Animal mind reading

Image from Wikipedia. Click for sourceRadioLab has a fantastic programme on what animals can understand about the minds of humans, their own species, and other creatures.

When we gaze into the eyes of our beloved pets, can we ever really know what they’re thinking? Is it naive to assume they might be experiencing something close to the emotions we feel? Or, on the contrary, is it ridiculous to assume that they AREN’T feeling anything back? In this hour of Radiolab, we explore what science can say about what goes on in the minds of animals.

Wonderfully put together, fantasti… oh you know the rest.

Link to RadioLab ‘Animal Minds’ episode.

The hazards of injecting toad venom

Image from Wikipedia. Click for sourceThe Journal of Forensic Sciences has an interesting, if not tragic, case of a death after the injection of toad extract. The injector apparently though he was injecting MDMA (‘escstasy’) but the substance he was sold turned out to contain lethal levels of bufotenine, a toad venom, which is occasionally used as a hallucinogenic drug.

From the case study:

A 24-year-old male was observed to collapse and die soon after an intravenous injection of 35‚Äì40 ml of what was thought to be ‚Äòecstasy‚Äô (methylenedioxy-methamphetamine or MDMA). A friend had injected a smaller volume (20 ml) and had vomited but survived. The decedent was a known intravenous amphetamine user but was not known to abuse any other illicit drugs. The body was transferred to FSSA for autopsy along with a plastic bag containing the injected material and the empty syringe…

The basic extract was also found to contain paracetamol, promethazine and diclofenac, in addition to bufotenine…

Bufotenine (dimethylserotonin) is a tryptamine derivative alkaloid related to the neurotransmitter serotonin. It is found naturally in certain plants and in the secretions of various toads. Resibufogenin, cinobufagin and bufalin, known collectively as bufadienolides, are nitrogen-free steroidal lactones that are also found in toad venom. They may be cardiotoxic, having a similar effect to digoxin [an extract of the foxglove plant]. Toad secretions have also been dried and smoked as bufotenine has hallucinogenic effects, resulting in classification as a prohibited substance in Australia.

Link to PubMed entry for case study.

American madness

The New York Times has a thought-provoking article on culture and mental illness, arguing that the American view of the disordered mind has been exported around the world and has influenced how other cultures actually experience mental distress.

It’s probably worth saying that none of the examples are solely ‘American’, although clearly it has had a huge influence our ideas about mental illness, despite being reined in on several occasions. Indeed, if mental illness had been truly Americanised, we’d all be living in a Freudian world by now.

However, the main thrust of the article to highlight the importance of culture in the shaping of mental illness:

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.

The essay has some important points (although with a few minor errors – for example, zar is not a Middle Eastern condition – but the name for a group of spirits which are believed to possess people and can lead to both helpful and disordered states) but you can it’s trying to walk a thin line between outlining the influence of culture on mental illness and avoiding suggesting that mental illness is nothing but the product of culture.

With this in mind, some of the explanations are a little one-dimensional: ‘expressed emotion’ accounts for differences in how patients with schizophrenia manage across cultures, Western-style anorexia appeared in Hong Kong due to the popularisation of the American diagnostic criteria, and so on, when the actual explanations are likely to be more complex and involve a range of biological, medical and social factors (Neuroanthropology has a really good take on this and I recommend their commentary).

I am hoping that this is because the article is taken from a much larger book which explores this topic in more detail, but as a quick introduction to some ideas about how out beliefs about illness can shape how we experience the illness itself, it is a good read.

UPDATE: I’ve just noticed Somatosphere also have a good discussion of the article that’s well worth checking out.

Link to NYT on ‘The Americanization of Mental Illness’.
Link to excellent Neuroanthropology culture.

The temperance pill

Photo by Flick user Smaku. Click for sourceNew Scientist has an excellent article looking at current attempts to develop a pill that will treat alcoholism or help people reduce their cravings for booze.

