Saturday, May 19, 2012
Friday, May 18, 2012
Experts say psychiatry's diagnostic manual needs overhaul
The Diagnostic and Statistical Manual of Mental Disorders (DSM), long the master reference work in psychiatry, is seriously flawed and needs radical change from its current "field guide" form, according to an essay by two Johns Hopkins psychiatrists published in the May 17 issue of the New England Journal of Medicine.
"A generation ago it served useful purposes, but now it needs clear alterations," says Paul R. McHugh, M.D., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and co-author of the paper with Phillip R. Slavney, M.D., a professor emeritus in the same department. "They say they can't do any better. We disagree and can show how."
The original DSM, published in the 1950s, was intended as a public health service documenting the incidence and prevalence of mental illnesses. By its third edition in 1980 (DSM-III), however, it had evolved into a reference book prescribing how clinicians should identify and classify psychiatric disorders.
Today, the Johns Hopkins psychiatrists say, DSM provides checklists of symptoms, offering few clues to the underlying causes of mental disease and making it difficult to direct treatment or investigate the disorders it details. A new edition, DSM-5, is due out in 2013.
The manual, put together by the American Psychiatric Association, currently identifies hundreds of conditions via lists of diagnostic criteria and symptoms, functioning exactly as does a naturalist's field guide but for mental illness. It offers no way to make sense of mental disorders and no way to distinguish illnesses that appear to be similar but actually are quite different and require different treatments, the psychiatrists argue.
"If you just name things and don't explain what the causes are, you do not know how to rationally treat or study the diseases," says McHugh, former director of Hopkins' psychiatry department. "The DSM gives everything a name but not a nature."
Before DSM-III, McHugh and Slavney say, psychiatrists typically used a "bottom-up" method of diagnosis, based on a detailed life history, painstaking examination of mental status and corroboration from third parties. The new emphasis on symptoms, they say, has unfortunately encouraged a cursory "top-down" method that relies on checklists and ignores much of the narrative of the patients' lives.
The causes of psychiatric disorders derive from four interrelated but separable categories: brain diseases, personality dimensions, motivated behaviors and life encounters, write McHugh and Slavney. The two physicians suggest that organizing mental illnesses based on these four causalities would "promote fruitful thought and, consequently, progress."
"Psychiatrists would start moving toward the day when they address psychiatric disorders in the same way that internists address physical disorders, explaining the clinical manifestations as products of nature to be comprehended not simply by their outward show but by the causal processes and generative mechanisms that provoke them," they write. "Only then will psychiatry come of age as a medical discipline and a field guide cease to be its master work."
Provided by Johns Hopkins University School of Medicine
"Experts say psychiatry's diagnostic manual needs overhaul." May 16th, 2012. http://medicalxpress.com/news/2012-05-experts-psychiatry-diagnostic-manual-overhaul.html
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Robert Karl Stonjek
Robert Karl Stonjek
An early historic inscription in Tamil language
An early historic inscription in Tamil language and in Tamil Brahmi script, dateable to c.200 BCE, has been found in the archaeological excavations by a German team at Tissamaharama in the down south of the island of Sri Lanka. The inscription deciphered by I. Mahadevan as ‘Thira’li Mu’ri,’ which means ‘written agreement of the assembly,’ was incised on an early historic Black and Red Ware pottery. The last letter of the inscription, which is retroflex Tamil ‘Ri’, is very clearly a Tamil phoneme in Tamil Brahmi script, academics commented. The Tamil Brahmi inscription is also found mixed with megalithic or early historic graffiti marks, which were probably the symbols of the guild, they further said. Tissamaharama or ancient Mahaagama is located close to Kathirkaamam (Kataragama), a famous pilgrim centre for Tamils as well as Sinhalese. (Black and Red Ware pottery inscribed in Tamil Brahmi found in the archaeological excavation of Tissamaharama.)
Prakrit and Tamil were the earliest written languages of South Asia.
The first evidences in these languages, in phonetic writing, appear from c.3rd century BCE.
