-
Is The DSM-IV (SCID) Misapplied? What About Bipolar Disorder?
Providence, RI, USA. Researchers have identified problems with applying the Structured Clinical Interview for DSM-IV (SCID) (http://cpmcnet.columbia.edu/dept/scid/), reporting that fewer than half the patients previously diagnosed with bipolar disorder received a diagnosis based on a comprehensive, psychiatric diagnostic interview — the SCID. The study in the American Psychiatric Association (APA) (http://www.psych.org/) (7 May 2008).
Is Bipolar Disorder Overdiagnosed? Mark Zimmerman, M.D.; Camilo J. Ruggero, Ph.D.; Iwona Chelminski, Ph.D.; and Diane Young, Ph.D. The Journal of Clinical Psychiatry. Pubished ahead of print.
The study method involved 700 psychiatric outpatients who were interviewed using the SCID and completed a self-administered questionnaire between May 2001 and March 2005. The questionnaire asked patients whether they had been previously diagnosed with bipolar or manic-depressive disorder by a health care professional. Family history of bipolar disorder was used as an index of diagnostic validity.
Of the 700 patients, 145 reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the 145 patients (43.4 percent) were diagnosed with bipolar disorder based on the SCID. Further, the study showed that patients diagnosed with bipolar disorder based on the SCID had a significantly higher morbid risk of bipolar disorder in first-degree relatives.
Unnecessary side effects are a significant concern of overdiagnosis. Because mood stabilizers are the treatment of choice for bipolar disorder, overdiagnosing can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.
Lead author Mark Zimmerman, M.D., director of outpatient psychiatry at Rhode Island Hospital (http://www.rhodeislandhospital.org) and associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University (http://bms.brown.edu/), notes, “Clinicians are inclined to diagnose disorders that they feel more comfortable treating. We hypothesize that the increased availability of medications that have been...
-
Out There: Some US Governorships Could Flip Partisan Control
Washington, DC, USA. After a pair of hard-fought primaries, North Carolina joins Missouri, Washington and Indiana on the Out There list of states where partisan control of the governorship could flip this fall.
Since January, the last time Out There assessed the 11 governorships up in 2008, the contests are swinging to extremes — either getting hotter than ever, or snoozier.
The likelihood of a switch in partisan control of the top spot has grown in at least three states — Missouri, Washington state and North Carolina — and remains high in Indiana, making these races the most vulnerable for the party in control, according to an analysis by Out There.
Meanwhile, depending on who chooses to run, Delaware and Vermont could find themselves breaking out of the “Safe” rating (for a likely win by the controlling party) into the currently vacant “Worth Watching” category. And the other five states? Let’s
just say the incumbents remain well-ensconced.
Vulnerable
Missouri Gov. Matt Blunt (R), besieged by low approval ratings, faced such an uphill climb to reelection against Attorney General Jay Nixon (D) that he decided earlier this year to forgo a second term, leaving voters to decide an unexpected open seat.
U.S. Rep. Kenny Hulshof and state Treasurer Sarah Steelman are competing for the GOP nod to run in the Aug. 5 primary. Either one would start as an underdog, since Nixon, a veteran campaigner, has been running and raising money for the better part of four years. And whoever wins the GOP spot, after already starting from scratch late in the cycle, won’t be able to focus his or her fire on Nixon until after the primary.
The two Republicans seem evenly matched, with the main difference being Hulshof’s six terms in Washington, which...
-
How Cell Communication Activates Cell Division Machinery
Barcelona, Spain. Developmental biologists have made strides in understanding how tissues are controlled at the molecular and genetic level. Detailed investigations into tissue growth and patterning can be a drawn-out affair, but process modeling is very useful, with high predictive value for the further study of comparable human systems. Drosophila melanogaster is such a system, with proven worth as a model because of its well-described developmental biology and suitability for genetic and molecular manipulations.
Researchers at the Institute for Research in Biomedicine (IRB Barcelona) (http://www.irbbarcelona.org/) performed studies on D. melanogaster, a common fruit fly, to understand the cell proliferation that results in the organized growth of an organ (in this case, the fly wing). The fruit fly wing is a vital experimental model to find future biomedical applications.
