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Wordpress Post: Academic Updates / Cooling Off Period

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Wordpress Post: Academic Updates / Cooling Off Period

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Academic Updates / Cooling Off Period – PsychiaLove

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The study itself is linked in the article.

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Full network of clitoral nerves mapped out for first time

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Anatomy of one of least studied human organs could improve outcomes for women who have pelvic surgery

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Great conference so far, but this session sticks out to me.

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Neural Correlates of Lyrical Improvisation: An fMRI Study of Freestyle Rap - Scientific Reports

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Scientific Reports - Neural Correlates of Lyrical Improvisation: An fMRI Study of Freestyle Rap

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Unfortunately, an increasingly important topic to review.

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Did a talk. Made a weird playlist.

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Just added today’s today on asexuality and aromanticism to the Talks Page.

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At Home tDCS Cleared For Depression in US

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At Home tDCS Cleared For Depression in US

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This has been one of those "coming soon!" things for years, but apparently it happened. Data isn't that impression in my opinion, but maybe combined with other treatments?

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Author links open overlay panelMarom Bikson PhD a, Andre R. Brunoni MD PhD b, Mark S. George MD c d

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US FDA approves home-delivered tDCS for treating depression

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On Dec 8, 2025, the US Food and Drug Administration (FDA) approved the Flow Neuroscience transcranial Direct Current Stimulation (tDCS) device for the…

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This is concerning to say the least.

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AI Slop Is Spurring Record Requests for Imaginary Journals

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The International Committee of the Red Cross warned that artificial intelligence models are making up research papers, journals and archives

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Wordpress Post: 2025 Grand Rounds Complete, Talks Being Uploaded

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Wordpress Post: 2025 Grand Rounds Complete, Talks Being Uploaded

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Updating the website out of obligation and between resident clinic patients.

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2025 Grand Rounds Complete, Talks Being Uploaded – PsychiaLove

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I just uploaded the talk page to have the PowerPoint file for the recent talk.

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Wordpress Post: Grand Rounds, Academic Interim Period

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Wordpress Post: Grand Rounds, Academic Interim Period

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The usual level of exciting post that you've come to expect.

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Haven't been posting as much here, mostly related to the time of the academic year / timing of lectures and working on grand rounds. I have been putting interesting articles on the Padlet link. I should probably post a few things about upcoming ANPA deadlines and events.

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Haven't been posting as much here, mostly related to the time of the academic year / timing of lectures and working on grand rounds. I have been putting interesting articles on the Padlet link. I should probably post a few things about upcoming ANPA deadlines and events.

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Good statement from APA - though would take issue with the "disorder" language (which is to be expected, though.)

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Skip to content

Washington, D.C. - In reaction to today's White House announcement, the American Psychiatric Association issued the following statement:

"It is essential that the administration prioritizes evidence-based support for individuals on the autism spectrum and invests in long-term comprehensive research about the disorder.

Vaccines do not cause autism. Claims of any such association have been repeatedly discredited in peer reviewed studies.

Autism is a complex disorder, and it is incorrect to imply that a handful of studies have established causation. A strong base of evidence shows that acetaminophen, when taken as directed, is safe for use during pregnancy. Any decisions around a course of treatment should be determined by a patient and their doctor.

Leucovorin (folinic acid) has not been a recommended treatment for autism. It will require many more years of research before we know if leucovorin is an appropriate treatment for individuals with autism.

Autism spectrum disorders exist on a spectrum of neurodiversity. The country must focus its resources on expanding access to care and to building the evidence-base for future treatments."

American Psychiatric Association

The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 39,200 physician members specializing in the diagnosis, treatment, prevention, and research of mental illnesses. APA's vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.

Medical leadership for mind, brain and body.

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APA Statement on White House Announcement on Autism

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In reaction to today's White House announcement, the American Psychiatric Association issued the following statement:

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I've always kind of likely "Functional Seizure" over "Psychogenic Non-Epileptic Seizure," but I also understood the argument for PNES.

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Interesting Concept: Noninvasive VNS For Plasticity In Treatments

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Interesting Concept: Noninvasive VNS For Plasticity In Treatments

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A case report and not ready for prime-time, but interesting thought - similar to other ways that we have considered increasing associative learning / neuroplasticity in treatments

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Another good article, this time from Drs. Cooper and Schildkrout

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Neurobiological Mechanisms of Electroconvulsive Therapy: Molecular Perspectives of Brain Stimulation

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Neurobiological Mechanisms of Electroconvulsive Therapy: Molecular Perspectives of Brain Stimulation

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A fairly detailed look at a complicated discussion.

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Neurobiological Mechanisms of Electroconvulsive Therapy: Molecular Perspectives of Brain Stimulation

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Electroconvulsive therapy (ECT) remains one of the most effective interventions for treatment-resistant psychiatric disorders, particularly major depressive disorder and bipolar disorder. Despite extensive clinical and preclinical investigations,…

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Electroconvulsive therapy and the WHO: patients and professionals deserve expertise and facts, not ideology

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Electroconvulsive therapy and the WHO: patients and professionals deserve expertise and facts, not ideology

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In response to recent WHO tomfoolery.

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Electroconvulsive therapy and the WHO: patients and professionals deserve expertise and facts, not ideology - Der Nervenarzt

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AJP Article: From Crisis to Action: Psychiatry’s Ethical Imperative to Defend Transgender People’s Rights, Dignity, and Access to Care

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AJP Article: From Crisis to Action: Psychiatry’s Ethical Imperative to Defend Transgender People’s Rights, Dignity, and Access to Care

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“Yet, in this contentious environment, advocacy presents ethical dilemmas (23), as clinicians must navigate conflicts between professional ethics and restrictive legal mandates (24). Providers may face risks—including loss of licensure, firing, or even arrest—when they resist any existing legal obligations to out trans youths to abusive parents or report colleagues offering care (25). In such cases, ethical resistance and, at times, medical disobedience, may be necessary to keep our patients alive (26). Moreover, these actions may be part of a grand tradition that reveals strategies for resisting unjust laws, including historical precedents like harm reduction efforts in substance use treatment and abortion care pre- and post–Roe v. Wade (27, 28).”

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Cool Case Report: Crying Spells Triggered by Right Hand Thumb-Index Rubbing (including imaginal)

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Cool Case Report: Crying Spells Triggered by Right Hand Thumb-Index Rubbing (including imaginal)

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There is also a video on Bluesky of the patient.

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Crying spells triggered by thumb-index rubbing after thalamic stroke: a case report - BMC Research Notes

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Background Pathologic crying, devoid of any emotional counterpart, is known to occur as a consequence of various brain stem, cortical hemispheric and cerebellar lesions or, quite exceptionally, of “dacrystic” epilepsy. The case reported here suggests that thalamic lesions may also cause crying spells, under the special circumstances described below. Case presentation After a mild left thalamic stroke a caucasian 77 years old man presented with crying spells with no emotional counterpart, triggered by thumb-index rubbing of his right hand. Only a modest sensation loss on right infra-orbital and nose-labial areas and the first three right fingers could be detected at clinical examination. The circumstances and processes leading to the crying spells were investigated, together with their neural substrate. Brain computerized tomography (CT), magnetic resonance imaging (MRI) and functional magnetic resonance imaging (fMRI) were conducted. Neurophysiologic studies included Video-Electroencephalography, Electromyography, motor and sensory Evoked potentials. Active thumb-index rubbing, passive fingertips stimulation and interaction of sensory-motor stimulation with cognitive/speech activities were tested under different paradigms. A treatment with pregabalin (75 mg twice a day) was attempted. CT and MRI showed a small ischemic infarct in the left ventral postero-lateral thalamus, while fMRI led to the expected findings, i.e. a bilateral activation of the hand motor representation during the crying-triggering right-hand finger rubbing activity. Sensory potentials evoked from stimulation of the right upper limb were the only abnormal neurophysiologic test. Crying spells could be invariably evoked by both real and imagined active finger rubbing, in either the left of right hemi-space. Rubbing by an examiner was ineffective. Immersion in water (18 °C) but not oiling of the fingertips prevented the symptom. Administration and discontinuation of pregabalin 75 mg daily could be associated with suppression and reappearance of the symptom, respectively. Conclusions In this patient loss of sensation seemed to generate crying spells rather than the more common allodynia. As a matter of speculation, both symptoms might represent responses to a sensory loss, but in this case the pathway might have been selectively affected providing inhibition from the lateral to the medial segment of the VPLT, which is linked to the anterior cingulate (limbic) cortex engaged in emotional behaviour.

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AI/LLM Chatbots are basically acting like anthropomorphized echo chambers - like a king having a sycophantic servant that has to say "yes" to everything, or at the very least can't truly say "no." A good friend / therapist / whoever is compassionate but will tell you when you are acting like a fool

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Bromism is back, measles are back, syphilis is increasing, patent medicines are popular - we're in a retro craze here in the medical field!

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We live is sad and scary times.

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I’m a perinatal psychiatrist. The US is promoting misinformation on SSRIs and pregnancy | Sunny Patel

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A recent FDA advisory panel discussion contained falsehoods and overstated risks. That’s dangerous for mothers-to-be

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"Alarmed" to say the least.

