The insanity epidemic, 1907

I’ve happened upon an interesting snippet from the regular Nature “100 years ago” feature concerning a 1907 debate on whether insanity was really increasing or whether it just seemed that way due to changes in diagnosis and treatment methods.

It made me smile because it is almost exactly the same argument that is being had now about whether cases of autism are genuinely increasing or whether this just reflects changes in diagnosis and treatment methods:

Notwithstanding the much improved statistics recently issued by the Lunacy Commissioners, thoroughly satisfactory materials are still wanting for solving the question whether the prevalence of insanity is or is not increasing. The importance of the problem… imparts special interest to a paper by Mr. Noel A. Humphreys on the alleged increase of insanity… This paper shows in a striking manner the value of scientific statistics in checking crude figures.

The author expresses a decided opinion that there is no absolute proof of actual increase of occurring insanity in England and Wales, and that the continued increase in the number and proportion of the registered and certified insane is due to changes in the degree and nature of mental unsoundness for which asylum treatment is considered necessary, and to the marked decline in the rate of discharge (including deaths) from asylums.

From Nature 18 July 1907.

Link to Nature “100 years ago” snippet.
Link to Wikipedia page on epidemiology of autism.

Creative in love

The Scientific American Mind blog Mind Matters has a fantastic article on the links between love and creativity and how just thinking of a romantic relationship can have an immediate effect on creative thinking.

The piece covers several studies which have shown that love or the concept of love promotes a ‘big picture’ thinking style while thinking of a quick shag seems to do the reverse:

The clever experiments demonstrated that love makes us think differently in that it triggers global processing, which in turn promotes creative thinking and interferes with analytic thinking. Thinking about sex, however, has the opposite effect: it triggers local processing, which in turn promotes analytic thinking and interferes with creativity.

Why does love make us think more globally? The researchers suggest that romantic love induces a long-term perspective, whereas sexual desire induces a short-term perspective. This is because love typically entails wishes and goals of prolonged attachment with a person, whereas sexual desire is typically focused on engaging in sexual activities in the “here and now”. Consistent with this idea, when the researchers asked people to imagine a romantic date or a casual sex encounter, they found that those who imagined dates imagined them as occurring farther into the future than those who imagined casual sex…

A global processing style promotes creative thinking because it helps raise remote and uncommon associations.

Clearly there is a happy medium to be found here, and I have to say, “would you like me to balance your processing styles?” has the makings of a great chat-up line.

Link to Does Falling in Love Make Us More Creative? (via Frontal Cortex)

Side-effects from placebos can be drug specific

Photo by Flick user Cayusa. Click for sourceA fascinating study just published in the medical journal Pain examined the side-effects reported by patients taking placebos in clinical trials to test migraine drugs. It found that side-effects from placebo were almost as common as from the actual drug, but most interestingly, were specific to side-effects you would expected from the comparison medication.

In other words, the side-effects you get from a sugar pill in a study on anticonvulsant drugs closely resemble side-effects you get from anticonvulsants and are different from the side-effects you get from a sugar pill in a study on pain killers, which more closely resemble pain killer side-effects.

The researchers, led by neuroscientist Martina Amanzio, looked at trials for three type of migraine drugs: NSAIDs (like aspirin), triptans that work on the serotonin system, and anticonvulsant drugs more often used to treat epilepsy.

Side-effects from placebo are known as the nocebo effect and just the combined list of side-effects from the placebo groups in this study is surprising enough:

abdominal pain, anorexia or/and weight loss, attention difficulties, burning or/and flushing, chest discomfort, chills, diarrhea, dizziness, dry mouth, dyspepsia, fatigue, heaviness, injection side reaction, insomnia, language difficulties, memory difficulties, nasal signs and symptoms, nausea, numbness, paresthesia or/and tingling, pharyngitis, somnolence or/and drowsiness, stinging or/and pressure sensation, taste disturbance, tinnitus, upper respiratory tract infection, vomiting, weakness

It turns out that when placebo was being compared to an anticonvulsant, side-effects more common in these drugs – like fatigue, reduced appetite, sleepiness and tingling sensations – were more common in the placebo. In contrast, stomach upsets and dry mouth were more common in the placebo group when the comparison was with NSAID painkillers, which more often cause these symptoms themselves.

One explanation may be that before taking part in a clinical trial, patients are informed of the possible side-effects that the active drug may cause, regardless of whether they are going to be given placebo or the actual medication.

