Personality or Mood?

One of the unwritten truths in psychiatry is that when we talk about personality we mean one. The Borderline. It is not that the others don't exist, it is that they are not the ones that cause us problems. Clinically, it is a challenging diagnosis to make. Do not believe the textbooks that make it … Continue reading Personality or Mood?

Moderate effects are useless

I like negative meta analyses. They say: many have been down this path. It has no fruit. Here be but salt, ash, and stone. Nothing whole liveth here. Do not repeat this: investigate elsewhere. The more difficult meta analyses are those that show a moderate effect. This week's JAMA psychiatry has such an analysis. The … Continue reading Moderate effects are useless

Genetics of depression show sexual dimorphism?

The genetics of depression has been an interestly difficult problem. In this paper, which is long, complex, and well worth reading, post mortem brain samples are used to demonstrate differential genetic expression by region between people with depression and controls, that differ by sex. This is then replicated in mice experimental models, and using a … Continue reading Genetics of depression show sexual dimorphism?

Yes, Virginia, medications may work.

Child Psychiatry is not adult psychiatry: children are not adults: what works for adults may not work for kids, and when kids are involved the problem is often affecting the family, the school or the wider society. So, let us start with the latest press problems: the number of prescriptions in Scotland in going up. … Continue reading Yes, Virginia, medications may work.

Educationalist ruin professional education?

If you make things too onerous, there will be pushback. My boss has the American Board, and every few years he has to go over the States and sit a MOC exam. From their website. Maintenance of Certification program participation includes meeting all four components of the MOC Program. Diplomates are only required to complete … Continue reading Educationalist ruin professional education?

Anxiety is not a risk factor for suicide, PTSD included?

There are many who will look at completed suicide and consider that any mental health disorder caused it. There are others who work from theory and consider that those who are frightened may be at risk, so those with clinical panic symptoms or phobias or overwhelming worry must be at higher risk. There is a … Continue reading Anxiety is not a risk factor for suicide, PTSD included?

Watch this neuroimaging space?

Some of the tools we have coming out of the Magnetic Resonance Suite look attractive, such as high resolution diffusion imaging. On a population basis, you can see the difference between normal, psychotic, depressed and manic networks. The pictures are pretty, and some of them may be useful. Recent work from the international Study to … Continue reading Watch this neuroimaging space?

Epidemiology shot: economic chaser.

The drinking age in NZ is 18. One of the minor parties is wanting to increase the drinking age to 20 and tax alcohol by content. Is this a problem? anecdotally, not as much: I'm middle class with a driving licence. I don't drink unless I'm going to use a taxi. But I know there … Continue reading Epidemiology shot: economic chaser.

Risk assessment in self harm adds nothing.

I don't normally discuss risk assessment of repeat self harm. I'm more interested in suicide, and this paper does not report such data. Instead it looks at a more common event -- recurrent self harm within six months. The authors used a series of measurements -- the ReACT tool, the Manchester rule, the SAD persons … Continue reading Risk assessment in self harm adds nothing.

In praise of the lecture

The best lecturer I had at medical school taught anatomy, was close to retirement, and did not give out lecture notes. He spent his entire lecture drawing: starting with the bones, he would add the muscles, viscera and have a discussion as to how this worked. He was impossible to take notes from unless you … Continue reading In praise of the lecture