “phrenic” (“minded”) added because most people named “Jason” are not horror movie killers. Or “berserkers” (though I think that’s kind of mean to the originals. I wonder if they had to go around after battle explaining to people that they weren’t the equivalent of horror movie killers?). I also came up with the idea of “Voldemorts” since everybody loves Harry Potter, but I’m told that he’s not violent enough.

And then we would have the word “Jasophrenic” to describe something that probably doesn’t exist as a discrete clinical entity, just as a catchy mental concept, and we might make more headway in explaining that “psychotic” covers a great deal of ground that doesn’t involve it, and so does “schizophrenic” and “crazy” and “mentally ill,” and even “psychopathic” does too. That might be a lot of education gained for a pretty cheap memehack.

Stabilizing circadian rhythms can be helpful with bipolar disorder, and there’s even one treatment called (straightforwardly) “dark therapy”, in which complete darkness is used to reset the circadian clock (there’s some limited data supporting this). Jim Phelps of bipolar site has written about circadian rhythms and dark therapy, and now has a paper out looking to get around the issue where nobody actually wants to be in total darkness for long periods of time except maybe when they’re sleeping.

The paper doesn’t have a controlled trial, just a series of case studies where people with bipolar disorder were able to fall asleep faster when they were undergoing treatment involving amber-tinted safety goggles, which block some wavelengths of light that knock melatonin levels down (e.g., the goggles keep melatonin at night-time levels).

So, don’t go out and buy dorky goggles just yet, and maybe not at all depending on how the evidence turns out, but if you’re interested in the circadian-rhythm angle this might be something to keep an eye on.

Bonobos are a species of chimp, and were for a long time confused with the common chimpanzee. Bonobos are awesome for many reasons:

1) Whereas common chimps solve interpersonal and intergroup problems with violence, bonobos solve them with sex. Human tend to do some of both, and are about equally related to both bonobos and common chimps. Overemphasizing our similarities to common chimps makes us look like nastier critters than we actually are, and remembering our relation to bonobos is something of a check on that self-image. (It’s not that we’re *not* violent, as a species. We have plenty of capacity for violence, and also plenty of capacity for intimacy, love, and yes, lots of gettin’ it on.)

2) Male bonobos are nice and gentle, unlike chimp males who tend to be aggressive. This is because female bonobos have, over evolutionary time, formed female-female coalitions that prevent aggressive male bonobos from gaining sexual access to females. So they didn’t get to have little future-aggressive bonobo sons.

3) Momma bonobos play airplane.

Like other (non-psych) medical problems, mental illnesses can be exacerbated by situational triggers. And the theory is, if you figure out what those are, you can avoid them. Personally, I’m pretty sure I could avoid the majority of things that make me extremely stressed, but my stepping out to preserve my mental health would often offend and anger other people.

For example, tonight I had made plans with a relative to go over to their house for dinner after work. I’m leaving out a lot of stressors, but they decided we were going to a friends’ house instead, and we got to the house about an hour after I normally eat dinner. The friend had not started planning dinner – she only started going through the refrigerator after we got there, trying to figure out what she had that she could feed us. There was chaos in the kitchen and I wasn’t anywhere familiar and I really wanted to just leave.

But you can’t walk out on a family friend you haven’t seen in ten years who invited you over for dinner, just because she didn’t have dinner ready when you got there. Especially when she’s clearly stressed out – if you walked out on someone who was displaying social penitence for something, you’re going to make them feel pretty awful.

Whenever people talk about feeling trapped by social requirements, someone always wants to say “Of course you can, look at me, I do it all the time!” which is funny because that person is usually the one person in the room everyone thinks is an asshole, but who doesn’t know they’re an asshole, because they’re not socially sensitive enough to know that they’re shooting themselves in the foot over and over.

The point, of course, is not that people who feel trapped by social requirements are unaware that they are free agents; the point is that social requirements (if you prefer, intense expectations) have consequences whether you follow them or break them, and sometimes avoiding a trigger means lots of different triggers instead. So you take the least worst course of action that you can make for yourself.

So I did that. I feel bad, this entry is late, and there’s no science. But, I didn’t feel bad, offend someone, make them angry at me, and feel worse and have no entry at all because I was too strung out to concentrate.

Stuff like this contributes to mental health being so difficult to achieve and maintain.

Here’s an article on a review of 33 studies of strategies such as question prompt sheets, pre-session “coaching sessions”, and watching videos. The review found that some strategies were “somewhat effective”, i.e., nothing seemed made more than a small improvement, but it did make an improvement. The lead author, Paul Kinnersly of Cardiff University, suggests that people think about a doctor’s appointment ahead of time, write down their concerns, and consider bringing a family member to help ask questions and to remember the answers.

It seems there’s also room for targeted strategies; I mean, doctors, like people who are not doctors, vary in how you can best communicate with them.

One thing we suggest to people at CrazyBoards, a support forum for mentally ill people, when they are having trouble communicating something serious (and/or complicated) to their doctor, is to print out the post they talked about it all in, and bring that in to their doctor. If the immediate interpersonal pressure of the social interaction is what’s making it extra hard (or the problem is having to say it aloud, or to interrupt the doctor, or to say their piece without being interrupted, or something similar) thinking it all out ahead of time, writing it down, and asking them to read what you’ve written may help.