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Updated 7/2025

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Trans Resources In Chicago Area – PsychiaLove

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Due to some recent changes in coverage in certain large medical systems, here are some options for trans care in Chicago:

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Another one

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Stanford Research Finds That “Therapist” Chatbots Are Encouraging Users’ Schizophrenic Delusions and Suicidal Thoughts

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A new pre-print study from Stanford researchers finds that AI chatbots used for therapy routinely fail at providing safe, ethical care.

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This is definitely something we are going to see more of - especially if even a person who should know better / how AI works doesn't seem to get either the limitations of LLM/AI or it's proper use?

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A Prominent OpenAI Investor Appears to Be Suffering a ChatGPT-Related Mental Health Crisis, His Peers Say

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Bedrock co-founder Geoff Lewis has posted increasingly troubling content on social media, drawing concern from friends in the industry.

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Wordpress Post: Upcoming Catatonia SIG Journal Club

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Wordpress Post: Upcoming Catatonia SIG Journal Club

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Watch brain nerds argue about definitions?

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Upcoming Catatonia SIG Journal Club – PsychiaLove

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The Catatonia SIG is meeting soon – and plan to discuss this article and it’s interesting points / limitations:

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Wordpress Post: Four Great Viewpoints In One JAMA

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Wordpress Post: Four Great Viewpoints In One JAMA

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These were all in the same issue, back-to-back.

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From the June 24, 2025 edition, four great viewpoints in a row:
The FDA's Crisis Is Everyone's Crisis The Role of Affirming Language Heath and Human Services Restructuring - Threats to the US Preventive Services Task Force & Health Psychiatry and the Make America Healthy Again Commission
Just like how I don't usually do "book reviews," I don't necessarily always promote editorials or articles - but having four in a row like this caught my eye.

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From the June 24, 2025 edition, four great viewpoints in a row: The FDA's Crisis Is Everyone's Crisis The Role of Affirming Language Heath and Human Services Restructuring - Threats to the US Preventive Services Task Force & Health Psychiatry and the Make America Healthy Again Commission Just like how I don't usually do "book reviews," I don't necessarily always promote editorials or articles - but having four in a row like this caught my eye.

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Wordpress Post: New Academic Year, New Academic Post

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Wordpress Post: New Academic Year, New Academic Post

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Hello all,

It's a new academic year? I'm mostly typing this to keep the blog active, though I don't have much to say. Working on a couple of talks and considering some curriculum changes. For the residents (which should be the biggest percentage of people reading this) - remember to check the Dropbox.

I'm also now at the Associate Professor level, which doesn't really change much but seems like an accomplishment. Seems like the most appropriate thing to do is post my book (though these are only the ones in my work office):

In order to celebrate my promotion to Associate Professor, here are some dorky-ass photos of me with all of the books in my office.Not included: the other large amount of books at home, including the disturbingly large "to read" section in my home office.

- Dr. Psychialove (he/him) (@psychialove.com) 2025-07-04T21:20:54.363Z

I have some thoughts on the academic / medical education landscape in light of recent events, as well as some thoughts on science, pride, and the important of professional organizations - but (1) this blog is probably my lowest "update this" priority (2) it is more focused on education specifically (3) I'm not necessarily the best person to talk about it vs. reposting other things (4) the Dropbox is more active for academic stuff, and my personal journal is more for "getting the feelings out." That being said, I'm going to try to repost and promote organizations and people on the Padlet and social media that are better about speaking out about these things.

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Hello all, It's a new academic year? I'm mostly typing this to keep the blog active, though I don't have much to say. Working on a couple of talks and considering some curriculum changes. For the residents (which should be the biggest percentage of people reading this) - remember to check the Dropbox.

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Wordpress Post: Veteran Books For Trainees

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Wordpress Post: Veteran Books For Trainees

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Post about some book recommendations, though the most important resource would be trainings and education from VA, VSOs, and related groups.

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Military Appreciation Month, Books? – PsychiaLove

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This year, I'm focusing on asexuality again due to likely doing a new talk soon.

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Since this came up recently - highly recommended for anyone that works VA, DOD, or related.

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A Civilian’s Guide to the U.S. Military by Barbara Schading, Richard Schading, Virginia Holeman: 9781582974088 | PenguinRandomHouse.com: Books

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Attention! Learn more about your military now! Does a corporal have to salute a lieutenant or is it the other way around? What are forward-deployed units? Is an “armored cow” a type of tank or something…

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"Post" that is just a link to the discussed book.

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PGY-2s: Brain & Behavior Book – PsychiaLove

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A follow-up from my previous book recommendations for residents / trainees - this is also great for them but also great for non-professionals.

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Mind the Science: Saving your Mental Health from the We…

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A clinical psychologist who regularly deals with some o…

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Apparently some people at higher level need to watch this

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Updated and with PDF

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Trans Resources In Chicago Area – PsychiaLove

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Due to some recent changes in coverage in certain large medical systems, here are some options for trans care in Chicago:

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Every year on April 6th. Makes me want to work on my revamped talk, though also probably need to focus on getting the current one done first?

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International Asexuality Day (IAD) will take place on April 6th. IAD is a coordinated worldwide campaign promoting the ace umbrella, including demisexual, grey-asexual and other ace identities.

The four themes of IAD are:

These themes highlight the aims of recognising and enabling the work that the international ace community and organisations do, particularly in non-Western and/or non-English speaking countries.

We encourage anyone who identifies under the ace umbrella to participate in IAD, particularly but not exclusively in non-anglophone and/or non-Western countries. Participation could be as simple as sharing a post on social media, but there are also organisations all over the world who are holding events, running campaigns and supporting causes. To get involved or find out about your local organisations, please see our Find Local Advocates page.

For more information about asexuality, the ace umbrella and how to know if you're ace, visit: Wikipedia

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International Asexuality Day (IAD) will take place on April 6th. IAD is a coordinated worldwide campaign promoting the ace umbrella, including demisexual, grey-asexual ...

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The link between DLPFC and sgACC (anticorrelated activity) has been mentioned a lot in the rTMS literature - this study was able to use neurosurgical patients to show some evidence of a mechanism.

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DLPFC Stimulation Suppresses High-Frequency Neural Activity in the Human sgACC

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Transcranial magnetic stimulation (TMS) to the dorsolateral prefrontal cortex (DLPFC) is hypothesized to relieve symptoms of depression by inhibiting activity in the subgenual anterior cingulate cortex (sgACC). However, we have a limited understanding of how TMS influences neural activity in the sgACC, owing to its deep location within the brain. To better understand the mechanism of antidepressant response to TMS, we recruited two neurosurgical patients with indwelling electrodes and delivered TMS pulses to the DLPFC while simultaneously recording local field potentials from the sgACC. Spectral analysis revealed a decrease in high-frequency activity (HFA; 70-180 Hz) after each stimulation pulse, which was especially pronounced in the sgACC relative to other regions. TMS-evoked HFA power was generally anticorrelated between the DLPFC and sgACC, even while low-frequency phase locking between the two regions was enhanced. Together, these findings support the notion that TMS to the DLPFC can suppress neural firing in the sgACC, suggesting a possible mechanism by which this treatment regulates mood. ### Competing Interest Statement CJK holds equity in Alto Neuroscience, Inc. and is a consultant for Flow Neuroscience. NTT has previously received grant funding from Magnus Medical, Inc. No other conflicts of interest, financial or otherwise, are declared by the authors.

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Catatonia SIG's "Editor's Choice" in JNCN

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Catatonia SIG's "Editor's Choice" in JNCN

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Something we worked on for a bit - great to see it come together! Looking forward to more good work with the SIG this year.

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ECT Book Recommendation For PGY-2s and Beyond

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ECT Book Recommendation For PGY-2s and Beyond

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The PGY-2 ECT Course is already over, but the APA just released the new "Practice Recommendations" book, and it honestly does a pretty good teaching what we go over in the lecture (and very much beyond.) I will likely be updating my two lectures based on it, especially the "managing complications" one as that is very detailed in the book:

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The Practice of Electroconvulsive Therapy: Recommendati…

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Discover and share books you love on Goodreads.

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Wordpress Post: Lectures Coming Up, Recent Updates

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Wordpress Post: Lectures Coming Up, Recent Updates

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A semi-boring entry to be there in case I forger prior to lectures starting

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Lectures Coming Up, Recent Updates – PsychiaLove

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I’m still trying to figure out how to use the combination of the blog, Padlet, and Bluesky – considering that this is mostly for trainees and colleagues, and that I don’t have much time to do much else with it, I’m not sure what is best? The website / blog is the “anchor” but the Padlet is more casual and requires less time to post interesting things (as long as I remember to do so?)

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Possibly for people that are looking for some clinical resources that can't rely on certain systems anymore

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Trans Resources In Chicago Area – PsychiaLove

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Due to some recent changes in coverage in certain large medical systems, here are some options for trans care in Chicago:

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This isn't a new article but I felt it was good to promote again.

