A Monthly Summary of News and Events
Vol. 8 No. 9 - September 2005
This newsletter is sponsored by EEG Spectrum International Intl, Inc.,
a leader in providing clinical service and training professionals.
Past issues are available at start.eegspectrum.com/Newsletter/
Information on how to subscribe or cancel a subscription appear at the end.
The opinions related in this newsletter reflect those of the author only.
Copyright (C) 2005 by David Kaiser or ESII. All rights reserved.
|
|
|---|
All links at: news.yahoo.com/fc/Science/Brain_Research
Shakespeare delves into madness, its nature, tone, and cause, in King Lear, one of drama's greatest tragedies. Mistreated by two of his three daughters King Lear in a fury of madness stumbles upon another man who is also suffering the consequences of familial betrayal, and says to the infinite: "What, have his daughters brought him to this pass?" (Act III Scene iv)
The other man has no daughters, but to Lear everyone has cruel "pelican daughters." It is a subtle but insightful reveal into mental illness -- the obsessive self-absorption, delusion as self-consideration without distraction.
Fast forward four centuries and although many Elizabethan ills have since been cured or curbed, such as scurvy, smallpox, and syphilis, mental illness like Lear in the storm (Act III) rages on. The current lifetime prevalence rate for mental disorders is 1 in 2. The one-year prevalence rate 1 in 4 -- a quarter of the population suffering from mental illness, with women succumbing twice as often to depression and anxiety, men twice as often to addiction.
Due to advances in diagnosis and therapy, half a million adults institutionalized for psychological disorders 50 years ago has been reduced to nearly a tenth of this number today, 65,000. Whereas the institutionalized have dwindle, the number of diagnoses has not, but in fact exploded. In 1952 the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of clinical psychology and psychiatry, listed 60 conditions. In 1994 the 4th edition weighed in with 410 conditions, a exponential increase. Are we getting more mentally ill as time proceeds? No, but our powers of perception are improving, leading to prognostic delineations -- subtyping, new classifications, with targeted treatments, which has led to the drop in institutionalizations.
Mood disturbances go hand and hand with the arts and humanities, cognitive disturbances with science and mathematics. A list of bipolar or unipolar depressed composers might capture nearly every name you know, except Bach. Of famous writers, John Milton of Paradise Lost fame wrote: "The mind is its own place, and of itself/ Can make a Heaven of Hell, a Hell of Heaven." Creativity seems to flow from mood dysfunction. Perhaps it is the emotional reactivity of the bipolar artist, the unfiltered life; or perhaps the disinhibited or loose associations; or perhaps the grandiosity spurs an absorption on a single topic longer than most would care to focus and finally it cracks open and reveal some transpersonal plunder. The intense creative episodes during hypomania are where many bipolar composers and writers do their best (and sometimes only) work. Here is a list of famous artists with bipolar disorder:
Hans Christian Anderson Ludwig von Beethoven Lord Byron Charles Dickens T. S. Eliot Ralph Waldo Emerson William Faukner F. Scott Fitzgerald Paul Gauguin Ernest Hemingway Michelangelo Sylvia Plath Edgar Allan Poe Gordon Sumner (Sting) Peter Tchaikovsky Leo Tolstoy Mark Twain Virginia Woolf Tennessee WilliamsMany of these artists took their own life, which is not uncommon in bipolar disorder. A survey of writers at the University of Iowa's famed Writers' Workshop in 1987 by Nancy Andreason found 80 % of the faculty with mood disorders, 43% bipolar, 30 % addicted to drugs,, and 12% eventually killed themselves.
Nobel Laureate Albert Camus opens "The Myth of Sisyphus" with the surprising statement: "There is only one really serious philosophical question, and that is suicide." Wittgenstein said it was language, but I tend to agree with the less Aspergerish philosopher Camus. How we communicate is less important than why we would want to stop communicating with others forever. Unfortunately nearly 30,000 Americans each year do so, taking their own lives, nearly twice our homicide rate. Suicide is the 8th leading cause of death in adults, 3rd leading cause for teenagers, and since 1950 the rate for teens has tripled, a disturbing commentary on our culture. Overall we are twice the world rate, with only Japan, a culture of honor and suicide for centuries, coming in ahead of us, 16.7 suicides per 100 thousand compared to 11.9 for the US. In the US females attempt three times more often than males, but males succeed four times as often, probably because women tend to reach for pills, men reach firearms, and firearms are more lethal, accounting for 60% of success attempts.