It’s a really well-rounded piece that captures the problems with the ‘cure in a pill’ method as well as the neuroscience behind attempts to alter the chemistry of craving and addiction.

Apart from drugs to treat associated mental illnesses, one of the few widely used treatments at the moment, naltrexone, is designed to make booze less pleasurable by blocking opioid receptors, but it is far from effective for everyone:

Naltrexone’s biggest stumbling block, however, is that it fails to treat some of the more painful aspects of abstinence. Drinking dampens the brain’s response to stress – indeed, many heavy drinkers become hooked on alcohol for this reason alone. The result is that going cold turkey without also calming the brain’s stress pathways can be a distressing experience. “People feel just terrible,” says George Koob, a specialist in the neurobiology of addiction at the Scripps Research Institute in La Jolla, California. “These individuals are miserable. They have panic attacks.”

Targeting these drink-hijacked stress pathways – often without even touching the brain’s pleasure circuits – is now the hottest area in alcoholism research.

And several of the new drugs outlined in the article are designed to do exactly this.

It’s probably worth mentioning that, apart from naltrexone, probably the only other widely used medication is disulfiram, which, rather than change the cravings, just makes the patient unpleasantly ill if they do drink alcohol as a form of chemical dissuasion.

Of course, if the patient is determined to continue drinking, they’ll just stop taking the drug, a problem with all chemical treatments, and so comprehensive addiction treatment needs to be more than just medication.

Link to NewSci on ‘Could popping a pill stop you hitting the bottle?’

The case of the haunted scrotum

This is quite possibly the oddest example of an illusory face I have ever discovered.

Seeing meaningful information in meaningless data is a psychological effect known as pareidolia or apophenia and this is an example that was published in the Journal of the Royal Society of Medicine in 1996:

The case of the haunted scrotum

A 45-year-old man was referred for investigation of an undescended right testis by computed tomography (CT). An ultrasound scan showed a normal testis and epididymis on the left side. The right testis was not visualized in the scrotal sac or in the right inguinal region. On CT scanning of the abdomen and pelvis, the right testis was not identified but the left side of the scrotum seemed to be occupied by a screaming ghostlike apparition (Figure 1). By chance, the distribution of normal anatomical structures within the left side of the scrotum had combined to produce this image. What of the undescended right testis? None was found. If you were a right testis, would you want to share the scrotum with that?

J R Harding
Consultant Radiologist, Royal Gwent Hospital

Link to PubMed entry for ‘The case of the haunted scrotum’.

Motivated reality

Photo by Flcikr user AMagill. Click for sourceNeurophilosophy has a great piece on a new study finding that the perception of distance to an object was altered by how much someone wanted it, with a greater desire leading the people in the study to perceive the object as closer. This a summary of one of the several experiments that demonstrated the effect:

Participants were asked to throw a small rubber bean bag towards a gift voucher placed on the floor in front of them, and told that the person whose toss landed closest to the voucher would win it. One group was told that the voucher had a value of $25, thus making it desirable to them, while the other was led to believe that it was worthless. This experiment confirmed the earlier ones – those participants who believed the voucher was worth something perceived it to be nearer, and consequently underthrew the bean bag so that it fell short of the target.

As Mo notes, these experiments are related to what is known as the ‘New Look’ movement in psychology which arose in the 1940s as a direct challenge to the behaviourists who said that all mental states, such as beliefs and desire, were illusions and had no scientific basis.

The New Look theories argued that our perception of reality could be directly influenced by our desires and set about proving behaviourists wrong by using their own tools, physical measurements of perception, to prove them wrong.

The movement was sparked by a 1947 study by psychologists Jerome Bruner and Cecile Goodman that has become a classic in the field and is still fascinating today.

They asked children to estimate the size of coins using an adjustable ‘collar’ and found the kids consistently judged the coins to be bigger than identically sized cardboard circles, suggesting the monetary value of the coins was influencing how big they perceived the dimensions to be.

But the clincher for the idea that value and desire altered perception was that the children from poorer backgrounds perceived the coins to be bigger than children from richer backgrounds.

