Encephalon 46th edtion on The Neurocritic
Welcome to the Forty-Sixth Edition of Encephalon, a neuroscience blog carnival.
The best neuroscience posts of recent on The Neurocritic
May 2008
Grand Round 4.36 on Parallel Universes
This is my 5th time to host (Thanks, Nick!) and I have not stopped enjoying the privilege of hosting this wonderful weekly anthology of the best posts of the medical blogosphere. Since FIVE is the lucky number for me today, I am opening this round with five of the best posts submitted to me this week…
A lot of excellents posts from the medblog sphere, go read them on Parallel Universes
Grand Round: Gene Genie #32 – Googling the Genie
Welcome to the 32nd edition of Gene Genie, a blog carnival devoted to genes and genetic conditions. This edition includes some excellent articles on genes and gene-related diseases, genetics, genomics and personalized genetics.
Dr Shock is in this excellent grand round with genes and gene related diseases. Go read these excellent articles about the newest research on genes: the 32nd edition of Gene Genie
Blog Addicted or Internet Addicted
The next three weeks Dr Shock is on vacation. This blog has been updated daily for more then a year. Since blogging is fun I will probably keep on blogging during these three weeks but maybe not daily and the long posts your used to.
No cold turkey to prevent withdrawal symptoms from blog addiction or is it Internet addiction? Won’t need shocktherapy for this I hope. But blogging is good for your health, at Living the Scientific Life
By the way there another stupid thing people believe you can get addicted to. Here is a good one: internet dating. Thanks Pure Pedantry
After these three weeks I will probably start with a new design, maybe I will need your help with that, looking forward to all this.
Cognitive Safety of Deep Brain Stimulation for Treatment Resistant Depression
Apart from a transient mild decline in manual motor speed, there seems to be no
adverse cognitive effects associated with chronic Deep Brain Stimulation (DBS) in Cg25 for Treatment Resistant Depression (TRD) in this sample of 6 patients with a follow-up of 12 months.
Another important conclusion from this research:
Several areas of cognition that were below average or impaired at baseline improved over follow-up, and these changes were not correlated with improvements in mood.
Broadman Area 25 as target for deep brain stimulation in treatment resistant depression. This area in the brain is from the most important publication about DBS and depression in Neuron march 2005 by Helen Mayberg. This is the location used in the largest trial with DBS in TRD. Other locations for DBS in TRD appear as well but these publications concern individual cases.
Functional neuroimaging as well as antidepressant treatment effects suggest that this area plays an important role in modulating negative mood states. Clinical response was demonstrated in 4 of 6 patients using standardized psychiatric end points. These results suggest that modulation of pathological activity in specific limbic-cortical circuits by electrical stimulation of Cg25 can effectively reverse symptoms in previously TRD patients.
Comparison to ECT
Moreover, in contrast to the memory deficits consistently reported with
ECT, no consistent declines in memory for either verbal or visual material were noted after onset or maintenance of DBS over baseline.
Limitations
- small sample size (n=6)
- the lack of a matched control group
- the lack of control (on-off) conditions for stimulation
- impact of repeat testing or regression toward the mean may have nonetheless affected the results
- patients were not free of psychopharmacological drugs
Other indications for DBS:
McNeely, H.E., Mayberg, H.S., Lozano, A.M., Kennedy, S.H. (2008). Neuropsychological Impact of Cg25 Deep Brain Stimulation for Treatment-Resistant Depression. The Journal of Nervous and Mental Disease, 196(5), 405-410. DOI: 10.1097/NMD.0b013e3181710927
3 Health Portals
Other blog such as clinical cases and Medgadget also discovered the news around Google Health. For some screen shots see Dr Shock. Eye on FDA also reviews Google Health:
It is a pretty neat concept and, as a big fan of Google myself, I can say that it maintains Google standards for easy maneuverability and is extremely friendly for the user. If you use a Google Reader as an aggregator – this is far easier to negotiate. You put in a few details about yourself, including your medications and already can gain access to a good deal of interesting information.
The other contester looking for your medical history is Microsoft with HealthVault. A screen shot is on the top of this post. You will need a LiveID or create one. Tried to create a LiveID, very difficult, it kept complaining about the strength of my password. Even medium strength was not enough, doesn’t sound hopeful if they even don’t trust their own system.
The website of the Canadian Medical Association has it’s own system for patient information and medical history: http://www.mydoctor.ca Health Portal
The new portal, created by Practice Solutions, a CMA company, allows physicians to register their patients with any or all of the online tools the portal offers – asthma tracker, blood pressure tool and weight tracker and a personal health record. Designed by physicians, the portal also provides secure messaging, ensuring a private channel of communication between patient and doctor.
