Neural Stem Cells
Stem cell research presents us with one of the most difficult moral and ethical dilemmas. Most of us have our opinions about the whole matter. But there is now a very real possibility that the scientific piece may be resolved in a different way altogether.
A recent study in the Proceedings of the National Academy of Sciences has confirmed that in adult mammals, the regions of the brain below the ventricles – the fluid-filled spaces – of the brain, harbor neural stem cells. The evidence for their existence has been building over the last five years. But this latest report is of great interest. The scientists were able to show that a soluble carbohydrate-binding protein named galectin-1 promotes the proliferation of these neural stem cells in the adult brain. These neural stem cells are highly active in the forebrains of mice.
We have yet to discover their role in adult human brains. But it would seem a safe bet that they will if anything be more active in humans, since we are endowed with incredible neural plasticity that is way beyond anything seen in most other species. And we would therefore expect to see more potential for neurogenesis in the human brain. It is valuable to place this new finding in the context of experimental work indicating that some medicines may stimulate adult neurogenesis.
“I’ve found that the chief difficulty for most people was to realize that they had really heard new things: that is things that they had never heard before. They kept translating what they heard into their habitual language. They had ceased to hope and believe there might be anything new.”
–Peter Demianovich Ouspensky (Russian Philosopher, 1878-1947)
Technorati tags: Stem cells Neurogenesis Adult brain
Psychotropic Medicines and Neurogenesis
One of the genuine breakthroughs of the last few years has been the understanding that the brain is not a static structure, but is instead an organ that grows, refashions and repairs itself to a remarkable degree.
You may be interested in a brief review article looking at the effects of some of the medicines that appear able to stimulate neurogenesis in the adult brain.
It is no longer far-fetched science fiction to say that we are likely soon to be able to regenerate parts of the brain and spinal cord that have been damaged by disease or trauma. And in the meantime, we have an array of stratgeies that you can adopt to keep your brain active throughout life, while dramatically reducing your risk of developing dementia.
Technorati tags: Neurogenesis Antipsychotics Antidepressants Brain repair
An Online Resource for Attention Deficit Disorder
Regular readers will know that I am very interested in attention deficit disorder, and I have written a number of articles on it. (Just click on the Category over on the left hand side).
It a common clinical problem, thought to affect 5% of American adults and an even larger number of children. Yet there is even more to it, in that attentional problems may also be able to teach us a great deal about gender differences in the brain and in psychology. To say nothing of helping us learn methods for improving everyone’s abilities to concentrate, focus and pay attention, at a time when ever more objects and events are demanding our attention.
Additude magazine has as its mission statement "to provide clear, accurate, user-friendly information and advice for families and individuals affected by AD/HD." Even as a professional, I have found the quality of the magazine to be excellent, and they are certainly succeeding in their aims. They certainly do not focus on medication as anything more than one aspect of treatment.
If you are interested in ADD, I highly recommend this resource.
“Life is denied by lack of attention, whether it be to cleaning windows or trying to write a masterpiece.”
–Nadia Boulanger (French Conductor and Musician, 1887-1979)
Technorati tags: Attention Attention deficit disorder Gender differences
The Passing of the Crazy Diamond
You may have heard of the passing of Syd Barrett, one of the founding members and creative drivers of Pink Floyd. He was only 60 years old.
His extraordinary creativity is well known: his fingerprints were all over the early performances and albums, and he was a muse to a generation of performers. I remember everyone’s consternation as his behavior became progressively more erratic between 1967 and 1968. I was very young then, but we all loved the music.
Some blamed his psychological meltdown on his consumption of prodigious amounts of LSD and all manner of other trendy chemical amusement aids. But in hindsight, he was probably suffering from a psychotic illness, and he was either self-medicating, or the drugs pushed him over the edge. Without doing a full evaluation, I could not say for sure. Although it’s now a moot point, several things make me think that he had a psychotic illness:
1. His startling type of creativity before and in the early stages of his illness.
2. There are clues suggesting that he already had problems before become obviously unwell.
3. The chronicity of his problems are not at all like drug-induced psychosis. I saw a man in Australia who told me that all his years of psychosis were the result of a single “bad trip” in the 1960s. Unlikely.
4. He suffered for years from diabetes mellitus. Diabetes may be as much as twice as common in people suffering from schizophrenia and bipolar disorder, and also in their first-degree relatives. (England’s first chess grandmaster, Tony Miles, who sadly had a psychotic episode in the late 1980s, also struggled with diabetes for many years, and died at the age of only 46.)
Why does any of this matter now?
If you ever see a young person abusing drugs, be aware that it is not necessarily that he or she is being impulsive or has just fallen in with a bad crowd. It may be that they are self-medicating.
People with major mental illnesses are at increased risk of many other physical illnesses, not all of which are a result of poor lifestyle choices. If you in contact with someone struggling with mental illness, anything that you can do to help them look after their physical health is all to the good.
And finally, a favorite song of mine that was written about Syd. According to legend, by a strange coincidence he arrived at the Abbey Road studio un-announced, at very time that the song was being recorded. It was nice that he was well enough to come and listen.