Information on the possible side-effects will be specific to the real medication, and, as we know that expectation plays a big part in the placebo effect, it is probably also shaping the nocebo effect and leading to the production of symptoms through expectancy.

Link to PubMed entry for study.

Ultra marathon for the mind

An extraordinary 2006 article from The New York Times profiles ultra-endurance cyclist Jure Robič who apparently regularly loses his sanity during his races Рliterally becoming psychotic as he pushes himself to the limit.

The craziness is methodical, however, and Robic and his crew know its pattern by heart. Around Day 2 of a typical weeklong race, his speech goes staccato. By Day 3, he is belligerent and sometimes paranoid. His short-term memory vanishes, and he weeps uncontrollably. The last days are marked by hallucinations: bears, wolves and aliens prowl the roadside; asphalt cracks rearrange themselves into coded messages. Occasionally, Robic leaps from his bike to square off with shadowy figures that turn out to be mailboxes. In a 2004 race, he turned to see himself pursued by a howling band of black-bearded men on horseback…

In a consideration of Robic, three facts are clear: he is nearly indefatigable, he is occasionally nuts, and the first two facts are somehow connected. The question is, How? Does he lose sanity because he pushes himself too far, or does he push himself too far because he loses sanity? Robic is the latest and perhaps most intriguing embodiment of the old questions: What happens when the human body is pushed to the limits of its endurance? Where does the breaking point lie? And what happens when you cross the line?

It’s a wonderfully written article that touches on the man himself, the physiology of fatigue and the psychological strain of intense athletic feats.

Link to NYT article on Jure Robič.

Classic Sacks

I’ve just found this remarkable TV interview with Oliver Sacks from 1986, only a year after the publication of his famous book A Man Who Mistook His Wife for a Hat.

It’s a fascinating discussion, not least because it’s something you don’t see much these days – an extended interview that focuses solely on a neuroscientist and his work.

There are no gimmicks or attempts to jazz it up with fancy editing and graphics. We see everything during the discussion, including Sacks’ many ‘ums’ and ‘ahs’ and even hear a telephone going off half way through!

Still, it’s a really wide ranging discussion which covers everything from the effects of brain injury to the role of doctors in exploring their patients’ lives.

From what I can make out, the interviewer is Harold Channer who did the piece for a Manhattan-based public access TV network probably before Sacks became well-known.

The video quality is a bit ropey but Sacks has a spectacular beard and is as chaotically engaging as ever. Classic stuff.

Link to Oliver Sacks interview from 1986.

No research, no problem

Time magazine has a remarkably one-sided article on America’s first ‘internet addiction’ clinic. The clinic turns out to be a few rooms in someone’s house, but the article gives away an interesting if not depressing gem about the likely status of the ‘internet addiction’ diagnosis in the DSM-V, the next version of the psychiatrists’ diagnostic manual:

“The central issue is the absence of research literature on this,” says Dr. Charles O’Brien, director of the University of Pennsylvania’s Center for Studies in Addiction and the current chair of the DSM-V committee to revise the manual, adding that with the backdrop of the health-care debate, now is a precarious time to introduce new disorders that will require more money to treat.

“At this point I think it’s appropriate that it’s not considered an official disease,” says O’Brien. “We are probably going to mention it in the appendix.”

The appendix refers to Appendix B, which is a list of diagnoses worthy of future study, and yes, that’s the head of the DSM addiction committee saying that an “absence of research literature” makes something worthy of future study.

In which case, I might write to him and ask to have my own diagnosis of “impulsive diagnosis inclusion syndrome” listed on the same basis.

But not only is his reasoning rather odd, he’s also wrong. There’s quite a sizeable literature on the ‘internet addiction’ diagnosis and, as noted by a meta-analysis published last year, it turns out to be rubbish.

If you’re interested in reading something a little more balanced, I get to spar with Kimberley Young, one of the long-standing ‘internet addiction’ promoters, in an article in this month’s Canadian Medical Association Journal.

Link to Time on America’s first ‘internet addiction’ clinic.
Link to ‘internet addiction’ scrap in CMAJ.

Encephalon 76 slides home

The 76th edition of the Encephalon psychology and neuroscience carnival has just appeared on the Neuroskeptic blog and is packed full of mind and brain goodness.

A couple of my favourites include an excellent piece from Providentia about the violin prodigy Josef Hassid whose career was cut short by a brain tumour, and another is a great post on AK’s Ramblings about counter-intuitive labels in neuroscience.

A whole lot more mind and brain writing awaits, all bang up-to-date and hot off the press.

Link to Encephalon 76.