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Recommendations to distinguish behavioural variant frontotemporal dementia from psychiatric disorders - PubMed

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The behavioural variant of frontotemporal dementia (bvFTD) is a frequent cause of early-onset dementia. The diagnosis of bvFTD remains challenging because of the limited accuracy of neuroimaging in the early disease stages and the absence of molecular biomarkers, and therefore relies predominantly o …

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Discussion of Amplitude, Fields, and ECT

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Discussion of Amplitude, Fields, and ECT

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Optimization of ECT is one of my favorite topics, though to be honest it is sometimes frustrating to see it not translate quickly into clinical cafre.

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Amplitude-determined seizure-threshold, electric field modeling, and electroconvulsive therapy antidepressant and cognitive outcomes

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Electroconvulsive therapy (ECT) pulse amplitude, which dictates the induced electric field (E-field) magnitude in the brain, is presently fixed at 800 or 900 milliamperes (mA) without clinical or scientific rationale. We have previously demonstrated…

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Wordpress Post: ANPA 2025 + Looking Forward

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Wordpress Post: ANPA 2025 + Looking Forward

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I'm adjusting to being back and I have a migraine, but I'm motivated to post through it!

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ANPA 2025 is over - just got home so still transitioning back to "real life," but the conference was great and Montreal was great. Good topics, great people at ANPA, and Montreal itself was great in terms of people, food, music, and general vibes.

I'm posting a few things on the Padlet about some neuromodulation stuff and maybe some other things.

Looking forward - hopefully will be motivated and able to work on grand rounds, also upcoming PGY-2 and then PGY-4 lectures, and otherwise working through / advocating during these weird political times.

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ANPA 2025 is over - just got home so still transitioning back to "real life," but the conference was great and Montreal was great. Good topics, great people at ANPA, and Montreal itself was great in terms of people, food, music, and general vibes.

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Lots of interesting talks at ANPA 2025, this one stuck out - mostly because of the ongoing conversation about optimizing ECT and eliminating side effects.

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Current in Montreal at ANPA 2025 - starting off with Dr. Adrian Owen and functional imaging in acute brain injury.

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Dr Adrian Owen and his team at Western University, Canada try to understand the effects of brain injury to improve diagnosis and early detection in hopes one day treatments may be found.

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In Chicago, cognitive behavioral therapy shows promise curbing youth violence

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The program, which focuses on mentoring and therapy, relies on the idea that most violent crimes are emotional, not rational.

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Reaffirming the JAMA Network Commitment to the Health of Patients and the Public

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Reaffirming the JAMA Network Commitment to the Health of Patients and the Public

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Reaffirming the JAMA Network Commitment to the Health of Patients and the Public

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In the first month of the new administration responsible for leading the US, the executive branch has issued a flurry of orders, including ones associated with the dismissal or resignation of tens of thousands of federal employees. Many of these have substantial consequences for science, medicine,…

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Wordpress Post: ANPA Is Coming + New Dropbox Files Incoming

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Wordpress Post: ANPA Is Coming + New Dropbox Files Incoming

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A boring post in these troubling times

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ANPA Is Coming + New Dropbox Files Incoming – PsychiaLove

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It's unfortunate that the completely unscientific and skewing Cass Report is given any credibility - and it's good to see the NEJM officially discuss it.

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The Future of Gender-Affirming Care — A Law and Policy Perspective on the Cass Review | NEJM

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The Cass Review on gender-affirming care, which has been used to justify bans in U.S.
states, transgresses medical law, policy, and practice, which puts it at odds with
mainstream U.S. expert guide…

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Wordpress Post: New Year, New Opportunities and Struggles

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Wordpress Post: New Year, New Opportunities and Struggles

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Most important part is the new Talks page, though it is a test as of now.

Also RIP to David Lynch - probably could do a whole entry on that if I felt inspired.

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New Year, New Opportunities And Struggles – PsychiaLove

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“Not just rebellious, it's revolutionary”: Do-it-yourself hormone replacement therapy as Liberatory Harm Reduction

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“Not just rebellious, it's revolutionary”: Do-it-yourself hormone replacement therapy as Liberatory Harm Reduction

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“Not just rebellious, it's revolutionary”: Do-it-yourself hormone replacement therapy as Liberatory Harm Reduction

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Harm reduction and [even more so] self treatment is controversial in medicine - though I feel we are better about discussing harm reduction, and it is only easy to be against DIY treatment when there is an actual alternative (see also: women's health)

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Autistic Psychiatrists And Recognizing Themselves / Others

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Autistic Psychiatrists And Recognizing Themselves / Others

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Interesting article about autistic psychiatrists

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Autism recognition is rising, particularly among the 'lost generation' of autistic adults who were not picked up in childhood and are now presenting for diagnostic assessment.Reference Lai and Baron-Cohen1 Autism diagnosis usually falls under the remit of psychiatry. Although debate is ongoing as to whether this should be within specialist autism services or whether autism should be the business of every psychiatrist, there is little doubt that psychiatry is to the forefront in both setting the diagnostic criteria and assessing autistic people.Reference First, Yousif, Clarke, Wang, Gogtay and Appelbaum2 The question of how to configure services to meet this demand is a topical debate in neurodevelopmental psychiatric discourse and healthcare service planning in the UK and beyond.3,Reference Lord, Charman, Havdahl, Carbone, Anagnostou and Boyd4 Autism is commonly missed or misdiagnosed.Reference Fusar-Poli, Brondino, Politi and Aguglia5 Recent research spotlights the high prevalence of previously unrecognised autism among people presenting to mental health services across all settings, including in-patient and out-patient services and crisis presentations to emergency services.Reference Nyrenius, Eberhard, Ghaziuddin, Gillberg and Billstedt6-Reference Bourke, Say, Carison, Hill, Craig and Hiscock9 Recognising underlying autism in such cases may provide the key to positive outcomes, yet healthcare providers report lack of knowledge and confidence in doing so.Reference Shaw, Doherty, McCowan and Eccles10-Reference Gilmore, Longo, Krantz, Radford and Hand11

It has more recently been recognised that psychiatrists themselves could be autistic. A study exploring the knowledge, attitudes and experiences of psychiatrists in the UK in relation to autism recruited 172 participants, of whom two identified as autistic.Reference Crane, Davidson, Prosser and Pellicano12 The first publication on autistic psychiatrists appeared in 2022, calling for their inclusion in the Royal College of Psychiatrists Equality Action Plan.Reference McCowan, Shaw, Doherty, Grosjean, Blank and Kinnear13 Little is known about the experiences, perspectives and insights of autistic psychiatrists. A study of autistic doctors across all specialties found psychiatrists to be the second largest specialty group within the peer support group Autistic Doctors International (ADI).Reference Shaw, Fossi, Carravallah, Rabenstein, Ross and Doherty14 It is not known whether this reflects a wider prevalence of autism among psychiatrists. Most autistic adults may not realise they are autistic.Reference O'Nions, Petersen, Buckman, Charlton, Cooper and Corbett15 However, we do not know whether this is also true for psychiatrists. Published accounts from autistic psychiatrists are rare, and it may be that most autistic psychiatrists who are self-aware do not disclose.Reference Shaw, Fossi, Carravallah, Rabenstein, Ross and Doherty14,Reference Davidson16,Reference Davidson, Carpenter and Mohan17

Autism is currently diagnosed based on externally observed differences from a perceived norm.Reference Pellicano, Fatima, Hall, Heyworth, Lawson and Lilley18 Embodying such differences may in itself inhibit the recognition that one is actually different from the majority. Alternatively, autistic strengths such as enhanced pattern recognition may aid self-recognition. There has been no research exploring the impact on autistic psychiatrists of their awareness of their own autistic nature, either for their own benefit or that of their patients. Considering the core role of psychiatrists in the recognition and diagnosis of autism, this is a topic warranting investigation. This project is part of a wider doctoral study exploring the experiences of autistic psychiatrists. For this paper, our overarching research question was: 'what are the experiences of autistic psychiatrists in relation to recognising autism?'

Method

Results

Discussion

This qualitative study explored the experiences of autistic psychiatrists in relation to autism recognition. Their potentially enhanced ability to recognise autism once they had self-identified or been diagnosed may offer benefits to both patients and colleagues. Their individual journeys to autistic identity, recognising themselves as autistic, led to the subsequent recognition that many colleagues in psychiatry - particularly in neurodevelopmental psychiatry - were also potentially autistic. Such psychiatrists may be disadvantaged on a personal level by not recognising themselves as autistic, but there are also implications for patient care. Perceived similarities between patient and psychiatrist may act as a confounder in clinical encounters.Reference Street, Gordon and Haidet24 Our data suggest that psychiatrists not recognising themselves as autistic potentially risks under-recognition of autistic people attending for assessment or utilising mental health services.