Remember when you were young, you shone like the sun.
Shine on you crazy diamond.
Now there’s a look in your eyes, like black holes in the sky.
Shine on you crazy diamond.
You were caught on the cross fire of childhood and stardom,
blown on the steel breeze.
Come on you target for faraway laughter, come on you stranger,
you legend, you martyr, and shine!
You reached for the secret too soon, you cried for the moon.
Shine on you crazy diamond.
Threatened by shadows at night, and exposed in the light.
Shine on you crazy diamond.
Well you wore out your welcome with random precision,
rode on the steel breeze.
Come on you raver, you seer of visions, come on you painter,
you piper, you prisoner, and shine!
Technorati tags: Syd Barrett Pink Floyd Psychotic illness Diabetes mellitus Substance abuseSelf-medication
Helping to Prevent Suicide
Unless you work in psychology or psychiatry, you may not know that in the United States, there are considerably more suicides each year than there are murders.
Though there is sometimes little warning that someone might be about to harm themselves, in the majority there have been some warning signs.
The American Association of Suicidology expert consensus panel has just published a mnemonic to help professionals and the general public recognize some of the major risk factors. You can find a brief article with a link here.
Here is the whole mnemonic:
I Ideation
S Substance abuse
P Purposelessness
A Anxiety
T Trapped
H Hopelessness
W Withdrawal
A Anger
R Recklessness
M Mood changes
This is only a first attempt at an evidence-based summary of some of the major risk factors, and the sensitivty and specificity of the list is still quite low. But If awareness of some of these warning signs and risk factors saves even a single life, this post will have been worthwhile.
Technorati tags: Suicide Depression Self-harm
Understanding Attention Deficit Disorder as a Long-term Challenge
Regular readers will know that I am a huge advocate of natural and non-invasive methods of treatment whenever possible. But sometimes we reach an impasse, and the only option is to use pharmacological or other types of conventional intervention. But even then, it is a mistake to assume that physical treatment alone will be sufficient to help the individual and their family: it is only sensible also to address the psychological, social, subtle and spiritual dimensions of the person. And we must never lose sight of the positives: some people who have health challenges are transformed for the better, and some “illnesses” may carry gifts with them. I’ve talked about the creativity of people with bipolar disorder and schizotypy and the empathy and innovation that may accompany attention deficit disorder.
There is often a fine balance between the positives and negatives of an illness and the types of help that may be of greatest value.
I have just been involved in a common discussion at this time of year: a young person has quite bad attention deficit disorder (ADD). Since she started pharmacological treatment not only has she risen from being a failing student to getting all As and Bs, but the quality of her life has improved dramatically. Unfortunately, she has been told that she only needs to take her treatment when she feels that it is necessary to complete her schoolwork. Many healthcare providers continue to believe that ADD and ADHD are just academic problems. There is a very good new review article that discusses this misperception in some detail. Prescription patterns show that the majority of school-age children are only being treated from Monday to Friday, and from 7AM to 3PM. Why does this matter?
There is excellent and extensive research about the consequences of non-treatment, and most of it has nothing at all to do with school. If people with ADD and particularly with ADHD are left untreated, they are more likely to:
1. Develop substance abuse
2. Be involved in a serious accident
3. Engage in illegal activities
4. Contract a sexually transmitted disease
5. Have an unplanned pregnancy
6. Become separated or divorced
The article makes a point that we have often discussed with families: these consequences of non-treatment are events that primarily occur outside the school environment. So withholding medicine just when it is needed the most may be a risky business.
We are now seeing increasing evidence that successful pharmacological treatment reduces these consequences of untreated ADD/ADHD to the rates found in the general population. Simply using appropriate medications can protect people from adverse consequences of these problems both now and in the future.
I think that we should look at ADD in the same way that we look at an illness like diabetes. In diabetes, the high blood glucose and elevated lipids are not themselves the problem. They may cause symptoms, but the real danger lies in the long-term physical consequences of high glucose and lipids. It is these that can be so devastating to the person with the illness, causing the so-called complications of diabetes, such as retinopathy, kidney and heart disease.
Similarly ADD/ADHD may cause symptoms – such as problems in school – but it is the long-term consequences that can cause such problems. Children and adolescents, and for that matter some adults with both illnesses don’t realize that these are the main reasons for treatment.
There is a common myth that adults know that they need to take their medication, and so they do. Hands up anyone who has only taken half of a course of antibiotics!!
There is very striking study of adults with ADHD who were asked to do a simulated driving test while on and off their medicines. The people in the study rated their driving performance just the same whether they were on or off their medicines. Despite the fact that when they were off their treatment they were an astounding five “standard deviations” worse in terms of driving safety and responsibility! For people not used to looking at statistics this may not seem like much, but the difference is astonishing. You would not want to share the road with an untreated person with ADD.
We know that within the first three months of treatment 50% of children and adults will have stopped their ADD/ADHD treatment and most studies agree that by 18 months, the figure is around 80%.
We need to get the message out that:
- ADD and ADHD can create some nasty long-term problems if not adequately treated.