Sinhala, as an identifiable language appears in the inscriptions from c. 8– 9th century CE onwards.
The following is what I. Mahadevan, doyen of the study of Tamil Brahmi, wrote on Tissamaharama potsherd inscription in The Hindu, Thursday:
“Tamils have been living in the northern and eastern parts of the island from time immemorial. Several small fragments of pottery with a few Tamil‐Brahmi letters scratched on them have been found from the Jaffna region. However, a much more sensational discovery is a pottery inscription from an excavation conducted at Tissamaharama on the southeastern coast of Sri Lanka. A fragment of a high‐quality black and red‐ ware flat dish inscribed in Tamil in the Tamil‐Brahmi script was found in the earliest layer. It was provisionally dated to around 200 BCE by German scholars who undertook the excavation. The inscription reads tiraLi muRi, which means “written agreement of the assembly” The inscription bears testimony to the presence in southern Sri Lanka of a local Tamil mercantile community organised in a guild to conductmaritime trade as early as at the close of the 3rd century BCE”.
Writing on “An Epigraphic perspective on the Antiquity of Tamil.” Mahadevan cited the American scholar Thomas Trautman and said: “The three ‘fundamental discoveries’ in indological studies are the discovery of the Indo-European language family (1786); the discovery of the Dravidian language family (1816), and the discovery of the Indus civilization (1924). It is significant that two of the three ‘fundamental discoveries’ relate to the Dravidian, though the latest one is still being ‘debated’ for want of an acceptable decipherment of the Indus Script.”
Mahadevan continues: “Part of the problem in the delayed recognition accorded to Tamil in Indological studies was the non‐availability of really old literary texts and archaeological evidence for the existence of Tamil civilisation in ancient times. The critical editions of the earliest Tamil literary works of the Sangam Age, especially by U.V. Swaminathaiyar from 1887, have led to a radical reassessment of the antiquity and historicity of Tamil civilisation. What Swaminathiyar did for Tamil literature, K.V. Subrahmanya Aiyer accomplished for Tamil epigraphy. He demonstrated (in 1924) that Tamil (and not Prakrit) was the language of the cave inscriptions of Tamil Nadu..”
Eezham Tamil academics sadly commenting on the repeated assertions of Mahadevan in giving exclusive credit to Swaminathaiyar for the publication of Changkam literature and not giving due credit to the efforts of Eezham Tamils, said scholars from Jaffna did the pioneering work decades before Swaminathaiyar.
The first ever Changkam text that saw the light of print was Thirumurukaattuppadai of Paththuppaaddu (one of The Ten Idylls), which was brought out by Arumuga Navalar of Jaffna in 1851.
The first of the Eight Anthologies (Edduththokai) of the Changkam classics that got printed was Kaliththokai (1887). This was brought out by C.W. Thamotharam Pillai of Jaffna, who was an old student of the Jaffna College and was the first graduate of the University of Madras.
Swaminathaiyar brought out his first edition of the Changkam classics Paththuppaaddu in 1889.
Earlier to bringing out Kaliththokai, Thamotharam Pillai started publishing post-Changkam classics such as Choo'laama'ni, Tholkaappiyam etc right from 1860's.
The pioneering work of translating the Changkam classics into English, to the awareness of the outside world, was also done by Eezham Tamil scholars.
J V Chellaiah of Jaffna College did the entire translation of Paththuppaaddu in 1945. This was decades before A K Ramanujan or Hart translating parts of the Eight Anthologies.
Swami Vipulanandar of Batticaloa who made arrangement for the publication of Chellaiah’s translation painfully notes how the then Madras government or the Annamalai university didn’t give any help to the venture even though they admired the translation, and how he finally brought it out as a publication of the government press of then British Ceylon.
Ref https://sites.google.com/
— with Bhagat Singh Kranti Sena, Badsha Arass, Shamila Navarathnam, Mussanthini Utha
Study finds herbal extract may curb binge drinking
An extract of the Chinese herb kudzu dramatically reduces drinking and may be useful in the treatment of alcoholism and curbing binge drinking, according to a new study by McLean Hospital and Harvard Medical School researchers.