Depression, especially bipolar depression, has a cycle to it. In bipolar it is normalcy, which rises toward manic peak, peak, decline, normalcy (for the lucky ones), decline toward bottom, bottoming out, rise from bottom (lucky again), and back to normalcy. Unipolar depression does not have a manic component, but both have higher suicide rates which coincide with the mood cycle. Suicide is most often attempted during the rise out of the bottom and there are two schools of thought as to why: (1) an individual wants to die while at the lowest point but hasn't the energy or motivation to complete any plans, and therefore only attempts suicide when energy has returned, during the rise, and (2) more disturbingly, while in the pit of despair an individual make plans to end his or her life, and to finally exert some control over one's life (its end) improves the mood, pulling them out of the pit.
From mood to cognition, we have perhaps the worse mental disorder on the books, Schizophrenia, "split mind," a gross distortion of thought and perception with eventual loss of contact with reality. Schizophrenia is the disorder of science and math: Isaac Newton suffered a psychotic break at age 41, Albert Einstein had a schizophrenic son, and the recent Oscar winning film Beautiful Mind chronicled the tragic life of Nobel Laureate mathematician John Nash Jr, a chronic schizophrenia.
Three types of schizophrenia exist: Paranoid, with delusions or hallucinations often include extreme suspiciousness and hostility; Disorganized, with signs of illogical thinking and speech, and Catatonic, with extremes in motor behavior. A fourth classification, Undifferentiated, is reserved for those who fit the diagnosis but no clear subtype. In schizophrenia we have positive and negative symptoms. Positive symptoms are not good positive, but positive in the sense of excessive, behaviors in addition to the normal ones. Positive symptoms or excesses such as hallucinations, delusions, thought disorders, and bizarre behaviors. Negative symptoms are cognitive, emotional, and behavioral deficits, reductions of the normal behavioral repertoire, such as apathy, flattened affect, social withdrawal, inattention, and slowed speech or no speech.
Here is schizophrenia by the numbers:
- 1% across all cultures, despite few offspring - Male = females, or slightly more males - More in jails than psychiatric hospitals - 50% never accept that they are ill - 90% go off meds once+ (most if not all relapse) - Nearly 100% smoke (nicotine self-stimulates) - Higher prevalence in lower socioeconomic class - 25% full remission, 50% recurrent relapses, 25% permanently hospitalized - 40% attempt suicide, 10% succeed
Delusions are incorrect conclusions about perceptions and include peculiar beliefs such as alien abductions, secret lovers, paranoia, grandiosity, thought insertion or broadcast, and erotomania (everyone loves you), which strikes women four times more than men, interestingly. Other delusions are ideas of reference, that events has special personal meaning, and magical thinking such as controlling events from afar. Most diehard Red Sox fans exhibit the latter two symptoms, at least until the World Series is over.
Hallucinations are inaccurate perceptions, and most are (perhaps surprisingly) auditory -- commanding voice of authority or derision, often a mother, dead or alive, riding her child. Speech changes are often common, in polar extremes, mute or pressured; overall they are insensitive to the informational needs of audience, failing to provide enough consensual reference in their communications, to close to the vest, thoughtwise. Schizophrenics' mood symptoms range from blunted, inappropriate, to exaggerated, with chronic cases often exhibiting flat affect, anhedonia, avolitional, to the point of being vegetative.
As a 20 y old college student I traveled one summer to the mental state hospital systems in New England for my job with Connecticut's conservatorship office. Some of the schizophrenics I dealt with were personable, some bitter, a few grandiose, a few still a bit scary to deal with. One chopped up his mother and put her in the freezer, but it was believed she died naturally and he was merely hiding her body from social workers so he wouldn't be institutionalized. Well, I met him at an institution in Massachusetts, and he was personable, even knew the recent Yankee and Red Sox ball game scores. I couldn't make out his gaze, though: his eyes looked off into the ether, one pointing east, the other roughly west.
Another older schizophrenic responded well to the question how he was doing. "Fine, fine, fine... " he said, then went silent. After a few minutes of trying to get another response from him, asking about the hospital, nursing staff, weather, he showed his annoyance with me by choking the air with his fists. He wanted me, the young kid, to leave his plane of existence I gathered. But then I spoke up again, "How are you doing?" .... Oh fine, fine, fine, he chirped, then withdrew into his head again. We could have done this for hours -- he had the time -- but I didn't, and it was a sad little game.
