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See you there!

blog migration and dichotomy article

I’m working on setting up my blog on its own server. If you use http://empiricalinsanity.net to access this blog, things may be down/absent/weird at that URL at times in the next couple days. http://empiricalinsanity.wordpress.com will stay pointing to this version. Apologies.
More Dichotomy Week stuff: A call to end the notion of a mind-brain split, in an article in Psychiatric News from earlier in August.

knowing what your triggers are isn’t enough

Like other (non-psych) medical problems, mental illnesses can be exacerbated by situational triggers.  And the theory is, if you figure out what those are, you can avoid them.  Personally, I’m pretty sure I could avoid the majority of things that make me extremely stressed, but my stepping out to preserve my mental health would often offend and anger other people.

For example, tonight I had made plans with a relative to go over to their house for dinner after work.  I’m leaving out a lot of stressors, but they decided we were going to a friends’ house instead, and we got to the house about an hour after I normally eat dinner.  The friend had not started planning dinner – she only started going through the refrigerator after we got there, trying to figure out what she had that she could feed us.  There was chaos in the kitchen and I wasn’t anywhere familiar and I really wanted to just leave.

But you can’t walk out on a family friend you haven’t seen in ten years who invited you over for dinner, just because she didn’t have dinner ready when you got there.  Especially when she’s clearly stressed out – if you walked out on someone who was displaying social penitence for something, you’re going to make them feel pretty awful.

Whenever people talk about feeling trapped by social requirements, someone always wants to say “Of course you can, look at me, I do it all the time!” which is funny because that person is usually the one person in the room everyone thinks is an asshole, but who doesn’t know they’re an asshole, because they’re not socially sensitive enough to know that they’re shooting themselves in the foot over and over.

The point, of course, is not that people who feel trapped by social requirements are unaware that they are free agents; the point is that social requirements (if you prefer, intense expectations) have consequences whether you follow them or break them, and sometimes avoiding a trigger means lots of different triggers instead.  So you take the least worst course of action that you can make for yourself.

So I did that. I feel bad, this entry is late, and there’s no science.  But, I didn’t feel bad, offend someone, make them angry at me, and feel worse and have no entry at all because I was too strung out to concentrate.

Stuff like this contributes to mental health being so difficult to achieve and maintain.

Break-from-the-usual Friday: The hottest thing since Johnny Depp

What could be hotter than Johnny Depp, you ask? The answer is: the sexiest, awesomest citation manager ever. No, wait, don’t run away (skip to the bonus picture of the baby miniature donkey, at least). Zotero is a Firefox extension that captures citations from the webpage you’re viewing (automatically, if you like), along with associated full texts, webpages, images, and more. It stores everything for you, lets you tag entries with multiple tags, lets you store as many notes as you want on an entry, and they’re working on collaboration support, so that you can share your library, contribute to mutual libraries, etc. It not only solves the problem of having to switch between Word, a reference manager, and your browser, and cut-and-paste and retype things manually, and it lets you keep track of lots and lots of information and organize it in ways that let you make better use of it. In short, leaps and bounds better than anything that existed before. Big step forward in helping us do better research, and helping humanity, and all that warm fuzzy stuff that I sincerely believe in, and the kind of thing that I want to (after I’m finally out of school) help make happen.

And now, the baby miniature donkey!

So cute. So awkward.

schizoaffective disorder: what the hell is it?

Schizoaffective disorder is a less well-known diagnosis than schizophrenia, depression, or bipolar disorder, and it tends to confuse people. It was categorized under schizophrenia in earlier versions of the DSM, but in the current version you have to have a mood episode for a “substantial portion” of the time, as well as having psychotic symptoms outside of a mood episode.

That last bit is important because some people with bipolar disorder have psychotic symptoms during manic periods, and some people with bipolar disorder and some people with major depressive disorder have psychotic symptoms during depression. But (according to the DSM-IV) they don’t have psychotic symptoms outside of mood episodes.

But we don’t know from this what schizoaffective disorder actually is. Is it having both a mood disorder and schizophrenia at the same time? Is it a separate disorder from either? (And what about if your depression isn’t long enough or severe enough to be schizoaffective disorder and you get diagnosed with schizophrenia with comorbid depression? Is that a totally different thing?)