The study caused huge interest and many studies followed in the subsequent years, partly as the field allowed the combination of both experimental psychology and Freudian-inspired ideas about the power of unconscious motivations.

These latest studies, covered expertly by Neurophilosophy, follow in the same tradition.

Link to Neurophilosophy on how ‘Desire influences visual perception’.
Link to full text of Bruner and Goodman’s classic study.

The Year in Robotics

MIT’s online magazine Technology Review has a good short article reviewing the year in robotics, giving the highlights of the latest developments from 2009.

The piece has loads of links so you can read up, and sometimes see, the robots in action and it looks like giving robots ‘social skills’ to interact with humans has been a big area of progress:

The socialization of robots was an important area of research this year. Many researchers believe that giving robots social skills will make them better at assisting people in homes, schools, offices, and hospitals. Andrea Thomaz, a TR35 innovator for 2009, created robots that can learn simple grasping tasks from human instructors who use social cues, such as verbal instructions, gestures, and expressions.

Another robot, made by a group at Carnegie Mellon University, guides conversations by making “eye contact” to suggest that it’s time to speak (“Making Robots Give the Right Glances”). Researchers at the University of California, San Diego, created a machine-learning program that lets a robotic head develop better facial expressions. By looking in a mirror, the robot can analyze the way its motors move different parts of the face, and create new expressions (“A Robot that’s Learning to Smile”). And a virtual robot mimicked sneakiness, hiding in virtual shadows and darting between obstacles to remain undetected (“Modeling Sneaky Robots”).

Link to Tech Review Year in Robotics.

2010-01-08 Spike activity

Quick links from the past week in mind and brain news:

New Scientist looks at a new theory of synaesthesia that goes beyond the ‘crossed senses’ idea.

Looking younger may be a matter of looking less masculine, according to a study covered by the Psychology of Beauty blog.

The Psych Files show interviews psychologist Scott Lilienfeld on his new book on 50 myths of popular psychology.

There’s a review of Stanislas Dehaene’s new book Reading in the Brain by psychologist Alison Gopnick in The New York Times.

The Neurocritic looks at whether roller coasters cause more brain damage than pillow fights.

How is the internet changing the way we think? asks Edge. Answers from numerous contributors. Beard stroking abound.

The BPS Research Digest covers a study suggesting that prejudice towards migrants stems partly from the fact that they’re awkward to think about.

Autism clusters linked to parents’ education not environmental factors finds new study covered by Scientific American. Predictable nuttiness in the comments. Also good <a href="Autism 'Clusters' Linked To Parents' Education”>coverage from NPR.

Not Exactly Rocket Science covers a fascinating study on how we get tripped up by the details when trying to see ourselves as others do, who are more likely to focus on the ‘bigger picture’.

Cocaine vaccine leads addicts to take 10 times more cocaine according to a new study covered by Popular Science. That’ll be the same effect as when addicts prescribed methadone ‘top up’ with heroin then.

The Times on how regional accents are strengthening in the UK despite predictions that increased mobility would lead to their loss.

A new TED talk shows Ramachandran still sipping the mirror neuron Kool-Aid. They’re responsible for building civilisation apparently. I say they also shot JFK.

GimpyBlog has an excellent piece about how media psychologist Aric Sigman has been off on another confused ramble about how product placement apparently damages childrens’ impulse control which could lead to violence!

Neuroscientist Curtis Bell has is asking people to sign a “Pledge by Neuroscientists to Refuse to Participate in the Application of Neuroscience to Violations of Basic Human Rights or International Law”. Neuroethics at the Core kick off a debate on the issue.

New Scientist has an essay by Ray Tallis on why you won’t find consciousness in the brain.

Athletes, doctors, and lawyers with first names beginning with “D” die sooner, according to a study just published in Death Studies.

NPR has a brief segment on how WWII conscientious objectors doing civil service exposed mental ward horrors.

The brain’s flexible perception of time is covered in an article for The New York Times.

