Malinconia, by Venezuelan artist Javier Rodriguez, deals with one of the most prominent mental health issues of recent times: depression. Malinconia is the Italian word for melancholy. Depression and melancholia can be viewed as one and the same thing.
The piece is a collage based on the Jan van Eyck painting Portrait of a Man with a Turban, a famous work of the Northern Renaissance. From the mouth down the picture is untouched retaining the classic Renaissance pose and stoic expression. But from the nose up the picture is a distortion: a confused jumble of images. This image of the Renaissance and all it entails – discovery, progress and a greater understanding of the universe – is juxtaposed with images of confusion and doubt, perfectly encapsulating the milieu that so often leads to melancholy: that greater knowledge leads not to greater understanding and certainty, but instead to more questions and uncertainty.
The most powerful part of the piece is the man’s eyes. Slightly off-centre, they are where the face first becomes distorted. His eyes are the windows to his melancholia, their downward slant conveying his angst.
Peering from within the folds of the turban are four eyes, indicating a strong influence of the surrealist movement, who themselves were influenced by psychoanalysis.
Rodriguez’s works are intricate compositions made from antique books. This mixture of old materials and modern technique perfectly encapsulates his sensibility of classic ideas in a contemporary context. Please visit http://www.javierrodriguez.co.uk to see his work.
Shrink Life in General
- Self help interventions have better effect when volunteers enter these form of treatment for depression. Intervention with patients recruited from clinical settings had a smaller effect. The evidence base used for the NICE guideline for self-administered treatments for depression is almost entirely conducted in volunteer populations.
- Self-help interventions are more effective with actual existing problems. The preventive capacity of self-help treatment can be less efficacious. The capacity of self help in populations at risk may be smaller compared to those with even mild problems. In populations at risk but without symptoms it can be difficult to show additional benefit from any intervention.
- Self-help interventions should be based on cognitive behavioral therapy principles rather than education.
- “Guided interventions” are superior to “pure” self-help treatments. Guided and inspiring you to be here now means the presence of therapist contact as part of the intervention. Therapist being either a professional or paraprofessional (no graduate mental health qualification) care taker. The guidance could be by face-to-face or telephone, e-mail and written contact.
- There was no clear advantage associated with contact that involved supportive guidance beyond monitoring. With monitoring is meant: checking that patients had used the materials, assisting with queries about use, or whether there was a specific statement that therapeutic techniques such as counseling were not used. When the intervention involved more than simple monitoring, which might include advice from the therapist about specific problems, motivation or support.
Implications of this publication:
The appropriate self-help treatment for depression should be based on Cognitive Behavioral Therapy with guidance from a health professional, although the length or nature of that guidance are less clear.
What has been done?
This recently published study is a systematic review of the randomized controlled trial literature to determine intervention, population and study design factors that moderate the treatment effect of self-help interventions for depression.
The researchers found 34 published studies reporting 39 relevant comparison. they included more and more recent studies compared to earlier reviews.
They used complicated statistical methods for their calculations: meta-analysis, meta regression with multivariate and secondary analysis as well as analysis of publication bias. I won’t trouble you with the ins- and outs of these complicated statistical methods mostly because I find it difficult to grasp or explain anyway.
These results should be viewed with cautions since they may reflect statistical confounding. The reason why I have written this post about the publication is that their findings sound very rational and recognizable. This is also a well done review worth mentioning in the absence of other comparable meta-analysis.
What is Self-Help for Depression?
In general, the interventions of interest were designed to assist patients in the treatment of their depressive symptoms, using a health technology such as written information, audiotape, videotape or computer presentation. Interventions were designed to be conducted predominantly independent of professional or paraprofessional contact.
Examples of self-help for depression:
Self Help for Depression: Depression Learning Path
Helpguide.org: Recovering from Depression
Psychol Med. 2007 Sep;37(9):1217-28. Epub 2007 Feb 19.
What makes self-help interventions effective in the management of depressive
symptoms? Meta-analysis and meta-regression.
Gellatly J, Bower P, Hennessy S, Richards D, Gilbody S, Lovell K.
