Blog Explanation

This blog brings together content that is noticeable, important or otherwise interesting from a human givens point of view.

Tuesday, 13 September 2011

Harold Laski The Dangers of Obedience

“Civilisation means, above all, an unwillingness to inflict unnecessary pain. Within the ambit of that definition, those of us who heedlessly accept the commands of authority cannot yet claim to be civilized men and women...”

Monday, 12 September 2011

Pre-Bed Booze May Bust Rest

A nightcap may force the body to work harder at repair during sleep, making for a less restful night. Katherine Harmon reports
People often turn to wine, beer or cocktails to unwind at the end of the day. These drinks might seem to be relaxing and to aid sleep. But research has shown that people who drink alcohol in the evenings actually get less REM sleep and have less restful nights.

Now a study demonstrates that late-night alcohol might decrease the amount of necessary overnight repair work that the body can do.

Subjects in the study drank strong, weak or alcohol-free beverages an hour-and-40-minutes before going to bed. The more booze the volunteers imbibed, the higher their overnight heart rate. These rapid beats were an indication that their bodies were not in the most productive rest mode, say the researchers. The work appears in the journal Alcoholism: Clinical & Experimental Research. [Yohei Sagawa et al., "Alcohol Has a Dose-Related Effect on Parasympathetic Nerve Activity During Sleep"]

The findings might help explain why those who frequently drink often suffer from insomnia at night and sleepiness during the day, as well as more long-term health effects.

So if you're looking for better, more healthful sleep, maybe avoid the night-time nightcap.

—Katherine Harmon

For those interested, here is the study abstract:

Alcohol Has a Dose-Related Effect on Parasympathetic Nerve Activity During Sleep
  • Yohei Sagawa,
  • Hideaki Kondo,
  • Namiko Matsubuchi,
  • Takaubu Takemura,
  • Hironobu Kanayama,
  • Yoshihiko Kaneko,
  • Takashi Kanbayashi,
  • Yasuo Hishikawa,
  • Tetsuo Shimizu
Article first published online: 16 AUG 2011


  • Alcohol;
  • Ethanol;
  • Sleep;
  • Autonomic Nerve Activity;
  • Heart Rate Variability
Background: The aim of this study was to identify the acute effects of ethanol on the relationship between sleep and heart rate variability (HRV) during sleep.
Methods: Ten healthy male university students were enrolled in this study. An alcoholic beverage was given to each subject at a dosage of 0 (control), 0.5 (low dose: LD), or 1.0 g (high dose: HD) of pure ethanol/kg of body weight. All experiments were performed at 3-week intervals. On the day of the experiment, a Holter electrocardiogram was attached to the subject for a 24-hour period, and the subject was instructed to drink the above-described dosage of alcoholic beverage 100 minutes before going to bed; polysomnography was then performed for 8 hours. Power spectral analysis of the HRV was performed using the maximum entropy method, and the low- (LF: 0.04 to 0.15 Hz) and high-frequency (HF: 0.15 to 0.4 Hz) components along with LF/HF ratio were calculated.
Results: As alcohol consumption increased, the heart rate increased and the spectral power of HRV measured at each frequency range decreased. Higher doses of ethanol also increased the LF/HF ratio compared with the measured ratio of the control group.
Conclusions: Acute ethanol intake inhibits parasympathetic nerve activity and results in predominance of sympathetic nerve activity during sleep, in a dosage-dependent manner. The results of this study suggest that ethanol interferes with the restorative functions of sleep

PTSD Can Surface for Years After Initial Trauma, Post-9/11 Study Shows Pauline Anderson