A Wingless and Notch double-repression mechanism regulates G1-S transition in the Drosophila wing. Héctor Herranz, Lidia Pérez, Francisco A Martín and Marco Milán. The EMBO Journal 1 May 2008. doi: 10.1038 / emboj.2008.84
The signaling pathways involved in this process are also conserved in humans. When altered in diverse tissues, they can give rise to alternative development and the appearance of different types of cancer, including cancer of the colon and skin, and leukemia. The findings appear in The EMBO Journal (http://www.nature.com/emboj/index.html), sponsored by the European Molecular Biology Organization (EMBO) (http://www.embo.org/), and document the distinct signaling pathways that operate between neighboring cells to activate the cell proliferation machinery.
Marco Milán, ICREA Research Professor at IRB Barcelona, led a study team in Milán's Cell and Development Biology Laboratory.
In multicellular organisms, groups of cells assemble to form tissues. Initially homogenous, the field of cells (tissue) subdivides into smaller territories. This is the beginning of a spatial pattern. The subdivision of of D. melanogaster depends on mechanisms...
-
World's First Completely Automated Anesthesia System Underway
Montreal, Quebec, CAN. Researchers performed the world’s first totally automated administration of an anesthetic. Nicknamed “McSleepy,” the new system administers drugs for general anesthesia and monitors their separate effects completely automatically, with no manual intervention. The anesthetic technique was used on a patient who underwent a partial nephrectomy, a procedure that removes a kidney tumor while leaving the non-cancerous part of the kidney intact, over a period of three hours and 30 minutes.
The work was done at McGill University (http://www.mcgill.ca/) and the McGill University Health Centre (MUHC) (http://www.muhc.ca/). We have been working on closed-loop systems, where drugs are administered, their effects continuously monitored, and the doses are adjusted accordingly, for the last five years,” said Dr. Thomas M. Hemmerling of McGill’s Department of Anesthesia and the Montreal General Hospital (http://www.muhc.ca/pfv/mgh/), who heads ITAG (the Intelligent Technology in Anesthesia research group), a team of anesthesiologists, biomedical scientists and engineers.
Hemmerling says to “Think of “McSleepy” as a sort of humanoid anesthesiologist that thinks like an anesthesiologist, analyses biological information and constantly adapts its own behavior, even recognizing monitoring malfunction.
During the the partial nephrectomy, McSleepy manipulated the various components of general anesthesia. The automated system measured three separate parameters displayed on a new Integrated monitor of anesthesia (IMATM):
depth of hypnosis via EEG analysis,
pain via a new pain score, called Analgoscore™, and
muscle relaxation via phonomyography™.
All of the parameters were developed by ITAG. The system then administered the appropriate drugs using conventional infusion pumps, controlled by a laptop computer on which “McSleepy” is installed.
Using these three separate parameters and complex algorithms, the automated system calculates faster and more precisely than a human can the appropriate drug doses for any given moment of anesthesia. “McSleepy” assists the anesthesiologist in the same way...
-
Protocols, Shrinks, & Therapists: Answering The Question Game
Springfield, VA, USA. In my ancient days at university, back when we did math in our heads or used a slide rule (gather round children it was a time when there were no hand held calculators and computers were large exotic creatures that spoke Fortran and COBOL), so long ago that the revered shrinks were two — Freud and Jung — and Carl Rogers was the hot pop-psych guru.
I was a psychology minor with a double minor in education, eventually earning a grand total of 30 semester units in psychology (that would be something like 4000 quarter units, I guess).
All of this was accomplished while completing a BA in English, a Masters in Rhetoric, and a Secondary Teaching Credential and doing my best to avoid the draft and participation in the Viet Nam War.