- For a host of reasons, most people will stop their treatment, so plan for it, and don’t just wait for it to happen.
- Adequate treatment consists of a lot more than giving medication and hoping for the best.
- People need psychoeducation.
- They need to learn coping strategies.
- The family needs to know how to help and how to deal with the problems that someone with ADD/ADHD may be causing them.
- And people need to know how and when to use medications and how to integrate them with non-pharmacological strategies.
Technorati tags: Attention deficit disorder Attention deficit hyperactivity disorder Substance abuse Treatment
Healia.com
Carol Kirshner, web mistress extraordinaire, has just alerted me to a great resource for anyone looking for information on health, wellness and healing, called Healia.com.
Carol’s review is excellent, and now that I’ve tried out the website, I really do share her enthusiasm.
One of the reasons for creating my own blog is that the internet is full of medical misinformation. I have just been writing an article that I am going to post tomorrow. My initial reactions to some of the statements that I found on line would not have been fit for you gentle reader. Suffice to say that there were comments on some websites that betrayed a complete ignorance about the workings of the human body and recommendations that can best be described as bovine excreta.
Healia.com seems to be very different. I have been putting it through its paces, and I’ve so far not found a single problem or contentious area, despite throwing a lot of unusually tough questions at it. I fully anticipate that it’s going to become one of my major research tools, and for matters pertaining to health, it seems to be better than any other search engine that I’ve found.
Technorati tags: Internet search engine Health Healing Wellness
Attention Deficit Disorder, Allergies and Membranes
There has been a long-running debate about the relationship – if any – between allergies and attention deficit disorder (ADD).
As long ago as 1991 a paper seemed to indicate that there were higher rates of hyperactivity in the parents of children with allergies as well as increased rates of allergies in children with ADD. Recently a study from New York seemed to show higher rates of allergic rhinitis in children with ADD. The problem with all this is that we are looking at two common problems and trying to sort out a genuine connection can be tricky.
I started thinking about this problem again, after a recent report that some children had symptoms of hyperactivity, inattention, attention-deficit/hyperactivity disorder, and excessive daytime sleepiness as a result of sleep-disordered breathing. But what was remarkable was the number who improved after they had their tonsils taken out. The tonsils are one of the first lines of defense in the immune system, which is why they so often become enlarged with infections, or for that matter in any kind of immunological reaction. Now I’m not much of one to take out tonsils unless there’s a really good reason, but it is certainly an important observation for anyone who has a child with behavioral or cognitive difficulties: he or she may not be sleeping properly.
I have seen quite a number of people who had physical and psychological problems, including headaches, depression and attentional problems, who turned out to have either allergies or environmental sensitivities, and when those were addressed, the symptoms resolved. I have also seen some people who followed the notoriously difficult Feingold diet with some success, even though the research doesn’t seem to be very supportive of elimination diets. And I’ve seen just as many people who got no relief at all from elimination diets.
I have just done a detailed literature review on the topics of allergy and attention, and I don’t think that we have enough evidence to suggest that everybody with attention deficit needs to see an allergist. But what this highlights is that not all people with attentional problems or hyperactivity have ADD. They may have attentional problems because of sleep disturbance, depression, anxiety, obsessive compulsive disorder and a range of other problems.
There is some exciting research indicating that one of the problems in many cases of ADD is a disturbance in the normal functioning of cell membranes. If that is correct, it may be that there are disturbances in the membranes of both neurons in the brain and membranes of cells in the immune system. That link is not entirely proven. But it has received further credence by the finding that some children and adults with ADD seem to show improvements of both attention and immune function when they take omega-3 fatty acids. I have recently been hearing some encouraging reports from people who have used the Omega-3 Formula made by Omegabrite (And no, I have no link with the company!)
Technorati tags: Attention deficit disorder Allergy Atopy Hyperactivity Tonsils Cell membrane Omega-3 fatty acid
Diagnosing Illnesses
I am pleased to say that my recent item about Categorical and Dimensional ways of looking at illnesses has provoked some spirited correspondence and questions. Far from indicating that the art of diagnosis is arbitrary and vague, it reflects clinical reality. I get a great many magazines and articles from supporters of alternative medicine, and some have so misunderstood the principles of diagnosis that they think that illnesses don’t exist! One of the reasons for this flawed thinking is that we all have a bad case of physics envy. The success of Newtonian physics and Humean philosophy has seduced us into thinking that everything has a single cause, and that every item and every event has clearly defined boundaries.
We are complex and ever-evolving individuals and we are also members of of constantly changing groups, so we have to be seen not only as "objects" wth diagnostic labels, but also as people with a time and developmental dimension: you and your life challenges will change over time as you continue to develop and evolve. As the great Scottish poet Robert Burns said: “Nature‘s mighty law is change.”
I think that is important to let you know how this field is developing, and why it is that we cannot always come up with a cut and dried answer to the question "Well, what has he got then?"
On May 24th, I wrote a short article about the inter-relationships between schizophrenia and bipolar disorder that you may find interesting. It develops some of the points that I made in my previous article.
Technorati tags: Diagnosis Category Bipolar disorder Schizophrenia