May 29, 2009 — A new study that assessed New Yorkers exposed to the events of September 11, 2001 provides additional evidence that posttraumatic stress disorder (PTSD) can surface up to 2 years after the event in individuals with preexisting emotional or social problems.
The study, which offers unique insights into the effects on the population of the same traumatic event, found that possible contributing factors to PTSD include a history of depression, female sex, Latino ethnicity, and low self-esteem.
In addition to this delayed reaction, the response to the original traumatic event could be triggered by a subsequent stressful event, such as a job loss, said lead author, Joseph A. Boscarino, PhD, from the Geisinger Center for Health Research, in Danville, Pennsylvania.
"Doctors should be aware of these background factors and that there could be a triggering event that all of a sudden causes a person to lose his or her psychological resources and social support and could manifest in a full-blown PTSD reaction," Dr. Boscarino told Medscape Psychiatry.
"They might misdiagnose this symptom onset as depression or substance abuse, and it's not. If these patients don't get to psychotherapy or get to a mental-health professional, the diagnosis might be missed."
The study is published online March 7 in Social Psychiatry and Psychiatric Epidemiology.
Dr. Boscarino and colleagues interviewed a random sample of English- and Spanish-speaking adults who were living in New York City on the day of the World Trade Center (WTC) disaster. At baseline, they conducted 2368 diagnostic interviews by telephone about between October and December 2002. At 1-year follow-up, they interviewed 1681 of the original sample.
To meet PTSD criteria, subjects had to be exposed to a traumatic event and to have experienced intense feelings of fear, helplessness, or horror. In addition, they had to have suffered symptoms of avoidance, intrusive thoughts, and increased arousal for at least 1 month, and these symptoms had to have a negative impact on their functioning or caused significant distress.
The baseline and follow-up PTSD assessments covered the year prior to the date of the interview.
Delayed And Persistent Cases
Investigators classified resilient cases of PTSD as those that did not meet PTSD criteria at either baseline or follow-up and remitted PTSD cases as those that met criteria at baseline but not at follow-up. Delayed PTSD cases did not meet criteria at baseline but did at follow-up, and persistent PTSD cases met criteria at both baseline and follow-up.
Demographic variables included age, sex, marital status, and race. Stress variables included degree of exposure to the WTC disaster (low, moderate, high, or very high) and traumatic events experienced before or during the year after the WTC disaster. Psychosocial variables included social-support availability and self-esteem. Researchers also assessed respondents for lifetime depression, panic attack during the WTC disaster, handedness, and presence of attention-deficit disorder (ADD).
The study found that the majority of PTSD cases that occurred at baseline and follow-up appeared to be related to the WTC disaster and not to some other trauma — not surprising, considering the impact of this event.
Lifetime Trauma Significant
At baseline, there were significant associations between PTSD and being female (odds ratio [OR], 3.64), having depression before the WTC disaster (OR, 3.30), having been exposed to more lifetime traumas (OR, 1.33), having self-esteem (OR, 0.88), having social support (OR, 0.90), and having greater exposure to the WTC-disaster events (OR, 1.34).
At follow-up, the most important associations with PTSD were being Latino (OR,2.33), being mixed-handed (OR, 2.61), being an immigrant (OR, 1.95), having experienced recent negative life events (OR, 1.92), having been exposed to more lifetime traumas (OR, 1.19), and having self-esteem (OR, 0.77).