Dopamine D2 receptor reduction seems to decrease the capability of learning from errors. The sensitivity to negative action consequences is diminished. This may explain an increased risk for developing addictive behaviors in certain individuals. Addictive behavior can be seen as risk taking behavior. Individuals with A1-allele of the D2 dopamine receptor gene polymorphism are at risk. These carriers have a reduced dopamine D2 density in their posterior medial frontal cortex. They learn to avoid actions with negative consequences less efficiently. Many studies have found relations between a reduced dopamine D2 receptor density and addiction, obesity, or compulsive gambling with I casino games.
Normally we learn from our mistakes. Positive outcome is a reinforcer and negative outcome should lead to avoidance of the erroneous behavior.
The performance monitoring system consists of:
1. Posterior medial frontal cortex (pMFC) signals the need for adjustment
2. The rostral cingulate zone (RCZ) of this location is involved in learning from errors
3. Dopaminergic neurons from the midbrain into this cingulate zone is involved in judging a situation as better or worse than expected
4. The basal ganglia in particular the nucleus accumbens (NAC) plays a role in reward based learning
5. Interaction with the hippocampal formation enables learning of stimulus-reward associations.
26 healthy males grouped by 2 different genotypes of the polymorphism (A1 allele carries, n=12 and the non A1 allele carriers, n=14)under study were recorded with functional magnetic resonance imaging (fMRI). A learning task sensitive to dopaminergic manipulation was used.
The group with the A1-allele avoided the negative outcome significantly less, they also showed a reduced negative feedback related fMRI signal in the rostral cingulate zone.
The reward related activity increase in the nucleus accumbens was related to positive feedback as compared to negative feedback. This reward related increase was reduced in the A1-allele group in the right nucleus accumbens.
Science. 2007 Dec 7;318(5856):1642-5.
Genetically determined differences in learning from errors.
Klein TA, Neumann J, Reuter M, Hennig J, von Cramon DY, Ullsperger M.
More on NatureNews
Instructing someone to be more positive or to think positive instead of negative is not seldom met by a lot of sepsis. Today a patient was admitted to our ward. His wife had a bad cervix smear two weeks ago. He blames himself for this bad luck. He is sure he has HIV as well. Discussing his frame of mind was to no avail. Now this is a case of a severe depression of which I will not go into further detail. but I will say sometimes our negativity destroys us, we have seen patients who get extremely anxious about their future just because something didn’t turn out the way they wanted.
Less severely depressed patients are also hard to persuade to think more positively.
I recognized these myths of positive thinking very well in this post on Think Simple Now.
Myth #1: Negative thinking is more realistic.
Have you ever heard a negative person say that they aren’t negative; they’re just being ‘realistic’? This myth keeps people locked in a negative reality of their own creation.
A person’s thoughts, whether positive or negative, do have an effect on their environment. If you think negatively, your mind will automatically seek out confirmation that the world is a terrible place. Seeing is believing, and your mind reinforces your belief that reality is negative. See how it’s a downward spiral of negativity? If you expect negative results, you are less likely to take risks and try new things. Negative thinking masks your impressions in fear.
Positive thinking works the same way. With a positive mental attitude, you’ll seek out positive choices and expect positive results. This helps you move past fear and try things that others may believe “can’t be done”. This typically end in positive results.
In a previous post on this blog the disadvantages of direct to consumer advertising are summarized:
The International Society of Drug Bulletins warns against this legislation. It is wrong to confuse information with advertising.
The dangers of “direct-to-consumer-advertising” are:
1. advertisements from drug companies are mostly limited to those drugs with the highest profit
2. efficacy is often exaggerated
3. risks are usually obscured
4. it confuses patients when suggested another drug by their physicians
5. it forces physicians to use the advertised drug
6. advertisements by drug companies lack comparison with drugs from other companies or other treatments, making it hard for consumers to compare different drugs or other treatment option
Pharmalot has a follow-up on this issue between the European Commission and
Four groups representing complementary health insurers, independent medical bulletins and long term medicaid services have issued a joint press release claiming: “The European Commission is supportive of the industry’s moves: its ‘consultations’ are little more than an attempt to sway public opinion.”
Apparently there was a recent press release
The press release was issued on Wednesday by the International Society of Drug Bulletins (ISDB), the Medicines in Europe Forum, Health Action International (HAI) and the Association internationale de la mutualité (AIM) and charge that the EC is trying to overlook the “underlying risks to health” and ignore “the likely impact on the financial sustainability of Member states’ public health systems.”
Go read the post on Pharmalot
I am not supporting direct to consumer advertising of drug for reasons given at the beginning of this post.