XKCD has a great parody of the recent ‘disappearing g-spot’ research.

There’s an awesome article at The Boston Globe on how our assumption of how much <a href="Think you have self-control? Careful.”>self-control we have affects our ability to exercise self-control.

BBC News reports that France is considering a law against ‘psychological violence’. Paris waiters to be first against the wall.

Straight thinking neuroscientist Lise Eliot is interviewed in Discover Magazine about the evidence for human sex differences in the mind and brain.

The New York Times has a piece on how armodafinil, the right-handed molecule of stay-up-forever drug modafinil (armodafinil = R-modafinil, geddit?) is closer to being approved for jet lag (yes, jet lag). See our piece from last year for more background on the new drug

A film by drug lord Pablo Escobar’s son on coming to terms with his father’s atrocities and halting the cycle of violence is covered by Time.

The New York Times reviews a new book on psychedelic experiments in the Harvard psychology department of the 1960s.

Psychologist is in America’s top 100 jobs (at sexy 69) and with psychiatrist at 98, according to a survey by The Wall Street Journal (philosopher is 11th!). Compare recent survey by CNN Money (psychologist 23rd, psychiatrist 24th).

The Times reviews the new exhibition on ‘identity’ at London’s wonderful Wellcome Collection.

A new study in JAMA showing antidepressants only effective for severe depression is covered by The New York Times.

The Sunday Times has a review of the new book ‘Smile or Die: How Positive Thinking Fooled America and the World’. Someone got out of the wrong side of bed this morning.

There’s an interesting piece on the psychology of conspicuous consumption over at New Scientist.

Dr Petra has a fantastic A-Z guide to ‘sex in the noughties’: A-G, H-O and P-Z.

Journalists, lawyers, business people, marketers. Want to get up to speed on the latest neuroscience without the crap? The University of Pennsylvania is running it’s Neuroscience Boot Camp again this August.

The evolution of projectile weapons

American Scientist has a fascinating podcast on the evolution of the human capacity for killing at a distance – in other words, the cultural evolution of projectile weapons.

The talk is by anthropologist Steven Churchill who looks at what motivated the development of projectile weapons – initially rocks, slings and spears and – and what effect these developments had on the culture of ancient peoples.

He starts as far back as the time when neanderthals and modern humans were both in existence and discusses how the development of these weapons may have influence the competition between the two species.

He also discusses how these weapons may have affected human evolution and notes that these weapons make group attacks easier, meaning that it was probably easier for societies to police themselves and so leading to selection against aggressive individuals.

A thoroughly fascinating discussion, where Churchill talks about historical evidence as well as his own studies where he’s asked people to test the limits of using ancient weapons.

Link to ‘The Evolution of the Human Capacity for Killing at a Distance’.

The chopstick: reloaded

The New York Daily News reports on a 14-month old Chinese boy who survived brain surgery to remove a chopstick that accidentally ended up in his brain after entering through the nose.

If your jaw has dropped, amazed at such a freaky and unusual accident, you may comfortably close your mouth – there is a surprisingly large medical literature on stray chopsticks that have become lodged in the brain.

In fact, there are no less than 13 published articles on this serious neurological condition. Here are some of the more notable ones:

A case of unusual difficult airway because of an intracranial foreign body of bamboo chopstick. [link]

Transoral penetration of a half-split chopstick between the basion and the dens. [link]

Transorbital penetrating injury by a chopstick–case report [link]

Intracerebellar penetrating injury and abscess due to a wooden foreign body–case report. [link]

Chopsticks and suicide [link]

Unusual craniocerebral penetrating injury by a chopstick. [link]

Link to New York Daily News on boy with chopstick in brain.

A clarion call for a decade of disorder

This week’s Nature has an excellent editorial calling for a greater focus on the science of mental illness and summarising the challenges facing psychology and neuroscience in tackling these complex conditions.