As a matter of course, I learned how the Rorschach works [1] and other devious mechanisms of psychological deviltry intended to dissect the human mind. The mind professors taught me the difference between what was considered normal and the people they would really like to
get their hands on for research. [2]
When I met my Shrink (and he met me), I told him up front that I had been part way up the mountain (not mentioning what I had learned on my own), promising I would try to respond spontaneously to his questions and not run my thoughts through a pre-amp filter. Then I mentioned that he was sitting at the proper shrinking distance — close enough to the patient to seem friendly, far enough away to retain distance and authority — and off we went, traipsing through the twists and eddies of my psyche. [3]
Meanwhile, back in school, I had learned that all psyche’s were...
-
Toying With Powerful Forces: We Know What We Are Doing.
-
Can The US States Fix The 2012 Presidential Primary Process?
Cambridge, MA, USA. What if the presidential primary worked more like a lottery with all the states having a chance at the ultimate prize of being first to vote in the nominating schedule, ending the coveted tradition of New Hampshire and Iowa leading the pack? That’s a simplified version of one of several ideas being considered by top party and state officials, who aim to prevent a repeat of states’ helter-skelter scramble for early presidential primary dates in 2008.
While voters in Indiana and North Carolina went to the polls today (6 May 2008) to help Democrats pick Hillary Clinton or Barack Obama as their nominee and Republicans rally behind John McCain, party insiders and state election officials are in informal talks to improve the presidential nominating contests for 2012 and beyond.
“Following the frenzied 2008 primary and caucus schedule that began just a few days into the new year, election officials have a strong interest in curbing the impacts of frontloading and restoring order to the process,” said Todd Rokita (R), Indiana secretary of state and president of the National Association of Secretaries of State (NASS) (http://www.nass.org/) during a bipartisan gathering at Harvard University (http://www.harvard.edu/) here April 29 that brought together party and state leaders to discuss the presidential primary process.
While all sides agreed that this year’s historic run for the White House has energized voters, as evidenced by the record voter registration and primary turnout in many states, many are concerned that this cycle’s very early start was unfair to candidates and some voters.
Candidates were forced to start campaigning at Thanksgiving, giving an unfair advantage to highly-funded candidates with name recognition, critics say.
And for some voters, their ballots may not count. States like Florida and Michigan were in such a...
-
Legacy Of Our Mothers: How We Function In Adult Relationships
Los Angeles, CA, USA. Clinical Psychologist Stephan B. Poulter explores how our mothers' emotional legacy directly connects to out ability to function in adult relationships. His new book discusses the powerful influence of our mothers in The Mother Factor: How Your Mother's Emotional Legacy Impacts Your Life (Prometheus Books). He argues that that most of us will never understand the complex legacy imparted by our mothers or its far-reaching impact on our lives, with effects that extend to the mothering of our own children.
The initial bonds we form become the foundation from which our emotional development, communication style, and personality type evolve through adulthood. No other relationship in our lives has the potential to shape us like the one we share with our mothers, and the more we understand the emotional components of it, the more choices and opportunities for relationship change and personal growth will be available to us.
The Mother Factor: How Your Mother's Emotional Legacy Impacts Your Life. Stephan B. Poulter. Prometheus Books. ISBN-10: 1591026075; ISBN-13: 978-1591026075
Poulter defines the mother factor as our emotional development, functioning, and ability to form meaningful relationships in family life, in social life, and with intimate partners. It is an emotional template started with the mother-child relationship that influences our feelings of frustration, love, fear, and hope. Our mothers’ style of parenting is the template for our emotional disposition and our core sense of who and what we are in the world. Poulter stresses that our emotional functioning is consciously and unconsciously shaped by our mothers.
The mother factor can work for or against us. Poulter shows that in order for it to work for us, we must understand the pervasive influence of our mothers. By focusing on our mother factor from many different angles and...
-
Politically Unconnected: Chris Matthews Ready to Play PA Hardball
Washington, DC, USA. Now no longer the center ring for the traveling Democratic presidential nomination circus, Pennsylvania’s inventive political community has discovered a new favorite political parlor game to while away the brisk springtime evenings: will Chris Matthews, the irrepressible host of MSNBC’s Hardball, step down from his pundits perch to run for the US Senate against Arlen Specter in 2010? To a remarkable degree, speculation abounds over this possibility in the Keystone State.
