Recommended reading is a weekly summary of interesting posts and selected links I posted on Twitter

• New therapy gives hope for very severe depression
  Source: PHYSorg.com: Psychology & Psychiatry News
  German physicians at the University Clinics of Bonn and Cologne have treated ten patients with deep brain stimulation. This involved implanting electrodes in the patients' nucleus accumbens. This centre has a key role in as the brains reward system, whose function may be impaired in depressive people. Subsequent to this treatment, the patients' depression improved significantly in half of the patients.
  Thanks to a new method there is a reason for hope for patients with very severe depression. German physicians at the University Clinics of Bonn and Cologne have treated ten patients with deep brain stimulation...
• Why doctors and patients shouldn't discuss medical problems on social media
  Source: SCOPE
  Doctors and patients shouldn’t be discussing patient-specific issues in the social space.
  Bryan Vartabedian, MD, a Baylor physician, has a great post on 33 Charts today about doctor-patient conversations on social media. His conclusion: Doctors and patients shouldn’t be discussing patient-specifi...
• Transcranial Magnetic Stimulation for Depression: Not so Effective, but FDA Approved
  Source: Clinical Psychology and Psychiatry: A Closer Look
  My opinion on rTMS in depression has been discussed in several posts on my blog. Had to update some of the information regularly.Rapid Transcranial Magnetic Stimulation (rTMS) to the left prefrontal cortex is not more effective than sham rTMS for depression. This was the result of a recent published randomized controlled trial with 4 month follow-up.
  Apparently, the FDA will approve just about anything as an antidepressant. Despite patients indicating that they don't perceive Abilify to work as an antidepressant, the FDA approved it, likely leading to ten...
• Review: The Age of Empathy by Frans de Waal
  Source: New Scientist - Online News
  Empathy, de Waal explains, is the social glue that holds communities together, and if humans are empathetic animals it is because we have "the backing of a long evolutionary history". "Bonding... is what makes us happiest," he writes, and rapidly accumulating evidence from the behavioural and neural sciences supports the claim.
  Evidence continues to show that animals (including humans) are naturally cooperative - so why do we cling to the idea that nature is "red in tooth and claw"?
• Find Your Colleagues and Future Mentors on Twitter: Search for Doctors by Specialty
  Source: Clinical Cases and Images - Blog
  Twitter Searches You Didn’t Think Were Possible: Search By Profession
  Twitter Searches You Didn’t Think Were Possible: Search By Profession http://is.gd/20GoNSearch By Profession on Twitter by using TweepSearch - example: http://bit.ly/129ATEHospitalists on Twitter: http://bit...
• Plugin by C. Murray Consulting

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Tomorrow it’s 20 years ago that the Berlin Wall started to crumble. This nice video is a short history of an important “mistake”. Walls are not a solution, never. An important moment in history and the end of the Berlin Wall, one of the most impressive moments in my live.

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Enterprise 2.0 Booth Video from PBworks on Vimeo.

I have a wiki up at PBWorks. I mostly use it as an eportfolio, a ‘living document’, it is a kind of curriculum vitae getting updated when necessary. I would be really pleased to get feedback about the construction of this ePortfolio.

I also use it to exchange large files or a place for those attending lectures, courses etc to download the slides and papers. Developments are going fast. It’s now a serious rival for Google Wave, don’t believe me have a look at the video above.

We made this video for Enterprise 2.0 to display the key features of our recent releases — Project edition, social release features and the upcoming real time chat, live editing and voice conferencing features.

Fast forward to 1:44 to see the new real-time collaboration features in action or watch the entire video to catch up on features you may have missed.

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This entry for NewScientist proves that squirrels don’t smell nuts. A squirrel’s memory is phenomenal. If you try this experiment at home it is important to distinguish between different squirrels. In this experiment there were three of them. All three squirrels exhibited the same memory traits: They always returned to the same position. Collectively they made over 300 separate trips and seemed to work as a team to systematically clear the hoard of nuts

How to set up a scientific experiment.

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Had an idea to use writing of a blog for a minor in medical education. The idea was sacrificed for other options for minors. Seems that blogs in medical education can promote reflection and professionalism. Professionalism being one of the CanMed competences used in medical education and one of the most important ones not easily educated.

An important part of professionalism is self reflection. It’s necessary for the integration of theory with experience. For acquiring a professional attitude one needs to reflect on his or her own values, shortcomings, improvable aspects of their role as physician. A blog during medical education can promote reflection on professional development.

How was this research done?
It was a 4 week medicine clerkship rotation at an academic institution.

Students were asked to contribute two reflective postings to a class web log (blog) during their rotation. They were able to read each other’s postings and leave feedback in a comment section. An instructor provided feedback on entries, aimed to stimulate further reflection. Students could choose anonymous names if desired.

This research was done during one year from December 2006 until November 2007. 91 students participated, writing 177 posts. Approximately one-third of students (31/91) left comments, either on other students’ posts (21/91) and/or responding to feedback on their own (13/91). The majority of students did not respond to instructor feedback in writing. Few students posted more than two posts; half (53%) chose an anonymous username. The posts were analyzed with scales for reflectivity and for common themes. Most reflections were exclusively on experiences not on self reflection.

