December 31, 2007

Q "Our mother died about nine months ago, and our father is a shambles. He does not seem to get over it, stays alone, does not take care of himself....should we be worried enough to get help for him?"

A "Bereavement is associated with an increase in mortality risk, particularly in the first weeks or months following a loss. A "broken heart," or the psychological stress following the loss of a loved one, along with related losses such as changes to living arrangements and economics, may increase the risk for death in the person who is mourning.

Further, people who have been bereaved are more likely to have physical health problems, with higher rates of disability, medication use, and hospitalization, compared with nonbereaved people, they note. However, in most cases, professional counseling does not improve outcomes for people who are grieving the loss of a loved one, but rather, most cases of uncomplicated grief will resolve without intervention.

For most people, the experience, though difficult, is tolerable and abates with time. For some, however, the suffering is intense and prolonged. Several studies in Europe and North America have examined excess mortality in relation to bereavement. One, for example, found a 3.3-fold increase in risk for suicide in men over 60 years of age who lost their wife, but no such increase in women of the same age who lost their husband.  Another report in 2006 showed that widowers had a 21% increased risk for all-cause mortality and widows a 17% increased risk. Risks were further increased in the first 30 days after bereavement. For parents losing children, a Danish study published in 2003 showed fathers and mothers have an increased risk for suicide after the death of a child, a risk that is higher with younger children and particularly high in the first 30 days after bereavement.

Grief is the primarily emotional reaction to the loss of a loved one through death, is a normal but complex reaction to loss, incorporating diverse psychological and physical manifestations. For most people, family, friends, religious and community groups, and various societal resources provide the necessary support. Professional psychological intervention is generally neither justified nor effective for uncomplicated forms of grief." Lancet. 2007;370:1960-1973.

December 24, 2007

Q "Did I hear that depression causes breast cancer?"

A That would be too great a generalization. This is an area under investigation. "Depression appears to somewhat heighten the risk of breast cancer, but has no significant association with lung, colon or prostate cancers.

Depression is related to a slightly increased risk of cancer. The relation with breast cancer gets stronger with a longer follow-up period."

With the evidence available at this moment, it's difficult to disentangle the possible effects of depression and antidepressants on the occurrence of subsequent cancer. With the current knowledge, it not yet possible to translate these results into preventive interventions.

Clin Prac Epid Mental Health 2007.

December 17, 2007

Q "Did you read that article about the brain and uncertainty?"

A You may be referring to this one: "A new study shows that belief, disbelief, and uncertainty may be distinguishable using functional neuroimaging. Researchers report that subjects challenged with statements that were true, false, or undecidable showed activation in distinct regions of the prefrontal and parietal cortices and the basal ganglia.

These results suggest that the differences among belief, disbelief, and uncertainty may one day be distinguished reliably, in real time, by techniques of neuroimaging. This would have obvious implications for the detection of deception, for the control of the placebo effect during the process of drug design, and for the study of any higher-cognitive phenomenon in which the differences among belief, disbelief, and uncertainty might be a relevant variable.

The difference between believing and disbelieving a proposition is one of the most potent regulators of human behavior and emotion. When one accepts a statement as true, it becomes the basis for further thought and action; rejected as false, it remains a string of words.

When they contrasted the trials of belief vs disbelief, they found increased signals in the ventromedial prefrontal cortex (VMPFC), which is involved in linking factual knowledge with emotion. The involvement of the VMPFC in belief processing suggests an anatomical link between the purely cognitive aspects of belief and human emotion and reward.

Ethical belief followed a similar pattern of activation to mathematical belief, they noted, suggesting that the physiological difference between belief and disbelief is not related to content or emotional associations.

Contrasting disbelief with belief showed increased signals in the anterior insula, a brain region involved in the sensation of taste, perception of pain, and the feeling of disgust. Uncertainty evoked a positive signal in the anterior cingulate cortex and a decreased signal in the caudate, a region of the basal ganglia that plays a role in motor action. Because both belief and disbelief were associated with an increased signal in the caudate compared with uncertainty, the authors suggest that the basal ganglia may play a role in mediating the cognitive and behavioral differences between decision and indecision."

Ann Neurol. December 10, 2007.
 

December 10, 2007

Q "Learning disorders are due to psychological problems like trauma, right?"

A Actually, no: "Research implicates defects in brain white matter in impaired reading fluency, seen both in people with dyslexia and patients with a rare genetic brain condition called periventricular nodular heterotopia (PNH)

The research could have implications for the type of learning strategies that might be useful for the estimated 5% to 17% of children who have dyslexia. This research helps to support the notion that reading fluency has to be considered a neurobiologically important aspect of reading problems.

There are nodules of misplaced gray matter that contain neurons that should have migrated out to the surface of the brain and failed to do so.
Even with these large regions of misplaced gray matter, PNH patients appear outwardly normal. These are individuals who have normal intelligence, normal attention, normal memory; they typically go through school and work normally. However, PNH patients do develop seizures, and that is usually how they are diagnosed.

The study showed that the more the white matter was disorganized in the PNH patients, the worse their reading fluency.

So white-matter disruptions may explain the difficulty with the "rapid, automatic, smooth serial processing" that is required for reading. Reading fluency may have this distinct structural basis in the brain, which may be different from the structural basis for other aspects of reading difficulty, like phonological difficulty. Reading fluency problems are particularly difficult to remediate, more difficult than the typical phonological problems, and yet many remediation programs focus on phonology."