Goodwin and Jamison do a quick review, which I will summarize:

The five major schools of thought are:

• a separate disorder (but it doesn’t run in families, so this seems less likely)
• “an intermediate form on the continuum of psychosis” (I think this means that if you think of disorders as lying along a continuum of psychosis, like you could think of bipolar symptoms as lying along a continuum of severity, schizoaffective is inbetween schizophrenia and bipolar with psychotic symptoms)
• comorbid schizophrenia and depression/bipolar
• more severe bipolar
• less severe variant of schizophrenia

Another school of thought might be that schizoaffective disorder is actually several different things, which is what they tentatively suggest (we’re a little short on actual research to draw strong conclusions):

• People who are primarily manic and less pronouncedly psychotic may have an especially severe form of bipolar disorder (suggested by studies showing that it is more associated with bipolar disorder and has a worse course: Gershon et al, 1982; Coryell et al., 1990).
• People who are predominantly psychotic and have less prominent, exclusively depressive symptoms may have a less severe variant of schizophrenia (suggested by studies showing outcomes or neuropsych profiles similar to schizophrenics: Brockington et al, 1980; Tsuang and Coryell, 1993; Evans et al, 1999).
• People who have about an equal mix are the unlucky bastards who just happened to get both a mood disorder and schizophrenia.  (suggested by the epidemiological prevalence of the disorder being a fraction of a percent, about what you’d expect for those two just happening to co-occur: Kendler et al, 1993, 1996).

Again, this is still speculative and we don’t have enough research to confirm (or deny) it.  But it’s pretty interesting, no?  Maybe we’ll get a bipolar 0.5 to complement I and II?  Since all the love’s been going in the other direction, maybe it’s time the crazier among us got a little more attention.  And what kind of “less severe” schizophrenia manages to hit you with something akin to major depressive disorder, yet still be less disabling than regular schizophrenia?

a peek into the future

I’m probably going to switch to posting longer, higher-quality stuff once a week or so, and post news stories or tidbits the other days of the week.  Attempting to do topics justice while still posting frequently doesn’t go so hot with a full-time job.  (I’m having a lot of fun, though.  Here and at the job.  But not, you know, too much fun.)

Here is a sampling of topics I’d like to write about at some point (not in any order).  If anyone votes for anything, I’ll bump it up in the schedule.  If anyone wants to propose a topic, I’ll drop it in the list as long as it’s vaguely appropriate.

• medication for youth (this has a vote already)
• antipsychotics for youth
• worries about personality and perceptions of self with regards to medication
• relapse rates in bipolar
• kindling
• violence rates/types (both by and against the mentally ill)
• creativity and medication
• firearms (second amendment, deaths by suicide)
• transient mental disorders (like hysterical fugue, that was once popular and is now almost gone)
• more on culture and mental disorders because I <3 culture
• evolutionary psychology/biology of mental disorders (because I <3 evolution)
• culture and evolution with regards to mental disorders (because I <3 the interrelationship of culture and evolution more than almost any academic topic)
• approaches to decreasing stigma and stereotypes
• weird crap I find on the internet
• multiple personality disorder, soulbonds, and theory of mind (i.e., lots of speculation)
• otherkin, and fringe religious beliefs: I don’t believe you’re really an iridescent winged fox like you think you are, but I don’t think you’re mentally ill, either
• these weird things you have to get differentially diagnosed with and that almost no one has (like cycloid psychosis and brief psychotic disorder): what the hell are they?
• inaccuracies in science reporting
• symptom clusters in unipolar depression: withdrawal vs. support-seeking
• Munchausen’s (people faking disorders including mental illness for personal gain)
• dumb things people say – not the standard dumb things like”depression means you’re weak” but new fun wacky stuff
• Is schizoaffective disorder a form of schizophrenia, a form of bipolar, its own thing, or something else?
• spectrum disorders, public perception, and identity politics
• other identity politics stuff
• legal stuff (I don’t know enough about this yet to break it down into subcategories)

misc

I was in the second of two all-day meetings today.  The first I got through by being actively interested plus taking adderall, but by today I was so tired of paying attention that the adderall wasn’t much help. (It doesn’t fix not wanting to pay attention, luckily; the first add medication I tried caused me to pay attention to everything anybody said no matter what even if I really wanted to think about something else.)  So tonight is Random Facts From Goodwin & Jamison (2007) Night, instead of semi-coherent post on something substantive night.

