"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

There's a rather timely article in the current American Journal of Psychiatry: Assuring That Double-Blind Is Blind.

Last month the proposed draft of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) came out.

Absinthe is a spirit. It's very strong, and very green. But is it something more?

I used to think so, until I came across this paper taking a skeptical look at the history and science of the drink, Padosch et al's Absinthism a fictitious 19th century syndrome with present impact

Absinthe is prepared by crushing and dissolving the herb wormwood in unflavoured neutral alcohol and then distilling the result; other herbs and spices are added later for taste and colour.

It became extremely popular in the late 19th century, especially in France, but it developed a reputation as a dangerous and hallucinogenic drug. Overuse was said to cause insanity, "absinthism", much worse than regular alcoholism. Eventually, absinthe was banned in the USA and most but not all European countries.

Much of the concern over absinthe came from animal experiments. Wormwood oil was found to cause hyperactivity and seizures in cats and rodents, whereas normal alcohol just made them drunk. But, Padosch et al explain, the relevance of these experiments to drinkers is unclear, because they involved high doses of pure wormwood extract, whereas absinthe is much more dilute. The fact that authors at the time used the word absinthe to refer to both the drink and the pure extract added to the confusion.

It's now known that wormwood, or at least some varieties of it, contains thujone, which can indeed cause seizures, and death, due to being a GABA antagonist. Until a few years ago it was thought that old-style absinthe might have contained up to 260 mg of thujone per litre, a substantial dose.

But that was based on the assumption that all of the thujone in the wormwood ended up in the drink prepared from it. Chemical analysis of actual absinthe has repeatedly found that it contains no more than about 6 mg/L thujone. The alcohol in absinthe would kill you long before you drank enough to get any other effects. As the saying goes, "the dose makes the poison", something that is easily forgotten.

As Padosch et al point out, it's possible that there are other undiscovered psychoactive compounds in absinthe, or that long-term exposure to low doses of thujone does cause "absinthism". But there is no evidence for that so far. Rather, they say, absinthism was just chronic alcoholism, and absinthe was no more or less dangerous than any other spirit.

I'm not sure why, but drinks seem to attract more than their fair share of urban myths. Amongst many others I've heard that the flakes of gold in Goldschläger cause cuts which let alcohol into your blood faster; Aftershock crystallizes in your stomach, so if you drink water the morning afterwards, you get drunk again; and that the little worm you get at the bottom of some tequilas apparently contains especially concentrated alcohol, or hallucinogens, or even cocaine maybe.

Slightly more serious is the theory that drinking different kinds of drinks instead of sticking to just one gets you drunk faster, or gives you a worse hangover, or something, especially if you do it in a certain order. Almost everyone I know believes this, although in my drinking experience it's not true, but I'm not sure that it's completely bogus, as I have heard somewhat plausible explanations i.e. drinking spirits alongside beer leads to a concentration of alcohol in your stomach that's optimal for absorption into the bloodstream... maybe.

Link: Not specifically related to this but The Poison Review is an excellent blog I've recently discovered all about poisons, toxins, drugs, and such fun stuff.

Padosch SA, Lachenmeier DW, & Kröner LU (2006). Absinthism: a fictitious 19th century syndrome with present impact. Substance abuse treatment, prevention, and policy, 1 (1) PMID: 16722551

Craig Bennett (of Prefrontal.org) and Michael Miller, of dead fish brain scan fame, have a new paper out: How reliable are the results from functional magnetic resonance imaging?


Tal over at the [citation needed] blog has an excellent in-depth discussion of the paper, and Mind Hacks has a good summary, but here's my take on what it all means in practical terms.

Suppose you scan someone's brain while they're looking at a picture of a cat. You find that certain parts of their brain are activated to a certain degree by looking at the cat, compared to when they're just lying there with no picture. You happily publish your results as showing The Neural Correlates of Cat Perception.

If you then scanned that person again while they were looking at the same cat, you'd presumably hope that exact same parts of the brain would light up to the same degree as they did the first time. After all, you claim to have found The Neural Correlates of Cat Perception, not just any old random junk.

