Man hammers nail into head every week for 11 weeks

I just found this jaw-dropping case study of a man who banged 11 nails into his head while sadly quite distressed and psychotic.

The X-ray images are striking on their own, and what is even more astounding is that he made a full recovery.

Penetrating head injury in planned and repetitive deliberate self-harm.

Mayo Clinic Proceedings. 2007 May;82(5):536.

Demetriades AK, Papadopoulos MC.

44-year-old man presented to his local emergency department wearing a baseball cap and complaining of headaches that had progressively worsened over the preceding 11 weeks. After we provided generous analgesia and performed simple investigations that failed to identify a diagnosis, the patient removed his cap to reveal an assortment of metallic objects embedded in his scalp. Plain radiographs showed 11 nails penetrating into his brain. A detailed history revealed a diagnosis of paranoid schizophrenia, and the patient confirmed that he had hammered a nail into his head each week for the past 11 weeks to rid him of evil. The nails were removed with the patient under general anesthesia, and he made an uncomplicated recovery with no neurological deficits.

Link to abstract on PubMed.

From the nose to the genitals and back again

Recently, the Journal of the Royal Society of Medicine has had some interesting letters on a theory from times past – the nasogenital reflex theory – that says that the nervous system makes a direct link between the erectile tissue in the genitals and the nose.

The nose has tissue which, like the genitals, can become engorged with blood, which is part of the reason we get a stuffy nose. To counter this, most nasal decongestants contain a drug which acts as a vasoconstrictor to reduce blood flow (sometimes this is a type of amphetamine).

The possible link between nose and genital tissue was first proposed by American surgeon John McKenzie in 1883:

Over one hundred years ago, neurological reflexes emanating from the nose — termed the nasal reflex neurosis — were considered to be the cause of many symptoms, including symptoms related to the genitalia. In 1883 McKenzie, an otolaryngologist from Johns Hopkins Hospital, proposed a nasogenital reflex responsible for symptoms such as dysmenorrhea, pelvic pain, etc. and described improvements following nasal treatments.

In other words, he argued that problems with the nose could also results in problems with the genitals and vice versa.

Later, Wilhelm Fleiss, a German ear, nose and throat specialist and a close friend of Freud’s elaborated the theory, and suggested that nasal tissue could be the cause and cure of a number of illnesses in body and mind:

In 1893 Fleiss published his monograph on ‘The Nasal Reflex Neurosis’, in which he claimed that back pain, chest tightness, digestive disturbances, insomnia and ‘anxious dreams’ could all be attributed to nasal pathology. He also claimed that temporary relief of these symptoms was possible with the topical application of cocaine, of which Freud had published the first account of local anaesthetic properties.

Gradually the list of conditions grew to include migraine, vertigo, asthma and then gynaecological conditions such as dysmenorrhoea and repeated miscarriages.

Freud became quite influenced by this theory at one time, and referred a patient to Fleiss for nasal surgery to cure her depression. Sadly, surgical complications nearly cost the patient her life and Freud became disenchanted with the theory.

While it is now clear that the nose isn’t a major cause of other disturbances in the body and mind, and the nervous system has no major pathway that connects the tissues of the nose and the genitals, there are some clues that they might both be affected by similar things.

Reports of ‘viagra nosebleeds‘ and ‘honeymoon rhinitis‘ (a stuffy nose and sneezing after sex) suggest that they may react similarly in some instances.

Link to JRSM letter (not open-access yet).
Link to second JRSM letter (not open-access yet).

Tortured minds: psychiatry and human rights

ABC Radio National’s All the the Mind has just concluded a two part series on human rights and psychiatry that looks at the role of mental health professionals in military interrogations, and the rights of psychiatric detainees.

The first part is based at the World Psychiatric Association conference in Australia and interviews several psychiatrists about their views on whether mental health professionals should be involved in, most relevantly, ‘war on terror’ interrogations that some argue are tantamount to torture.

The response is a bit predictable as psychiatrists have already firmly decided to have no part in these interrogations which they see as incompatible with their oath to ‘do no harm’, unlike the American Psychological Association which has decided to endorse participation within some rather vague limits.