"Our study is further evidence that components found in kudzu root can reduce alcohol consumption and do so without adverse side effects," said David Penetar, PhD, of the Behavioral Psychopharmacology Research Laboratory at McLean Hospital, and the lead author of the study. "Further research is needed, but this botanical medication may lead to additional methods to treat alcohol abuse and dependence."
In the study, published in the current issue of Drug and Alcohol Dependence, researchers in the Behavioral Psychopharmacology Research Laboratory at McLean Hospital looked at one of the major components of the kudzu root—the isoflavone puerarin—to determine whether it would reduce alcohol consumption in a laboratory simulation of an afternoon drinking session.
According to Penetar, puerarin was selected over other kudzu root components because its safety and efficacy have already been established in humans, particularly in China where it is approved for intravenous injection to treat coronary heart disease, myocardial infarction and angina. Puerarin is also less potent than other parts of the kudzu plant, so it has few side effects and has none of the estrogenic activity found in other components, making it safe for women.
In the study, Penetar and his colleagues looked at 10 men and women, all in their 20s and all reporting regularly consuming alcohol weekly. A laboratory at McLean Hospital was set up as an apartment, with TV, DVD player, reclining chair and other amenities. The unit was also stocked with a refrigerator full of each subject's favorite beer and other non-alcoholic beverages.
In an initial 90-minute session in the "apartment," each subject was allowed to consume as many beers as he or she wanted—up to a maximum of six. After the session, each was given either puerarin or a placebo and told to take it daily for a week. Then, each returned to do the experiment again. Two weeks later, the subjects returned for a third session to see if they had returned to their baseline drinking levels. After that, each subject was given the pill he or she didn't get the first time and told to take it for a week. Each then returned for a fourth and final drinking session.
The study showed that subjects taking puerarin drank significantly fewer beers—dropping from 3.5 beers on average to 2.4.
"This was a simulation of a binge drinking opportunity and not only did we see the subjects drinking less, we noted that their rate of consumption decreased, meaning they drank slower and took more sips to finish a beer," explained Penetar. "While we do not suggest that puerarin will stop drinking all together, it is promising that it appears to slow the pace and the overall amount consumed."
The Behavioral Psychopharmacology Research Laboratory at McLean Hospital has been involved in a series of research projects for more than 10 years, looking at the ability of extracts of the kudzu root and its components to reduce excessive drinking with very encouraging results.
Provided by McLean Hospital
"Study finds herbal extract may curb binge drinking." May 17th, 2012. http://medicalxpress.com/news/2012-05-herbal-curb-binge.html
Posted by
Robert Karl Stonjek
Robert Karl Stonjek
Pain relief through distraction -- it's not all in your head
Mental distractions make pain easier to take, and those pain-relieving effects aren't just in your head, according to a report published online on May 17 in Current Biology.
The findings based on high-resolution spinal fMRI (functional magnetic resonance imaging) as people experienced painful levels of heat show that mental distractions actually inhibit the response to incoming pain signals at the earliest stage of central pain processing.
"The results demonstrate that this phenomenon is not just a psychological phenomenon, but an active neuronal mechanism reducing the amount of pain signals ascending from the spinal cord to higher-order brain regions," said Christian Sprenger of the University Medical Center Hamburg-Eppendorf.
Those effects involve endogenous opioids, which are naturally produced by the brain and play a key role in the relief of pain, the new evidence shows.
The research group asked participants to complete either a hard or an easy memory task, both requiring them to remember letters, while they simultaneously applied a painful level of heat to their arms.
When study participants were more distracted by the harder of the two memory tasks, they did indeed perceive less pain. What's more, their less painful experience was reflected by lower activity in the spinal cord as observed by fMRI scans. (fMRI is often used to measure changes in brain activity, Sprenger explained, and recent advances have made it possible to extend this tool for use in the spinal cord.)