The saddest story from this summer now 20 years gone belonged to a young schizophrenic girl who ran through the ward every morning singing the Rolling Stones tune "You can't always get what you want." True, she didn't get what she wanted. Last I heard she was still institutionalized.
Scientist TJ Crow believes schizophrenia is an overreliance on the diffuse representational system of the right hemisphere. Perhaps, but I also believe schizophrenia, like autism, is first and foremost an attention disorder, an individual addicted more to his thought processes than the world's sensory extravaganza. From such concentration on inward processes may derive loose associations, eventual memory impairment, and finally poor management of mental content, i.e., executive dysfunction, but it is the inward addiction that leads to the latter. Schizophrenics, like autistics, also exhibit impaired theory of mind, a failure to monitor what different people can know and even one's own intentional actions.
Failure to develop dominant hand early (by age 7, say) is a sign of eventual schizophrenia (and very common in autism as well). Future adult schizophrenics at 8 to 12 years of age begin to show interpersonal problems, poor emotional control, sometimes a high IQ, but by early teen years we often see cognitive problems emerging, underachievement, disorganized thoughts, poor emotional rapport, few friends, and finally withdrawal, decreased grooming, delusions, and commonly hallucinogens abuse (like marijuana or LSD). One of my closest friends during the summer in Connecticut was a schizophrenic who would take his Haldol as the doctor prescribed, then take a hit (of marijuana) to keep the inward kaleidoscope flowing.
This ends my "Psychopathology by the numbers" lecture, given to introductory Psychology students. The lecture comes with fancy powerpoint pictures to entertain the kids, which they need, because if you haven't notice, attentional disorders in this culture are on the rise.
-DK
News & Reviews
NEW BOOKS
Delivered from Distraction : Getting the Most out of Life with Attention Deficit Disorder
by Edward M. Hallowell M.D.
Very readable overview of latest in ADHD research.
--www.amazon.com/exec/obidos/ASIN/034544230X/eegspectrum
Atlas of Ambulatory EEG
by Schacter, et al
Reference describing EEG patterns in normal and abnormal individuals.
--www.amazon.com/exec/obidos/ASIN/0126213453/eegspectrum
Children and Behavioural Problems: Anxiety, Aggression, Depression ADHD
by Martine F. Delfos
A biopsychological model of children mental health, focused on diagnosis and treatment
--www.amazon.com/exec/obidos/ASIN/1843101963/eegspectrum
Epidemiology of Sleep: Age, Gender, and Ethnicity
by Kenneth L. Lichstein, et al
Sleep of normal individuals is reviewed by age and gender.
--www.amazon.com/exec/obidos/ASIN/0805840796/eegspectrum
Essentials of Clinical Neurophysiology
by Thomas C. Head
Outlines the theory and practice of such neurodiagnostic techniques as electroencephalography, electromyography with nerve conductions, evoked potentials, and polysomnography.
--www.amazon.com/exec/obidos/ASIN/0750674415/eegspectrum
Learning the Language of Addiction Counseling
by Geri Miller
Review of addiction counseling basics for clinicians and grad students.
--www.amazon.com/exec/obidos/ASIN/0471696129/eegspectrum
Assessment of the Human Stress Response: Neurological... Psychological Foundations
by George S. Everly, Steven A. Sobelman
Soon to be released book in the Stress in Modern Society series, a timely topic.
--www.amazon.com/exec/obidos/ASIN/0404632548/eegspectrum
Substance abuse in patients with ADHD
:
A third of adults with ADHD either have a history of substance abuse or currently suffer from it, so pharmaceutical treatments need to be tailored to lower the risk of abuse potential.
Sources of cortical rhythms during physiological aging
:
Age and occipital delta magnitude correlated. This study highlights an analysis to predict dementia in mild cognitive impairment.
Antidepressants may protect against frontal gray matter decline in geriatric depression.
:
Larger orbitofrontal cortex was seen in depressed patients exposed to antidepressants than drug-naive depressed geriatric patients.
Self-regulation of slow cortical potentials.
:
Brain-computer communication based on auditory stimulation only is possible.
