<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_359"
                     title="Fish Oil May Prevent Psychotic Episodes (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Psychiatry/Schizophrenia/tb/18242?impressionId=1265762911374"
                     
      &lt;p&gt;High-risk psychiatric patients were less likely to have psychotic episodes when they took daily doses of omega-3 (&amp;#969;-3) polyunsaturated fatty acids (PUFAs), according to results of a small, randomized clinical trial.&lt;/p&gt;
&lt;p&gt;Fewer than 5% of patients had psychotic episodes with &amp;#969;-3 PUFAs, versus more than 25% of patients given placebo (&lt;em&gt;P&lt;/em&gt;=0.007), investigators reported in the February &lt;em&gt;Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;The &amp;#969;-3 PUFAs, derived from fish among other sources, also reduced positive, negative, and general symptoms and improved functioning compared with placebo, the researchers found.&lt;/p&gt;
&lt;p&gt;&quot;The present trial strongly suggests that &amp;#969;-3 PUFAs may offer a viable prevention and treatment strategy with minimal associated risk in young people at ultra-high risk of psychosis, which should be further explored,&quot; G. Paul Amminger, MD, of the Medical University of Vienna in Austria, and co-authors concluded.&lt;/p&gt;
&lt;p&gt;Early treatment of schizophrenia and other psychotic conditions may lead to better outcomes, the researchers noted. Subclinical psychotic symptoms may predict psychotic disorder, and the propensity for psychosis in a particular population may influence the prevalence and incidence of psychotic disorders.&lt;/p&gt;
&lt;p&gt;Intervention in at-risk populations, therefore, may lead to even better outcomes, they asserted.&lt;/p&gt;
&lt;p&gt;Dysfunctional fatty acid metabolism has been proposed as a contributing factor in psychotic conditions, and several clinical trials have demonstrated beneficial effects of &amp;#969;-3 PUFA supplementation in patients with schizophrenia. Some studies, however, yielded negative results.&lt;/p&gt;
&lt;p&gt;Data from the schizophrenia studies, evidence of neuroprotective properties, and an absence of clinically relevant adverse effects make &amp;#969;-3 PUFAs &quot;an ideal candidate for indicated prevention in young people at risk of psychosis, in whom the use of antipsychotic medication is controversial, the authors wrote.&lt;/p&gt;
&lt;p&gt;To evaluate potential benefits of &amp;#969;-3 PUFAs in subclinical psychosis, investigators enrolled patients ages 13 to 25 who met criteria for one of three operationally-defined, high-risk groups: attenuated positive psychotic symptoms, transient psychosis, and genetic risk plus a decrease in functioning.&lt;/p&gt;
&lt;p&gt;&quot;These criteria comprise a combination of trait and state factors that identify people whose risk of becoming psychotic may approach 40% within a 12-month period,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;The study included 81 patients, who were randomized to 1.2 g/d &amp;#969;-3 PUFA or matching placebo for 12 weeks, plus 12-months of follow-up.&lt;/p&gt;
&lt;p&gt;The authors reported that 76 patients (38 in each group) completed the 12-week intervention phase and 67 completed the 12-month follow-up. The primary outcome was conversion to a psychotic episode, defined by the Positive and Negative Syndrome Scale (PANSS) and sustained for one week.&lt;/p&gt;
&lt;p&gt;At 12 months, two of 41 patients assigned to &amp;#969;-3 PUFA therapy (4.9%) converted to psychotic episodes, compared with 11 of 40 (27.5%) in the placebo group.&lt;/p&gt;
&lt;p&gt;The &amp;#969;-3 group also had significantly lower PANSS positive, negative, general, and total scores at 12 weeks, six months, and 12 months (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05 to &lt;em&gt;P&lt;/em&gt;=0.01). Patients in the &amp;#969;-3 group also had significantly better functioning (&lt;em&gt;P&lt;/em&gt;=0.002).&lt;/p&gt;
&lt;p&gt;Calculation of number needed to treat (NNT) showed that four at-risk patients would have to be treated to prevent one psychotic episode during one year, which the authors said is comparable to the NNT from trials of antipsychotic medications.&lt;/p&gt;
&lt;p&gt;The authors noted several limitations, including the relatively small size of the study and the fact that this was a highly selected population, so the results cannot be generalized.&lt;/p&gt;