There’s a particularly interesting contribution from psychiatrist Prof Steven Sharfstein, who as president of the American Psychiatric Association was taken to Guantanamo Bay by the US Government, presumably to reassure him and other clinical leaders that the horror stories about the place were unjustified.

Instead, he came away convinced that Guantanamo should be closed for good.

In contrast, the American Psychological Association president, Prof Ronald Levant, who attended the same visit, came away with no strong convictions that any unethical practices were taking place.

The second part of the All in the Mind special investigation looks at the treatment of psychiatric patients across the world, particularly focusing on parts of the developing world where asylums can sometimes be little more than prisons.

The programme mentions a 2003 edition of Time Asia which had a photo essay on some of the shocking conditions in some Asian institutions.

It also discuss the newly agreed UN Convention for the Rights of Persons with Disabilities which is likely to have a significant impact on the rights of people with mental difficulties.

One of the most interesting contributions is from psychiatrist Prof Vikram Patel who headed up the excellent Lancet series on Global Mental Health.

It was a fantastic series of articles, including a paper entitled ‘Barriers to improvement of mental health services in low income and middle income countries’ which identifies education and funding as two key factors, and another called ‘Resources for mental health: scarcity, inequity, and inefficiency’.

Without a hint of irony, the series is closed-access and individual articles are charged at $30 each.

The last in the series of article urges the global mental health community to “scale up the coverage of services for mental disorders in all countries, but especially in low-income and middle-income countries”.

So I’ve uploaded all the articles to the web. Enjoy.

No health without mental health [pdf]

Resources for mental health: scarcity, inequity and inefficiency [pdf]

Treatment and prevention of mental disorders in low-income and middle-income countries [pdf]

Mental health systems in countries: where are we now? [pdf]

Barriers to improvement of mental health services in low income and middle income countries [pdf]

Scale up services for mental disorders: a call for action [pdf]

Link to AITM on participation in interrogation or torture.
Link to AITM on ‘Who speaks for the chained and incarcerated?’.
Link to 2003 Time Asia article and photo essay on Asia’s mental health centres.

Has shyness been transformed into a mental illness?

Bookslut interviews author Christopher Lane, who argues in a new book that shyness has been transformed in the mental illness ‘social phobia’, partly due to it being used as a political football during a time of theoretical upheaval in psychiatry.

Social phobia is a type of anxiety that is triggered in social situations.

It can be specific to a certain situation, such as eating in public, or more generally associated with interacting with any group.

Some have argued that it is a prime example of where drug companies have picked up on an unpleasant but common anxiety and promoted it as a mental illness to be treated with medication, whereas others feel it is disabling enough to require wider recognition and medical attention.

As in a previous article for The New York Times [pdf] and seemingly in this book, Lane argues that definition is so vague as to be virtually meaningless.

Throughout the book, Lane suggests that the conceptual problems of the DSM arise in part from its weird eagerness to break decisively with Freud. Lane has vividly reconstructed the decision-making process of the DSM-III in the 1970s, showing how scoring points over rival theoretical schools frequently trumped logic or consistency. Insisting on the biochemical nature of all mental suffering leads psychiatrists to turn away from the vicissitudes of the mind — what Lane calls “the strange, unusual turns of consciousness, themselves in thrall to vivid memories, irrational fantasies, persistent associations, and sometimes-inexplicable impulses.” By reducing the complexity of these “turns” into “disorders” — no matter how “multiaxial” — modern psychiatry seems to drain the life out of the mind. Shyness is passionately and compellingly argued, in clear prose that is in turn scathing, hilarious, and sympathetic.

In the interview below, Lane discusses the origins of the book, the implications of shifting from a “reaction-based” to a “disorder-based” model of diagnosis, the differences between psychoanalysis and neuropsychiatry, and the problem of emotional blunting.

Link to interview with Christopher Lane.
Link to book details with excerpt.
pdf of NYT article ‘Shy on Drugs’.

CT in the Sky with Diamonds

Inkling Magazine has discovered a curious episode in the history of music and neuroscience where The Beatles helped to fund the development of the CT scanner.

If you ever suffer a head injury, you’re likely to given a CT head scan as its a quick, convenient way of look for damage to brain tissue.