Compared with resilient cases, persistent PTSD — those cases present at baseline and at follow-up — were more likely to have a history of depression (RR, 4.08); be mixed-handed (relative risk [RR], 4.63), female (RR, 2.80), an immigrant (RR, 2.73), or Latino (RR, 2.54); having had greater negative life events (RR, 2.20), greater WTC-disaster exposure (RR, 1.70), or greater lifetime trauma exposure (RR, 1.40); and having self-esteem (RR, 0.75).
Being Latino seems to carry a special vulnerability to PTSD even after for socioeconomic status and language were controlled for, said Dr. Boscarino, adding that it is not clear why this is.
Ambidextrous Individuals More Vulnerable
The genetic predisposition to be able to use both hands interchangeably is another prominent risk factor for PTSD. "It means your brain is wired somewhat differently, and your right brain is dominant," said Dr. Boscarino. "When that occurs, it appears that you're more susceptible to emotional responses, and you have a greater, more intense fear response."
This study found that females were at risk for PTSD at baseline, although they tended to recover somewhat by the follow-up period, and other studies show that war veterans are more susceptible than civilians to posttraumatic stress, suggesting that female veterans might be at especially high risk for this disorder.
"From the studies I've seen, women soldiers who had domestic problems and then served overseas are more vulnerable to PTSD," said Dr. Boscarino. He added that the US government is working to address stress among female veterans.
Delayed onset of PTSD may help explain why some veterans with few initial symptoms remain vulnerable to PTSD over a relatively long period of time, said the Dr. Boscarino. Factors that might explain the delay could include underreporting of symptoms at an initial assessment or overreporting of symptoms at later assessments.
Loss of Coping Mechanism
The fact that PTSD symptoms can appear 2 years after a stressful event is important, since currently the definition of delayed-onset PTSD encompasses symptoms that surface only up to 6 months following an event, said Dr. Boscarino. He added that a "triggering" situation, such as a job loss, financial problem, or death in the family years after the initial event can cause individuals to lose their coping mechanisms.
"Delayed PTSD is not something that people make up; it is real, and there are risk factors that can predict it," said Dr. Boscarino.
Complicating delayed PTSD are matters related to disability and compensation. "The whole issue of delayed PTSD is still being worked out in medical sciences and in the courts," he said.
Information on the length of time from a trauma to symptom onset as well as information on past mental health and the presence of potential "triggering" events should be taken into consideration when making a diagnosis of PTSD, especially delayed PTSD, said Dr. Boscarino.
Study Missed the "Big Bump"
Since the study did not start until a year after 9/11, it missed "the big bump" in PTSD among New Yorkers just after the disaster, said David Spiegel, MD, from Stanford University School of Medicine, in California, when asked for a comment. At that time, residents of certain areas of the city had rates of PTSD of up to 20%, he said.
"Much of the acute PTSD came and went within 6 months, so this study is dealing with relatively late and chronic cases."
Still, the findings are important, said Dr. Spiegel. For one thing, they send an important message — that early social support can serve as a "buffer" to protect against posttraumatic stress. "People who don't have good social support are more likely to get PTSD."
The authors report no conflicts of interest.
Soc Psychiatry Psychiatr Epidemiol. Published online March 7, 2009. Abstract