Medbloggers do not significantly prefer dark chocolate above the inferior kinds of chocolate such as white chocolate and chocolate. This is the result of the poll: What kind of chocolate do you like? The hypothesis was that medbloggers like dark chocolate significantly more than other kinds of chocolate. Analysis was performed with Man-Huxley tests for categorical variables. Preference for dark chocolate was 10/17 (58%), chocolate 3/17 (17%) and white chocolate 4/17 (23%).
Nevertheless I am still convinced that someone with a Medblog prefers dark chocolate. This opinion is strengthened by another important publication in the British Medical Journal.
Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomized controlled trials
Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.
Based on observational data I am convinced that Medbloggers are dark choclate users.
BMJ 2003;327:1459-1461 (20 December), doi:10.1136/bmj.327.7429.1459
Gordon C S Smith, professor, Jill P Pell, consultant
If you or someone you love has been through alcohol or Treatment of Alcohol Abuse, you’ve likely heard something along the lines of, “You can’t make an addict stop. They will only stop when they’re ready.”
It’s true that while the addict is the only person who can stop their own alcohol use, loved ones can still take certain steps to try and curb addictive behaviors, but masking sure the addict gets a drug detoxification as soon as possible is extremely important. Here are 5 excellent tips and explanations on helping someone with alcohol or drug addiction.
Spiritual River is about overcoming addiction, based on the idea that personal growth is a mechanism for maintaining sobriety.
As an example the most hard one is usually setting limits and boundaries between yourself and the addicted.
One example of setting a boundary is telling a close friend that you prefer they not be around you if they are drunk or high. Notice that it is specific, and you have to sit down and communicate this type of request explicitly with someone. Setting a boundary like this is difficult because there is this tendency to hurt other’s feelings.
Another important observation on that matter:
If a person is in complete denial of their addiction, then there is little that you can do other than focus on your own behaviors and actions. The best that you can do in this case might be to communicate your boundaries with the person and let it be known that you won’t be bailing them out of any jams. Do you or someone you love suffers from an addiction? Get expert addiction treatment from Abbeycare Foundation. We pride ourselves in providing the best care and rehabilitation for long term recovery.
Yesterday here in The Netherlands we had a symposium about sleep wake cycle disorders. Again I was astonished by the fact that most complaints of sleeplessness could be seen as poor sleep hygiene and sleep wake cycle disorders.
Simple sleep hygiene measures are mostly effective. In case of an underlying psychiatric illness the treatment of this illness is the most important solution to treat the accompanying sleep complaints.
This post is inspired by a cry for help on intueri: to contemplate: Stop prescribing antipsychotic medications as sleepers!
In a comment complaints about sleep are compared to pain
I have never understood writing out prescriptions for “sleepers” on request. Do we do the same with pain? (”My chest hurts.” “Here, have some Vicodin.”)
Stop prescribing sleep drugs period, first find out the underlying cause of this complaint.
My father and my grandfather also suffered from this disease, as well as many other friends of mine. There where times when I was trying to find out more about hemorrhoids, but the sites that I found on internet were full with commercials and ads. I decided to build this site as a complete hemorrhoid resource on internet, so that people like me to find what they need.
A site well done, technically as well as content: Hemorrhoids.com
Hemorrhoids are swollen tissue around the anal canal and can be internal or external. They are often painful, itchy, reoccurring and embarrassing. Sound familiar? Perhaps you’ve tried everything to try to eliminate your hemorrhoids, Venapro can help.
1. Prostitution is almost regulated by the government
2. The sale of cannabis as UK Meds in “coffee shops” is regulated by the government
3. It was also the first country to legalise euthanasia.
Well let me fill you in on some new developments. There is still a lot of illegal prostitution going on, the new administration is trying to forbid “coffee shops” in the neighborhood of schools. They are doing their best to get a grip on illegal cannabis plantations.
And now there is news about cannabis in The Netherlands from the Sydney Morning Herald:
The Dutch Government said on Wednesday it wants to promote the development of cannabis-based medicine and will extend the drug’s availability in pharmacies by five years to allow more scientific research.
This development is going on for a long time. A change of the Dutch law on controlled substances (Opium Act) took effect on 17 March 2003. It includes regulations for applications regarding the cultivation of cannabis for medicinal purposes and guidelines for cultivating cannabis.