A German study just published by Moritz and colleagues provides an interesting insight into antipsychotic drugs used in the treatment of schizophrenia and other psychotic illnesses. Data was collected by asking psychiatric patients to complete a questionnaire about their experiences in taking antipsychotic medication for their mental disorder. The conclusion was that such drugs are effective because they dampen emotion rather than treating any specific symptoms. ‘Doubt, numbing and withdrawal were the main subjective antipsychotic effects’. Basically such drugs just keep patients quiet – an effect which many patients find unpleasant. One reviewer says ‘It is clear we need better ways to help people’.
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The American Psychiatric Association are preparing the next edition of the Diagnostic and Statistical Manual of Mental Disorders, due for release May 2013. They are currently testing some of their new criteria in field trials. This involves clinicians using the list of proposed clinical characteristics to diagnose patients. Comparisons are then made between clinicians to see how reliable the diagnoses are i.e. whether clinicians agree on the diagnoses they give.
The field trials use a statistic called kappa where 1 means effect agreement and 0 is agreement may just be due to chance. A few of the current results are kappas of 0.32 for major depressive disorder, 0.2 for generalised anxiety disorder and 0.01 for patients with symptoms of anxiety and depression. A recent article in the New Scientist (‘Diagnosis Uncertain’) reports that leaders of the DSM revision are suggesting that kappas as low as 0.2 should be considered acceptable whereas others dispute this. The end result may be that millions of people end up with erroneous diagnoses.
Some recent research reported here suggests the fMRI studies may present a misleading picture of brain activity. Such studies are used to provide evidence that certain areas of the brain are active when a person is engaged in a target task. However the new research has demonstrated that, while certain areas may be especially active, it isn’tt a question of them being the only active areas – they are simply more active than the rest of the brain. This means that conclusions that link a specific area of the brain to a specific behaviour may be unjustified, because many other areas are also involved.
A team of Scottish researchers (Perrin et al., 2012) have produced evidence that ECT decreases connectivity in the brain of depressed patients, leading to a reduction in symptoms. They used fMRI (functional magnetic resonance imaging) to scan the brains of nine patients, all of whom had severe clinical depression and had not responded to drug therapy. Each received ECT for two sessions per week, an average total of 8 treatments. They were scanned before ECT was applied, and then again afterwards. Using a new mathematical analysis they were able to determine to what extent 25,000 different brain areas ‘communicated’ with each other. This indicated changes after ECT in the left dorsolateral prefrontal cortical region; connectivity was reduced and this was associated with improvements in depressive symptoms.
When a patient has depression, parts of the brain that control mood and those involved in concentration and thinking have an overactive connection. So it appears that ECT ‘turns down’ these connections leading to improved mood.
There is increasing evidence that psychoanalysis may be an effective therapy. A landmark review by Shedler (2010) included a number of randomised control trials* where psychodynamic therapies proved as effective as other forms of therapy. Midgley and Kennedy (2011) conducted another review, this time of studies relating to children and young adults and again found strong evidence of the value of psychodynamic therapies.
In fact Shedler suggests that non-psychodynamic therapies may be effective in part because therapists use techniques that have long been central to psychodynamic theory and practice, such as gaining awareness of previously implicit feelings.
Shedler describes psychodynamic therapies as ‘a range of treatments based on psychoanalytic concepts and methods that involve less frequent meetings and may be considerably briefer than psychoanalysis proper. Session frequency is typically once or twice per week, and the treatment may be either time limited or open ended. The essence of psychodynamic therapy is exploring those aspects of self that are not fully known, especially as they are manifested and potentially influenced in the therapy relationship’. In his article he provides a useful description of the techniques used in the therapy.
*A randomised control trial is the gold standard of medical research where patients are randomly assigned to treatment or no treatment groups.
The excellent BBC radio series about case studies in psychology is returning this week and is about Henry Molaison (HM) – on Wednesday 11 August at 11 am. You can find details here. The blurb in the Radio Times says ‘In 1953, after a brain operation to cure his epilepsy, Henry Molaison was left unable to form new memories. But he was happy that others would benefit from the research conducted into his condition; he was happy every time he was told about it because it was always news to him. Recordings of Molaison made before he died in 2008 make this a particularly poignant programme. Claudia Hammond talks to the scientists who studied him and got to know him, though, sadly, he never got to know them.’
The programme also covers the story of HM’s brain after his death – which you can read about here. Provokes some interesting ethical questions about a person who couldn’t give informed consent.
The previous case studies series covered Kitty Genovese, The Wild Boy of Aveyron, The Man with the Hole in his Head and Little Hans. Some of these can be downloaded from Psychexchange, see here.