&lt;p&gt;In addition, they pointed out that efficacy beyond the 12 month study period is unknown and it is possible that the transition to a first episode of psychosis may have been delayed rather than prevented.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by the Stanley Medical Research Institute.&lt;/p&gt;&lt;p&gt;The authors reported no relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_356"
                     title="Exercise Builds Brain Volume in Schizophrenia (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/Psychiatry/Schizophrenia/tb/18236?impressionId=1265762911374"
                     
      &lt;p&gt;Three months of aerobic exercise significantly increased the volume of the hippocampus in patients with chronic schizophrenia, researchers said.&lt;/p&gt;
&lt;p&gt;The increase was accompanied by &quot;modest&quot; increases in short-term memory and markers of neuron production, according to Frank-Gerald Pajonk, MD, of Dr K. Fontheim&apos;s Hospital for Mental Health in Liebenburg, Germany, and colleagues.&lt;/p&gt;
&lt;p&gt;But it&apos;s too early to say whether incorporating aerobic exercise into treatment programs might reduce the disability associated with schizophrenia, the researchers said in the February&lt;em&gt; Archives of General Psychiatry&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Among schizophrenics, the hippocampus, which plays important roles in memory and spatial navigation, is known to be reduced in volume, Pajonk and colleagues noted.&lt;/p&gt;
&lt;p&gt;Unlike other forms of psychosis, they added in the journal, schizophrenia is characterized by persistent disability, perhaps because the production of new neurons is impaired.&lt;/p&gt;
&lt;p&gt;As well, they noted, in healthy humans it has been shown that exercise stimulates the production of new neurons.&lt;/p&gt;
&lt;p&gt;For those reasons, they speculated that aerobic exercise might increase the volume of the hippocampus in people with chronic schizophrenia, perhaps leading to clinical benefits.&lt;/p&gt;
&lt;p&gt;To test the idea, they enrolled 24 schizophrenia patients and eight healthy controls.&lt;/p&gt;
&lt;p&gt;Thirteen of the patients, selected randomly, were assigned to a three-month program of aerobic exercise  --  cycling three times a week for 30 minutes. The controls also took part in the cycling program.&lt;/p&gt;
&lt;p&gt;The remaining patients were assigned to play table soccer, again for 30 minutes three times a week.&lt;/p&gt;
&lt;p&gt;The primary endpoint was the change in hippocampal volume, assessed by magnetic resonance imaging, but the researchers also looked at changes in schizophrenia symptom scores, memory, and the ratio of N-acetylaspartate to creatine in the hippocampus. The latter is a regarded as a marker of neuron production.&lt;/p&gt;
&lt;p&gt;They found: &lt;ul&gt; &lt;li&gt;Compared to baseline, hippocampal volume increased 12% in the exercise group and 16% in the controls, changes that were significant at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001.&lt;/li&gt; &lt;li&gt;On the other hand, there was a nonsignificant 1% drop in volume among patients who did not take exercise.&lt;/li&gt; &lt;li&gt;The changes in hippocampal volume in the exercise group were significantly correlated (at r=0.71 and &lt;em&gt;P&lt;/em&gt;=0.003) with better aerobic fitness, as measured by change in maximum oxygen consumption.&lt;/li&gt; &lt;li&gt;Among patients in the exercise group, change in hippocampal volume was associated with a 35% increase in the N-acetylaspartate to creatine ratio, which was significant (in a post-hoc analysis) at &lt;em&gt;P&lt;/em&gt;=0.04. There was no significant change in the healthy controls.&lt;/li&gt; &lt;li&gt;And short-term memory improvements among the patients were correlated (at r=0.51 and &lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) with changes in hippocampal volume.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The change in hippocampal volume was the &quot;most robust&quot; of the findings, Pajonk and colleagues said, and is roughly comparable with what is seen in other subcortical structures when schizophrenia patients switch from typical to atypical medications.&lt;/p&gt;
&lt;p&gt;The study was limited by its small size, they said, and the volunteers were selected for their willingness to take part in three months of an exercise program.&lt;/p&gt;
&lt;p&gt;As well, patients had to have chronic disease and be on stable medication programs, they said.&lt;/p&gt;