In a recent talk, consultant radiologist Dr Ben Timmins claimed that the sales of Beatles records allowed EMI to fund Sir Godfrey Hounsfield to develop the first scanner.

As a direct result of The Beatles’ success, Dr Timmis claimed, the scanner’s inventor, Sir Godfrey Hounsfield, was able to devote about four years developing the scanner from its 1968 prototype, to something that could be used in a clinical setting. His work was done in the Central Research Laboratory, a facility near Heathrow airport that was part of the EMI Group. Having sold 200 million of the Fab Four’s singles, (at seven inches, almost enough vinyl to stretch the length of the equator) the Beatles’ record company, EMI, was able to fund Hounsfield to do his research and the scanner was ready be used in hospitals in the 1970’s.

Link to Inkling Magazine on The Fab Four and CT scanners.
Link to The Independent with a short article on new CT scan and its history.

2007-12-14 Spike activity

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

Novelist A.S. Byatt (who has had a long-standing interesting in brain science) writes an article in The Times arguing that ‘neuroscience is helping us to understand how art works ‚Äì and it may offer us a way out of narcissism’.

We perceive music differently depending on how we dance to it. A completely fascinating study covered by the inimitable Cognitive Daily.

Tonometric is a website where you can take musical perception tests which contribute to studies on the neuroscience of music.

Developing Intelligence looks at work which suggests IQ can be predicted by a simple reaction time test.

How would you complete the word jo_? Students who had been asked to contemplate their own death were more likely to form positive words (like ‘joy’) than others. More evidence for a positive cognitive bias in the face of death, reported by the BPS Research Digest.

The Literary Review gets stuck into a new book on Freud’s last year.

Wired reports that Sega and NeuroSky are to make mind-controlled toys.

SciAm’s Mind Matters blog discusses some recent work on ‘stereotype threat‘, an interesting effect where people perform worse if they think the test might confirm a stereotype about them (e.g. black people are academic under-achievers, white men are athletic under-performers etc).

PsyBlog asks you to vote now for your favourite in its weird psychology studies series.

Repeated Exposure to Media Violence Is Associated with Diminished Response in an Inhibitory Frontolimbic Network. Important research published in PloS One.

Corpus Callosum discusses a case of personality change caused by a brain tumour in a 28-year-old male-to-female transsexual patient that was recently reported in the NEJM.

The New York Times discusses the phenomena where parents look back and realise they may have elements of conditions such as autism or ADHD after their children are diagnosed.

The Neurocritic has a fantastic article on altered self-perception in people with body dysmorphic disorder.

Remarkable savant Daniel Tammet, is profiled in The New York Times.

Why do I feel like I’m falling when I go to sleep? Pure Pedantry digs up some fascinating work on this curious and common experience.

Infiltrating the waiting room: ‘Information leaflets’ in doctor’s surgeries could be drug company advertising according to an article in The Guardian.

Crap headline but interesting story about decoding the neural code of neurons involved in visual recognition.

Neurophilosophy collects four parts of his essay on axon guidance in a single post and gets confirmation of what we already knew.

Kooky cool on the catwalk

The New York Times has an interesting piece on Heather Kuzmich one of the recent contestants on reality TV show America‚Äôs Next Top Model who reportedly has Asperger’s syndrome.

Asperger’s syndrome is essentially High Functioning Autism (the difference in diagnosis lies in a fairly academic point about the age at which someone acquires language), meaning that the person is not impaired in terms of intelligence, but has difficulties understanding others’ emotions, social interactions and can have ‘special interests’ or repetitive behaviours.

The stereotype of someone with Asperger’s is that they’re quite shy, withdrawn or socially unattractive.

In contrast, a video of Kuzmich on YouTube shows her to be an engaging and outgoing personality with a delightfully kooky edge that shines through.

It’s always great to see when someone doesn’t conform to a negative stereotype and the impact is all the more enhanced when it’s someone high profile or in the public eye.

Link to NYT article ‘Asperger‚Äôs Syndrome Gets a Very Public Face’.

Fighting the tide of prison suicides

The Boston Globe has produced a powerful video documentary and article series on prison suicide and mental illness.

Treating mental illness in prison is a complex business. As Time reported earlier this year, the rates of mental illness are much higher among offenders, confinement is known to worsen mental health, and prison treatment facilities are usually poor.

