Podcast 64: Brain Freeze

Happy Holidays, everyone.  We taped this a few weeks ago, but Shrinky Podcasts always make for good holiday chatter.   Today we talk about 
1) Brain Freeze-- inspired by a Well article in the NYTimes for 11/10 on Rick Perry's Brain Freeze.  You'll note that in this podcast, Dinah reads Roy's mind, and no has brain freeze from eating cold ice cream.  We kind of ramble, and so what else is new?  We talk about memory and attention and learning and Dinah explains why men don't take out the garbage during football games.  Clink talks about the scientific phenomena of "brain overload."

2) Siri-- ah, we did this podcast right after I got my new iPhone and it was new and exciting and I was working on an article on Siri and the Psychiatrist.  We ask Siri where we can buy a duck and when the world will end.  Apparently we have 5 billion years.  And Sigourney Weaver was 62 years, 1 month, and 5 days old at the time we recorded.


3) Prison Food-- inspired by a lawsuit in which a prisoner contends that the soy-based food being served in prison is 'cruel and unusual punishment' which caused him cramps. Clink talks about how prison food is handled.  She also talks about nutrient rich Nutraloaf that can be eaten without utensils and she discusses an NPR story which includes the recipe for anyone who would like to try nutraloaf. 


If you'd like to try it:
Special Management Meal
Yield - Three Loaves

• 6 slices whole wheat bread, finely chopped
• 4 ounces imitation cheddar cheese, finely grated
• 4 ounces raw carrots, finely grated
• 12 ounces spinach, canned, drained
• 2 cups dried Great Northern Beans, soaked,
cooked and drained
• 4 tablespoons vegetable oil
• 6 ounces potato flakes, dehydrated
• 6 ounces tomato paste
• 8 ounces powdered skim milk
• 4 ounces raisins

From Clink: You mispelled nutraloaf. Don't worry, I fixed it. Also, by pure coincidence today's correctional nursing topic on Lorry Schoenley's Blogtalk radio show was all about managing food allergies in corrections. For those of you who want to know what happens to inmates with peanut allergies, here it is directly from someone in the know.

This podcast is available on iTunes or as an RSS feed or Feedburner feed. You can also listen to or download the mp3 or the MPEG-4 file from mythreeshrinks.com. 

Thank you for listening.

Send your questions and comments to: mythreeshrinksATgmailDOTcom, or comment on this post

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Suicide, Brains, and Football

In yesterday's New York Times, Alan Schwarz wrote about the tragic suicide of football player Dave Duerson this past week. Schwarz notes that prior to shooting himself, Duerson texted family members that he wanted his brain examined for Chronic Traumatic Encephalopathy, a condition we've discussed before in our post Brains, Behavior, and Football.

Schwarz writes:

Doctors, N.F.L. officials and even many players denied or discredited the links between football and such brain damage for months or even years. The roughly 20 cases of C.T.E. that have been identified by groups at Boston University and West Virginia University were almost always men who had died — most with significant emotional or cognitive problems — with no knowledge of the disease. Now, for the first time he knows of, Stern said, a former player has killed himself with the specific request that his brain be examined.

I'm left to wonder, did this former football player have this problem? Sometimes depression alone causes memory problems and sometimes people with depression worry that they have Alzheimer's disease, or any number of other illnesses for that matter. Treating the depression may help the memory problems, and may alleviate the fears of other illnesses. And we don't know much about the Chronic Traumatic Encephelopathy induced by repeated head injuries: is the course of the dementia altered by early intervention with medications? Does the depression respond to the usual treatments for mood disorders? Could Mr. Duerson have been saved, at least for a while?

Here's an article on the treatment of chronic brain injury with hyperbaric oxygen in animal models:
http://www.hbot.com/first-successful-treatment-of-chronic-traumatic-brain-injury

And here's an emedicine article on treatments for repetitive brain injuries (not necessarily specific to CTE) with medicine recommendations, but no mention of antidepressants or medicines to slow the course of dementia:
http://emedicine.medscape.com/article/92189-treatment

Here's a medscape article on CTE and dementia:
http://www.alzheimersreadingroom.com/2010/08/causes-of-dementia-chronic-traumatic.html

And, finally, here's a shout out to my friend and med school classmate Robert Morrison, M.D., Ph.D. whose paper for our public health class was published in JAMA back in 1986 as a state of the art review of boxing and brain injury: http://jama.ama-assn.org/content/255/18/2475.short

Is it worth it in the name of sports?