It’s generally a very well-informed piece, but it does make one widely repeated blunder in the last sentence of this paragraph:

Frustratingly, the effectiveness of medications has stalled. Nobody understands the links between the symptoms of schizophrenia and the crude physiological pathologies that have so far been documented: a decrease in white brain matter, for example, and altered function of the neurotransmitter dopamine. The medications, which are often aimed at the dopamine systems associated with delusions, have advanced over the decades not in their efficacy but in a reduction of their debilitating side effects.

The idea that newer antipsychotic drugs have less side-effects is a myth, albeit one that was widely promoted by drug companies in the early days of the newer ‘atypical antipsychotics’.

The early antipsychotics were notorious for causing a syndrome of Parkinson’s disease-like abnormal movements owing to their long-term effect on the dopamine system.

The popular newer generation drugs do indeed produce fewer of these problems, although the difference is much smaller than was originally thought. But in addition, they tend to cause metabolic syndrome – weight gain, diabetes, heart problems – something which wasn’t such an issue with the older drugs.

In other words, the side-effects aren’t less, they’re just different. While the old drugs were more likely to produce movement problems, the newer are more likely to make you fat and give you diabetes.

Although antipsychotics were one of the most important medical advances of the 20th century, as the Nature editorial notes, there has been no improvement in the ability of these drugs to actually treat psychosis in the last few decades.

One of the main problems is that the most effective antipsychotics seems to have the highest levels of side-effects and a huge advance would simply be the production of a drug that was of equal effectiveness but less damaging to patients’ health.

Apart from this minor error, the Nature piece is an excellent brief summary of where psychiatric research is at, and where it needs to go to better tackle these episodes of mental turmoil, and comes highly recommended.

Link to Nature piece ‘A decade for psychiatric disorders’.


The Fortean Times has a delightful article about a period at the turn of the 20th century where there was a brief but intense interest in the possibility of ‘the psychic project¬≠ion of images directly onto film’.

This was sort of thing was much less of a fringe interest then and it drew in some serious scientific and academic heavyweights interested in whether thoughts could be imprinted onto photographic material.

In 1893, the no less enterprising Nicola Tesla came up with a plan for a Gedankenprojektor (‘thought projector’) [pictured]. As he recalled 40 years later: “I became convinced that a definite image formed in thought must by reflex action produce a corresponding image on the retina, which might be read by a suitable apparatus. This brought me to my system of television which I announced at the time… My idea was to employ an artificial retina receiving an object of the image seen, an optic nerve and another retina at the place of reproduction… both being fashioned somewhat like a checkerboard, with the optic nerve being a part of the earth.”

This was a time when radio waves and electricity were still poorly understood and it wasn’t at all clear to many that they were any different to psychic or supernatural phenomena.

As we’ve discussed previously on Mind Hacks, the idea that such technology could allow us a gateway to the ‘spirit world’ was taken quite seriously.

This idea is still prevalant, of course, but doesn’t particularly preoccupy the most eminent scientists of the day.

However, one of my favourite Spanish-language books, and indeed, one of my favourite books in my collection, is a tome entitled 7 Metodos Para Comunicarse Con El Mas Alla, or, ‘7 Methods to Communicate with The Beyond’.

Among other things, it’s a guide to contacting the dead through your computer.

I’ve yet to try it myself as I have enough trouble contacting the living through my computer, plus, receiving penis enlargement spam from the recently deceased must surely be a little discouraging.

Link to Fortean Times on the curious history of ‘thoughtography’.

Not your usual memento

Probably not everyone’s definition of what might be included in the “personal effects” of a recently departed loved one. From a brief article in Las Cruces Sun-News:

ALBUQUERQUE – Members of a New Mexico family are suing an Espanola funeral home after their grandmother’s brain was sent home in a bag of personal effects given to them after her death.

The discovery was made the day after interment, when relatives “smelled a foul odor coming from the bag” they received from DeVargas Funeral Home and Crematory of the Espanola Valley, according to a lawsuit filed on behalf of four family members in state District Court in Albuquerque. The Albuquerque Journal reported on the lawsuit in a copyright story published Wednesday.