On top of this, some prisoners attempt to fake mental illness to gain hospital privileges, so working out whether someone is genuinely at risk of harming themselves can be quite tricky.

All of these factors can contribute towards the high suicide rate in prisons, and create tension between staff and families.

As prisons become the asylum of last resort for the mentally ill, desperation, frustration and violence are rising on both sides of the cell door. About 50 times each month, inmates are assaulting prison staff members. And, at nearly the same rate, inmates, many of whom say they are abused by officers, attempt to kill or injure themselves. The Spotlight Team examines the tension between mentally disturbed inmates and their jailers.

The Boston Globe has produced a remarkably comprehensive resource, with video, articles, prisoners suicide notes, official reports, and personal stories.

Link to Boston Globe special report on prison suicide.

Scanning psychopaths

Today’s Nature has a great article [pdf] on the neuroscience of psychopaths, as investigated by an ingenious study being run by a group of Dutch researchers.

Although there is a higher number of psychopaths among violent criminals, a psychopath is not necessarily someone who is violent.

The term describes someone who is considered to lack empathy or conscience, is superficially charming, manipulative, has ‘shallow affect’ (doesn’t have a big emotional range) and has poor impulse control.

More recently, psychopathy has become synonymous with the use of the PCL-R, the diagnostic tool also known as the Hare Psychopathy Checklist after it’s creator and psychopathy researcher Robert Hare.

The Dutch team, however, are working with psychopaths who are in prison for presumably quite serious crimes, precisely because they lack empathy.

They are comparing the brain activation between psychopaths and non-psychopaths when they view material that communicates emotions and normally evokes an empathy-driven reaction.

By looking at which areas are less active in the presumably empathy-less psychopaths, they hope to find out the crucial empathy-related brain circuits.

There are more details about the study in the article, but one bit is particularly interesting, where one of the participants, from a high security prison, comments on the study:

When he entered the prison five years ago, Boerema says, ‘borderline personality’ was the fashionable term, and his designated pigeonhole. “The psychopathy label is more damaging though ‚Äî it prompts everyone to see you as a potential serial killer, which I could never be.” (Note, in reporting this article it was agreed that inmates’ crimes would be neither asked about nor reported on.) But Boerema also wears the score as a badge of honour: “I think my high psychopath score is a talent, not a sickness ‚Äî I can make good strong decisions, and it’s good to have some distance with people.”

Interestingly, Boerema (not his real name) makes a couple of points that have also been made in the psychological literature.

Ian Pitchford proposed in a 2001 article that psychopathy could be an evolutionary advantage for a minority of individuals, as it allows them act violently or antisocially without any emotional cost to themselves.

Furthermore, discussion in both the psychological and legal literature has focused on whether labelling someone a ‘psychopath’ is unjustly stigmatising.

One article even goes as far as to suggest that ‘psychopathy’ is just a modern term we’ve invented to replace the world ‘evil’.

pdf of Nature article ‘Scanning Psychopaths’.

What IQ doesn‚Äôt tell you about race

IQ has suddenly become a hot topic again, owing to a certain DNA-discovering Nobel laureate putting his foot in his mouth and the publication of a couple of books on the subject. Malcolm Gladwell has written a great article for the New Yorker that summarises many of the recent arguments and suggests why comparing IQ scores of different races is doomed to failure.

IQ is designed so it always has a mean of 100 and a standard deviation of 15. However, during the past decades people have been scoring better on IQ tests, something known as the Flynn effect, meaning the new versions have been re-adjusted to make sure the mean stays at 100.

This is important, because it means that comparing IQ from the 1950s is not a far comparison to IQs from the 2000s, because they use tests with different standards.

Some of the people who argued that certain races are more intelligent than others have failed to include these changes in their calculations, and, as Gladwell points out, when these are accounted for, many of these differences completely disappear.