Autistic doctors are a hidden minority in the healthcare workforce.Reference Moore, Kinnear and Freeman25 Psychiatrists may fail to recognise themselves as autistic for many reasons. Undergraduate and postgraduate teaching on autism usually relates to deficit-based, stereotypical presentations, which are often conflated with learning disability.Reference Thurm, Farmer, Salzman, Lord and Bishop26 There is a lack of lived experience co-delivery of autism education and training, which could help to shift attitudes and understanding towards a more neurodiversity-affirmative perspective. Autism is an intensely stigmatised diagnostic label, with negative assumptions around empathy and theory of mind.Reference Davidson, Doherty, Hayden, Kingdon, Rowlands and Stein27 Changes in the conceptualisation of autism and indeed the diagnostic criteria have had positive impacts, but myths, misconceptions and stereotypes prevail.Reference Happé and Frith28 The diagnostic criteria for autism remain deficit focused and do not appear to include the possibility of an autistic person thriving.Reference Pellicano, Fatima, Hall, Heyworth, Lawson and Lilley18 Therefore, successful psychiatrists may fail to see themselves reflected in these criteria. Another possibility is not recognising autism alongside ADHD. Until the publication of the DSM-5 in 2013, autism and ADHD were deemed to be mutually exclusive. Although it is increasingly recognised that co-occurrence with other neurodevelopmental conditions is the norm rather than the exception, the traditional separation may have a persisting impact.

Resource constraints and gatekeeping in autism services may perpetuate difficulties in recognising autistic people not in obvious difficulties.Reference Hayes, Ford, McCabe and Russell30,31 Service capacity limitations commonly mean that those with co-occurring mental illness or significant challenges are prioritised for diagnostic assessment.31,Reference Spain, Stewart, Mason, Robinson, Capp and Gillan32 Autistic people who are thriving - those who are in employment and perhaps have families, and are without obvious major challenges - are deprioritised and may not meet the perceived threshold for clinical assessment. This reinforces the association between being autistic and being in difficulty, which makes it harder to recognise oneself when one is successful and well.Reference Crane, Batty, Adeyinka, Goddard, Henry and Hill35

The recognition of one's autistic nature is commonly perceived as life-changing in a positive way for late diagnosed autistic adults. It is an opportunity to reframe one's perspective and realise that rather than being a failed version of a neurotypical person struggling to exist in a neurotypical world, one is a perfectly good autistic person - different rather than disordered or defective.Reference O'Connor, Doherty, Ryan-Enright and Gaynor37 For psychiatrists caring for patients experiencing mental illness, recognition of underlying autism brings the possibility of offering reasonable adjustments and a reframing of personal identity in line with a neurodiversity perspective, which may improve mental health outcomes.Reference Shaw, Doherty, McCowan and Eccles10,Reference Rutherford and Johnston38

Neurodivergent and autistic traits are common and are increasingly recognised as valuable in medicine.Reference Davidson, Carpenter and Mohan17 Considering personal and patient-centred benefits of self-awareness and the apparent concentration of potentially autistic psychiatrists in neurodevelopmental services suggested by our data, it may be that all psychiatrists, and particularly those in relevant services, may benefit from considering their own autistic traits and their own position along the spectrum of neurodivergence. Self-reflection is already a core element of training and practice for many psychiatrists, although adding consideration of neurodivergence may seem novel.

Following self-recognition, the question of disclosure is a significant consideration. The experiences and perspectives of autistic psychiatrists in relation to disclosure, including reasons for non-disclosure, form another part of this wider doctoral project and will be reported in depth elsewhere. Our findings in this paper suggest that not recognising one's own autistic nature may risk missing an autism diagnosis for patients presenting for autism assessment or mental healthcare. Recognition of one's own positionality is a private affair and in no way implies a need to disclose to anyone else. Personal and patient benefit is achieved on recognition, independent of disclosure, which may carry professional risk.Reference Davidson, Carpenter and Mohan17,Reference Doherty, Johnson and Buckley40 However, potential implications of non-disclosure in psychiatric education and practice warrant consideration at a wider cultural level. Although it is important to avoid speculation in relation to individual colleagues, it should not be assumed that a psychiatrist not disclosing an autism diagnosis is not autistic. Making this assumption risks imposing a similar confounder to a lack of self-recognition, in terms of recognising autistic patients, as psychiatrists risk missing patients who present with similar mannerisms and communication styles to colleagues who are autistic but not openly so. The range of autistic presentation is vast; if the wide variability is not recognised, autistic patients may continue to be missed.

The Royal College of Psychiatrists is actively working to support autistic psychiatrists in response to calls to recognise their existence and meet their needs.Reference Davidson16,Reference Davidson, Carpenter and Mohan17 Future projects might explore the support needs of potentially autistic psychiatrists, particularly those who are tentatively exploring personal relevance. This is currently a lonely path to tread. Challenges are exacerbated when colleagues or professionals in support roles question the possibility that doctors can be autistic.Reference Doherty, Johnson and Buckley40 Peer support groups including ADI are open to those confident in their autistic identity, whether formally diagnosed or not, but there is a dearth of resources for those wishing to explore the possibility.

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Autistic psychiatrists' experiences of recognising themselves and others as autistic: a qualitative study | BJPsych Open | Cambridge Core

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Autistic psychiatrists' experiences of recognising themselves and others as autistic: a qualitative study - Volume 10 Issue 6

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Single Day Course of rTMS + d-Cycloserine + lisdexamfetamine for Depression?

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Single Day Course of rTMS + d-Cycloserine + lisdexamfetamine for Depression?

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Interesting idea - would need to be replicated and determine efficacy, if all elements are required / optimized, etc. - would also recommend follow-up with a therapy program or similar for "rehab" and to maintain effect, and with close psychiatry follow-up.

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Actually just a new theme.

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I don't usually formally review books on here (or even on Goodreads) - and a majority of the books that I read I like - but considering that this site is mostly informally used for trainees, I would highly recommend this book.

Apparently the first book in the series is about pop psychology, which may also be recommended - but I haven't read yet.

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Read reviews from the world’s largest community for readers. Investigating Clinical Psychology takes a deep dive into the field of clinical psychology thro…

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AAN Position Statement on Advancing LBGTQ+ Care

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AAN Position Statement on Advancing LBGTQ+ Care

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https://www.neurology.org/doi/10.1212/WNL.0000000000210119?fbclid=IwZXh0bgNhZW0CMTEAAR1h5C3hBSRnH46Pe2AlgKftjeY4-68XFEhdphuILQtdZWTdbpXNFedwDKw_aem_0kaAhG_nMZXZbtQ8x0kOzA

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Wordpress Post: ANPA 2025 Agenda Released

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Wordpress Post: ANPA 2025 Agenda Released

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Agenda for the meeting is released!

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The agenda for the 2025 American Neuropsychiatric Association Annual Meeting is Toronto has been released:

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I feel like this comes up every week in resident clinic, so here's an article! Attention is affected by almost anything, so you need to look for "secondary ADHD" as well as mimics.

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Attention Deficit Hyperactivity Disorder Misdiagnosis: Why Medical Evaluation Should Be a Part of ADHD Assessment - PubMed

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Our review suggests that a thorough medical evaluation should be conducted prior to the diagnosis of ADHD. Allied health professionals and psychologists who diagnose ADHD should seek medical clearance from a physician prior to making the ADHD diagnosis in order to reduce misdiagnosis rates and impro …

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Wordpress Post: With and As PPT and PDF!

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Wordpress Post: With and As PPT and PDF!

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Fixed the annoying JSON error so the website is now only slightly horrible!

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With And As: PPT and notes – PsychiaLove

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I’m having some WordPress woes, but this is hopefully working – a PPT of my recent talk:

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Wordpress Post: ANPA 2025 Is In Montreal

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Wordpress Post: ANPA 2025 Is In Montreal

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Wordpress Post: 2024 Grand Rounds Is Over

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Wordpress Post: 2024 Grand Rounds Is Over

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Completed my 2024 grand rounds – I have some mixed feelings about it overall, to be honest.

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https://open.spotify.com/playlist/1yR33FNMH7wAVCRdsqFBsB?si=cef89fae20db4a22

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In anticipation for the upcoming talk, here is the official Spotify playlist:

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I'm still here!

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I haven’t posted much recently – this is a perennial issue, but to my credit I have some excuses this time- (1) focusing on some family things (2) being “off-season” in terms of lectures (3) new computer (4) website woes (5) spending too much time reading and working on a grand rounds.

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Magventure Coils Cleared For Peripheral Pain

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Magventure Coils Cleared For Peripheral Pain

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Not "rTMS" as it isn't transcranial, but interesting use of the stimulator with peripheral coils for pain. Not my general area of expertise, so not sure where it would fit in practice - though any non-opiate pain treatments would be welcomed if they work.

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riding the waves of relief

Magnetic Peripheral Nerve Stimulation (mPNS) is an efficient and painless way of treating chronic pain without the use of drugs and surgery. This non-invasive treatment option has an average pain relief of up to 87%**.

*magnetic Peripheral Nerve Stimulation
** Bedder M, Parker L.: Magnetic Peripheral Nerve Stimulation (mPNS) for Chronic Pain, 2023

3-4

sessions first 2 months
and maintenance every
6 to 8 weeks

Pain therapy system

Setting you apart

MagVenture Pain Therapy is an FDA cleared magnetic stimulator system that provides brief and focused magnetic pulses to non-invasively stimulate peripheral nerves and provide relief of chronic intractable, post-traumatic and post-surgical pain for patients 18 years or older.

A complete treatment set-up consists of a magnetic
stimulator, stimulation coil(s), a liquid cooling unit (optional), and a trolley.