“This service really shows the role of technological innovation in raising the standards of health care delivery in Canada,” said Dr. Brian Day, President of the CMA. “The mydoctor.ca Health Portal provides a new way for physicians to give each patient the care and attention they deserve while also empowering patients to become active participants in their care.”
Here is a screen shot of the patient’s dashboard.
You can read the Press release about mydoctor.ca
Peer Review Is Sacred
Peer review means reviewing the research of other scientists in your field for publication in a scientific journal. This procedure is confidential. Reviewers should abstain from peer review if there is a conflict of interest not only financial but also scientifically.
Pfizer subpoenaed the New England Journal demanding that the Journal produce peer-review and other editorial documents on all manuscripts concerning Pfizer’s cyclooxygenase-2 (COX-2) inhibitors, valdecoxib (Bextra) and celecoxib (Celebrex) specific articles that they had published and any others that we had rejected for publication. Pfizer wanted the peer-review documents, including the critiques prepared by reviewers for the authors, to help defend itself in product-liability litigation, the company was not looking for specific information. Pfizer was hoping to use the Journal’s expert reviewers and their critical commentary in an attempt to challenge scientific aspects of the articles, adding what Pfizer’s attorneys called the “significant imprimatur” of the Journal to their case.
Fortunately
the judge decided that while the materials Pfizer sought were relevant, their probative value was limited. As Sorokin concluded, even though the information sought was relevant, “the NEJM’s interest in maintaining the confidentiality of the peer-review process is a very significant one, especially in light of its non-party status, and tips the scales in favor of the NEJM.”
Yoiu can read the whole editorial: Peer Review in the Balance
Screening Adolescents for Depression on the Internet
Screening for depression through the Internet is feasible and is acceptable to large groups of adolescents. Furthermore, the Major Depression Inventory (MDI) and the Center for Epidemiological Studies-Depression scale for Children (pdf, small) (CES-D) are reliable and valid instruments that can be used for this screening.
By the age of 18 about one in every four adolescents has had at least one
depressive episode, and most adults with recurrent depression have their initial depressive episodes as teenagers
Teen depression or depression during adolescence can be hard to discover. There is even a website about depression for children and parents: KidsHealth. It is a doctor-approved website with health information about children from before birth through adolescence. KidsHealth provides families with accurate, up-to-date, and jargon-free health information they can use.
Ellen Aronis Heard’s programs for teenagers a lot of treatments for depression in adolescents are available. Usually treatment is started with cognitive therapy. The combination with antidepressants is also very effective in treating depressed adolescents.
Despite the availability of effective treatments, however, undertreatment is considerable in depressed adolescents because:
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- adolescents tend to consider help-seeking as a sign of weakness
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- they do not consider their problems to be mental health problems that can be treated
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- they prefer to solve their problems on their own
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- both parents and health professionals consider mental health problems a normal part of adolescence
The Internet may be an acceptable medium for adolescents to receive help.
In this research two screening instruments for depression in adolescents the Center forEpidemiological Studies-depression scale(pdf, small)(CES-D); and the major depression inventory, MDI) were validated for the use through the Internet.
What was done in this research?
A total of 1,392 adolescents, recruited through high schools and the
Internet, filled in the online questionnaires. Of these, 243 (17%) were interviewed with the MINI diagnostic interview to assess the presence of a mood disorder.
So not only were these screening instruments used they were also validated against the the International Neuropsychiatric Interview (MINI). Not the best diagnostic instrument but a good one.
From the two screening instruments the MDI has the advantage that it is considerably shorter than the CES-D (12 compared to 20 items), and requires less time input from the adolescents.
Several recent studies have shown that Internet-based interventions are as effective in the treatment of depression as more traditional types of psychological treatment, although most of these studies have been conducted with adults. But Cognitive Therapy through Internet might be an acceptable treatment and medium for depressed adolescents.
Cuijpers, P., Boluijt, P., Straten, A. (2008). Screening of depression in adolescents through the Internet. European Child & Adolescent Psychiatry, 17(1), 32-38. DOI: 10.1007/s00787-007-0631-2
New Grand Round
The New Grand Round of this week is up on Musing of a Dinosaur.
Grand Rounds has become the contemporary weekly portrait of medicine through the eyes of the medical bloggers.
Life Hacks for Doctors
Dr Shock is a fan of Life hacks. He even reviewed some books about it on this blog: Getting Things Done, and Upgrade Your Life.
But now he discovered a slide show with Life Hacks for Doctors. There is even a blog dedicated to efficiency for doctors: The Efficient MD and a WIKI.
The Efficient MD Wiki is designed to help healthcare professionals and medical students discover clinical pearls, useful resources, life hacks, and strategies to improve the practice of medicine.
Thanks clinical cases and images, who is also a collaborator on this new project, The Efficient MD Wiki.