&lt;p&gt;They also noted that while the main finding was robust, the statistical significance of the secondary results would not have survived a correction for multiple testing.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers did not report any industrial support for the study. Pajonk reported financial links with AstraZeneca, Eli Lilly, Janssen, Novartis, Wyeth, Bristol-Myers Squibb, Pfizer, Sanofi-Synth&amp;#233;labo, and Merz.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_180"
                     title="APsaA: Connecting Online with Patients in China"
                     score="-0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18016?impressionId=1265762911374"
                     
      &lt;p&gt;NEW YORK  --  As some analysts become comfortable with the notion of &quot;the chair,&quot; instead of &quot;the couch,&quot; others are welcoming yet another setting: the computer screen.&lt;/p&gt;
&lt;p&gt;Though it may be controversial among the conservative clinicians, researchers have been using a popular online video chat program known as Skype to reach faraway patients, particularly those in China.&lt;/p&gt;
&lt;p&gt;Ubaldo Leli, MD, an analyst in private practice in New York City, is vice president of the China American Psychoanalytic Alliance (CAPA), an organization that treats patients and trains mental health professionals in China.&lt;/p&gt;
&lt;p&gt;At a session at the American Psychoanalytic Association meeting here, Leli said he conducted his first Skype analysis with a Chinese patient in 2004.&lt;/p&gt;
&lt;p&gt;&quot;When I did my first Skype analysis, I had many doubts,&quot; he said. &quot;Will the analytic process develop? Will there be language differences? Cultural differences?&quot;&lt;/p&gt;
&lt;p&gt;He soon began to feel that the Skype analysis was &quot;similar to any type of analysis.&quot;&lt;/p&gt;
&lt;p&gt;He recalled one Chinese patient who was seated on his own couch in his own living room, with his computer (and hence, Leli on video chat) behind him, as in a typical analytic setting.&lt;/p&gt;
&lt;p&gt;&quot;He was talking, and then he stopped, and I asked him why he stopped,&quot; Leli recalled. &quot;He replied that he sensed a change in my breathing and thought I wanted to say something.&quot;&lt;/p&gt;
&lt;p&gt;The popular Skype software (available at skype.com) is a free download that allows users to make free voice or video calls (if both sides are equipped with Web cameras) anywhere in the world. The company also provides low-cost long distance calls between Skype users and standard local phone customers. Other programs provide many of the same features.&lt;/p&gt;
&lt;p&gt;Although Skype can create a sense of connectedness, Elise Snyder, MD, an analyst from New Haven, Conn., and president of CAPA, said it &quot;simultaneously provides intimacy and distance.&quot; Patient and analyst are in separate spaces, and are often divided by many hours  --  about 13 with Chinese patients.&lt;/p&gt;
&lt;p&gt;And it introduces issues of language and culture that are not typically present in analysis. Snyder said these are &quot;not insurmountable, but they are present.&quot;&lt;/p&gt;
&lt;p&gt;Lana Fishkin, MD, who is on the board of directors of CAPA, said from a cultural standpoint, sex is often a troublesome issue in remote sessions. While discussion of sex is a usual component of analysis in America, it&apos;s rarely mentioned among Chinese patients.&lt;/p&gt;
&lt;p&gt;During analysis, Fishkin said she&apos;s &quot;hesitant to point out that it&apos;s absent, because I&apos;m not sure what it means in Chinese culture.&quot;&lt;/p&gt;
&lt;p&gt;She also called attention to differences within the Chinese culture itself.&lt;/p&gt;
&lt;p&gt;&quot;There have been huge changes over just one generation in China that both we and they have to deal with,&quot; she said.&lt;/p&gt;
&lt;p&gt;Ralph Fishkin, DO, who is also on CAPA&apos;s board, said language issues can be tricky as well.&lt;/p&gt;
&lt;p&gt;&quot;You have to pay more attention to the word the person uses and what exactly they mean by it,&quot; he said. &quot;You have to ask yourself if you&apos;re precisely understanding their feelings.&quot;&lt;/p&gt;
&lt;p&gt;He added that the process of analysis itself is different in the context of Skype: &quot;You&apos;re in your room, they&apos;re in their room. It&apos;s like making a house call at the same time the patient is coming to your office.&quot;&lt;/p&gt;
