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Wednesday, March 31, 2010

Predicting Psychosis

"Prevention is better than cure", so they say. And in most branches of medicine, preventing diseases, or detecting early signs and treating them pre-emptively before the symptoms appear, is an important art.

Not in psychiatry. At least not yet. But the prospect of predicting the onset of psychotic illnesses like schizophrenia, and of "early intervention" to try to prevent them, is a hot topic at the moment.

Schizophrenia and similar illnesses usually begin with a period of months or years, generally during adolescence, during which subtle symptoms gradually appear. This is called the "prodrome" or "at risk mental state". The full-blown disorder then hits later. If we could detect the prodromal phase and successfully treat it, we could save people from developing the illness. That's the plan anyway.

But many kids have "prodromal symptoms" during adolescence and never go on to get ill, so treating everyone with mild symptoms of psychosis would mean unnecessarily treating a lot of people. There's also the question of whether we can successfully prevent progression to illness at all, and there have been only a few very small trials looking at whether treatments work for that - but that's another story.

Stephan Ruhrmann et al. claim to have found a good way of predicting who'll go on to develop psychosis in their paper Prediction of Psychosis in Adolescents and Young Adults at High Risk. This is based on the European Prediction of Psychosis Study (EPOS) which was run at a number of early detection clinics in Britain and Europe. People were referred to the clinics through various channels if someone was worried they seemed a bit, well, prodromal
Referral sources included psychiatrists, psychologists, general practitioners, outreach clinics, counseling services, and teachers; patients also initiated contact. Knowledge about early warning signs (e.g., concentration and attention disturbances, unexplained functional decline) and inclusion criteria was disseminated to mental health professionals as well as institutions and persons who might be contacted by at-risk persons seeking help.
245 people consented to take part in the study and met the inclusion criteria meaning they were at "high risk of psychosis" according to at least one of two different systems, the Ultra High Risk (UHR) or the COGDIS criteria. Both class you as being at risk if you show short lived or mild symptoms a bit like those seen in schizophrenia i.e.
COGDIS: inability to divide attention; thought interference, pressure, and blockage; and disturbances of receptive and expressive speech, disturbance of abstract thinking, unstable ideas of reference, and captivation of attention by details of the visual field...
UHR: unusual thought content/delusional ideas, suspiciousness/persecutory ideas, grandiosity, perceptual abnormalities/hallucinations, disorganized communication, and odd behavior/appearance... Brief limited intermittent psychotic symptoms (BLIPS) i.e. hallucinations, delusions, or formal thought disorders that resolved spontaneously within 1 week...
Then they followed up the 245 kids for 18 months and saw what happened to them.

What happened was that 37 of them developed full-blown psychosis: 23 suffered schizophrenia according to DSM-IV criteria, indicating severe and prolonged symptoms; 6 had mood disorders, i.e depression or bipolar disorder, with psychotic features, and the rest mostly had psychotic episodes too short to be classed as schizophrenia. 37 people is 19% of the 183 for whom full 18 month data was available; the others dropped out of the study, or went missing for some reason.

Is 19% high or low? Well, it's much higher than the rate you'd see in randomly selected people, because the risk of getting schizophrenia is less than 1% lifetime and this was only 18 months; the risk of a random person developing psychosis in any given year has been estimated at 0.035% in Britain. So the UHR and COGDIS criteria are a lot better than nothing.

On the other hand 19% is far from being "all": 4 out of 5 of the supposedly "high risk" kids in this study didn't in fact get ill, although some of them probably developed illness after the 18 month period was over.

The authors also came up with a fancy algorithm for predicting risk based on your score on various symptom rating scales, and they claim that this can predict psychosis much better, with 80% accuracy. As this graph shows, the rate of developing psychosis in those scoring highly on their Prognostic Index is really high. (In case you were wondering the Prognostic Index is [1.571 x SIPS-Positive score >16] + [0.865 x bizarre thinking score] + [0.793 x sleep disturbances score] + [1.037 x SPD score] + [0.033 x (highest GAF-M score in the past year – 34.64)] + [0.250 x (years of education – 12.52)]. Use it on your friends for hours of psychiatric fun!)

However they came up with the algorithm by putting all of their dozens of variables into a big mathematical model, crunching the numbers and picking the ones that were most highly correlated with later psychosis - so they've specifically selected the variables that best predict illness in their sample, but that doesn't mean they'll do so in any other case. This is basically the "voodoo" non-independence problem that has so troubled fMRI, although the authors, to their credit, recognize this and issue the appropriate cautions.