The system is easy to use
At MagVenture, we prioritize reliable and user-friendly systems. We assist in every step of the process, from selecting the most suitable system for your requirements to complete installation and staff training, as well as ongoing service and support.

Take the lead
If you want to stand out from other clinics and offer your patients a promising way of managing chronic pain, contact us for a more in-depth discussion. Our products are based on more than 30 years of knowledge as the world leader in Magnetic Stimulation.

advantages

Why choose MagVenture Pain Therapy

9 good reasons to choose MagVenture Pain Therapy and Magnetic Peripheral Nerve Stimulation (mPNS) as your future option of managing peripheral pain.

FDA cleared

The MagVenture Pain Therapy system is intended to stimulate peripheral nerves for relief of chronic
intractable, post-traumatic and post-surgical pain for patients 18 years or older. It is a relatively new technique in the US for pain relief in the clinical setting and thus not very widespread yet.

Promising pain relief

Evidence shows Magnetic Peripheral Nerve Stimulation (mPNS) to have a promising average pain relief of up to 87%.* Using magnetic pulses, MagVenture Pain Therapy engages sensory, pain, and motor fibers mechanistically to recondition the central nervous system by eliminating noxious pain signals to the brain, reducing chronic neuropathic pain for respondent patients.
*Bedder M, Parker L.: Magnetic Peripheral Nerve Stimulation (mPNS) for Chronic Pain, 2023

Reduction of opioids or other medications

mPNS represents another option for chronic neuropathic pain management that can minimize dependence on opioids and other medications with potentially adverse side effects by an average of 51%.*
*Bedder M, Parker L.: Magnetic Peripheral Nerve Stimulation (mPNS) for Chronic Pain, 2023

guide to coil selection

Unlocking the power of Magnetic Peripheral Nerve Stimulation (mPNS)

MagVenture's versatile coil selection accommodates for different anatomical regions of the body offering a range of options for the treatment of pain. We are proud to provide the largest selection of coils for pain relief on the US market. Have a look at the four different coil shapes and discover their advantages when it comes to managing pain.

Pain relief

Electrical and magnetic nerve stimulation

A basic comparison between managing peripheral pain with electrical stimulation (TENS) and the approach using magnetic peripheral nerve stimulation (mPNS). Have a look at the table below for an overall comparison.

MagVenture Pain Therapy is comparable to TENS, yet different. They both stimulate nerves for relief, but in very different ways.

Exciting publications

At MagVenture, we believe in the importance of evidence-based treatments. We have selected a number of key research studies that we believe to be some of the most significant milestones in the Magnetic Peripheral Nerve Stimulation (mPNS) journey as a treatment for chronic pain. The main challenge within the pain field is still to identify studies with statistical quality. We remain committed to staying up-to-date with the latest research in the field to ensure that we continue to provide the most effective treatments possible.

BASIC ELEMENTS

MagVenture Pain Therapy system

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Pain (professionals) - MagVenture MagVenture Pain Therapy

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Treat chronic pain with MagVenture Pain Therapy. Painless peripheral magnetic stimulation relieves pain by up to 87%. Learn more at MagVenture.com

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Back from a great conference.

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A great conference this year, with great topics and events! I wish that I had taken more pictures – the only one that I have is this random picture of the prosecco that was at the poster session, which makes the event seem way more formal and bougie than it was.

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I previously posted on the "weird neuromod" of generating aesthetic chills - apparently some ongoing research.

Could be interesting considering the (unscientifically named) concept of "ASMR" as well as the sensation of "spine-tingling" "eureka" or "sense of enlightenment" - would also be interesting as "placebo" in psychedelic trials though that is complicated if the results in this article are replicated.

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Show authors

BMC Psychiatry 24, Article number: 40 (2024) Cite this article

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Abstract

Background

Depression is a major global health challenge, affecting over 300 million people worldwide. Current pharmacological and psychotherapeutic interventions have limited efficacy, underscoring the need for novel approaches. Emerging evidence suggests that peak emotional experiences characterized by awe, transcendence, and meaning hold promise for rapidly shifting maladaptive cognitive patterns in depression. Aesthetic chills, a peak positive emotion characterized by physical sensations such as shivers and goosebumps, may influence reward-related neural pathways and hold promise for modifying core maladaptive beliefs rooted in early adverse experiences.

Methods

We enrolled 96 patients diagnosed with major depressive disorder. A validated database of multimedia known to elicit chills responses (ChillsDB) was used for stimulus presentation. Participants' emotional responses were assessed using the Emotional Breakthrough Inventory (EBI), while shifts in self-schema were measured via the Young Positive Schema Questionnaire (YSPQ).

Results

The study found that chill-inducing stimuli have the potential to positively influence the core schema of individuals with depression, impacting areas of self-related beliefs. The associated phenomenology triggered by chills appears to share similarities with the altered states of consciousness induced by psychedelic substances like psilocybin.

Conclusions

These preliminary results suggest that the biological processes involved in aesthetic chills could be harnessed as a non-pharmacological intervention for depression. However, further investigation is necessary to comprehensively understand the neurophysiological responses to chills and to evaluate the practicality, effectiveness, and safety of utilizing aesthetic chills as a preventive measure in mental health care.

Peer Review reports

Introduction

Depression is a debilitating mental illness characterized by emotional numbness and a generalized lack of motivation or pleasure in life [ 1, 2]. Depressed patients often exhibit patterns of constant negative rumination about themselves and others, as well as social isolation [ 1, 2, 3]. Depression is associated with dysregulation in the brain's mesocortical and mesolimbic reward pathways, particularly in areas like the ventral tegmental area (VTA) and the nucleus accumbens (NAc) [ 4, 5]. These areas, rich in dopaminergic neurons, are crucial for experiencing pleasure and motivation [ 4, 6]. Such neural changes can diminish a patient's ability to experience pleasure and contribute to core aspects of depressive symptomatology, such as feelings of worthlessness, hopelessness, and an inability to envision a positive future [ 6, 7]. Psychotherapy for these patient populations typically attempts to stop the self-reinforcing cycle of negative emotions by addressing the patient's core maladaptive beliefs, a process known as cognitive restructuring [ 8, 9, 10]. Specifically, evidence shows that schema related to self-image play an essential role in depression and should be the main focus of intervention [ 9, 11]. In recent years, there has been considerable interest in psychedelic compounds (e.g., psilocybin, lysergic acid diethylamide [LSD]) and their extraordinary phenomenology as a means to induce flexibility in such core beliefs [ 12], sometimes leading to considerable transformation and behavioral change [ 13, 14]. Evidence indicates that psychedelics alleviate the symptoms of depression, including in long-term treatment-resistant patients [ 15, 16, 17]. Crucially, subjective experience has been found to be a major predictor of long-term therapeutic outcomes and patient well-being [ 18, 19]. However, these peak experiences typically require years of psychotherapeutic support and are difficult to reproduce in the absence of psychotomimetic drugs, which may carry contraindications and potential side effects.

Here, we investigated whether the peak experience of aesthetic chills could mimic some of these effects and thereby induce changes in deep-seated models of the self to mitigate shame (i.e., foster self-acceptance) in patients with a depressed mood. Aesthetic chills (thereafter "chills") are a peak emotional response induced by powerful, sometimes life-changing stimuli [ 20, 21, 22, 23]. They are characterized by a specific bodily response of thermoregulatory mechanisms such as shivers and goosebumps [ 21, 24, 25, 26] and discrete neural correlates associated with reward and well-being [ 21, 24, 25, 26, 27]. Stimuli known to induce chills include music [ 28], film [ 29], speech [ 30], as well as secular and religious rituals [ 20]. Notably, preliminary evidence suggests that musical chills may induce psychological insight [ 31], a core phenomenological component of psychedelic experiences and psychotherapeutic work [ 19, 32]. As a strong hedonic response to emotional stimuli engaging the brain reward system [ 21, 27], chills may hold scientific and clinical potential for reward-related or dopaminergic illnesses such as depression [ 33, 34]. However, not much is known about chills and psychopathology [ 35]. The goal of this study is to examine the effects of chills stimulation on maladaptive cognitions in subjects clinically diagnosed with depression. We investigated whether (1) chill-inducing content may affect the core schema of depressed patients (specifically shame and self-acceptance) and (2) the mechanism at play during the chills response may resemble the form of experience induced by the psychedelic and psychotherapeutic experience, leading to similar positive outcomes for affective disorders patients. To measure the psychedelic phenomenology we used the recently developed Emotional Breakthrough Inventory which typically predicts long-term therapeutic outcomes in psychedelic-assisted psychotherapy [ 18], and to assess positive belief change after the exposure we used Young Positive Schema Questionnaire (YSPQ) [ 36].