Could I ask a huge favor of the next football player who considers suicide? Instead of completing the act, could you have your depression treated and then write about the results? It would be an enormous contribution. Sure, it would be an anecdote, and not a controlled trial, but perhaps it would add something to the field. And we'd be happy to publish your story here on Shrink Rap.

My heart goes out to the family of Dave Duerson.

Meditation: Does it Do Anything?

Meditation sounds like a great idea from the perspective of a psychiatrist: anything that calms and focuses the mind is a good thing (and without pharmaceuticals: even better!).

Personally, I tried Transcendental Meditation as a kid...more to do with my mother than with me...and found it to be boring. I have trouble keeping my thoughts still. They wander to what I want for dinner and should I write about this on Shrink Rap and will Clink and Victor ever eat crabcakes with me again and did I remember to give my last patient informed consent and a zillion other things. Holding my thoughts still is work.

The New York Times Well blog has an article on Meditation and Brain Changes. In "How Meditation May Change the Brain," Sindya N. Bhanoo writes:

The researchers report that those who meditated for about 30 minutes a day for eight weeks had measurable changes in gray-matter density in parts of the brain associated with memory, sense of self, empathy and stress. The findings will appear in the Jan. 30 issue of Psychiatry Research: Neuroimaging.

M.R.I. brain scans taken before and after the participants’ meditation regimen found increased gray matter in the hippocampus, an area important for learning and memory. The images also showed a reduction of gray matter in the amygdala, a region connected to anxiety and stress. A control group that did not practice meditation showed no such changes.

-------Lower stress, lower blood pressure, higher empathy.... I may have to give meditation another try. The cartoon above, by the way, shows Roy leading a meditation session. Now there's a thought.

Brains, Behavior and Football

In psychiatry, we've had a hard time drawing precise links between brain pathology and psychiatric disorders. We can do it for groups of people: Disease X is associated with changes in brain structure of Brain Area Y or metabolic changes in Brain Area Z. But it's groups, not individuals, and it's an association, not a cause>effect, or a definite. We still can't use this information for diagnosis, and there are still patients with any given psychiatric diagnoses who will have brains where Area Y is the same size as those without the disorder.

We're learning.

From what I read in this New York Times article, Owen Thomas was a bright, talented young man with no history of psychiatric disorder, and no history of known concussion. In April, he committed suicide-- a tragedy beyond words. Sometime people commit suicide and every one is left to wonder: there was no depression, no obvious precipitant, no note left behind, and every one is left to wonder why. The guilt toll on the survivors is enormous, as is the grief for their families and communities. In this case, according to the Philadelphia Inquirer, the young man was apparently struggling with the stress of difficult school work and concerns about his team and employment.

Owen's family donated his brain to Boston University's Center for the Study of Traumatic Encephalopathy.

They discovered that Owen's brain showed damage similar to that seen in older NFL players who've-- he had a condition called Chronic Traumatic Encephalopathy. In terms of Owen's suicide, it's hard to know what this means: did the brain injury contribute to or cause a psychiatric disorder, such as depression, that led to his suicide? Did it make him more impulsive, so that he was more likely to act on suicidal thoughts? It's hard to say: suicide is a common cause of death among young people who die. This is the first documented case of chronic traumatic encephalopathy in a college football player. It's not, however, the first suicide of a college football player.

The only way to know if encephalopathy causes depression which causes suicide, is to keep studying it. It's horrible to lose a child, and I applaud this young man's parents for contributing his brain to a research project, and for making his situation public. Millions of young people play football each year: maybe we need to be doing more to protect their brains, though that will not be popular statement among die-hard football fans (some of whom are my relatives). When it comes to sports and driving, we tend to minimize the risks. On the other hand, it's hard to live life with the shutters drawn.