Practical problems:
It was hard to get all students signed up to their personal blog. Some students put off posting until the last week and some students wrote very small posts. Another practical aspects is security.

A lot of effort with little profit? What do you think?

Chretien, K., Goldman, E., & Faselis, C. (2008). The Reflective Writing Class Blog: Using Technology to Promote Reflection and Professional Development Journal of General Internal Medicine, 23 (12), 2066-2070 DOI: 10.1007/s11606-008-0796-5

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If your like me, having 5 e-mail accounts, a couple of websites, wikis, several calendars and address books it’s hard to keep everything in sync. Cloud computing or living in the Cloud has it’s benefits. Cloud Computing refers to Internet-centric software and services that are outsourced to someone else and in this case to Google. Everything is on the servers of google and you can access it from anywhere with a browser when connected to the Internet.

Advatages of cloud computing with Google:

• it’s free or cheap, for 50 dollars a year you get support
• back up
• up time of 99%
• platform and browser agnostic
• constant improvements
• someone els is responsible for the hardware
• reliability
• you can share your information.

Google wave hasn’t replaced this for me yet. If you need some guidance on setting up the free Google Apps Standard Edition to get Gmail, GTalk, GCal, and GDocs running behind it have a look at my review of this book Google Apps Deciphered.

When your up and ready learn some more tricks in setting up Google Apps on Lifehacker by Gina Trapani and have a nice and productive life. Especially liked create a Catch-all e-mail adress

By the way if anyone has suggestions for using Google Wave to get things done please let me know in the comments. Things like blogging, productivity etc. I know you can use google wave for collaboration in a workgroup as you can with google apps. You can set up Google Apps and plan to set up a workgroup behind that domain. But with google apps you can do much more, no?

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• patients with depression often complain of difficulty getting to sleep, frequent awakenings during the night, early morning awakening, or nonrestorative sleep
• patients with mood disorders exhibit higher rates of sleep disturbance than the general population, and sleep disturbance can continue even during periods of remission
• patients with insomnia are up to 10 times more likely to have depression than normal sleepers
• individuals with persistent insomnia have a significantly higher risk of developing new-onset depression than those who have no sleep complaints
• 14% of patients with persistent insomnia had concurrent depression whereas depression occurred in less than 1% of patients who had no sleep complaints
• patients with persistent insomnia had a substantially higher risk of developing a new major depression compared with those whose insomnia resolved

These observations don’t explain the relationship between insomnia and depression. Insomnia can precede or co-occur with depression. Moreover, not only insomnia but also excessive sleep and fatigue has been associated with depression, more exactly with seasonal affective disorder and atypical depression. The’re a number of biological mechanisms hypothesized to explain the relationship between sleep disorders and depression.

• deficits in monoaminergic neurotransmission
• abnormalities in circadian genes
• overactivity of the hypothalamic–pituitary–adrenal (HPA) axis
• impaired functioning of plasticity-related gene cascades

Never heard of this last hypotheses before. Is an interesting one especially in relation to sleep deprivation as treatment of depression.

Neural plasticity is closely linked to learning, sleep and cortisol regulation for example, genes related to plasticity increase expression during waking, whereas genes related to synaptic downscaling are expressed during sleep, particularly SWS. It is feasible that sleep is required for the downscaling of synapses on a daily basis and that alterations in sleep and/or mood disorders could affect this process. Conversely, sleep deprivation may increase plasticity-related gene expression, strengthening synapses in brain regions involved in mood regulation, and it is this hypothesis that helps to explain some of the acute antidepressant effects of sleep deprivation therapies

Benzodiazepines are not a good treatment for insomnia, not in depression nor without depression. Benzodiazepines have disadvantages: adverse events, withdrawal potential, lack of longterm safety, and potential for rebound insomnia. Antidepressants are a better choice for insomnia and insomnia with depression. Tricyclic antidepressants all improve restorative sleep and are very efficacious in treating depression.

BENCA, R., & PETERSON, M. (2008). Insomnia and depression Sleep Medicine, 9 DOI: 10.1016/S1389-9457(08)70010-8

Holshoe, J. (2009). Antidepressants and Sleep: A Review Perspectives in Psychiatric Care, 45 (3), 191-197 DOI: 10.1111/j.1744-6163.2009.00221.x

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Aging is associated with well described changing in sleep patterns.

• Total sleep time decreases, elderly sleep less
• It takes longer before falling a sleep
• Elderly go to bed earlier and they awake earlier
• There sleep architecture has changed, the slow wave sleep on EEG is reduced, REM sleep is reduced
• They’re easier aroused from sleep
• They sleep fragmented with many arousals
• Daytime napping

In case of primary insomnia, that is sleeplessness that is not attributable to a medical, psychiatric or environmental cause. In that case the general principles of sleep hygiene are applicable.