Neurology. 2007;69;2146-2154.
 

December 3, 2007

Q "Too little sleep causes disease right?  Then the more sleep the better?"

A Not necessarily.  It depends upon your regular pattern and changes from that pattern. "Significantly changing normal sleep patterns — either getting much more or much less sleep — increases the risk for mortality. The study found that decreasing nightly sleep from 6, 7, or 8 hours doubles the risk for cardiovascular death, while increasing sleep from 7 or 8 hours doubles the risk for noncardiovascular death.

If you have a regular pattern — 6, 7, or 8 hours — and you maintain that over time, that’s protective against premature mortality. If you move out of that to the 9-hours-or-more category, that seems to increase all-cause mortality and the group of deaths that increases is the noncardiovascular deaths. If you go to the short end of the spectrum, you increase your risk for cardiovascular mortality.

The study found a U-shaped association in both phases between sleep and subsequent all-cause mortality. The link between decreased hours of sleep and higher cardiovascular mortality risk seems to make some sense: Short sleep duration is a risk factor for weight gain, insulin resistance, and type 2 diabetes, the authors write. Short sleep is also accompanied by increased cortisol levels and abnormal growth hormone secretion and has been associated with hypertension and some cardiovascular diseases.

However, the link between deaths and longer sleep patterns is not as clear. We really don’t know what’s driving that. Researchers may want to take a look at the role of increased cancer deaths or trauma deaths among patients changing to a long sleep pattern.

A significant change in sleep patterns may be a red flag for some underlying disease, she said. “If somebody comes to you and they’re now reporting having moved from a normal sleep pattern either to the very short end of the sleep spectrum or the long end of the sleep spectrum and that appears to be a pattern that’s continuing over time and is not their regular pattern, then that is probably a marker of something. Sleep. 2007;30:1659-1666.

November 26, 2007

Q "People with Alzheimers get very agitated with urinary tract infections...I have read.  Is this an organ system that creates other problems for them from a psychological standpoint?"

A "Stroke survivors who develop urinary incontinence are less attentive than continent patients. Attention-focused training might therefore be helpful in regaining bladder control.

Compared to continent patients, those with urge UI had poorer power of attention and speed of memory. However, these patients had similar continuity of attention to continent subjects. Patients with IA-UI performed worse than continent patients and those with urge UI in all categories.

Sustained attention seems important for outcome and should be taken into account in the rehabilitation process. In patients who recognize their incontinence, attention-focused training might be the most effective measure of reestablishing bladder control."

J Am Geriatr Soc 2007;55:1571-1577.

November 19, 2007

Q "Is there not a relationship between heart disease and Alzheimer's Disease, and could fixing the first, help the last?"

A Not exactly, but there is a relationship between medication that lowers cholesterol and its impact upon mental functioning: "Research links statin use to reduced cognitive decline, but it uncovers a curious phenomenon: African American patients who stopped taking statins appeared to reap an even greater cognitive benefit than those who continued taking this cholesterol-lowering medication....seem to underline the complex nature of the relationship between statins and dementia prevention.

Statins play an important role in the prevention of cardiovascular disease (CVD), and given the apparent link between CVD risk factors and risk factors for cognitive decline, it is possible that statins could also play a role in prevention of dementia, the authors conclude.

The researchers noted that 25% of the elderly African American sample were using statins in 2001, perhaps not surprising since African Americans have a higher prevalence of coronary risk factors than other populations in the United States.

Adjusting for age at baseline, sex, education, and ApoE status, researchers found less cognitive decline among statin users than among non–statin users.

If statin use reduces cognitive decline, then it is reasonable to assume that continued use of statins would produce a greater reduction. However, that was not the case in this study. Researchers found that those who continued to take statins from 2001 to 2004 had greater cognitive decline than those who were taking statins in 2001 but were no longer taking them in 2004. Neither the lipid-lowering nor the anti-inflammatory effects of statins could explain the effect of statins on cognitive decline.

It is possible that some other mechanism of statins — for example, their antioxidant effects or protective effect on endothelial dysfunction — is at work. In addition to lowering lipids in plasma, statins also lower the level of a major product of brain cholesterol metabolism. Statin use plays an important role in the prevention of cardiovascular disease...And there may be a link between cardiovascular risk factors and risk factors for cognitive decline and Alzheimer's disease."

Neurology 2007;69:1873-1880.
 

October 29, 2007

Q "Can deep brain stimulation work for things other than conversion disorder...I read about it being used for conversion?"

A "Deep brain stimulation (DBS) of the nucleus accumbens was associated with remission of alcohol dependence in a man with severe anxiety disorder and secondary depression.

Researchers used bilateral DBS of the nucleus accumbens in the patient, in an attempt to treat his severe anxiety disorder and secondary depressive disorder. DBS had no beneficial effect on the patient's primary disorder, but there was a remarkable change in alcohol dependence.

After only a month of DBS, the patient did not consume alcohol on most days, no longer drank excessively, and reduced his consumption to 1 to 2 drinks on days when he did consume alcohol.

A year after starting DBS, the patient only occasionally consumes alcohol. He claims to have lost the desire to drink and says the pressing need to consume alcohol has almost disappeared. A relatively general consensus prevails that the mesocorticolimbic system, especially the nucleus accumbens, is to be viewed as the primary area impaired by psychotropic substances and consequently as the neural substrate for substance dependencies."

J Neurol Neurosurg Psychiatry 2007;78:1152-1153

October 22, 2007