If you're an athlete, help the cause and donate your brain here.

Can We MAKE You Crazy?

In today's NY Times Magazine, Ethan Watters discusses cultural influences in the etiology and expression of mental illnesses in his article entitled "The Americanization of Mental Illness." Watters is not a big a big proponent of the idea that psychiatric disorders are brain-based diseases, and he points to ways that Western ideas have changed the incidence and thinking in other parts of the world. Watters writes:

Western mental-health practitioners often prefer to believe that the 844 pages of the DSM-IV prior to the inclusion of culture-bound syndromes describe real disorders of the mind, illnesses with symptomatology and outcomes relatively unaffected by shifting cultural beliefs. And, it logically follows, if these disorders are unaffected by culture, then they are surely universal to humans everywhere. In this view, the DSM is a field guide to the world’s psyche, and applying it around the world represents simply the brave march of scientific knowledge.

Of course, we can become psychologically unhinged for many reasons that are common to all, like personal traumas, social upheavals or biochemical imbalances in our brains. Modern science has begun to reveal these causes. Whatever the trigger, however, the ill individual and those around him invariably rely on cultural beliefs and stories to understand what is happening. Those stories, whether they tell of spirit possession, semen loss or serotonin depletion, predict and shape the course of the illness in dramatic and often counterintuitive ways. In the end, what cross-cultural psychiatrists and anthropologists have to tell us is that all mental illnesses, including depression, P.T.S.D. and even schizophrenia, can be every bit as influenced by cultural beliefs and expectations today as hysterical-leg paralysis or the vapors or zar or any other mental illness ever experienced in the history of human madness. This does not mean that these illnesses and the pain associated with them are not real, or that sufferers deliberately shape their symptoms to fit a certain cultural niche. It means that a mental illness is an illness of the mind and cannot be understood without understanding the ideas, habits and predispositions — the idiosyncratic cultural trappings — of the mind that is its host.

Watters then goes on to ask if the medicalization of mental illness does in fact lead to destigmatization. He cites a study where college students give bigger shocks to test subjects trying to learn a new task if they believe the test subject has a mental illness caused by a biological problem rather than a childhood problem. I'll skip even thinking about this study, but why do so many studies have college students shocking each other? Shouldn't they just hit each other with baseball bats?

Watters goes on to conclude:

CROSS-CULTURAL psychiatrists have pointed out that the mental-health ideas we export to the world are rarely unadulterated scientific facts and never culturally neutral. “Western mental-health discourse introduces core components of Western culture, including a theory of human nature, a definition of personhood, a sense of time and memory and a source of moral authority. None of this is universal,” Derek Summerfield of the Institute of Psychiatry in London observes. He has also written: “The problem is the overall thrust that comes from being at the heart of the one globalizing culture. It is as if one version of human nature is being presented as definitive, and one set of ideas about pain and suffering. . . . There is no one definitive psychology.”

Memorial For A Brain

When I was in medical school I was fascinated by neuroanatomy and neuroscience. I enjoyed reading popular science books like Broca's Brain and The Three Pound Universe. I liked reading about the classic clinical cases studies that taught us a lot about how the brain works---cases like Phineas Gage, the Nineteenth Century railroad foreman whose brain injury revealed the purpose of frontal lobes, or the case of H.M., the man whose temporal lobectomy taught us about the how memory works.

Patient H.M. had parts of both his temporal lobes removed in order to treat a seizure disorder. After the surgery he was unable to form new memories at all, and he became one of the most-studied subjects in the field of neuropsychology. From H.M. we learned that there are two types of memory, declarative and procedural memory. Declarative memory is the what we use when we learned facts. Procedural memory is what we use when we learn how to do things, like brush our teeth or ride a bike. H.M's temporal lobectomy destroyed his declarative memory, but his procedural memory was left intact.

I'm bringing this up now because of an article in Wednesday's New York Times, "Dissection Begins on Famous Brain". Patient H.M., whose name we now know is Henry Molaison, died last year and donated his brain to a neuroscience project at M.I.T. They are in the process of sectioning his brain to learn more about what went wrong with it. There is even a web site, the Brain Observatory, where you can watch the sectioning as it happens.