Ivan Tyrrell talks about hypnosis and techniques for induction

Tuesday, 6 September 2011

Exercise is Medicine - from Positive Psychology News

By  on July 25, 2011 – 9:51 am  23 Comments
Elaine O'Brien, MAPP, is a student in the Doctor of Philosophy program, working as a Teaching Assistant in Kinesiology, Temple University, College of Health Professions and Social Work. Her area of study and practice is the Psychology of Human Movement. Elaine is a professional dance-exercise/group fitness/health trainer, coach, writer, consultant, speaker, and program designer. Elaine has expanded her fitness leadership practice into consulting and writing about the field of Lifestyle Medicine. .

In their new book, Practical Wisdom: The Right Way to Do the Right Thing, Barry Schwartz and Kenneth Sharpe call for excellence in action: wisdom centered on human values, character strengths, moral purpose, and our and society’s positive transformations. Practical wisdom, or phronesis, is the solution-based concept Aristotle identified as “the essential human quality that combines the fruits of individual experiences with our empathy and intellect.” Practical wisdom is acting wisely, where we are guided by the proper aims (telos), or goals of a particular activity. Practical wisdom combines will with a moral skill that enables us to flourish, as individuals and a society.
Evening Jogger
Happily, important practical wisdom is part of the American College of Sportsmedicine’s (ACSM) multi-organizational, multi-national initiative, promoting moderate physical activity: Exercise is Medicine® (EIM). This global enterprise aims to prevent disease and improve health. EIM is sparking some positive changes in health and medical care. Since its launch at the first World Congress of Exercise Is Medicine last year, the momentum is building internationally.
Recognizing physical inactivity as a major life/health risk factor, the EIM intention is to recognize, validate and roll out the powerful benefits of moderate exercise in our life, health and well-being. The ACSM/EIM exercise guidelines call for a minimum of 150 minutes of moderate physical activity a week for adults, and a minimum of 420 minutes a week for children
Dr. Karim Khan: Inactivity even Worse than Smokadiabesity
The recent ACSM conference had a record number of participants with over 6,000 in attendance. Eminent professor (in departments of exercise science, epidemiology and biostatistics at Arnold School of Public Health, University of South Carolina), Dr. Steve Blair, reported a highpoint moment when Dr. Karim Khan spoke about “smokadiabesity,” (smoking, diabetes, obesity). Dr. Khan’s “creative and thought-provoking” presentation, “Supersize my Exercise: Learning from Mad Med, the Marlboro Man and Freakonomics to Promote Physical Activity,” educated and inspired people to make/find more time to be active. This keynote was aimed at those trying to influence government, health authorities, professional organizations, schools and community groups to embrace the vital physical activity message.
Dr. Kahn provided striking new findings related to the power of exercise for health domains, such as brain function, cancer prevention, and depression. Kahn showed data supporting the view that inactivity/low fitness causes more deaths than smokadiabesity! “At epidemic proportions, smoking, diabetes and obesity are major public health concern, … yet low physical fitness kills more people than all these in combination!”
Dr. Bob Sallis: Exercise as a Vital Sign
Leader and founder of the ACSM’s program, Exercise is Medicine, Dr. Bob Sallis, Kaiser Permanente, recently posted a robust editorial for the British Journal of Sports Medicine titled Developing Health Care systems to Support Exercise: Exercise as a 5th Vital Sign. At Kaiser Permanente, Dr. Sallis has instituted the idea of Exercise Vital Signs. He believes all physicians need to ask patients how many minutes of moderate exercise they perform in a week.
Children need activity
Dr. Sallis’ important message is that exercise as a vital sign is a “minimal standard of care.” Exercise reporting should be a part of every patient’s intake, and part of their medical chart, as much as the other vital signs of blood pressure, heart/pulse rate, respiration rate, and body temperature. In addition to documenting his patient’s exercise, he also charts their body mass index (BMI). To date he has collected exercise as a vital sign for over 3.5 million people in Southern California, with the goal of charting over 12 million people in the next year!
Dr. Sallis, a model of fitness, writes with passion and verve, “The importance of physical activity to health and wellness has been established incontrovertibly. There is a linear relationship between physical activity and health. Those who maintain an active and fit way of life live longer, healthier lives.”
He further discusses how sedentary, unfit behaviors “predictably” develop chronic diseases prematurely and die at a younger age. Asking Dr. Sallis, about moderate physical activity/exercise as a medical vital sign, he urges, “The goal is in ensuring that physical activity levels are assessed and prescribed at every visit.” This is the basic standard of care he expects.
In discussing medical school’s current standards of training, he opines, “It may be easier to change standards of care, and then medical schools will follow suit.”
U.S. National Physical Activity Plan
Dr. Blair encourages people who are interested in physical activity and health to get involved in promoting and implementing the U.S. National Physical Activity Plan, which was released in May 2010. The plan focuses on strategies and tactics in multiple sectors such as education, public health, clinical medicine, worksites, urban planning and transport, and other areas. Dr. Blair wisely acknowledges, “We have a huge public health problem of inactivity, and it will take extensive efforts by many groups over many years. Please review the Plan and find a way to get involved.”
Dan Henkel, ACSM Senior Director of Communication & Advocacy, concurs, “We can each look at the National Physical Activity Plan and see how we can help bring about changes in our own communities to make them more conducive to healthy and active lifestyles.” He discusses advocating for more bike lanes, hiking trails, pocket parks, and workplace wellness programs that reduce health care costs and absenteeism. He believes there are opportunities and rewards in helping our fellow citizens become more active and healthy.
Human Choreography
Human Choreography and Lifestyle Medicine
In his recent presentation on passion, President-elect of International Positive Psychology Association (IPPA), Dr. Robert Vallerand discussed recent research around Harmonious Passion, where we can experience positive emotions that feed us and lead us to developing positive relationships.
I believe that we can find harmonious passion in moving well. I believe we can merge areas on Positive Psychology and Positive Physical Activity, and establish Positive Exercise Prescriptions (PEP) for flourishing individuals and communities. By developing a positive relationship with kinesiology, we can inspire others to reach for healthier, happier and richer lives. With principled doctors joining fitness professionals to help lead the reduction of the grave risks of inactivity, there is great hope in the phronesis of medical wellness in action.