The indications that Matthews will run are abundant. His MSNBC contract runs out next summer, and both he and the network show signs they might be ready for a break from each other. In addition, journalists are reporting that Matthews has been seeking advice privately from key Democrats across the state about his chances against Specter. Reportedly these contacts have included discussion with Governor Rendell concerning campaign resources.
Publicly Matthews has done little to disguise his interest in the race. Asked if he was running on a recent Colbert cable show, Matthews said this:
Did you ever want to be something your whole life … ? When you grow up, some kids want to be a fireman. I want to be a Senator …
There’s a difference between being a celebrity and working for the people. And it’s a greater thing to work for the people than being on television.
If Matthews does run he will not be a stranger either to Pennsylvania or to politics. Born and raised in Philadelphia, he ran and lost a quixotic bid for Congress in 1974. This led him to staffer jobs on Capitol Hill and in the White House, ending his Washington career
as a key aide to Speaker of the House Tip O’Neill during the Reagan years.
What to make of the Matthew prospects. Certainly one...
-
Worth Noting: Oregon Voters' Guide Promotes Phone Sex
Washington, DC, USA. An Oregon voters’ guide lists a very wrong number. California’s governor insults rural legislators who hail from “little towns” should see more of the brave new world. The Illinois Department of Transportation apparently lacks a sense of humor. Parts of the Missouri Governor’s Mansion are fraying and literally falling apart. And Pennsylvania considers selling wine in vending machines. In case you missed those stories this week, Worth Noting fills you in.
Citizens in Oregon who called a voter-information hotline recommended by Oregon Secretary of State Bill Bradbury reached a different sort of hotline — the kind that offers “an exciting new way to go live, one-on-one, with hot, horny girls” for just $2.99 a minute (99 cents for voice mails). The glitch came when Bradbury’s office accidentally switched the correct 866 toll-free area code to an 800 area code, The Oregonian reports. Bradbury released an apology statement and emphasized, “Don’t call that wrong number.”
California Gov. Arnold Schwarzenegger (R) believes state legislators who hail from “little towns” should see more of the brave new world and its technological marvels, including “an airport,” “a highway that maybe has 10 lanes” or even “a highway on top of another highway.” State Sen. Dean Florez (D), whose hometown has 14,000 residents, told The Sacramento Bee he has indeed seen all those things. “Does the governor think that I just normally fly up on ‘crop dusters’ to Sacramento field by field?” he said.
The Illinois Department of Transportation apparently lacks a sense of humor. It ordered Oak Lawn Mayor Dave Heilmann to remove the additional signs he posted beneath 50 red octagonal stop signs, the Chicago Tribune reports. Heilmann hoped the quirky signs would make motorists pay more attention and actually stop. A sampling of the signs: “Stop…and...
-
The Road To Drug Information Systems Is Marked By Icons
Paris, France. So here we are in the 21st century still trying to decipher a busy physician's handwriting and ensure that drug prescriptions do not have errors. The number of medical codes in common use among the industrialized nations continue to increase but medical charts and other documents rely on old-fasioned manual transcription. At the same time, electronic devices, such as a Personal Data Assistants (PDA) with touch screens are increasingly available.
Icons can be a convenient graphical shorthand for what would be otherwise lengthy text descriptions. They are very common in online applications ranging from websites to music downloads, as well as more tradional settings such as supermarket and road signage. Up until now, there has not been a focused attempt to bring a meaningful graphical notation to bear on medical issues.