&lt;p&gt;Some audience members at the session pointed out that there&apos;s no data on the subjective impact of the &quot;space&quot; that patient and the analyst are in. They also questioned the analyst&apos;s ability to maintain perfect eye contact with the patient, as well as the potential to pick up on other body language that would be perceived during an in-person session.&lt;/p&gt;
&lt;p&gt;Yet one of CAPA&apos;s goals is to train Chinese analysts so patients there can have one-on-one interaction.&lt;/p&gt;
&lt;p&gt;Snyder said next year&apos;s class has 100 applicants, among whom 40 or 50 will be accepted to the program.&lt;/p&gt;
&lt;p&gt;She noted that the &quot;community interested in analysis is small in China,&quot; which can create ethical dilemmas. Shanghai may have 22 million inhabitants, but psychoanalysts will be familiar with everyone in their community, including patients.&lt;/p&gt;
&lt;p&gt;&quot;It does raise ethical issues in confidentiality,&quot; she said.&lt;/p&gt;
&lt;p&gt;Psychoanalysis via Skype can also help analysts keep in touch with patients who used to come to in-person sessions but have since moved away  --  although there are no data on how many currently practice this type of remote analysis.&lt;/p&gt;
&lt;p&gt;&quot;Skype is only the beginning,&quot; Leli said. &quot;There are all sorts of new technological developments that will modify the way we think about the analytic frame.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_179"
                     title="APsaA: Do We Need the Past to Imagine the Future?"
                     score="-0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18012?impressionId=1265762911374"
                     
      &lt;p&gt;NEW YORK  --  Imagining future events depends on much of the same cognitive and neural machinery as remembering past events, researchers said here.&lt;/p&gt;
&lt;p&gt;In several brain imaging studies, similar areas of the hippocampus were activated when patients recalled past events or imagined future ones, Daniel L. Schacter, PhD, of Harvard University, said during a plenary session at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;Memory can be thought of as a tool used by the brain to allow us to generate predictions and simulations of upcoming events,&quot; he said.&lt;/p&gt;
&lt;p&gt;Schacter and colleagues have conducted several studies involving the link between memory and imagining future events. They&apos;ve found that in remembering past events, patients&apos; brains don&apos;t just replay the scenario the way a computer pulls up a file.&lt;/p&gt;
&lt;p&gt;&quot;We don&apos;t need to preserve every detail,&quot; he said. &quot;We&apos;re good at preserving the gist and meaning, and that serves us pretty well.&quot;&lt;/p&gt;
&lt;p&gt;In imagining future events, those remembered details tend to be recombined into a novel event.&lt;/p&gt;
&lt;p&gt;&quot;We link bits and pieces of information from different sources,&quot; he said.&lt;/p&gt;
&lt;p&gt;Schacter began wondering why humans may have this type of memory system rather than a literal one, and it led him to conduct several brain imaging studies.&lt;/p&gt;
&lt;p&gt;In their earliest work, Schacter and his colleagues were &quot;struck by the similarity we saw&quot; in the brain regions that became active when patients remembered past events or dreamed up possible future scenarios. The hippocampus was especially active.&lt;/p&gt;
&lt;p&gt;Schacter devised that the remembered details are not stored in one place, but are are reactivated during retrieval and reintegrated by the hippocampus into a coherent event.&lt;/p&gt;
&lt;p&gt;Yet the researchers noticed that a couple of regions activated selectively when patients imagined the future  --  particularly the anterior hippocampus.&lt;/p&gt;
&lt;p&gt;That region may play a role in &quot;active recombining that&apos;s critical to imagining one&apos;s future,&quot; he said.&lt;/p&gt;
&lt;p&gt;Based on their findings, the researchers formed the Constructive Episodic Simulation Hypothesis, which essentially states that imagining the future requires a system that can flexibly combine details from past events into novel scenarios.&lt;/p&gt;
&lt;p&gt;One caveat: although this theorized system is well-suited to simulate future events, it runs the risk of misrecombination that can result in memory errors, such as false recognition.&lt;/p&gt;