If you did find a perfect overlap in the area and the degree of activation that would be an example of 100% test-retest reliability. In their paper, Bennett and Miller review the evidence on the test-retest reliability of fMRI studies. They found 63 of them. On average, they found that the reliability of fMRI falls quite far short of perfection: the areas activated (clusters) had a mean Dice overlap of 0.476, while the strength of activation was correlated with a mean ICC of 0.50.

But those numbers, taken out of context, do not mean very much. Indeed, what is a Dice overlap? You'll have to read the whole paper to find out, but even when you do, they still don't mean that much. I suspect this is why Bennett and Miller don't mention them in the Abstract of the paper, and in fact they don't spend more than a few lines discussing them at all.

A Dice overlap of 0.476 and an ICC of 0.50 are what you get if average over all of the studies that anyone's done looking at the test-retest reliability of any particular fMRI experiment. But different fMRI experiments have different reliabilities. Saying that the average reliability of fMRI is 0.5 is rather like saying that the mean velocity of a human being is 0.3 km per hour. That's probably about right, averaging over everyone in the world, including those who are asleep in bed and those who are flying on airplanes - but it's not very useful. Some people are moving faster than others, and some scans are more reliable than others.


Most of this paper is not concerned with "how reliable fMRI is", but rather, with how to make any given scanning experiment more reliable. And this is an important thing to write about, because even the most optimistic cognitive neuroscientist would agree that many fMRI results are not especially reliable, and as Bennett and Miller say, reliability matters for lots of reasons:

Scientific truth. While it is a simple statement that can be taken straight out of an undergraduate research methods course, an important point must be made about reliability in research studies: it is the foundation on which scientific knowledge is based. Without reliable, reproducible results no study can effectively contribute to scientific knowledge.... if a researcher obtains a different set of results today than they did yesterday, what has really been discovered?
Clinical and Diagnostic Applications. The longitudinal assessment of changes in regional brain activity is becoming increasingly important for the diagnosis and treatment of clinical disorders...
Evidentiary Applications. The results from functional imaging are increasingly being submitted as evidence into the United States legal system...
Scientific Collaboration. A final pragmatic dimension of fMRI reliability is the ability to share data between researchers...

voxel size... repetition time (TR), echo time (TE), bandwidth, slice gap, and k-space trajectory... spatial realignment of the EPI data can have a dramatic effect on lowering movement-related variance ... Recent algorithms can also help remove remaining signal variability due to magnetic susceptibility induced by movement... simply increasing the number of fMRI runs improved the reliability of their results from ICC = 0.26 to ICC = 0.58. That is quite a large jump for an additional ten or fifteen minutes of scanning...

The generation of highly reliable results requires that sources of error be minimized across a wide array of factors. An issue within any single factor can significantly reduce reliability. Problems with the scanner, a poorly designed task, or an improper analysis method could each be extremely detrimental. Conversely, elimination of all such issues is necessary for high reliability. A well maintained scanner, well designed tasks, and effective analysis techniques are all prerequisites for reliable results.

Via Dormivigilia, I came across a fascinating paper about a man who suffered from a severe lack of monoamine neurotransmitters (dopamine, serotonin etc.) as a result of a genetic mutation: Sleep and Rhythm Consequences of a Genetically Induced Loss of Serotonin


Neuroskeptic readers will be familiar with monoamines. They're psychiatrists' favourite neurotransmitters, and are hence very popular amongst psych drug manufacturers. In particular, it's widely believed that serotonin is the brain's "happy chemical" and that clinical depression is caused by low serotonin while antidepressants work by boosting it.

Critics charge that there is no evidence for any of this. My own opinion is that it's complicated, but that while there's certainly no simple relation between serotonin, antidepressants and mood, they are linked in some way. It's all rather mysterious, but then, the functions of serotonin in general are; despite 50 years of research, it's probably the least understood neurotransmitter.

The new paper adds to the mystery, but also provides some important new data. Leu-Semenescu et al report on the case of a 28 year old man, with consanguineous parents, who suffers from a rare genetic disorder, sepiapterin reductase deficiency (SRD). SRD patients lack an enzyme which is involved, indirectly, in the production of the monoamines serotonin and dopamine, and also melatonin and noradrenaline which are produced from these two. SRD causes a severe (but not total) deficiency of these neurotransmitters.