Blair, 2009, British Journal of Sports Medicine, (43) pp 1-2.
Sallis, R. (2010). Editorial, Developing Healthcare Systems to Support Exercise: Exercise as the Fifth Vital Sign. British Journal of Sports Medicine, 45(6), 473.
Schwartz, B. and Sharpe, K. (2010). Practical Wisdom. Penguin Group. New York, New York

Monday, 5 September 2011

The woman misdiagnosed with Alzheimer's, and how we can all be affected by the suggestion that we have psychological problems

Psychologists in the Netherlands have documented the case of a 58-year-old woman who was misdiagnosed with Alzheimer's Disease. The would-be patient consulted a neurologist at a stressful time in her life, in the knowledge that her mother had had the illness. A brain scan indicated reduced activity at the front of her brain ("hypofrontality"), and the neurologist also estimated her performance on a test of cognitive impairment as poor (though no formal test was conducted). On this basis he diagnosed Alzheimer's*.

The woman was devastated and thereafter her condition deteriorated significantly, to the point that she was permanently confused and, at one point, suicidal. Some months later, after receiving advice from an Alzheimer's helpline, the woman consulted a different neurologist for a second opinion. She completed comprehensive memory tests and undertook a further brain scan. All results were normal. This neurologist surmised that her earlier hypofrontality was associated with depression. He also went to great lengths to explain the good news about her results and the misinterpretation of her earlier scan, but it proved extremely difficult to assuage her concerns.

Years later, Harald Merckelbach and his team have interviewed the woman and they report that she continues to experience intrusive thoughts about the misdiagnosis and to catastrophise her memory lapses. Merckelbach's group believe the effect of a misdiagnosis has parallels with the implantation of false memories. Just as false memories are difficult to reverse, so too are mistaken diagnoses. "Conferring a diagnostic label is far from a neutral act," they said. "Many diagnostic labels have strong stereotypical connotations and sometimes, these will automatically shape the experiences and behaviour of patients, a phenomenon called 'diagnoses threat'."

To test these ideas further, Merckelbach, with colleagues Marko Jelicic and Maarten Pieters, gave 78 undergrads a psychological symptoms questionnaire to complete. Afterwards the students performed Suduko puzzles as a distraction. Next, the researchers went through some of the students' answers with them. During this review, the researchers inflated two of the answers they'd given to anxiety items. For example, imagine a student had originally indicated that she never had trouble concentrating. The researcher would inflate that answer by two points on the scale, as if she'd said that she sometimes had trouble concentrating, and they then asked the student to explain why she'd given that answer. Remarkably, 63 per cent of the participants failed to notice that their answers had been altered, and they proceeded to describe their experience of the symptoms (readers may notice parallels here with a phenomenon known as "choice blindness", in which people seem to have little insight into a recent choice they made).

Ten minutes later, and again after one week, all the students re-took the psychological symptoms questionnaire. At both time points, students who'd earlier failed to notice that two of their answers had been altered, now gave higher ratings to those two items, as if they considered themselves to have those symptoms. Such an effect was not observed among the minority of students who'd earlier noticed that their answers had been altered. An analysis of all the students' original baseline answers uncovered higher average baseline symptoms among those who would fail to notice the inflation of their answers. "Apparently a non-zero symptom intensity level introduces ambiguity; thereby raising the probability that misinformation is accepted," the researchers said. However, it's not the case that the influenced participants were simply more keen to give answers that the researchers wanted - they scored just the same on a test of social desirability.

