How to make up your mind about choosing psychiatry as a speciality in medicine. An excellent introduction
Sure, ranomized controlled trials are better than naturalistic trials, but what we need is better memory tests, study other types of memory (everyday memory and semantic memory), longer follow-up and basic research to the question why some of the patients treated with ECT get memory deficits.
In his letter to the editor Prof Sackeim defends his findings of a naturalistic 7 centre trial to the side effects of ECT. He also used a biographical memory test. These tests are at the least not the best tests to examen retrograde amnesia. We should develop more specific and sensitive test for retrograde amnesia. Last month I made a post about better memory tests especially for retrograde anmesia. W’re doing a trial with a new test with ECT for retrograde amnesia. Patients are still incuded in this trial.
Moreover as stated in his letter the impact on every day living of retrograde amnesia is still to be researched. Besides everyday memory, semantic memory is of interest.
Also most research on side effects of ECT have a short follow-up. Randomized controlled trials control for such things as late onset depression and the side effects but with longer follow-up w’re able to look at the patients in which the depression is the first symptom of cognitive decline.
We now know a lot about dosage, electrode placement and cognitive side effects of ECT, but what we don’t know yet is how do these side effects appear, where do they originate. How can we adapt our techniques and devices to lessen cognitive side effects. More important, which individual factors of the patient makes him more or less prone to these cognitive side effects.
According to this study and article Yoga may help treat depression and anxiety. Even some data on brain scans and evidence for changes in neurotransmittors after Yoga.
It helps your body health, keeps you in shape and give you a lot of energy. It is a great exercise to do at home and there are a lot of products you can buy to do it without going to a professional class, one recommended is the URBNFit Yoga Ball to help your flexibility, and your balance.
This article by Laura D. Hirshbein is a clear description how depression became a specific disease category with concrete criteria. I thought depression was one of the most clearly described categories in human history. Depression was not a classification in the DSM I (1952). Depression as we know it today became only a diagnostic category in DSM III in 1980. There were certainly descriptions of melancholia in physicians writing throughout human history but the author states that depression as we know it is a twentieth-century phenomenon.
As a psychiatrist working on a depression unit I can most of the time clearly recognize depression. But many patient also present with depressive complaints which are clear depressions in terms of DSM IV criteria but differ from those patients in which a diagnosis of depression can’t be missed at least to my opinion.
The author has strong arguments for this 20th century phenomenon.Depression became topic of research in the 1950’s. In those days the inpatients mainly consisted of young women.The large number of women in clinical trials for depression in those days appeared to be a reflection of the hospital population of that time. Before the 50′ in pre world war 2 period the inpatients of a psychiatric hospital were mainly older men.
In the develoment of DSM III, groups of researchers developed specific diagnostic criteria for depression. They looked at populations of patients in hospitals.Symptoms were counted and analyzed to see which best characterized depression.Patients with drugs or alcohol abuses were excluded as in medication trials. Researchers tested those criteria in hospitalized depressed women. The question whether women were depressed more than men was never raised. The connection between women and depression has been a closed circle. This article gives some food for thought.
Forgetting May Be Part of the Process of Remembering – New York Times
Interesting article in Nature Neuroscience.
In all, this research suggests that memories are more often crowded out than lost. An ideal memory improvement program, Dr. Anderson said, “would include a course on how to impair your memory. Your head is full of a surprising number of things that you don’t need to know.”
Dr Shock is attending a symposium in Bolzano, Italy about ECT. On one of his days off he was hiking the mountains of the Dolomites in north eastern Italy were he met a 77 years old men Dr Ugo Bebetti. During a pranzo (lunch) in a lovely hotel in Bulla where they met, both on there way to the Alpe di Siusi he told Dr Shock about Dr Ugo Cerletti. The old man met Dr Cerletti during his resedency at the University of Rome.
This is one of the hardest questions to answer especially if your working on a inpatient unit with depressed patients. They are mostly severely ill for a long time and demoralised when they get admitted. To get a clear picture of what is wrong we usually get rid of all psychopharmacological drugs for diagnostic purposes. That’s why i find this article of major importance, clearly written by experienced clinicians. The table offers clinical features that may help differentiate chronic depression from personality disorder.
1. avoid unsupported conclusions based on nonresponse
2. bear in mind that depression is likely to make personality traits look more like full-fledged PDs by exaggerating a range of personality traits such as avoidance, dependence, and interpersonal sensitivity. Always consider what evidence exists that these were more than traits at any point when a patient was less markedly depressed
3. use multiple informants (family members, close friends, primary care doctors, psychotherapists) as well as other collateral information (eg, performance evaluations from work) to gauge the highest and usual levels of occupational and psychosocial functioning when less depressed. For example, even if the patient is in the middle of multiple struggles with his treatment team, a history from family and coworkers of the patient’s typically satisfying stable work and personal relationships before a first episode of MDD in his mid-20s should lead a diagnostician to question the hypothesis of borderline PD.
4. systematically assess personality pathology with specific questions about onset, quality of relationships, mood fluctuations, and patterns of coping. In this respect, clinician-rated, semistructured interviews that inquire about specific symptoms and behaviors and associated impairment may be helpful as a supplement to global clinical impressions. This may be even more reliable than patient-rated questionnaires, which may be more sensitive but less specific.