I read the story and checked out the sectioning web site, but my reactions are mixed. As a psychiatrist it's fascinating to see that we can study a lesion from an individual patient all the way down to the microscopic level, but as a human being it leaves me feeling rather sad for this guy. It was noble of him to donate his brain, and years of his life, to science but on the other hand I can't help wondering if he ever just wished people would leave him alone.

Does Facebook Destroy Your Brain?

I have a Facebook page, I even have "friends" (even Fat Doctor!!), but I haven't really figured out what to do with it, so it doesn't eat my time. Something to check here and there. Roy has a Facebook page, but alas, few friends, and he's too busy twittering for it to really matter. ClinkShrink stays out of the fray, but I do write on her sister's wall here and there.

With the kids, it's another story. It consumes their worlds. Even my patients talk in terms of Facebook. Who's befriended you, who's UNfriended you, who's in a relationship with who, it's all there. I stuck my head in a video my own kid was making, only to run into some teens in the grocery store the next day and have them say, "I saw you on Facebook!"

So is this a good thing? (How could it be?).

From today's Mail Online, David Derbyshire writes "Social Websites Harm Children's Brains." I've clipped some parts of the article below:

Baroness Greenfield, an Oxford University neuroscientist and director of the Royal Institution, believes repeated exposure could effectively 'rewire' the brain.

Experts are concerned children's online social interactions can 'rewire' the brain....

'My fear is that these technologies are infantilising the brain into the state of small children who are attracted by buzzing noises and bright lights, who have a small attention span and who live for the moment.'....

Psychologists have also argued that digital technology is changing the way we think. They point out that students no longer need to plan essays before starting to write - thanks to word processors they can edit as they go along. Satellite navigation systems have negated the need to decipher maps....

Educational psychologist Jane Healy believes children should be kept away from computer games until they are seven. Most games only trigger the 'flight or fight' region of the brain, rather than the vital areas responsible for reasoning.

Usually we think of computer games as being harmful in terms of exposure to violence, or in that they suck time away from important parts of life: contact with other people, exposure to new and interesting things. We don't usually think of these things in terms of the brain Hardwiring.

Interactive Brains

Neuroanatomy was my favorite class in medical school. I loved tracing out the brain pathways, figuring out which part did what, connecting up clinical syndromes to what I knew about brain structure and the nervous system. I learned all this back in the dark ages, back in the paleontologic age when whales had legs, before comets struck the earth and caused the last ice age. The World Wide Web didn't exist then either. I had to learn this stuff by examining the actual brains of dead people, by looking at stained microscope slides of brains and by pouring over books (the things with pages, covers and ink) rather than web sites.

So now the modern age is here and students get all kinds of cool high tech stuff to learn with. Just out of curiosity I scoured the web and put together a quick and dirty list of some web sites that provide interactive imaging of the human brain. Dang, I wish I had that when I was a med student.

Michigan State Brain Bank

Harvard's Whole Brain Atlas

University of Florida (takes a while to load, Flash-based, no labels)

University of Washington

Wayne State University

University of Utah (This one was my favorite atlas. It shows actual photographs of gross brain anatomy. You can click on the name of the structure and an arrow points to it. No neuroimaging to interpret, just identification of gross structures.)

University of Michigan

Columbia Brain Atlas

Here's When You Need A Psychiatrist

Have we written this one yet? I seem to think that Roy, our Consultation-Liason Boy, may have done this.

This is just my opinion, it's written with the non-shrink doc in mind, and it assumes access to psychiatric care:

So when should a patient be referred to a psychiatrist for care?