The best way to understand why I.Q.s rise, Flynn argues, is to look at one of the most widely used I.Q. tests, the so-called WISC (for Wechsler Intelligence Scale for Children)…

For instance, Flynn shows what happens when we recognize that I.Q. is not a freestanding number but a value attached to a specific time and a specific test. When an I.Q. test is created, he reminds us, it is calibrated or “normed” so that the test-takers in the fiftieth percentile—those exactly at the median—are assigned a score of 100. But since I.Q.s are always rising, the only way to keep that hundred-point benchmark is periodically to make the tests more difficult—to “renorm” them. The original WISC was normed in the late nineteen-forties. It was then renormed in the early nineteen-seventies, as the WISC-R; renormed a third time in the late eighties, as the WISC III; and renormed again a few years ago, as the WISC IV—with each version just a little harder than its predecessor. The notion that anyone “has” an I.Q. of a certain number, then, is meaningless unless you know which WISC he took, and when he took it, since there’s a substantial difference between getting a 130 on the WISC IV and getting a 130 on the much easier WISC.

Link to Malcolm Gladwell article in the New Yorker.

Ozzyform band degeneration

The Canadian Medical Association Journal has just published its traditional Christmas article which covers the lesser known diseases of popular culture. This year, the article tackles the scourge of cacophonopathology, a dreadful affliction caused by a disturbing reaction to music.

It notes that a particular form of the disorder affects fans of heavy metal:

A severe form of cacophonopathology, metallicus gravis, has also been identified among many of the misguided souls who followed the siren of cultura popularis. Victims of metallicus gravis attend mass gatherings to participate in this form of auditory abuse, which employs sound to numb rather than to enhance awareness. In its later stages, patients demonstrate involuntary movement disorders, such as caput metallicus (headbanging), florid hemiballismus (air guitar syndrome) and precipitous projectile collapse (crowd surfing).

Post-mortem findings include scarred cerebral gyri, which assume the texture of hard pebbles or rocks, diagnostic of dementia zeppelophilia plumbea. A related condition is black s*bbath excephalobaty (BSE), which features Ozzyform band degeneration and afflicts those who dismember flying rodents with their teeth.

The author suggests that a possible treatment might involve a slow immersion in classical music.

I, along with many others, have yet to be convinced by the evidence for this treatment, and tend to be guided by the trusted clinical maxim “a day without AC/DC is like a day without sunshine”.

I was reminded of the Journal’s fantastic Christmas tradition by Tom mailing me a wonderful article from 2004 about the neurology of Tintin’s possible hormonal problems.

The footnotes to the article are priceless, so have a look when you read the article.

Another past article took a neurodevelopmental approach to the pathologies of Winnie-the-Pooh and friends.

One of the best bits about these articles is the correspondence they generate. Letters are linked from the bottom of each article and as you can see, they can be a wonderful parody of medical argument and high-brow posturing.

Link to article on cacophonopathology.
Link to article on the neurology of Tintin.
Link to article on neurodevelopmental disorders in Winnie the Pooh.

How do psychologists think?

I believe that the important thing about psychology is the habits of thought it teaches you, not the collection of facts you might learn. I teach on the psychology degree at the University of Sheffield and, sure, facts are important here — facts about experiments, about the theories which prompted them and about the conclusions which people draw from them — but more important are the skills which you acquire during the process of learning the particular set of facts. Skills like finding information and articulating yourself clearly in writing. Those two things are common to all degrees. But lately I’ve been wondering what skills are most emphasised on a psychology degree? And I’ve been thinking that the answer to this is the same as to the question ‘how do psychologists think?’. How does the typical psychologist[*] approach a problem? I’ve been making a list and this is what I’ve got so far:

1. Critical — Psychologists are skeptical, they need to be convinced by evidence that something is true. Their default is disbelief. This relates to…

2. Scholarly — Psychologists want to see references. By including references in your work you do two very important things. Firstly you acknowledge your debt to the community of scholars who have thought about the same things you are writing about, and, secondly, you allow anyone reading your work to go and check the facts for themselves.

3. Reductionist — Psychologists prefer simple explanations to complex ones. Obviously what counts as simple isn’t always straightforward, and depends on what you already believe, but in general psychologists don’t like to believe in new mental processes or phenomena if they can produce explanations using existing processes or phenomena.

I am sure there are others. One of the problems with habits of thought is that you don’t necessarily notice when you have them. Can anyone offer any suggested additions to my inchoate list?

Continue reading “How do psychologists think?”