To test the effects of chills videos on depression and self-schema, we used two stimuli from ChillsDB, a recently constituted chills stimuli database [ 22]: one motivational video specifically targeting self-schema through emotional invectives to the listener and a viral commercial video targeting pro-social feelings and known to elicit chills and tears. Both have been shown in past studies to elicit chills in 80% of subjects as well as powerful emotional reactions [ 37]. To estimate the subjective effects of chills and assess to what extent they may resemble psychedelic or psychotherapeutic experiences, we used the recently constituted Emotional Breakthrough Inventory (EBI; [ 18]). To assess positive belief change after exposure, we used the Young Positive Schema Questionnaire (YSPQ; [ 36]). We hypothesized that (a) chill-inducing stimuli will increase self-acceptance and decrease shame in depressed individuals, as measured by the self-acceptance schema on the YSPQ and (b) the experience of chills will correlate with greater emotional breakthrough on the EBI. Testing these hypotheses will provide initial evidence on the effects of aesthetic chills on maladaptive cognition in depression, and determine if the chills mechanisms can potentially mimic psychedelic-assisted psychotherapy to modify entrenched negative self-schemas.

Methods

Participants

This study recruited a cohort of 96 participants (52 females; mean age = 37 years, SD = 14) through an online platform with comprehensive pre-screening features commonly used to recruit participants (Prolific). Prolific is a specialized online platform designed to connect researchers with a diverse global pool of participants for research studies, offering tailored participant recruitment through a range of pre-screening tools including mental health diagnoses, medication, age, gender identity, nationality, and employment status [ 38]. All participants reported a prior physician-diagnosed depression. Among them, 90.7% were currently undergoing therapy (N = 78), and 97.7% were on medication (selective serotonin reuptake inhibitor), N = 84. To ensure sample homogeneity and confirm that all participants were experiencing depression at the time of the intervention, we excluded 10 individuals who reported that they were neither undergoing treatment nor taking medication currently. Additionally, to ensure clarity in communication and reliability of responses, participants were screened for native-level English proficiency.

Procedure

After being informed about the experiment and signing the consent form, participants were randomly assigned to one of the two experimental conditions (Stimulus 1 vs. Stimulus 2). Participants were first asked to answer questions about demographics (age, gender, nationality, ethnicity), and questions from 5 YSPQ schemas: Self-acceptance, Trust, Social Belonging, Self-reliance/competence, and Emotional Fulfillment. Following the circumplex model of emotion [ 39], participants were asked to report their current mood in feeling "Extremely Unpleasant" to "Extremely Pleasant" for the valence rating, "Extremely Calm" to "Extremely Excited" for the arousal rating before exposure to the stimulus on a 10 point Likert scale. Immediately after watching the entirety of the stimulus, the participants were asked about their emotional valence and arousal, and some phenomenological questions about the experience (see the self-report subsection). Participants were asked whether they experienced chills, as well as the intensity, frequency, and duration of chills, whether the video reminded them of any personal experience, and to describe the content of the video that generated chills. Participants then answered the EBI and took the same 5 schemas from the YPSQ in a randomized order. Participants were provided with a contact for any further information. The experiment lasted about 15 min.

Materials

Stimuli

To identify the stimuli, we used ChillsDB, an open-source database of validated audiovisual stimuli that are known to elicit aesthetic chills (goosebumps, psychogenic shivers) in a US population [ 22]. The database consists of 204 chills-eliciting videos in three categories: music, film, and speech (see Fig. 1), which were validated across 600 + participants. ChillsDB was built using an ecologically valid method for harnessing chills stimuli "in the wild" by searching for mentions of somatic markers in user comments using algorithms to parse social media platforms (YouTube and Reddit). Two stimuli were extracted from the top six validated videos. Both stimuli have a probability ≥ 0.8 of eliciting chills in a US population. Stimulus 1: "Giving" (Thailand, 2013, 3 min) is a three-minute Thai TV commercial by the TrueMove mobile company. Stimulus 2: The Dream stimulus (6 min 19 s) was selected specifically for its ability to affect the self-image of subjects. It is a medley of motivational speeches by speakers such as Les Brown, Eric Thomas, and Will Smith, accompanied by emotional music.

Measures

a.
Emotional Breakthrough Inventory (EBI)

The EBI was developed using an Internet survey of those who reported using a psychedelic [ 18]. It is a reliable and validated scale that is positively associated with increases in well-being after a psychedelic experience [ 18]. The EBI consists of eight statements such as "I felt able to explore challenging emotions and memories" and asks about "emotional release", "closure", "emotional breakthrough" and "resolution of conflict". Participants rated the extent to which they agreed with each statement on a 0-10 scale (with 0 being "No, not more than usual" and 10 being "Yes, entirely or completely").

b.
Young Positive Schema Questionnaire (YPSQ)

The Young Positive Schema Questionnaire (YPSQ; [ 36]) is a 56-item self-report measure designed to assess 14 positive schema factors: Emotional Deprivation, Abandonment, Mistrust/Abuse, Social Isolation, Defectiveness, Failure, Dependence, Vulnerability to Harm, Enmeshment, Subjugation, Self-Sacrifice, Emotional Inhibition, Unrelenting Standards, and Entitlement. The YPSQ was developed to complement the Young Schema Questionnaire 3 Short Form (YSQ-S3; [ 10]) which measures early maladaptive or negative schemas. Participants respond to YPSQ items on a 6-point Likert scale ranging from 1 (completely untrue of me) to 6 (describes me perfectly). Scale scores are calculated by summing the items for each subscale. Higher scores indicate greater endorsement of the positive schema. For this study, we measured the schema most often associated with depression [ 8, 9, 11]. These are Self-acceptance/lovability schema (equivalent to the Shame/effectiveness schema in the original early maladaptive schema (EMS)), the Trust schema (equivalent to Mistrust/abuse in EMS), Social Belonging (Social Isolation and Belonging), Self-reliance/competence (Dependence / Incompetence), Emotional Fulfillment (Emotional Deprivation).

c.
Chills Self-Report

Chills were self-reported by the participants through a series of questions regarding their emotional and physiological responses to the stimulus. They responded to binary (Yes/No) questions such as "Did you experience chills?" and "Did you experience goosebumps?", as well as questions rated on a 0-10 Likert scale, including frequency and intensity. Additionally, a qualitative component involved open-ended responses, asking participants to describe their experience during the video, their description of what caused the chills in the video, and whether the video reminded them of a personal experience, providing a deeper insight into their emotional engagement with the content.

Ethics

The experiment complied with the Helsinki Declaration and was approved by the Committee on the Use of Humans as Experimental Subjects at the Massachusetts Institute of Technology (MIT). All participants gave their voluntary informed consent and we followed the Ethics Code of the American Psychological Association. All participants were informed about the purpose of the research, their right to decline to participate and to withdraw from the experiment, and the limits of confidentiality. We also provided them with a contact for any questions concerning the research and with the opportunity to ask any questions regarding the phenomenon under study (aesthetic chills) and receive appropriate answers. All participants reacted positively to the experiment and were thankful for the opportunity to learn about the phenomenon.

Data analysis

We employed descriptive statistics to calculate means and standard deviations for variables like emotional breakthrough and arousal ratings [ 40]. Following assumption checks, we used the Mann-Whitney U test for inferential analysis, suitable for non-normally distributed data [ 41], to compare the experiences of participants with and without chills. Additionally, we applied Spearman's rank correlation coefficient to assess the relationship between chill intensity and emotional breakthrough, a method effective for non-parametric data [ 42]. This combination of descriptive and inferential statistical approaches aimed to provide a robust analysis of the potential impact of aesthetic chills on depression symptoms. Following the standard reviewer disclosure request endorsed by the Center for Open Science [ 43], we confirm to have reported all measures, conditions, data exclusions, and how we determined our sample sizes.

Results

In total, 50 participants reported to have experienced chills (31 in the Giving stimulus, 19 in the Dream stimulus). The Shapiro-Wilk tests indicated non-normality for all variables of interests: Chills Intensity (W = 0.846, p < 0.001), Emotional Breakthrough (W = 0.925, p < 0.001), Valence Drift (W = 0.943, p < 0.001), and Arousal Drift (W = 0.968, p = 0.030), indicating the need to use non-parametric tests for subsequent analyses. We found that participants who experienced chills reported a more important emotional breakthrough (M EBI=3.91, SD = 2.35) than those who did not (M EBI=1.73, SD = 1.85). A Mann Whitney U revealed that this difference is statistically significant (U = 416, p < 0.001). The reported intensity of the chills positively correlated with the emotional breakthrough (r(94) = 0.542, p  < 0.001).

On the left, differences in emotional breakthrough across the chills and non chills conditions. On the right, chills intensity positively correlated with the emotional breakthrough

We then proceeded to test for differences in valence and arousal in subjects who experienced chills compared to those who did not. We did not find any significant difference (U = 793, p = 0.345) of pre-exposure arousal ratings between subsequently those who reported chills (M Arousal pre=3.92, SD = 1.99) and those who did not (M Arousal pre=3.44, SD = 1.73). Similarly, we did not find any significant difference (U = 852, p = 0.674) of pre-exposure -valence ratings between those who experienced chills (M Valence pre=5.88, SD = 1.99) and those who did not (M Valence pre=5.69, SD = 1.72), indicating independence between pre exposure emotional state on propensity of getting chills.