• When their distress due to psychiatric illness is such that they can't contain it and are driving the primary care doc nuts.
• Any patient with the new onset of a psychotic illness should initially be stabilized by a psychiatrist (this is just my opinion) if they are willing to go. Psychotic illness: any illness accompanied by hallucinations and/or delusions. Psychosis is frequently seen in Schizophrenia and Bipolar Disorder, but can also be seen with depression, delirium, and a host of other non-psychiatric illnesses. If the patient's hallucinations are caused by a brain tumor and they resolve with removal of the brain tumor, then the psychiatrist may not be necessary. Maybe Roy can write us a "causes of psychosis" post.
• For depression: my conservative rule would be to refer after the patient fails one antidepressant medication given at a therapeutic dose for long enough. What's a therapeutic dose: I go as high as a) the patient will tolerate or b) to the highest recommended dose (which ever comes first). If a patient can't tolerate more than 50mg of zoloft, well, this isn't a full trial. Switch to another med and try to get the patient up to a full dose. Wait AT LEAST four weeks (the mantra is 3 to 6 weeks) on a good dose. It's not uncommon to get a patient who has been on small doses of many anti-depressants, none for very long. And primary care docs aren't the best at augmentation strategies.
• Any patient with Bipolar Disorder needs a psychiatrist to stabilize them, and a psychiatrist available for management of episodes. If someone has been stable on Lithium for the past 8 years, they don't need a psychiatrist to prescribe it.
• When prescribing that first antidepressant, ask every patient with depression if they've had a manic episode: "Have ever had a time when your mood was too good, when you had excessive energy and needed less sleep, when you talked faster than usual, your thoughts raced, you were more impulsive than usual with regard to spending or sex?" Anyone who doesn't look at you like you're nuts for asking this needs to be questioned in more detail about manic episodes. If the patient has a history of even one manic episode, you're dealing with Bipolar Depression and prescribing antidepressants could be very risky-- not a bad time to refer.
• Don't prescribe Xanax for a chronic anxiety disorder. It's hard to treat patients who get dependent on xanax and it's hard to refer them if they end up on high doses.
• Any patient with a recent serious suicide attempt or recent psychiatric hospitalizations should be stabilized by a psychiatrist.
• Any patient with any psychiatric disorder that is compromising their ability to function, who does not improve after two to three months of treatment, should be referred for psychiatric care-- so OCD or Panic Disorder that is not getting better quickly.
• If a psychiatric disorder puts anyone's life at risk, it's probably more than a primary care doc wants to or should deal with.
• Any patient who is being treated by a primary care doc for a psychiatric illness should be asked if they want to see a psychotherapist (a shrink or a psychologist or a social worker or a nurse therapist). The patient may say that the pills have cured their depression and they don't need to talk. In the absence of information, this should be respected. But the gentle offer of a psychotherapy referral should be made early.

Sorry, a little haphazard, maybe Roy can come in and add an addendum....

How This Psychiatrist Thinks About Psychological Tests

First a big thank you to Gerbil for giving me the idea for this post. In a comment on my post "What Good Are Psychologists?" she mentioned psychiatrists who refer patients for diagnostic psychological testing. It got me thinking---this is a good thing---about why I do (or don't do) what I do.

I have to say I hardly ever request psychological tests. Even before I started working in prison, it just wasn't something I routinely did with my patients. When I was in residency we had lectures from psychologists about the different types of tests and what they're indicated for and a few things about interpretation, and later psychologists I've worked with have told me that I have a better understanding of testing than the average psychiatrist, but I'm not sure what that means.

For the lay readers among us, there are some general categories of psychological tests. There are personality tests that measures different character traits. There are intelligence tests that measure IQ. There are projective tests that are used to get an understanding of the person's interpersonal dynamics and style of thinking. There are neuropsychological tests that measure a person's cognitive capacity---ability to learn and remember, use language, coordinate eye-hand movements and so forth.

In general, when thinking about tests you have to consider what it is you're trying to figure out. If you have a patient who is failing in school you might want to order IQ or other achievement tests to see if the personal has a developmental disability or learning disability. If the patient has had a head injury or you think he or she might be getting demented you'd order neuropsychological testing. If you have a patient in therapy and you want material that might be useful to help the patient understand his own inner workings, you'd request projective testing and/or personality testing. Some tests are used as tools to predict certain things: whether or not someone would perform well on a certain job or whether or not they will re-offend as criminals.