An iconic language for the graphical representation of medical concepts. Jean-Baptiste Lamy, Catherine Duclos, Avner Bar-Hen, Patrick Ouvrard and Alain Venot. BMC Medical Informatics and Decision Making 2008, 8:16 doi: 10.1186 / 1472-6947-8-16. ISSN 1472-6947. [ Download PDF (http://ts-si.org/files/BMC-IconLanguage1472-6947-8-16.pdf) ]
VCM language learning and reference manual. Jean-Baptiste Lamy, et. al. University of Paris. 5 October 2007. [ Download PDF (http://ts-si.org/files/VCM-LanguageLearningReference.pdf) ]
Now, a new information icon system has been developed by researchers in France. The researchers describe their system, a graphical language for medical knowledge visualization called VCM (Visualisation des Connaissances Médicales), in the journal University of Paris (http://www.paris-sorbonne.fr/en/) and colleagues recognized that doctors do not always recall, nor have easy access to, detailed drug information. They can refer to drug monographs, but this can be inconvenient and time consuming in a busy medical practice. Lamy and his team reasoned that a new symbolic language for drug information could speed up the process and help avoid prescribing errors.
The VCM...
-
Although Maybe It's Just A Phase, Like Freshman Year In College
-
How Diagnostic Errors Can Lead To A Misdiagnosis Of Patients
Paris, France. How frequently do doctors misdiagnose patients? The issue of diagnostic error is rarely discussed and often understudied. While research has demonstrated that the great majority of medical diagnoses are correct, the answer is probably higher than patients expect and certainly higher than doctors realize. New research shows that errors ranged from <5% in the perceptual specialties (pathology, radiology, dermatology) up to 10% to 15% in many other fields.
In a Supplement to The American Journal of Medicine (http://www.amjmed.com/), a collection of articles and commentaries sheds light on the causes underlying misdiagnoses and demonstrates a nontrivial rate of diagnostic error.
Diagnostic Error: Is Overconfidence the Problem. Edited by Mark L. Graber MD, FACP, Eta S. Berner EdD, FACMI, FHIMSS. The American Journal of Medicine 121(5S) Supplement (May 2008).
The papers in this volume confirm the extent of diagnostic errors and suggest improvement will best come by developing systems to provide physicians with better feedback on their own errors.
Guest Editors Mark L. Graber, MD, FACP (Veterans Affairs Medical Center, Northport, NY (http://www1.va.gov/directory/guide/facility.asp?id=101) and Department of Medicine, SUNY Stony Book) and Eta S. Berner, EdD (School of Health Professions, University of Alabama at Birmingham (http://main.uab.edu/)) oversaw the development and compilation of these papers.
-
Sick: Normal Service Will Be Resumed As Soon As Possible
-
Influence Of Brain's Hard-wired Hierarchy On Health And Behavior
Bethesda, MD, USA. Does your position in a social hierarchy strongly influence your motivation and impact on your physical and mental health? Yes, M'am. Studies have shown that social status strongly predicts health. Animals chronically stressed by their hierarchical position have high rates of cardiovascular and depression/anxiety-like syndromes. A classic study of British civil servants found that the lower one ranked, the higher the odds for developing cardiovascular disease and dying early.
Lower social rank likely compromises health through psychological effects, such as by limiting control over one's life and interactions with others. However, in hierarchies that allow for more upward mobility, those at the top who stand to lose their positions can have higher risk for stress-related illness.
Know Your Place: Neural Processing of Social Hierarchy in Humans. Caroline F. Zink, Yunxia Tong, Qiang Chen, Danielle S. Bassett, Jason L. Stein, and Andreas Meyer-Lindenberg. Neuron 2008 58: 273-283.
Little has been known about how the human brain translates such factors into health risk. However, neuroscientists have instensified their investigations into how different parts of the brain are structured and which functions influence human behavior. New imaging studies have identified human brain circuitry associated with social status.
In this study, circuitry activated by important events responded to a potential change in hierarchical status as much as it did to winning money. They found direct evidence that different brain areas are activated when a person moves up or down in a pecking order — or simply views perceived social superiors or inferiors.
The findings were reported by researchers at the US National Institute of Mental Health (NIMH) (http://www.nimh.nih.gov/) of the US National Institutes of Health (NIH) (http://www.nih.gov/). Caroline Zink, Ph.D., Andreas Meyer-Lindenberg, M.D., Ph.D., and colleagues of the NIMH Genes Cognition and Psychosis Program, report on...
|
TS Symposium 