Fundamentals of good sleep hygiene
What to do

• Use your bed only for sleep and sexual activities. If you cannot sleep, get out of bed and read or do other
  relaxation activities before attempting to sleep again
• Make the quality of your sleep a priority. Go to bed and get up at the same time every day. Ensure a restful environment:
  • A comfortable bed in a cool, well-ventilated room
  • Protection from light and noise
• Develop and maintain bedtime “rituals” that make going to sleep a familiar routine; for example, prepare for sleep with 20–30 minutes of relaxation (e.g., soft music, meditation, breathing exercises, yoga), take a warm bath, have a light snack, which could include:
• Warm milk
• Foods high in tryptophan, such as bananas
• Carbohydrates, which can help induce sleep

What to Avoid:

• In general, refrain from: Napping, especially after 3:00 pm, Going to sleep too early in the evening (this can lead to phase advance syndrome)
• Before bedtime (or late in the day), avoid: Heavy eating, Consumption of caffeine or alcohol, Smoking (nicotine interferes with sleep), Exercise, which is a stimulant (althoughdaytime activity will promote later sleep)
• While you try to fall asleep, avoid: Thinking about life issues, Problem-solving, Rehashing the events of the day

Wolkove, N., Elkholy, O., Baltzan, M., & Palayew, M. (2007). Sleep and aging: 1. Sleep disorders commonly found in older people Canadian Medical Association Journal, 176 (9), 1299-1304 DOI: 10.1503/cmaj.060792

Wolkove, N., Elkholy, O., Baltzan, M., & Palayew, M. (2007). Sleep and aging: 2. Management of sleep disorders in older people Canadian Medical Association Journal, 176 (10), 1449-1454 DOI: 10.1503/cmaj.070335

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Manifesting The Mind is a forthcoming documentary about psychedelic drugs. The trailer features such heads as Dennis McKenna, Alex Grey, and Dr. Rick Strassman. When it comes to laying out a comsic rap about the magic of hallucinogens, these guys are pros. Manifesting The Mind

Reality as a construct of our neurotransmitters. Interesting views on consciousness and reality

Thanks BoingBoing

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A recent review about the relationship between exercise and mental health in the elderly discussed the results of clinical research and biological explanations for the effects of exercise on mental health. Exercise is studied in the elderly in depression, Alzheimer’s disease and Parkinson’s disease.

We’ve discussed the topic of exercise and depression before on this blog. The conclusion was that exercise is more effective than no treatment and that for mild to moderate depression it is efficacious and for severe depression it should be added to other treatments in the treatment program. In this more recent review on exercise and mental health the focus is on the elderly. Data on elderly patients are scarcer. Nevertheless investigations have shown that aerobic exercise at an intensity consistent with public health recommendations can be regarded as an effective treatment of mild and moderate depression. There is some evidence for a possible dose-response effect of exrcise on depression. Treatment not prevention? Indeed, this topic has not yet been extensively studied in the elderly yet.

What does that mean: aerobic exercise at an intensity consistent with public health recommendations?

Basic recommendations from the The American College of Sports Medicine (ACSM) and the American Heart Association (AHA).

• Do moderately intense aerobic exercise 30 minutes a day, five days a week
• Or Do vigorously intense aerobic exercise 20 minutes a day, 3 days a week
• And Do eight to 10 strength-training exercises, 10-15 repetitions of each exercise twice to three times per week
• And If you are at risk of falling, perform balance exercises
• And Have a physical activity plan.

What is a physical activity plan?
In short consult your GP before starting to exercise.

Older adults or adults with chronic conditions should develop an activity plan with a health professional to manage risks and take therapeutic needs into account. This will maximize the benefits of physical activity and ensure your safety.

Physical Exercise and Alzheimer’s Disease

• Epidemiological studies have associated exercise with reduced risk of Alzheimer’s disease
• Exercise as treatment for dementia showed efficacy for mood status, psychosocial functioning, physical health and caregiver distress
• Daily 30 minutes of exercise diminishes the number of hospitalization needed, decreased depressive symptoms, increased quality of life in patients with Alzheimer’s disease
• In comparison with a sedentary group, the group with a year of exercise intervention improved in quality of life

Physical Exercise and Parkinson’s Disease
Also in Parkinson’s Disease epidemiological studies have shown that exercise can protect against the disease. The disease is associated with tremor, rigidity, and hypokinesia which can result in falls and tiredness.The main advantage of exercise in PD is improvement of functional capabilities due to strength and balance training. This improves motor skills, improves their quality of life and reduces the number of falls.

Although somewhat limited, evidence suggests that exercise training is beneficial to patients with PD, especially in functional capacity and ADLs improvement

The protective effect of exercise can be explained by effects on the brain as can be read in the Neuroscience of Exercise on this blog.

Deslandes, A., Moraes, H., Ferreira, C., Veiga, H., Silveira, H., Mouta, R., Pompeu, F., Coutinho, E., & Laks, J. (2009). Exercise and Mental Health: Many Reasons to Move Neuropsychobiology, 59 (4), 191-198 DOI: 10.1159/000223730

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