It's important for tests to be used as part of an overall patient assessment. Test results fit into a whole database of information that a psychiatrist considers when making a diagnosis or putting together a treatment plan, in addition to a good patient history and a review of available treatment records.

It's also important to know whether or not the given test has been validated for your particular patient because 'normal' test results can be different for different groups of people. A test is only as good as the patients it's been based upon. For example, normal results for the original Minnesota Multiphasic Personality Inventory (MMPI, a test used to diagnose psychiatric disorders) was originally based upon only 500 people living in Minnesota. Much as I would like to think that Minnesota should be the gold standard for normalcy, this just isn't realistic. I mean really---Baltimoreans would end up looking pretty depressed compared to them. This is where a big limitation comes into play for me working in prison---many psychological tests have not been validated for use in prisoners.

Similarly, predictive tests only give group predictions and aren't necessarily reliable for the individual. A certain score on the Hare Psychopathy Checklist might give you a result that the patient has a 15% chance of re-offending, but that just means that out of 100 people with an identical score 85 will not re-offend and 15 will. The score doesn't tell you which of the two groups your patient will actually be in. The other trick with using tests to predict things is that many tests used for prediction have never been proven to have predictive value---there is no test to predict 'good parenthood', for example, yet psychological tests are used constantly in custody evaluations. It's important to know the limits of the test.

So...which tests do I actually use?

In prison the most common test I use is the Mini-Mental State Examination (MMSE). It was invented by two psychiatrists as a quick bedside test of cognitive functioning. You can give it in about ten minutes and it's a great way of measuring how brain impairment changes over time. You use it to check to see if someone's delirium is resolving, or as a screening tool for problems that should be investigated further.

In free society the most common tests I used, besides the MMSE, were general symptom inventories. For example, the Beck Depression Inventory (BDI) is a nice tool for measuring the severity of depressive symptoms. It's used to screen people for depression and also to monitor reponse to treatment.

I never use projective testing, mainly because I've never found it particularly useful for anything---maybe I would if I had a psychotherapy practice but even then I don't know too many psychiatrists who use them. I'd probably use neuropsychological tests if I could, but these are very specialized tests that have to be administered by a neuropsychologist (a subspecialty of psychology) and I don't know of any prisons who have one of those.

So that's my take on psychological tests. Thanks, Gerbil.

Sunday Brain Soup

I looked through Google News today to see what is happening in the world of "brains." Here's some of what I found . . .

* * *

A study came out recently in the journal Emotion reportedly showing that people identify fearful faces much more quickly than other faces. Makes sense. Apparently, the wide-eyed stare has a lot to do with it.

'The team found people became aware of fearful expressions much faster than neutral or happy faces. "We were seeing it pretty much universally," [David] Zald said.
He thinks it has something to do with the eyes.

"If you compare the amounts of the whites showing with a fearful face versus a neutral face, the difference is really quite striking," he said.'

So it's the whites of the eyes that do it. That explains the popularity of the runaway bride story a few years ago.

* * *

Of course, women are probably even quicker at this than men, because, as everyone knows, women have a much bigger crockus than men. What? You don't know your crockus from a hole in the ground? Maybe you missed that class. Or maybe you are just feeling empty-headed today (then maybe this belongs to you).

* * *

"First Successful Treatment For Chronic Traumatic Brain Injury In Rats"
This is great. We can't get funding to help find better treatments for people with traumatic brain injuries, but we now have a good treatment for rats who have had too many encounters with a broom handle.

* * *

Tech.Blorge is reporting that it is now possible to directly control your Second Life avatar with a brain-computer interface.

"Sometimes you look at a friend and could swear they're directly connected to the computer. New technology could soon make that the case. Professor Ushiba of Keio University has unveiled a brain-computer interface (BCI) that allows users steer characters with their thoughts, reports pinktentacle."

* * *

Finally, from Thailand's The King & I: "The reign in Chiang falls mainly in the brain."

VEGF: the New antidepressant

Vascular Endothelial Growth Factor (VEGF) stimulates the growth of new capillaries. In the brain, VEGF also stimulates the growth of new brain cells. A recent PNAS article, by Jennifer L. Warner-Schmidt and Ronald S. Duman from Yale, demonstrates that VEGF is a middle-man in the antidepressant response mechanism (better abstract here).