• People first developing bipolar disorder are, on average, 22.2 years old.  In 1990 that figure was six years higher for studies with similar inclusion/exclusion criteria.  Why? They mention a couple hypotheses: more people are being diagnosed bipolar instead of schizophrenic (and psychotic features appear to show up earlier), and antidepressants and stimulants are kicking off episodes earlier than they would naturally have occurred.
• A few entries from a long list of conditions and drugs reported to precipitate manic episodes: influenza, Syndenham’s chorea (movement disorder caused by infection), bromide (a sedative used in the late 19th and early 20th centuries), and Q fever.
• Apparently lithium during pregnancy isn’t anywhere near as likely to lead to a heart defect as we used to believe.  (But you still shouldn’t breastfeed on it.)

why bipolar ups suck more than people often think

Some terminology used for states in bipolar disorder:

mania: euphoria and/or irritability.  People who don’t know much about it sometimes think it’s the same thing as being extra-super-happy, and would like to have it.

hypomania: somewhat less euphoria and/or irritability.  People who don’t know much about it usually don’t know that it’s mania to a lesser degree, and therefore not as destructive, but if they did, they’d probably pick hypomania out as the fun mood state to be in, and pay more for this than mania.  (I’d sure pay a lot personally to trade out what I actually get for these happy, productive hypomanias.)

mixed state: a lot of people know something more about bipolar disorder aren’t familiar with this term.  It involves having symptoms of mania and depression at the same time.  Anybody who paid for this would want a refund.

dysphoric mania: Not a DSM term, and as far as I can tell, accounted for by the fact that even euphoric mania can suck, and the fact that mania with depression mixed in gets termed a mixed state.  Maybe someone will rescue it but I think this might be a red-headed stepchild.

depression: real depression (as opposed to fake-ass glamorous depression) is probably not worth much to anyone who isn’t in a mixed state.

First, mania and hypomania
I’m going to leave out all the objectively bad things for you that can happen during hypomania/mania – damaging relationships, losing jobs, spending yourself into debt, etc. – and instead concentrate on the subjective-type-stuff that happens during mania (data from table in Goodwin and Jamison):

percentage and symptom

76% flight of ideas / racing thoughts

75% Distractibility / poor concentration

29% confusion

54% delusions
29% persecutory/paranoid delusions

Hallucinations: 18% auditory, 12% visual, 15% olfactory

19% thought disorder

By definition you can’t get delusions or hallucinations in hypomania (if you do, it’s considered mania instead), but you can certainly get racing thoughts and crappy concentration (I don’t know how common confusion is, but I’ve seen the first two mentioned a lot).

I have no doubt that some people with bipolar disorder get the euphoric kind of mania without the subjectively unpleasant stuff, and that some get the euphoric kind of hypomania that is also useful and productive and doesn’t even screw up their life and people write books on it about how hypomania is great and how to prolong and maintain it.

But man, let’s have a little recognition of those of us who can barely read through a paragraph or write an email while we’re so pointlessly overenergized, and who can’t sleep or calm down or do anything because we can’t slow down or stop our speeding thoughts, etc.  All bipolar disorder sucks ass, but things suck especial ass when there’s a perception that there’s a good side for you that helps make up for the bad side, when it’s mostly just different kinds and degrees of painful.

And that’s mania and hypomania, the more positive side of bipolar disorder.  Later I’ll write about mixed states, which were what I actually wanted to write about, since there is some damn nifty research and theory on them.  And since they are also under-recognized, particularly popularly.

empiricalinsanity.net

My best friend is psyched enough about my blog that he surprised me with a domain name for a present (thank you!):

http://empiricalinsanity.net

It redirects to here, so going to empiricalinsanity.wordpress.com still works. I think the .net address is cooler though.

media and anecdotes vs. science and critical thinking

Yesterday I went to the Chattanooga aquarium almost all day, and it was awesome. When I got home I was too tired to think straight, and briefly posted something on psych meds and creativity that was inaccurate – oops. It may make another appearance later on. In the meantime, here’s something more off-the-cuff.