Link to story in Las Cruces Sun-News (via @bengoldacre).

Fighting fatigue

Photo by Flickr user ashley rose. Click for sourceChronic fatigue syndrome (CFS) makes people angry. Not so much the condition itself, which is associated with diffuse body pain, persistent tiredness and loss of concentration, but the science around it. After an American team announced last year that they had found a novel virus in 68 of 101 CFS patients, a UK team just reported that they failed to find the virus in any of the 186 patients they studied. Knives have already been drawn in the latest round of a long-running battle.

To understand why this is such an emotive issue, you need to get a handle on some key issues.

The first is that there is a heated debate as to the causes of the condition. On one pole of the debate is a group, largely of people affected by the condition, who believe that the condition is entirely caused by a biological disruption to the body, most likely an unidentified viral infection. On the other, is a group, largely consisting of researchers, who believe that there is a significant psychological component to the illness.

This is, of course, a bit of a simplification, but it broadly captures the two main sides of the debate and if you’re not familiar with how high feelings run, let me give you an example. I was contacted by one CFS researcher wanting a copy of a paper I wrote on extreme communities because their family was under police protection following death threats, subsequent to a public suggestion that psychology might play a part in the condition.

The emotion is fuelled by the common, insidious but wrong-headed notion that any condition that is influenced by mental states is not a ‘real illness’ and the widespread prejudice that individuals are more to blame for psychological problems because psychology is perceived as being just a matter of ‘changing your mind’.

There is a mountain of research to show that both of these claims are plainly ridiculous and psychology is likely important in all illness, but perhaps the clearest example is the placebo effect. You can’t just ‘decide’ to better but the placebo effect has been shown to improve the symptoms of almost any illness your care to think of, albeit to differing degrees.

But people affected by CFS are often on the sharp end of these prejudices and it is not uncommon that they have had the experience of someone telling them they are ‘putting it on’ or ‘aren’t trying hard enough’. When you are disabled to the point of immobilisation, this is pretty hard to take.

So it is not surprising that many are drawn to the exclusive ‘viral infection’ explanation, because it proves the idiots wrong, even if it does so using the opposite side of the same coin – prejudice about what constitute a ‘real illness’.

Proponents of the idea that the condition is influenced by psychology, including beliefs about its effects, behaviour patterns and perceptions of how the body is reacting, note that numerous controlled studies have found that a psychological approach, in the form of a cognitive behavioural therapy (CBT), is one of the most effective, if not the most effective treatment. Despite this, it is often rated as one of the least preferred among patients groups.

Into this hot button debate steps an American team who found evidence for the little understood retrovirus XMRV in about two thirds of patients with CFS. Proponents of the ‘viral theory’ rejoiced and the study made headline news around the world.

Considering the potential importance of the findings, a UK team then attempted to see if they could detect XMRV in British CFS patients. It has widely been described as a ‘replication’ of the original study in the media, but it really isn’t, as the team used a different, although still reliable ways of looking for the virus, while attempting to make improvements in lab management to reduce the chances of cross contamination and detecting false positives.

They found nothing in any of the 186 patients they studied. No sign of the virus at all. The research was published in PLoS One and if you want a flavor of the feeling the research has generated, take a look at the ratings and comments on the article since it was published earlier today. You can almost feel the anger simmering through.

From an outsider’s perspective, it’s interesting to see how CFS is considered by many to be a single condition that must have a single cause. But in reality, the diagnosis is just made on a collection of symptoms – tiredness, pain, impaired mental abilities and so on.

These symptoms are interesting because they occur in a whole range of conditions: in diabetes, after concussion, after a viral infection, after any of stroke, brain injury or Parkinson’s disease, alongside a range of mental illnesses, and so on.