The results from this study are consistent with past research showing how misinformation about physical symptoms can shape how people feel: for example, false feedback about asthmatic wheezing can trigger breathlessness in children with asthma.

Harald Merckelbach and his colleagues said their findings had particular significance for the way medical professionals interact with patients with unexplained symptoms, including those labelled with chronic fatigue, fibromyalgia, irritable bowel syndrome, and chronic pain. "... Expressing concern about the possibility of an underlying illness and, related to this, excessive investigation and attending patient support groups may all contribute to symptom escalation. What these interventions have in common is that they convey the message to the patient that his or her symptoms might be more intense and severe than he/she thinks they are. Our study suggests that blindness to unintended misinformation about the severity of the symptoms may underlie escalation of symptoms."

The researchers recommend that medics avoid mentioning the whole spectrum of possible symptoms when interviewing patients with medically unexplained symptoms. They also pointed to interesting avenues for future research. For example, notwithstanding the ethical issues involved, could patients benefit from receiving misinformation that lowered their symptom ratings? Also, is the inflated self-reporting of symptoms observed here based purely on exaggerated report, or is it grounded in an altered experience of symptoms?

Merckelbach, H., Jelicic, M., and Jonker, C. (2011). Planting a misdiagnosis of Alzheimer's disease in a person's mind. Acta Neuropsychiatrica DOI: 10.1111/j.1601-5215.2011.00586.x

Harald Merckelbach, Marko Jelicic and Maarten Pieters (In Press). Misinformation increases symptom reporting – a test – retest experiment. J R Soc Med Sh Rep.

*Many years later, the neurologist was found guilty of having misdiagnosed several patients with Alzheimer's and 26 malpractice suits were filed against him (the woman featured in this case study was not part of that litigation).


Anonymous said...
really interesting. I was sent to the doctor as a 15 year old with mood swings and was asked whether I ever felt like committing suicide or had thoughts of the same....... my answer was that no I never had...... not long after I had my first suicidal thoughts, which plagued me for about 20 years....
Mary MS said...
Shows, once again, the deep affect of suggestion - susceptibility increases by the degree of importance of the subject. Bernie Siegal, MD shows many worthwhile examples in his books - working in both directions, i.e. showing suggestion used in a positive way w/ patients, as well as the affects of on patients whose doctors were brutally blunt and predicted death w/in a specific time frame. Patients are so 'good', they believe the docs.
Which witch: This dementia alzheimers diagnosis is thrown around will nilly. I always ask when did this person have tests who diagnosed it etc.

I have just been taken off Lipitor (a Statin for reducing bad cholesterol). The side effects of which have been realised for some time. That is memory loss confusion and poor muscle control. My mother in law was diagnosed with dementia. This confusion I believe was due to the mistaken doubling of a dose of BP pills Royal Melbourne Hospital. Her continued use of Pepsidine an indigestion powder for 30 years (also causes confusion in the elderly) and banned by partner from water after 4.00 pm. The resulting dehydration and consequent reduction in blood supply to brain was obvious, obvious wrinkling of skin and no energy - not allowed to lie down after 8.00 am. I feared recently that I was about to be "put down". I am grateful to the homeopathy GP for switching me on to Bergamet (tablet) (mot = herb) which gave me access to good cholesterol and reduced bad cholesterol I am a Health scientist academic and activist, amongst other intellectual pursuits.
Neuroskeptic said...
Very interesting. I've often wondered actually whether simply asking people about psychiatric symptoms could make them worse. I mean we do this all the time in psychology - give people mood and anxiety questionnaires or whatever - but could that be encouraging people to think about those symptoms in an unhelpful way?

Problem is it would be hard to do a study on that. "We want to see whether anxiety questionnaires make people more anxious, and to measure anxiety we're going to use ... hmm..." I guess you could use a physiological measure like cortisol.