They show in rats that:

• VEGF goes up with ECT, with an sSRI (fluoxetine/Prozac), and with an sNRI (desipramine/Norpramine)
  


• This increase in VEGF is associated with new neuronal growth in the hippocampus


• Treatment with ECT, fluoxetine, or desipramine is associated with new neuronal growth in the hippocampus
  


• Injecting VEGF is associated with an antidepressant response in animal models of depression


• Blockade of the VEGF receptor with Flk-1 blocks the growth of new neurons in the hippocampus (in all 4 experimental arms--ECT, fluoxetine, desipramine, or VEGF injection)
  


• Blockade of the VEGF receptor blocks the behavioral response to ECT, fluoxetine, or desipramine in animal models of depression

This study adds to the weight of evidence that one of the end results for antidepressant treatment is stimulating new brain cell growth. It is not clear whether this is related or not to these drugs' effects on serotonin or norepinephrine, but it appears it may be possible to bypass neurotransmitter mechanisms (and avoid their subsequent side effects) and go directly to neurogenesis. This may lead to some entirely new treatments for depression and bipolar disorder down the road (way down the road).

My Three Shrinks Podcast 14: No April Fool

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Hard to believe we went so long without a podcast. Sorry about that, folks, but life got too hectic for a spell. We didn't do anything special for April Fools Day (except some funny YouTube links), but we still think you'll like today's podcast.

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April 1, 2007:


Topics include:

• Q&A: Midwife with a Knife, an OB/GYN, asks us about whether pedophilia is a disease or something else, and what we think about civil (as opposed to criminal) commitment for it. Clink uses one of her 50-cent words on us (ephebophilia, a term that Clink says was coined by John Money in his book, Love Maps). See also The Last Psychiatrist's posts on this here and here.
  
• NYT article: "The Brain on the Stand", by Jeffrey Rosen. Clink talks about this article about brain diseases being put on trial to explain bad behavior.
• Q&A: Dr Anonymous wants us to say more about our recent posts (here and here) on humor and medicine. This whole discussion (and the numerous comments on the blog) was started by Roy's lyrics to "Walk Like a Psychiatrist."
  

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Find show notes with links at: http://mythreeshrinks.com. This podcast is available on iTunes (feel free to post a review) or as an RSS feed. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com.

Thank you for listening.

My Three Shrinks Podcast 11: Lovely Spam

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We almost didn't make a podcast this week, as both Dinah and Clink were under the weather; but I brought my hazard suit and gel scrub and we managed to complete it. It did go a bit long, about 50 minutes.

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February 18, 2007:


Topics include:

• FDA Antidepressants Hearing, Revisited. We had previously blogged about suicide and antidepressants, followed by Roy's first-hand account of the December 2006 FDA hearing which Roy attended, where the committee voted to expand the black box warnings on antidepressants to indicate the risks of untreated depression and to mention the protective effects that antidepressants appear to have on older folks. The FDA has now released two transcripts of the hearing (Transcript 1 and Transcript 2), as well as the slide presentations from some of the speakers. These are excellent resources if you want to find out more on the subject. The recommended changes (see summary) to the black box include text to highlight the following:
  
• increased risk of antidepressant-associated suicidal thoughts and behaviors up to around age 25
• protective effect of antidepressants against suicidal thoughts and behaviors for older folks, particularly seniors
• balancing language which points out the increased risks associated with NOT treating depression (eg, suicide rates have increased for children since the 2004 decision to add black box warnings for antidepressants)
  
  
• Finland, Finland, Finland. The Finnish study that Dinah mentioned is discussed here. The Monty Python audio was found here.
  
• The Zyprexa Documents. The FuriousSeasons blog details the concerns that Lilly is holding out on important information about its antipsychotic drug.
  
• NYT: Bipolar toddler dead from medications. Raises questions about diagnosing severe mental illness in very young children.
• Lovely Spam. on YouTube.
• Q&A at mythreeshrinksATgmailDOTcom. Schizoid personality disorder: Is it real and does it predispose to schizophrenia? By Seamonkey. Diagnostic criteria. Pubmed review.
• Amygdala size and eye contact in Autism.
• Asperger's syndrome.
  