First, the media and anecdotes:

People with serious mental illness have problems using glucose efficiently in the brain

Okay, I find this completely fascinating and intuitively plausible. When I was around twelve – the first time I remember having mood problems, although probably not the first time I started having them – I started eating sugar excessively. Not just at dessert, but during the day. I’d take powdered sugar from the cabinet and put it in a tupperware and hide it in a drawer in my room and eat it straight. Among other things. I felt awful about it, but just stopping never seemed to work, even though I tried frequently. (If you can get addicted to video games, why not a substance that has immediate lifting effects on mood and energy, followed by a crash?)

When I was seventeen and working in a bookstore, I ran into a book with the badly-chosen title “Potatoes Not Prozac” which argued that sugar could be addictive, that it was related to alcoholism (I have alcoholism running on both sides of my extended family, and there’s a plausible evolutionary argument related to this I’ll share some other time), and that you could go off of it and get a drastic improvement in mental and physical health through a diet that can be summed up as sufficient protein and whole grains (similar to what later became very popular as the South Beach diet). This worked very well for me; it was like suddenly getting a stable personality, and was very similar to the first time I went on an antidepressant. Neither of those effects lasted, but they were amazing and gave me hope that life didn’t have to be the way it was most of the time.

Interestingly enough, when I’m stable on medication I can have a relationship with sugar that’s about what regular people have – it’s nice sometimes but I can drop it without a problem (unless I start eating dessert more than occasionally; I still have to watch for that).

Further anecdotal information: When I mention to psychiatrists that sugar affects my mood, they’re never surprised, although I don’t think any psychiatrist has ever suggested this as a factor up front. It’s pretty common in the patient literature, though.

So that’s the media and the anecdotes. Here’s some stuff to notice about the article (and the anecdotes):

1. There’s no mention of a published article. If it had been published, that would have almost certainly have been mentioned. That strongly suggests that this research has not been peer reviewed. (The list of articles on the lab’s website does not appear to refer to the research mentioned in the article. There’s something about glutamatergic dysfunction in schizophrenia that may be a precursor to this work.)

2. This is the only reference to that research I can find on google news or on google. I don’t have a way to cross-check the accuracy of the reporter’s take on what’s going on (I’ve seen enough errors in science reporting that I don’t want to trust an individual article, and this one appears to confuse “inefficient glucose processing” with “not enough glucose” and “lack of sugar” with “not enough glucose in the brain”).

3. I’m telling this anecdote where I’m linking my own personal screwed-up relationship with sugar to this brain glutamate thing, but I’m not sure they’re even related. I’m not sure what the relationship between ingested sugar and glucose in the brain is, but I doubt it’s all that straightforward, and anyway the article is suggesting it’s lack of sugar that’s the problem, right? And I actually felt better when I stopped, even though there was probably a reason I was eating it to begin with. (I’m pretty sure the “lack of sugar” thing doesn’t actually mean “go eat more sugar, it’ll make you feel better”, though, even if it’s possible to take that away from the article.)

4. Anecdotes aren’t data. Lots of anecdotes collected in a careful, systematic way using random sampling are data, but my telling you this stuff off the cuff isn’t data. I could be wrong about a connection between my craving sugar and my mood problems. I’ve been flat-out wrong about myself before – I thought some major issues I have following lectures and other extended verbal information would turn out to be due to an auditory processing problem, but they turned out to be due to ADD and disappeared with stimulants. (This is what we have highly trained medical professionals for – to save us from some of our best guesses.)

So what does this mean? Well, it doesn’t mean the researcher’s conclusions are incorrect. The article has some problems, like the “lack of sugar” bit giving the false impression that not getting enough sugar in diet = lack of glucose in brain, and that in turn giving the impression that the problem is lack of glucose in the brain when the research appears to implicate inefficient glucose processing.
But it doesn’t mean they’ve hit the status of widely accepted fact. It’s more of a back pocket kind of finding – very interesting, tuck it away, pull it out again later when you hear more – like another article mentioning a publication (or a publication itself), or another researcher’s work.