The most obvious symptoms of SRD are related to the lack of dopamine, and include poor coordination and weakness, very similar to Parkinson's Disease. An interesting feature of SRD is that these symptoms are mild in the morning, worsen during the day, and improve with sleep. Such diurnal variation is also a hallmark of severe depression, although in depression it's usually the other way around (better in the evening).

The patient reported on in this paper suffered Parkinsonian symptoms from birth, until he was diagnosed with dystonia at age 5 and started on L-dopa to boost his dopamine levels. This immediately and dramatically reversed the problems.

But his serotonin synthesis was still impaired, although doctors didn't realize this until age 27. As a result, Leu-Semenescu et al say, he suffered from a range of other, non-dopamine-related symptoms. These included increased appetite - he ate constantly, and was moderately obese - mild cognitive impairment, and disrupted sleep:

The patient reported sleep problems since childhood. He would sleep 1 or 2 times every day since childhood and was awake during more than 2 hours most nights since adolescence. At the time of the first interview, the night sleep was irregular with a sleep onset at 22:00 and offset between 02:00 and 03:00. He often needed 1 or 2 spontaneous, long (2- to 5-h) naps during the daytime.

Capitalists beware. No less a journal than Nature has just published a paper proving conclusively that the human brain is a Communist, and that it's plotting the overthrow of the bourgeois order and its replacement by the revolutionary Dictatorship of the Proletariat even as we speak.

Kind of. The article, Neural evidence for inequality-averse social preferences, doesn't mention the C word, but it does claim to have found evidence that people's brains display more egalitarianism than people themselves admit to.

Tricomi et al took 20 pairs of men. At the start of the study, both men got a $30 payment, but one member of each pair was then randomly chosen to get a $50 bonus. Thus, one guy was "rich", while the other was "poor". Both men then had fMRI scans, during which they were offered various sums of money and saw their partner being offered money too. They rated how "appealing" these money transfers were on a 10 point scale.

What happened? Unsurprisingly both "rich" and "poor" said that they were pleased at the prospect of getting more cash for themselves, the poor somewhat more so, but people also had opinions about payments to the other guy:

caution should be exercised in the use of reverse inference... In my opinion, reverse inference should be viewed as another tool (albeit an imperfect one) with which to advance our understanding of the mind and brain. In particular, reverse inferences can suggest novel hypotheses that can then be tested in subsequent experiments.

I just watched The Crazies, a remake of Romero's 1973 original of the same name, about a small town struck by an outbreak of insanity following a biological weapon accident. It's not for the faint of heart: I was unsettled by a number of the scenes and I watch a lot of horror movies.

Which is to say, it's excellent. It maintains a high pitch of tension through the whole 100 minutes, something that a lot of horror doesn't manage. All too often, I find, a movie will start out scary enough, but then by some point about half way through it's effectively turned into an action movie.

This happens when the nature of the monster/killer/zombies have been revealed and all the protagonists have to do is fight it out - with the uncertainty gone, the horror goes, too. Without giving too much away, The Crazies avoids this trap. (The last great horror movie I saw, Paranormal Activity, does too, although in a very different way).

Of course the real reason I liked this movie is that it's got some neuroscience. The Crazies is (spoilers) about an engineered virus that infects the brain. Early symptoms include fever, blank stares, flattened emotions and stereotypies. This then progresses, over the course of about 48 hours, to psychopathic aggression, at least in some cases, although other victims just become confused. The "crazies" are somewhat like zombies - they have a Zombie Spectrum Disorder, one might say - but they retain enough of their personality and intelligence to be capable of much more elaborate and calculating violence than the average braaaaaaains-muncher, which is what makes them so disturbing.

Could a virus do that? Rabies, notoriously, causes aggression in animals and humans, although the incubation period is weeks rather than days, and aggression is only one of many neurological symptoms of the disease. But maybe an engineered virus could achieve a more specific effect if it was able to selectively infect the area of the brain reported on in this rather scary paper:

The authors report a patient with advanced PD, successfully treated by bilateral stimulation of the subthalamic nucleus, who developed acute transient aggressive behavior during intraoperative electrical test stimulation. The electrode responsible for this abnormal behavior was located within the lateral part of the posteromedial hypothalamic region (triangle of Sano). The authors suggest that affect can be dramatically modulated by the selective manipulation of deep brain structures.