Tuesday, May 15, 2007

Psychiatry Updates

For those interested in teach-yourself knowledge about the brain, McGill University has a site The Brain Top To Bottom. The advantage is that it comes in Beginner, Intermediate, and Advanced versions, so you can click back and forth between levels of difficulty on a particular topic.

For those who like the genetic angle, there is an interview with Elliot Gershon about the overlap of affected genes in both schizophrenia and bipolar disorder. This remains preliminary, but intriguing.
DAOA (D-amino-acid oxidase activator) is strongly implicated in both bipolar disorder and schizophrenia,” Dr. Gershon says. “There is some evidence that NRG-1 (neuregulin-1) might overpresent in individuals with bipolar disorder, but they’re not conclusive. The dysbindin-1 encoding gene appears to be implicated mainly in schizophrenia.” Other genes that may be associated with both illnesses include COMT, BDNF, and DISC1.

“The overlap in genetic susceptibility is quite interesting,” Dr. Gershon says.

“It appears that, although they tend to run in different families, both bipolar disorder and schizophrenia may share some common genetic—and therefore biologic—susceptibilities. This may partly explain why the two disorder have shared symptoms and respond to some of the same medications.
The main page of this excellent site provides links to other new studies, including an update on the next generation of SSRI's, the SNRI's (serotonin norepinephrine reuptake inhibitors).

My department is suddenly awash in "bodywork" therapies, which I remain extremely skeptical of. These would including things like Reiki, Rolfing, Orgonomy, Pesso-Boyden, and a dozen others. There is nothing particularly objectionable to the overarching theory that the body and mind are closely tied or even a unity, and the mind can be repaired by interventions on the body. The idea is that postures, sensations, sounds, and the like can be used to work backwards, the body teaching the brain. The difficulty is that this has proved enormously difficult to substantiate. Much of the neurological and brain-response info that the bodywork people quote does not actually provide evidence for their theories, but only possible explanations at a brain structure level of how they could work. Much of the current focus is on remote trauma and attachment disorder treatment. It has always been hard to sort out with such folk what we might call a measurable improvement, and how much of that results from the specific treatment versus the presence of increased structured attention.

On an odd note, we have two patients who seem to have been successful at cheeking Zyprexa Zydis, which would be quite a feat. We have not only one classic A-B-A experiment, but two on each of them. We have a guess how they are doing it, which I won't mention in case some paranoid who wants to ditch his meds is googling "cheeking Zyprexa Zydis" and stumbles on this. But if any of the 40-per-day of you has any further comment or interest, contact me.


Anonymous said...

Cheeking Zydis? Hrm, yeah, don't put the details up--I might be tempted someday!

I like the brain site, thanks.

Anonymous said...

I'm feeling stupid here. I can't figure out how to get a hold of you and I want to know what cheeking zydis is. No, I'm not tempted... I don't think.

Assistant Village Idiot said...

"cheeking" means hiding a medication in your cheek (or under your tongue) and spitting it out surreptitiously. The term is used loosely to refer to any type of trickery in not taking meds. Zydis is a form of the medication that dissolves on contact with saliva. Which would theoretically fix that problem, right?

Contact me via my profile.