Participants who reported chills also reported greater valence (M Valence=7.30, SD = 2.22) and arousal ratings (M Arousal=5.72; SD = 2.08) after the stimulus than those who did not (M Valence=5.64, SD = 1.93; M Arousal=4.08; SD = 2.20) (Fig. 2). Both differences were significant across chills exposure conditions for both valence (U = 493, p < 0.001) and arousal ratings (U = 534, p = 0.001). We found that an increase in chills intensity correlates with an increase in valence (Spearman's rho 0.543, < 0.001) and arousal (Spearman's rho 0.384, < 0.001). Mediation analysis revealed that the intensity of chills significantly predicted the change in valence (total effect = 0.239, SE = 0.0622, Z = 3.84, p < 0.001), mediated by emotional breakthrough (indirect effect = 0.122, SE = 0.0430, Z = 2.84, p  = 0.005).

Finally, upon examining the impact of chills on YPSQ, we applied a Bonferroni correction to account for multiple comparisons across 5 tests, setting the significance threshold at p = 0.01. In this analysis, participants who experienced chills demonstrated a statistically significant improvement in self-acceptance (U = 570, p  = 0.003). Notably, this significant result was not observed in the other five tests, speaking to the specific impact of chills on self-acceptance.

Emotional drift in valence and arousal in chills and no chills conditions. The chills participants reported a greater drift in emotional valence and arousal, and a change from a bottom quadrant to a top quadrant, whereas the participants who did not experience chills remained in the same emotional space

Discussion and conclusion

In this exploratory study, we tested the effect of two chills stimulations on depressed subjects. We found that the subjects who reported chills displayed significantly greater self-acceptance (i.e., less shame), as measured by YPSQ, and compared to the subjects who did not experience chills. Furthermore, we found that participants who reported chills reported a greater emotional breakthrough, a measure commonly used in psychedelic research to assess the patient's propensity to experience difficult emotions during the session. Similar to prior studies [ 37], we also found that chills were significantly correlated with a change in valence and arousal, a positive outcome for depressed patients who ordinarily struggle with anhedonia and lower reward sensitivity [ 44, 45]. Interestingly, the change in valence score was mediated by the level of emotional breakthrough.

These results suggest that chill-inducing stimuli may have the potential to affect the core schema of depressed patients, specifically in terms of shame and self-acceptance. Core maladaptive beliefs can typically be traced back to adverse childhood experiences (e.g., rape, neglect, abuse) and are often met with considerable resistance by the patient due to the installment of a deep sense of shame and self-deprecation, where the patient perceives himself as inherently defective [ 46, 47]. The main challenge of psychotherapy is to address these dysfunctional patterns of thoughts and feelings learned early in childhood during states of heightened brain plasticity [ 48]. Aesthetic chills may potentiate cognitive restructuring through the release of dopamine, and a temporary enhancement of synaptic plasticity, critical for learning and cognitive change [ 49]. Dopamine's role in reward prediction error processing is essential for adapting and relearning emotional responses [ 50], particularly in the context of positive experiences [ 51] with increased dopamine levels associated with positive affect and enhanced cognitive flexibility [ 52]. The potent dopaminergic response elicited by aesthetic chills could interrupt negative thought patterns, providing a unique opportunity for positive cognitive and emotional relearning [ 34, 53, 54], especially with regards to orienting to the semantic content of the stimulus.

Interestingly, we did not find any difference in arousal scores beforehand for participants who reported chills compared to those who did not, contrary to the results of [ 55], where the statistical difference in arousal score before exposure can be used to predict for the subsequent occurrence of chills in healthy participants. Perhaps, the medication is damping the response.

The mechanism of action during the chills response is not well understood, but our results suggest that it may resemble the form of problem resolution induced by the psychedelic and psychotherapeutic experience [ 13]. This finding is intriguing, as it suggests that aesthetic chills may be able to mimic some of the therapeutic effects of psychedelics without the use of psychoactive drugs. This may be particularly useful for individuals who are unable or unwilling to use psychedelics for various reasons, such as legal restrictions, safety concerns, or personal preferences.

However, our study has several limitations. First, as an exploratory study, our sample size is limited and may not be representative of the general population. Second, this study lacked formal diagnostic assessment by a clinician at intervention time. Hence, a follow-up study should include detailed clinician interviews (e.g., using the MINI International Neuropsychiatric Interview) for a more robust validation of these preliminary findings. Third, we used a self-report measure to assess the effects of chills on shame and self-acceptance, which may be subject to some bias. Future research should aim to address these limitations and provide more robust evidence for the effects of chills on depression and other mental health conditions. This could be done through larger, more diverse samples, more objective measures of emotional response (e.g., neurophysiological), and more controlled experimental designs. Additionally, research should explore the underlying biological mechanisms of the chills response in the context of depression and its potential therapeutic applications, as well as the potential risks and drawbacks of using aesthetic chills as a therapeutic intervention.

Conclusion

Aesthetic chills may be a promising avenue for future therapeutic interventions and offer a non-pharmacological and easily accessible means to induce psychoplastogenic states. This preliminary study suggests that chill-inducing stimuli may have the potential to affect the core schema of depressed patients, specifically in terms of shame and self-acceptance. The mechanism of action during the chills response may resemble the form of insight induced by the psychedelic and psychotherapeutic experience, leading to similar positive outcomes for the subject. However, further research is needed to fully understand the immediate and long-term effects of chills on depression and other reward-related or dopaminergic illnesses.

Data availability

The data for this study is available on the FigShare repository:

Schoeller, F., Jain, A., Adrien, V., Maes, P., & Reggente, N. (2023). Aesthetic Chills Mitigate Maladaptive Cognition In Depression (Version 1). figshare. https://doi.org/10.6084/m9.figshare.24815574.v1.

References

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Funding

This research was partially financed by a Joy Ventures Research Grant and Tiny Blue Dot Foundation.

'Open Access funding provided by the MIT Libraries'

Author information

Author notes

Felix Schoeller and Abhinandan Jain contributed equally to this work.

Authors and Affiliations

1. Massachusetts Institute of Technology, Cambridge, MA, USA

Felix Schoeller, Abhinandan Jain & Pattie Maes

2. Institute for Advanced Consciousness Studies, Santa Monica, CA, USA

Felix Schoeller & Nicco Reggente

3. Department of Infectious and Tropical Diseases, AP-HP, Avicenne Hospital, Université Sorbonne Paris Nord, Bobigny, F-93000, France

Vladimir Adrien

4. Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, Inserm UMR-S 1266, Team Membrane Traffic in Healthy & Diseased Brain, Paris, 75014, France

Vladimir Adrien

Contributions

FS and AJ conceptualized the study and collected and analyzed the data. VA, NR, and PM contributed to the manuscript and theoretical framework.

Corresponding author

Correspondence to Felix Schoeller.

Ethics declarations

Ethics approval and consent to participate

This study was approved by the Committee on the Use of Humans as Experimental Subjects at the Massachusetts Institute of Technology (MIT). All participants gave their voluntary informed consent to participate.

Consent for publication

Not applicable.

Competing interests

This research was partially financed by a Joy Ventures Research Grant and Tiny Blue Dot Foundation. In the past years, FS co-founded and received compensation from BeSound SAS and Nested Minds LLC.

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Schoeller, F., Jain, A., Adrien, V. et al. Aesthetic chills mitigate maladaptive cognition in depression. BMC Psychiatry 24, 40 (2024). https://doi.org/10.1186/s12888-023-05476-3
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Aesthetic chills mitigate maladaptive cognition in depression - BMC Psychiatry

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Background Depression is a major global health challenge, affecting over 300 million people worldwide. Current pharmacological and psychotherapeutic interventions have limited efficacy, underscoring the need for novel approaches. Emerging evidence suggests that peak emotional experiences characterized by awe, transcendence, and meaning hold promise for rapidly shifting maladaptive cognitive patterns in depression.

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The ANPA Annual Meeting features internationally renowned clinician-scientists and clinician-educators offering presentations on the latest advances in the science of cognition, emotion, and behavior and the application of those advances to clinical practice, training, and certification. In addition to superlative presentations, our Annual Meeting presents an exciting opportunity for meeting and networking with fellow participants.

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Interesting possibilities for medical student, resident, and patient education; I'm not one to get too excited by 3D printing, but if it were otherwise available this would be cool:
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Learning about neuroanatomy is a prerequisite in medical curricula (3). Digital forms of neuroanatomy education, including three-dimensional (3D) image reconstruction of the human brain with artificial intelligence (AI) and 3D printing, are often incorporated to approach the challenges of studying t…

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This came out a little bit ago, but I haven't been updating social media or Wordpress / Padlet for a while

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Check out the Linktree for a couple of new social media options. Fairly quiet and uninspired recently but hopefully more to come.

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https://www.drugtopics.com/view/va-to-cover-lequembi-for-alzheimer-s-with-some-exceptions

There are still a lot of questions about the efficacy and even the theoretical underpinnings of this medication, but it is interesting.

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VA To Cover Alzheimer’s Drug, With Some Exceptions

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Per VA regulations, anyone who has had a stroke or seizure within the last year, as well as those with MRIs showing microhemmorrhages, aneurysms, lesions or tumors would be excluded from coverage of the drug, called Leqambi

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Virtual and in-person options!