Transcranial magnetic stimulation treatment for epilepsy
:
Reviews findings for depression and epilepsy as to whether they can be simultaneously treated with TMS.
Resting anterior cingulate activity and abnormal responses to errors
:
Abnormal responses to errors may arise from reduced affective and/or motivational responses to salient cues.
Thalamic mechanisms of EEG alpha rhythms and their pathological implications.
:
According to the authors, the neurocellular components underlying thalamic alpha rhythms is also responsible for (2-7 Hz) activity, when these cells are less depolarized.
Biophysical modeling of tonic cortical electrical activity in ADHD
:
According to a biophysical model, EEG abnormalities of ADHD are accounted for by increased dendritic response times, increased thalamic reticular nucleus activity, and increased intracortical activity.
Clinical application of single-pulse TMS for the treatment of depression.
:
Single-pulse TMS has antidepressive effects without inducing adverse reactions.
Region-specific changes in prefrontal function with age:
:
Normal ageing is concluded to produce differentiation of cortical function in bilateral ventral PFC and deficits in right dorsal and anterior PFC.
Upcoming CoursesA Pathway to Brain Regulation - Neurofeedback helps improve neuroregulation. It's used by health care professionals for ADHD, depression, anxiety disorders, LD, mood disorders, and behavioral problems. This 4-day course, Neurofeedback in a Clinical Practice, provides the basis for using Neurofeedback clinically. - *28 CEs
Our course is a hands-on experience right from the start. Attendees consistently say this format is a very good way to learn Neurofeedback. "Neurofeedback should be viewed as one of the three essential or primary forms of intervention - psychotherapy, psychopharmacology, and Neurofeedback. In my experience, neurofeedback is every bit as important and powerful as the other two forms of treatment." - Dr. Laurence Hirshberg of Brown University Medical School, a psychologist specializing in Developmental Disorders and Autism. Contact Karie Kramer, our training coordinator, for more information 818-789-3456 ext 847 or see www.eegspectrum.com/Training *EEG Spectrum International, Inc. is approved by the APA to offer continuing education to psychologists. ESII maintains responsibility for the program. |
Conferences for Neurofeedback Clinicians & Researchers | ||
|---|---|---|
| CONFERENCE | LOCATION | DATES |
| ISNR - http://www.isnr.org | Denver CO | Sep 8-11 |
Knowledge is a political process and science is no exception. Funding and voicing one's interpretations are socially controlled and while the Web attempts to level the playing field, the cacophony of information online still means that money and culture matter and direct opinion. Useful knowledge is a tool, a way to leverage one domain of nature against another, and neuroscience is the newest and strongest tool in our arsenal -- from clinical treatment to self-understanding. But it is a costly tool, politically controlled, and slow to take effect, but now it is finally taking wide effect (see Announcement, above, for instance).
I don't go to conferences for lectures but to talk. If I hear two new and interesting lectures over the weekend, well, that's a bonus. My conference, the real conference, happens in coffee shops, hotel lounges, and over dinner menus. Meeting people one on one, talking about the newest work with a speaker three feet away is how knowledge is best exchanged. Conversation creates knowledge, lectures only transmit it. That's also why I rarely attend early morning sessions -- up too late the night before talking one on one.
Here are the lectures I can recall best: Robert Coben's work on autism, Barry Sterman's mechanism behind SMR training, and Mario Beauregard's fMRI validation of neurotherapy. All of these people are doing interesting work. Mario and his colleagues in Montreal are working on Spiritual Neuroscience, where they study fMRI and EEG correlates of mystical experiences (remembrances from cloistered nuns). As it so happened, I went to the conference with my latest set of games, and one was a Serenity Set which uses quotes from various sources to facilitate oneness, calmness, perhaps even a mystic sense. For the first version of this set, with more to come, I relied on the Gospel of John (the most metaphoric of the gospels), Ecclesiastes (where earliest consciousness had just emerged historically -- "all is vanity, vanity" lines, etc), and the Tao. Feeling in touch with a higher power or recognizing that one can organize into a union that serves the interests of individuals better than going alone is important to mental health and neurotherapy. As I said during my lecture at the conference, there is an "infiltration of a supraorganizational force into the action of individual .... neurons" . Oh well, until the word "neurons" it sounded like I was talking about religion instead of the thalamocortical network.