Daily Express cures Alzheimer’s

The front page of the today’s Daily Express, a UK national newspaper, has one of the worst neuroscience stories I have a read in a very long time.

It’s actually on a valuable research project being run by an established team of researchers and involves giving people with Alzheimer’s disease a small digital camera to wear around their neck which takes pictures every 30 seconds.

The person then views the pictures at a later date. There is a rapid presentation mode (10 pictures per second) but the person has the option to view images individually at will.

It isn’t a cure, it’s just a useful way of reviewing events and ‘refreshing’ the memory. This is likely to prevent people with Alzheimer’s forgetting events so quickly if they’re captured on camera.

I say likely, because the research that the Daily Express story talks about hasn’t been published yet, but a single case study on a woman with limbic encephalitis did show it made a considerable difference to her recall of past events when compared to a diary.

Now let’s just pause for a minute and think what sort of headline you’d write if you were going to publish a story on this line of early research.

Obviously someone had the same decision to make at the Daily Express, and came up with:

BREAKTHROUGH ON ALZHEIMER’S
British scientists bring real hope of a cure

The paper describes the system as involving “a small camera taking photographs every 30 seconds which are then artificially ‘forced’ on to the brain” and says that “In some cases, patients have experienced up to 90 per cent of their memory being restored after just two weeks”.

How they got from ‘viewing pictures on a computer’ to ‘forcing images on the brain’ is anyone’s guess, and presumably the 90% figure is the score on a memory test rather than amount of memory loss restored, although without any published data its hard to say.

So how did this preliminary research make the front page of a UK daily as a “real hope of a cure”?

Microsoft have developed the camera and are funding this project (along with several other similar studies), and I can’t help but wonder whether their PR people have been at work behind the scenes.

Actually, there are other systems that have been around a while now which are equally as interesting. The NeuroPage system is another simple idea.

It’s a pager for people with memory problems and people can program the system to send reminders. So far, early research has found it to be quite effective in helping people with memory impairments.

Despite the hype, the SenseCam project is a great idea and could lead to a genuine benefit to people with memory problems, but it won’t cure Alzheimer’s.

Link to abstract of case study on person with limbic encephalitis.
Link to Microsoft SenseCam and memory loss page.

Mind and brain science storms NYT’s ‘Year in Ideas’

The New York Times seems to have been publishing loads of mind and brain articles recently and their end of 2007 round-up of ‘hot ideas’ contains no less than 11 articles on developments in psychology and neuroscience – including everything from Alzheimer’s to Zygotes (via Lap Dancing).

I was alerted to the series by Matthew Hutson, who emailed to say he’d written the article on ‘neurorealism‘ – the tendency for people to believe even quite outlandish claims if they think they’re backed up by neuroscience.

In a blog post about his piece, he notes some of the sources and origins of his article, including some peer reviewed research and our own Tom Stafford, who coined the term ‘neuroessentialism’ (independently, as did two others!) to describe the same phenomenon.

The other psychology and neuroscience articles cover a whole range of topics, and are all two-minute write-ups of ingenious studies or theories (sort of like a behavioural science tapas selection):

* Alzheimer’s Telephone Screening
* Faces Decide Elections
* Lap-Dance Science
* The God Effect
* Hope Can Be Worse Than Hopelessness
* Mindful Exercise
* Quitting Can Be Good for You
* Starch Made Us Human
* Zygotic Social Networking

UPDATE: Two more with mind and brain themes!

* The ‘Cat Lady’ Conundrum
* Ambiguity Promotes Liking

Multicoloured USB brain tee

One of the best brain t-shirts to come along in a very long time has just arrived, and, unfortunately, it sold out within days.

At least, if you’re after a male sizes that is. Luckily, there are still plenty in female sizes left.

It’s a beautiful multi-coloured brain where the brain stem changes in a series of USB plugs so you can connect your cortex to the nearest computer.

It’s a Threadless t-shirt, so despite the fact they’re out of stock, you can click to register your interest in getting them to print some more, and they’ll let you know when they’re ready.

In the mean time, you may have to find your nearest female neuroscience enthusiast to admire the t-shirt in all its glory.

Link to Threadless ‘Connect It’ t-shirt.