Several summers ago I spent six weeks in another country, doing research in collaboration with autism researchers there.  We traveled around by subway, train, and cab, visiting multiple schools with autistic children.  Some were regular schools that had an autism unit; others were boarding schools for special-needs children or for children with autism specifically.  We worked with the higher-functioning kids with autism (who had at least some language) and with younger mental-age-matched kids without autism (because mental retardation is very common in autistic kids – up to 74% although I read something non-peer-reviewed on the Internet that claims as low as 50% – to compare autistic and non-autistic kids on cognitive stuff you need to equate them on mental age, not chronological age).

We did a variety of tasks with the kids, involving stuff like sorting cards, or hearing stories and answering questions, or pushing buttons in response to pictures of faces on a computer screen.  One of the weirder tasks, which was something for our collaborators, not for me and my prof, involved measuring kids’ heads with a measuring tape.  I thought it seemed kind of an odd approach at the time – most of what I was involved in was heavily cognitive.  And so I’ve been surprised to see that line of research actually panning out.

Here’s a recent instance of it (citation below).  Researchers found that, very clearly, children with autism had larger head circumferences.  What I thought was interesting was that head circumference above the 75th percentile was  “associated with more impaired adaptive behaviors and with less impairment in IQ measures and motor and verbal language development.”

So something strongly associated with autism was also associated with less mental retardation (but mental retardation is strongly associated with autism).  There’s some interesting stuff in there…  I’m tempted to hypothesize beyond the data, but I’m not going to.

Larger head circumference was also associated with allergy/immune disorders in the kids and their first-degree relatives.  The researchers speculate that this relates to immune dysfunctions that themselves cause or are associated with increased cell cycle progression (cannot dredge what that means up out of my brain) and/or decreased apoptosis (deliberate, clean cell death).

At the time of my first couple years in grad school, it was being speculated that for the quarter or so of autistic kids who have a noticeable period of skill loss (coincidentally around the time of the MMR shot, which has led to a whole lot of bad crap) lose their skills around the time that the brain undergoes a major reorganization in which unnecessarily neuronal connections are “pruned” or cut back.

So: Maybe immune dysfunction leads to lack of cell death in pruning and maybe outside of it too, and thus autism and larger head circumference?

That and a dollar will get you one-quarter of a latte, or almost a small iced tea, or a tiny little bit of the funding necessary to gain actual knowledge, or a fair bit of annoyance from someone more educated who already knows why you’re wrong.   Speculation is tasty and rampant, but actual knowledge comes from eliminating the untrue theories with evidence, and hammering on the true ones until we decide there’s not much point in continuing to do so.

Sacco, R., et al. (2007) Clinical, Morphological, and Biochemical Correlates of Head Circumference in Autism. Biol Psychiatry.

Often studies only give you snapshots of a population – what one set of people looks like at hospitalization. What a different set looks like five years after hospitalization at a different hospital and in a different region. What fifty-year-olds look like right now, and what twenty-five-year-olds look like right now.

We often infer information about the course of a disorder based on who we can pick up at different points in life. But there’s no guarantee that the people we catch when they’re fifty were, at twenty-five, like the twenty-five-year-olds we’re catching now. We might have used recruiting techniques that caught (say) twenty-five-year-olds who are heavy drinkers, and fifty-year-olds who are drinkers now but were teetotalers at that age. There are a lot of ways these problems can come up, and researchers work diligently to do what they can with what is actually feasible to do, and we do our best to check on that knowledge in a variety of ways.

But it’s always good to have extensive longitudinal research to address questions about course of illness. Here’s an article (cite at bottom of entry) reporting on a large longitudinal study of people with bipolar I. I wanted to get ahold of the article to go into more depth, but my university doesn’t have it and it appears to be in either Portuguese or Italian, and since the closest thing I have is some Spanish my translation would be highly questionable.

This is from a decade-long project, the McLean-Harvard First Episode Project & International Consortium for Bipolar Disorder Research which followed people with bipolar disorder and psychotic disorders from their first hospitalization. This abstract only looked at data for bipolar I.

There are several findings I would prefer not to be true, but if we don’t consider the possibility, we can’t plan for them. People usually do not recover fully from their first episode, and they are very likely to have more episodes in the first two years (and to switch from depression to mania or vice versa),

Some conditionally good or bad stuff: Most people have the most problems early on with depression/dysphoria, and they tend to have a worse course. Initial mania or psychosis shows a better prognosis (interestingly enough). Very high rates of suicidal behavior accidents occurred early but not as much later on (this finding is pretty extensively reported). Early substance-use and anxiety go together. Prodromal symptoms (stuff indicating you’re about to have an episode) predicts bipolar disorder better than non-affective psychotic disorders (good for bipolar, bad for others).

Some good stuff: Most people didn’t cycle more and more over time (but if I’m reading the abstract right, they didn’t stick to a single steady cycle length, either). Also, how long people waited and how many episodes they’d had was unrelated to their response to mood stabilizers.

Salvatore, P., et al. (2007). Longitudinal research on bipolar disorders. Epidemiologia e psichiatria sociale, 16(2), 109-17.