&lt;p&gt;Schacter questioned whether the findings &quot;tell us something new about the hippocampus, or do we already know this because the hippocampus is involved in encoding information and memory? And maybe future simulation is just piggybacking on the role of the hippocampus in encoding.&quot;&lt;/p&gt;
&lt;p&gt;Either way, he said, the process is &quot;crucial for adaptive functioning.&quot;&lt;/p&gt;
&lt;p&gt;Henry F. Smith, MD, a psychiatrist in private practice in Cambridge, Mass., said that the &quot;simulation of future events may be what the brain does when we&apos;re not perceiving the present  --  we call it daydreaming.&quot;&lt;/p&gt;
&lt;p&gt;&quot;But,&quot; he added, &quot;if the memory of the past and the simulation of the future use the same brain system, maybe that&apos;s the reason [memories] get all jumbled up.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_177"
                     title="APsaA: Top Psychoanalytic Journals Lack Rigorous Research (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/MeetingCoverage/APsaA/tb/18010?impressionId=1265762911374"
                     
      &lt;p&gt;NEW YORK  --  The top three psychoanalytic journals are short on original research on psychoanalysis, researchers said.&lt;/p&gt;
&lt;p&gt;Combined, the journals produced fewer than 10 original research articles annually over a seven-year period, Jane G. Tillman, PhD, of the Austen Riggs Center in Stockbridge, Mass., and colleagues reported in a poster session at the American Psychoanalytic Association meeting here.&lt;/p&gt;
&lt;p&gt;&quot;That&apos;s not very many in a scientific field,&quot; Tillman said.&lt;/p&gt;
&lt;p&gt;Calls for rigorous psychoanalytic research studies have become more common in the past decade, as an increasing number of analysts have committed to demonstrating the validity and efficacy of what they do.&lt;/p&gt;
&lt;p&gt;But the debate also goes to the heart of the discipline itself.&lt;/p&gt;
&lt;p&gt;Critics argue that because psychoanalysis attempts to explain everything, it&apos;s not falsifiable and can&apos;t state a null hypothesis; thus it&apos;s not a proper science.&lt;/p&gt;
&lt;p&gt;While some analysts say psychoanalysis is an hermeneutic discipline because of its reliance on the interpretation of texts, others argue that it is indeed a science and must demonstrate validity and efficacy via a solid methodology.&lt;/p&gt;
&lt;p&gt;To shed light on the debate, the researchers investigated whether there were significant differences in the number of research articles published in the three major psychoanalytic journals: the &lt;em&gt;International Journal of Psychoanalysis&lt;/em&gt;, the &lt;em&gt;Journal of the American Psychoanalytic Association&lt;/em&gt;, and &lt;em&gt;Psychoanalytic Psychology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;They also looked at the characteristics of research samples in the studies, as well as the predominant methodologies.&lt;/p&gt;
&lt;p&gt;Between 2001 and 2008, they found 76 original research articles, which yielded a mean of 9.5 total articles per year  --  only about three in each journal.&lt;/p&gt;
&lt;p&gt;There were no significant differences in the number of research articles published each year by all three journals.&lt;/p&gt;
&lt;p&gt;About 40% of studies used interviews for their data collection.&lt;/p&gt;
&lt;p&gt;The researchers said their survey &quot;raises questions about the status of psychoanalytic research&quot; in these journals.&lt;/p&gt;
&lt;p&gt;Tillman said the absence of serious methodological and research education at many psychoanalytic training institutes may play a role in the lack of research.&lt;/p&gt;
&lt;p&gt;&quot;It really cuts down on the interest,&quot; she said. Yet she also acknowledged that it&apos;s &quot;hard to reduce the complexity of psychoanalysis into well-defined variables.&quot;&lt;/p&gt;
&lt;p&gt;The researchers questioned whether the major psychoanalytic journals receive more submissions of research articles than they print but reject them because of poor quality or poor fit with the aims of the journal.&lt;/p&gt;
&lt;p&gt;Or perhaps psychoanalytic researchers tend to publish in journals that are not identified as specifically psychoanalytic in order to broaden their readership, they suggested.&lt;/p&gt;
&lt;p&gt;Tillman said further research is necessary to find out. Also, based on the high percentage of interviews used in data collection, developing &quot;clear methodologies for working with the interview data&quot; may help increase the rigor of studies.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>