The problem with the fMRI

The functional Magnetic Resonance Image or fMRI has become a powerful
tool for researchers of the mind.

Here's a study I don't really understand yet.
What we can do and what we cannot do with fMRI
Nikos K. Logothetis
http://www.kyb.tuebingen.mpg.de/publications/attachments/NikosNatureJune2008_[0].pdf

Here's a snip.
"
I hope to point out that the
ultimate limitations of fMRI are mainly due to the very fact that it
reflects mass action, and much less to limitations imposed by the
existing hardware or the acquisition methods. Functional MRI is
an excellent tool for formulating intelligent, data-based hypotheses,
but only in certain special cases can it be really useful for unambiguously
selecting one of them, or for explaining the detailed neural
mechanisms underlying the studied cognitive capacities. In the vast
majority of cases, it is the combination of fMRI with other techniques
and the parallel use of animal models that will be the most effective
strategy for understanding brain function.
"

Bathing bird

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Dual diagnosis UK policy

The most recent NMHDU
(http://www.nmhdu.org.uk/silo/files/developing-a-capable-dual-diagnosis-strategy.pdf)
report I've read outlines the problems and puts forward a wonderful
vision...that will not be seen in practice.

The DH published the Dual Diagnosis Good Practice Guidance in 2002.

another problem with words - dual diagnosis and complex needs

There is a problem with this terminology. Dual diagnosis was a diagnosis
I received and meant drug addictions and other mental illness. It is
also known as complex needs. Some people know both of these to mean
mental illness and a learning disability.

In my opinion Dual diagnosis means comordibity, i.e. a primary and a
secondary diagnosis, however the sense I am using it in in recent posts
is comorbidity of addictions and another mental illness.

Some notes on drug use

There is no drug problem in the UK in my opinion. Everyone who wants
them can get them. The problem is they are illegal and that makes it a
hassle but not a barrier to someone who's determined to enjoy a drug
habit whether it's hard drugs that offer a profound shift in experience
or the milder ones like cannabis or alcohol.

The profit margins I assume are far higher for the harder entheogons.
Take cocaine for example. A point I've heard made by Howard Marx, the
UK's most famous drug dealer and author of Mr. Nice, is a plane load of
uncut Columbian cocaine is enough to keep the whole of the UK supplied
for a year (whereas a plane load of cannabis is enough for me). These
are aggressively marketed, for example by offers of free tasters of high
quality cocaine to get people into the high.

Yet the UK is not high on coke (no matter what the Daily Mail headlines
might say). The highest rate of hospitalisation is for alcohol then
cannabis. Hospitalisations for other drug-related mental illnesses pale
in comparison. The stronger enthogeons I would guess would be more
likely to cause problems that are labelled as mental illnesses. Most
people of the people who choose to use drugs habitually or chronically
use the softer drugs.

The majority of long term drug users use alcohol and a minority use
cannabis. A very small proprotion of long term drug users use hard drugs.

Chronic use is rare in professional circles though it is often hidden.
It is more common in poorer areas.

Drug use is highly stigmatised. Addiction is highly stigmatised by
mental health professionals. It was only 150 years ago that alcoholism
began to be accepted as a mental illness. A lack of compassion is common.

American academia produces two types of psychiatrists: mindless or brainless.

This looks like a great book. Wish I read books.

http://ajp.psychiatryonline.org/cgi/content/full/162/3/641

Psychological Treatment of Bipolar Disorder

Edited by Sheri L. Johnson and Robert L. Leahy. New York, Guilford Publications, 2003, 340 pp., $40.00.

ROBERT CANCRO, M.D.
New York, N.Y.

The late Ernest Gruenberg often said that "American academia produces two types of psychiatrists: mindless or brainless." Nowhere has this become more prophetic than in the deemphasis of psychosocial treatments among many psychiatrists. Psychiatric physicians now represent themselves as psychopharmacologists who spend a few minutes with patients, manipulate drugs, and send the patients on their way. Psychosocial interventions are relegated to those with "inferior training," so that the "well-trained" psychiatrist need not waste his or her time getting to know the patient and the patient’s problems. This is not meant in any way to deprecate the importance of a thorough knowledge of pharmacologic interventions but, rather, to recognize the unique role of the psychiatrist as the only mental health professional trained both psychosocially and biologically. It is an unfortunate consequence of the success of medications that many psychiatrists have felt it no longer necessary to spend time understanding the complexity of the patient’s life and life experiences.

This small volume is a welcome antidote to this situation. It is an effort to provide the practitioner with an understanding of diagnostic and clinical issues viewed from a psychosocial perspective so that the clinician can provide appropriate therapy for bipolar disorder. It recognizes the vital need for a comprehensive and integrated approach using both medication and psychosocial interventions.

It has both the virtues and deficiencies of all multiauthored texts. The chapters vary both in style and in quality. Nevertheless, the overall quality of the volume is excellent.

A particular virtue of this volume is the recognition of the underdiagnosis of bipolar disease in its early stages. It is far wiser to diagnose bipolar depression incorrectly rather than incorrectly diagnose unipolar depression in its early stages. There is little danger from the additional use of mood stabilizers, but much danger in the failure to recognize their necessity in the management of a particular case until the person is rapid cycling.

The authors recognize the obvious fact that the potential for bipolar illness does not guarantee the development of a bipolar illness. Psychosocial variables can act as precipitating events, and the management of these factors can be critical to the patient’s treatment.

There are excellent reviews of different forms of psychosocial intervention as well as a review of special issues such as compliance and the risk of suicide. The reviews of psychosocial approaches and their integration into pharmacologic management can benefit virtually every clinician. It is a rather sad commentary that the book had to be edited by psychologists, in order to bring back to psychiatrists that which they never should have abandoned.

Education, education, education

As an alternative to clozapine and prophylatic antipsychotic medication
in children self management programmes could have potential but they
aren't enough.

A good education can set a person up for life even if their mad as a
hatter.

It would not be an exaggeration to say that I've had an exceptionally
high standard of education as a child. It has ensured that when I am out
of crisis I can thrive and I think it's what's helped me survive on my
own when I'm in crisis.

Intelligence can be created and people have observed a correlation
between better outcomes and higher intelligence.

If a child who is given a diagnosis of severe mental illness is given an
education like mine then I am confident clozapine can be banned again.
It would be a cheaper way and it would mean they would live longer too.