Next week: Side effects of psychotherapy; evolutionary psychopathology; what happens in Vegas.
Last week's musical snippet was from the 2000 release, Strangelove Addiction, from the self-titled album by Supreme Beings of Leisure.

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Find show notes with links at:
http://psychiatrist-blog.blogspot.com/2007/02/my-three-shrinks-podcast-11-lovely-spam.html
This podcast is available on iTunes (feel free to post a review). You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com. Thank you for listening.

My Three Shrinks 5: Sex, Lies, and Neuroeconomics

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Today's podcast is brought to you by the letter "M" and the number "5".

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January 9, 2007:
Topics include:

• New Yorker Magazine (Sep 18, 2006): Mind Games: What Neuroeconomics tells us about money and the brain, by John Cassidy. The neuroanatomy and functional connectivity that lies behind our economic decisions and risk aversion. As measured by functional MRI imaging (fMRI), the constant tug-of-war between the orbitofront al lobe, the amygdala, and the insular cortex mediates everyday economic decisions. Related links include the Neuroscience Marketing blog, New York University's Center for Brain Imaging, Google "neuroeconomics", and the Omnibrain blog (one of our favorites).
• Book "Paving Wall Street: Experimental Economics and the Quest for the Perfect Market", by Dinah's brother, Ross.
• Dinah refers back to a Shrink Rap post on compulsive blogging and to another one on a combination Wellbutrin (bupropion)/Revia (naltrexone) pill called Contrave for weight loss.
• The Interview Room, a novel by forensic psychiatrist Roderick Anscombe, provides insight into how the brain betrays people's lies. His website provides 14 tips on how to spot the liar (very interesting reading).
• Washington Post (Oct 30, 2006): Using fMRI machines to detect lies. See also website for No Lie MRI.
• Be nice to Dinah, who had a bad day.
• Clink's Favorite Podcasts: BusinessWeek, NPR, State Department Press Briefings, Slash Dot Review, Byzantine Emperors.
  
• Roy's Favorite Podcasts: Comic Strip Live, FLOSS Weekly, Futures in Biotech, Inside the Net (now http://www.twit.tv/ITN), NEJM, This Week in Tech (TWiT).
  
• Dinah's Favorite Podcasts: "Umm, why would I want to listen to podcasts, anyway?"

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Find show notes with links at:
iTunes. You can also listen to or download the .mp3 or the MPEG-4 file from mythreeshrinks.com.

technorati tags:psychiatrists, psychiatry, blog, podcast, psychology, neuroeconomics, fMRI, MRI, brain, scan, lies

Blogged with Flock

Roy: Warrantless Brain Scans

This whole search for terrorist collaborators thing is getting a little ridiculous. Tapping into millions of domestic phone calls (and probably blogs and emails and IMs) in the name of terrorism? That's legal?

So, here's my nightmare scenario. If this is legal, the next step is to force functional MRIs on people to determine what they know (about terrorism, of course). The technology is there. Functional MRI (fMRI) measures minute changes in blood flow in the brain, comparing areas to see which ones have more blood flow, and thus are more active. It seems that one must use specific brain areas to make stuff up. This technology is being used for good purposes (eg, controlling chronic pain), but could certainly be applied to darker motives.

Talkleft asked:

"Would the Court view an involuntary brain scan as a nonintrusive gathering of information rather than a search governed by the Fourth Amendment? Would the Court view brain scans as forcing an involuntary disclosure of thoughts prohibited by the Fifth Amendment's requirement that individuals not be made to testify against their will?"

fMRI is not "invasive" in the classical sense. No needles. No tubes. Sorta like going through an airport scanner, but lying down (you can even keep your shoes on). So what's to stop them from using this technology on Gitmo detainees (or on us)?

The chronic pain link above is interesting, BTW. It makes me wonder if real-time fMRI scanning can be used to learn how to better control obsessive thoughts or auditory hallucinations or anxiety.