So overall, we can predict psychosis, sometimes, but far from perfectly. More research is needed. One of the proposed additions to the new DSM-V psychiatric classification system is "Psychosis Risk Syndrome" i.e. the prodrome; it's not currently a disorder in DSM-IV. This idea has been attacked as an invitation to push antipsychotic drugs on kids who aren't actually ill and don't need them. On the other hand though, we shouldn't forget that we're talking about terrible illnesses here: if we could successfully predict and prevent psychosis, we'd be doing a lot of good.

ResearchBlogging.orgRuhrmann, S., Schultze-Lutter, F., Salokangas, R., Heinimaa, M., Linszen, D., Dingemans, P., Birchwood, M., Patterson, P., Juckel, G., Heinz, A., Morrison, A., Lewis, S., Graf von Reventlow, H., & Klosterkotter, J. (2010). Prediction of Psychosis in Adolescents and Young Adults at High Risk: Results From the Prospective European Prediction of Psychosis Study Archives of General Psychiatry, 67 (3), 241-251 DOI: 10.1001/archgenpsychiatry.2009.206

Tuesday, March 30, 2010

Practicals

Uh oh. Science education in British schools is in trouble, say the BBC:
'Too few' practical experiments in science lessons

For according to an online poll conducted by the Science Learning Center,
A combination of curriculum pressure and over-assessment is strait-jacketing science teachers and limiting the amount of time spent on vital classroom practicals, according to a survey...96% of the 1,339 science teachers and technicians surveyed said they were in some way hindered from undertaking science practical work.
How, well, scientific this poll was we are not told, and as a poll it only tells us what people think, not whether practicals are actually getting harder to do or less common. But still, let's suppose it's true. Does it matter? Practicals are widely seen as an important part of science education. But what good they really do?

One answer is that practicals teach you experimental skills that you'll need if you want to do research. That would be good if it were true, but it's not. I went to a good school and we had many practicals, but as far as I can remember not one of them was useful to me when studying science at university or as a researcher.
In physics we did stuff with springs and pendulums. None of the physicists I know have touched one since school. In biology, I looked at plenty of yeast down a microscope, and counted a bunch of shells on a beach, but not once did I run a Western blot or do some PCR, basic techniques that almost all biologists actually use in real life.

Maybe practicals serve to
"help students to develop skills such as observation", as 82% of the polled science teachers think? If so, they are not very good at it: what usually happened at my school anyway was that most people's experiments wouldn't work for whatever reason, so instead of observing and recording the actual results, people looked up what the answer was meant to be and fudged their data to fit. Even when everything did work this didn't teach us to observe, because we already knew what to expect, so it simply confirmed that we'd done it right.

Perhaps they're there to help us
"develop an understanding of scientific enquiry" (80%)? I hope not, because doing real science is almost exactly the opposite of doing a practical. You don't get told what to do, you have to decide what to do in order to answer a question; you don't get told what methods to use; you don't know what the answer should be; and you don't know that your experiment will even work, because no-one has done it before.

In my experience practicals succeed at doing one thing: they make science lessons less boring. They're essentially entertainment. This is not a criticism - anything that keeps kids interested in science is a good thing, and a well-run practical is a lot more interesting than a textbook will ever be. So they're important. But we shouldn't pretend that practicals actually show people how to do science.

For that matter, though, neither does anything else: university practicals ("labs") don't either, although they're more likely to involve useful experimental techniques. Doing science is a skilled activity, like swimming: you can't be taught it in the abstract. A good teacher might help by holding your hand and making sure you don't sink, but
ultimately you learn by diving in and actually doing it.

Monday, March 29, 2010

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Prawn Fishing - RT/WW

Yippee! A prawn!

While meeting my friends for a meal at the Bottle Tree Park, I met several Japanese families enjoying their Sunday prawn fishing.

Having arrived in Singapore for slightly over a year, they have found fun ways to spend their weekends on this tiny island.
Waiting patiently for a prawn .....

It costs S$14.50 for an hour of prawn fishing, it's cheaper for 2.5hrs (S$29.00) and 4 hrs (S$43.50). Rods and bait are provided.