Sprenger and colleagues then repeated the study again, this time giving participants either a drug called naloxone, which blocks the effects of opioids, or a simple saline infusion. The pain-relieving effects of distraction dropped by 40 percent during the application of the opioid antagonist compared to saline, evidence that endogenous opioids play an essential role.
The findings show just how deeply mental processes can go in altering the experience of pain, and that may have clinical importance.
"Our findings strengthen the role of cognitive-behavioral therapeutic approaches in the treatment of pain diseases, as it could be extrapolated that these approaches might also have the potential to alter the underlying neurobiological mechanisms as early as in the spinal cord," the researchers say.
More information: Sprenger et al.: "Attention modulates spinal cord responses to pain." Current Biology, DOI:10.1016/j.cub.2012.04.006
Provided by Cell Press
"Pain relief through distraction -- it's not all in your head." May 17th, 2012. http://medicalxpress.com/news/2012-05-pain-relief-distraction-.html
Posted by
Robert Karl Stonjek
Robert Karl Stonjek
Research shows how to increase mental wellbeing and feel happy
Why is it that some people seem to waltz through life in a bubble of happiness, when for others each day is a struggle? Should we just accept the personality we're born with? Or can we act and think ourselves to happiness?
Victoria University PhD researcher Dr Erica Chadwick spent three years examining 'savouring strategies'—the thoughts and behaviours people use to create, maintain or enhance positive experiences—to ascertain what strategies were most effective for overall wellbeing and happiness.
While past research has examined how people savour major but fleeting events, such as going on holiday or receiving a high mark at school, Dr Chadwick investigated the impact of the minor, everyday positive events that make up life.
"I wanted to know not only what increased the feeling of happiness for a moment, but what made a difference to mental wellbeing over time. I also wanted to examine how savouring strategies changed from adolescence to adulthood."
Her research gathered the actions and thoughts of more than 400 young New Zealanders in the Bay of Plenty and 1,500 adults from across New Zealand and overseas, and grouped them into four overall strategies.
Actively boosting feelings of happiness involved physical actions such as celebrating by jumping up and down, high fiving or rushing over to a friend to share good news.
Subtle actions included being more mindful of your surroundings, living in the moment and paying greater attention to your enjoyment of minor events—such as savouring a meal.
Self-focused actions included thinking about being a lucky or fortunate person. They also included congratulating oneself after an achievement and actively realising a moment would be a memory to enjoy again in the future.
Dampening or "keeping things low key" had a negative effect on mental wellbeing.
"What I found interesting as I analysed my research results was that while subtle strategies such as mindfulness positively influenced adult wellbeing, they had a negative effect on adolescents. Instead, self-focused actions were the most powerful savouring strategies for youth," says Dr Chadwick.
"They may be the most effective because teenagers are naturally inward-looking, or it might be because New Zealanders' humble attitude and tall poppy syndrome thwart the effectiveness of more public behaviours."
Dr Chadwick says that for everyone, regardless of age, research clearly shows that meaningful social connections with family and friends remains the most valuable tool for feeling happy and mentally well.
Dr Chadwick graduated with a Doctor of Philosophy in Psychology at Tuesday's Graduation ceremony.
How to feel happier and improve your mental wellbeing:
1. Activate your mind: savouring is a conscious process so look for opportunities to make more of an experience or event, but don’t over think it.
2. Share positive news with other people, especially with those who’ll be happy for you too.
3. Acknowledge your achievements: although this might be anathema to New Zealanders, the research showed taking a moment to congratulate yourself, even silently, greatly improves your wellbeing.
4. And for adults particularly, slow down to more mindfully appreciate day to day activities. Be in the moment.
Provided by Victoria University
"Research shows how to increase mental wellbeing and feel happy." May 17th, 2012. http://medicalxpress.com/news/2012-05-mental-wellbeing-happy.html
Posted by
Robert Karl Stonjek
Robert Karl Stonjek
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