In other words, there is unlikely to be a single cause for CFS, because the same symptoms can be caused by any number of underlying problems. The reason that CFS isn’t diagnosed in all these other cases is because it is a diagnosis of exclusion – in other words, by definition, if you can’t find a clear cause, the symptoms are labelled as CFS. However, it doesn’t follow that all current cases of CFS will therefore by accounted by a single, currently unknown, problem.

I wouldn’t be surprised if some cases of CFS are triggered by an unknown viral infection, but to think that this is the sole explanation is likely to be missing the bigger picture.

Similarly, to deny a psychological component to any medical condition risks denying a useful tool to help those who need it most. As an illustration, surgeons now widely recognise that psychological factors are essential to the long-term success of a transplant.

You would be hard pressed to find a more ‘physical’ condition and yet psychology plays a key role. But to promote the importance of thinking about the role of our own minds in how disability affects us, be with transplants or CFS, we need to fight the prejudice associated with mental explanations.

Link to PubMed entry for US study on the XMRV virus and CFS.
Link to UK CFS study in PLoS One.

Full disclosure: I’m an unpaid member of the PLoS One editorial board.

Psychiatric drug combining on the rise

Photo by Flickr user DraconianRain. Click for sourceA study just released in the Archives of General Psychiatry has found that the prescription of multiple psychiatric drugs to individual patients has increased greatly in recent years despite their being little hard evidence about the benefits and risks of combining medication.

The practice of prescribing multiple drugs is called ‘polypharmacy‘ and usually occurs because a single medication doesn’t treat the symptoms adequately or quickly enough.

This situation is common in psychiatry partly due to what is euphemistically known as ‘treatment resistance’. This phrase is often used as if the patient has an especially tough case of the disorder (e.g. they have ‘treatment resistant schizophrenia’) or if it is a biological trait of the person (the patient is ‘treatment resistant’) but it could equally well describe the fact that the drugs don’t work very well – or rather, they don’t work very well for everyone.

This is common enough that in schizophrenia, about a third of patients show little or no response to common antipsychotic drugs and many of the rest don’t have their symptoms completely controlled. There are similar numbers in people with depression.

It may also be the case that a patient has other symptoms, severe anxiety for example, and in any of these cases the psychiatrist will often add medications on top of each other, attempting to improve the outcome.

However, there is very little research on medication combinations. We have some studies that show that adding one drug to another (‘augmenting’ in the jargon) can improve outcome with some drugs and in some conditions, but these are few and far between.

There is virtually no good quality evidence on the effects of three or more drugs, but this is exactly where the rates of prescribing have risen, as shown by the most recent study which looked at how common this was in US office-based (rather than on hospital ward) consultations with a psychiatrist:

Between 1996 and 2006, there was a substantial increase in the proportion of patient visits in which 2 or more psychotropic medications were prescribed. During this period, the proportion of visits in which 3 or more psychotropic medications were prescribed increased from fewer than 1 in 5 to nearly 1 in 3.

One of the reasons there are so few trials of medication combinations is that drug companies are reluctant to fund them, given that they would rarely include two in-patent medications from the same company, meaning they could use the results to promote their products.

This has meant that we have had to wait until quite recently for, for example, the results of the US government funded STAR*D study on depression treatment to find out whether some combinations actually help.

Link to study on increase in polypharmacy in psychiatry.

Tough on trauma, tough on the causes of trauma

Clinical psychologist and US Congressman Tim Murphy has volunteered to treat soldiers traumatised by the war he voted for.

From January’s APA Monitor magazine:

Clinical child psychologist Rep. Tim Murphy (R-Pa.) has consistently voted to continue America’s military efforts in Iraq and Afghanistan while appreciating the deepening psychological toll the repeated deployments and combat experiences are taking on service members. That’s why Murphy, 57 and now in his forth congressional term, secured a commission as a military psychologist in the Naval Reserve.

‚ÄúIt’d be difficult for me to continue to vote to send soldiers there and not provide for them what they needed when they got back,‚Äù he says.

Freudians would have a field day with you my lad.

Link to ‘U.S. Congressman will provide psychological services to military’.