After our meal, my friend paid for an hour of prawn fishing. It seems easy but he wasn't able to catch a single prawn after half an hour, but the man above was a pro.... he caught a prawn every 3 minutes! We were so envious, we moved to fish beside him. The prawns just did not want to eat our bait. grrrr.......


We screamed ourselves silly when we caught the first prawn after 40 minutes of waiting. lol... it's like striking lottery.

In the end, we only caught two pathetic prawns.


For young children, there is a unique “Long Kang” (drain) Fishing. Cost per child is S$10 (an hour) which includes a plastic fish tank and a net. I took a peep at several kids' catch of ornamental fishes which consisted of Red Guppy, Ribbons, Swordtail, Goldfish, Molly.

The activities are rewarding, exhilarating, educational and addictive and can be enjoyed by young and old alike.

It sure beats going to the crowded shopping malls. :D






First Commenter - Maurica

Sunday, March 28, 2010

Day 1 in Perth and a beautiful wedding

I'm in Perth!I arrived at 6am in the morning and promptly feel face first into my cousin's bed. After an exhausting week of work and overnight travels, I wasn't ready to move a muscle. But at noon, I got an invitation to go grab some lunch and the 'best burgers in Perth', so how could I say no?We drove down to Subiaco and hit up Jus Burgers on Newcastle St which lived up to its hype. The crowd

JAPANESE ARTIST - WHEN CUDDLY TOYS BECOME COLLECTIBLES FOR GOTH AND PUNK GENERATIONS, THEY MUST BE CALLED PUNKY MONSTER BY LIENS

Written by Valerie Fujita
Image source: LIENS
LIEN portrait by Valerie Fujita

You may be surprised that in Tokyo, one’s can find cuddly toys on the shelves of famous fashion department stores. From simple mobile phone accessories to handbags, this trend is palpable in almost all fashion stores. But in a city as oppressive as Tokyo, isn’t that just logical that many young women yet all respect deserved and almost well-balanced wish to offer themselves a little tenderness, a return to something sweeter, cuter and warmer.


Of course, our Gothic friends are no exception to this rule, on the contrary. And if H. Naoto or Putumayo through some of their creations like to share with us this pleasant time of childhood, some artists quickly made from this expending trend their specialty. But be careful, because if these creations look like children's toys, they are true collectibles. And when they are produced by the creative to the discreet charm named of LIEN, they probably have something a little ramshackle.

LIEN could be described by a punk elegance, that little something that suits to our Tokyo underground woman artists, no more fully teenagers, but who keeps the pleasure to create for themselves as much as they enjoy creating for the collectors searching for their new item or the ones who dare to order directly to the artist. LIEN is a whole character by herself; the young woman wouldn’t say she’s totally underground (there should be no so closed minds in artists’ world anyway), but of course she’s not mainstream either as she follows what her art guides her to do and also if we refer to the fact she does dress up with unique item collection brands (originality cannot be faked!). And it may be by pursuing this unique taste that the young quiet and timid woman embarked herself in the design and creation of her Punky Monsters, unique item soft toys (you'll never see two alike) WHO have their own names, their own character, their own astrological sign...




Collectibles more than simply cuddly toys, LIEN’s creations, distributed under the trade name LIENS have also their own price. They can usually be found for about 20 000 to 30 000 yen, but they are all sewn and accessorized in the designer’s personal atelier. Some exceptional pieces like a famous bag in a shape of a rabbit which destiny is to be carelessly handled on your shoulder to distribute candies stuffed in its back, would probably to be ordered directly to LIEN, a special order for which we agree to pay the price of individuality.

There-upon, LIEN is not like any other designers, for she has yet many famous collaborations. She collaborates with Peace Now since 2005, participates in special exhibitions organized by museums of modern art as the Edo Tokyo Museum Hakubutsukan (江 戸 东京 博物馆), creates in 2006 the main character for the renewal of the underground floor of Laforet Harajuku with her character Kiku, takes the direction of the online magazine Colletto in 2008.

It is only this same year that LIEN creates her unique collection of Punky Monsters that now appears in all Kera stores, has full pages on Lolita & Gothic Lolita Bible, Alice Deco, or Tokyo Graffiti magazine and also was quoted in the book Japanese Goth by Tiffany Goddoy and Ivan Vartanian.

LIEN’s creations can easily be found at Marui One Kera shop, in Shinjuku.

Some references:




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