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The 33rd Annual Meeting of the American Neuropsychiatric Association will be held LIVE at the

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Due to my website's woes, here is the

Linktree and disclaimer:
Social media is, in general, a minefield for professionals – especially considering that this website is mostly for colleagues, trainees, and anyone curious after seeing one of my talks.

This is especially true in light of certain recent (as of 2022) significant changes in the social media landscape.

Retweets or the equivalent are not endorsements. Any opinions expressed are my own and do not reflect the views of my employers or affiliates. None of this is medical advice or opinion.

More specific disclaimers:

Goodreads: I’ve mostly stopped rating books, but some old rating remain. Don’t trust those. Also – I read a lot of books about sexual health and gender and follow a lot of those artists / writers, so some potential scandalous and/or problematic books may be on the list. Again, read / want to read is not an endorsement

Gaming sites: I may put some IDs for programs / sites such as Steam, Blizzard, Discord, etc. Similar to above, I sometimes buy large bundles to support charitable causes, including some focused on sexuality. Being on my list, and even the company with the list itself, is not an endorsement

That being said, here is my Linktree:

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http://psychialove.com/website-woes/

Long story short - bookmark this page and the Linktree if you are interested in weird neuropsychiatry and adjacent articles, updates, etc.

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For any residents or colleagues randomly wandering on to this page - I mentioned in lecture that I've been having some website woes with my hosting. I'm working on getting this resolved at some point, but considering that I don't have the desire to spend time or energy on fixing it - I recommend bookmarking the Padlet as that seems to stay up -
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I also pop into social media at times:
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Unless this can get resolved, I may just cut costs and eliminate this WordPress and use that instead for a bit and may consider transferring to another host.

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For any residents or colleagues randomly wandering on to this page - I mentioned in lecture that I've been having some website woes with my hosting.

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Annual ANPA Meeting Registration Now Open!

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d-Cycloserine, 10Hz rTMS, and Neuroplasticity

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d-Cycloserine, 10Hz rTMS, and Neuroplasticity

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Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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Dear Editor,

Clinical applications of repetitive transcranial magnetic stimulation (rTMS) have advanced without complete understanding of its mechanisms of action. Pharmacology can help unravel the neuronal-level actions of rTMS in humans by blocking or targeting molecular mechanisms and examining the impact on neurophysiology measures such as motor-evoked potentials (MEPs). However, such studies are scarce and underpowered, necessitating replication studies to confirm these foundational findings (reviewed in Refs. [,

]). We sought to replicate our own experiment, which found a significant effect of n-methyl-d-aspartate (NMDA) receptor agonism on rTMS-induced plasticity, despite only 10 subjects and effect size of only 0.3 (Power = 0.42). We therefore sought to test the reproducibility of our previously low-powered study while retesting the role of the NMDA receptor in 10-Hz rTMS []. We hypothesized that 10-Hz rTMS strengthens affected networks by reinforcing synaptic connections through long-term potentiation (LTP), based on animal studies and our previous findings [,]. We therefore predicted that a single dose of DCS, relative to placebo, would enhance the magnitude of MEPs otherwise potentiated by 20 minutes of 10-Hz rTMS.

We used similar methods to the study performed at the Medical University of South Carolina (MUSC) [] by again recruiting ten healthy right-handed, non-smoking adults (6 female) from 21 to 39 years old (28 ± 6.0) into a randomized, double-blind, crossover study approved by the Butler Hospital Institutional Review Board. All participants provided informed consent prior to any research procedures, and we excluded those with brain disorders, or who were actively taking neuropsychotropic medications. We randomly assigned participants to a single dose of either 100 mg d-cycloserine or identical microcrystalline cellulose capsules (Tidewater pharmacy, Mt. Pleasant, SC) in a blinded random manner over two separate visits, at least 1-week apart ( Fig. 1 A).

A PowerMAG EEG100 power unit and PMD70-pCool Coil (Mag&More, Germany) were used to stimulate the left motor cortex "hotspot". MEPs were recorded from the right first dorsal interosseous (FDI) muscle with surface electromyography (EMG) electrodes (Cardinal Health, USA). The raw signal was amplified and filtered by CED 1902 and 1401 microprocessors and analyzed with Signal software (Cambridge Electronic Devices, UK). Pulses were kept within 0.5 mm of target with neuronavigation performed with a Brainsight 2 System (Rogue Research, Quebec, Canada).

Approximately 60 minutes following drug administration, we measured baseline assessments including: resting motor threshold (rMT), one bin of 40 single-pulses (SP) at 120% rMT, and one SP at every percent intensity from 20% to 100% of maximum machine stimulator output in randomized order fit to a Boltzmann sigmoidal recruitment curve (RC). Pulses were jittered at 4-7 second intervals. Paired-pulse measures including short intracortical inhibition (SICI) and intracortical facilitation (ICF) were collected as previously described []. Long intracortical inhibition (LICI) was produced with pulses separated by 100 ms at 120% rMT. These were followed by an rTMS 'plasticity protocol' (20 min of 10-Hz stimulation; 1.5 sec on/58.5 sec off at 80% rMT) two-hours after drug administration. rTMS parameters were based on Jung et al. (2008) []. We then conducted the same assessments over 1-h after the plasticity protocol, with bins of 40 SP collected every 15 minutes (see Fig. 1 A for details). Baseline measures were collected after drug administration in order to directly test the effect of DCS on rTMS, rather than on baseline excitability, which DCS has been previously shown to have no effect [].

All data were analyzed with R software (version 4.2, R Core Team, Vienna, Austria). We analyzed SP data over a 1-h time course with a general linear mixed model for continuous outcomes with a random effect for repeated measures using the package lme4. We fit a series of models testing the effects of drug, time, and the drug x time interaction. ANCOVA was used to test potential order effects. Raw RC data was fit to a Boltzmann sigmoidal function using Levenberg-Marquard nonlinear least-mean squares algorithm. Paired student's t-tests were used to compare RC slope, intercept, and height averages before and after rTMS, as well as percent change associated with rTMS between drug conditions. The level of significance was set at p < .05. All subjects completed the study and reported no adverse effects. Subjects correctly guessed which pill they received 4/20 times.

Our 1-h time-course data revealed a similar trend to our previous single-pulse results, but did not reach significance ( Fig. 1B, F = 2.19, p = .12). Drug order had no effect on MEP amplitudes (p = .52). Our nonsignificant results with n = 10 emphasize the need for larger sample sizes. Power analysis with our effect size of 0.3 suggests 19 subjects would be required. Nevertheless, faciliatory changes in RC supported our central hypothesis. We found a significant difference in the degree of rTMS-mediated change (before vs after rTMS) in intercept between placebo and DCS conditions ( Fig. 1D, p = .04). We further observed a decrease in intercept exclusively in the DCS condition from pre to post rTMS, indicating a left (excitation) shift ( Fig. 1E, p = .03). rTMS had no significant effect on the RC slope nor height for either drug despite visual differences seen in plateau ( Supplemental Fig. 1) and there was also no difference in the degree of pre-to post-change between drug conditions for either measure (slope: PBO 1.18 ± 0.64, DCS 1.12 ± 0.45, p = .78; height: PBO 1.26 ± 0.52, DCS 0.94 ± 0.28, p = .19).

Our pharmaco-rTMS replication study suggests that NMDA activation may be sufficient to enhance 10-Hz rTMS-induced facilitation as captured by excitatory left-shift in RC ( Fig. 1C), and produced trend-level MEP enhancement in response to single-pulses over a 1-h time-course, consistent with results published previously ( Fig. 1 B) []. Our trend-level results may be the result of insufficiently powered experiments. Our original study was likewise underpowered, although the results were significant. Many of the foundational studies elucidating the mechanism of TMS have likewise had very small sample sizes. These results demonstrate the need to adequately power future experiments to ensure correct mechanistic conclusions.

10-Hz rTMS lowered the average intercept (before and after, p = .03) after taking DCS, but not placebo (p = .80). Differential proportion of cortical involvement (compared to spinal) may be one reason that recruitment curves appeared to be more sensitive to NMDA agonism on rTMS effects than set stimulus MEPs. In fact, even when compared with intracortical excitability assays, recruitment curves have been reported to be more sensitive to receptor modulation []. Thus, acute pharmacologic NMDA receptor activation was sufficient to enhance rTMS-induced potentiation, demonstrating a more specific role of NMDA receptors in rTMS facilitation (compare with necessity of NMDA receptors demonstrated by Huang et al., 2007 []). Taken together, these results and other human data [,,], combined with prior animal data [] support the notion that 10-Hz rTMS-induced motor plasticity may work through LTP-like mechanisms.

To date, no studies have examined whether NMDA receptor augmentation is necessary to enhance the faciliatory effects of 10-Hz rTMS in humans, though parallel work with intermittent (i)TBS demonstrates their necessity []. DCS has been found to reverse the excitatory effects of iTBS [

] and blunt responses in a replication study [] in healthy human subjects. Interestingly, DCS was sufficient to stabilize iTBS effects in depressed subjects over a 24-h period []. Moreover, preliminary data from a randomized controlled study found that DCS enhanced iTBS antidepressant effects by more than 2-fold []. These results emphasize the therapeutic potential inherent in rTMS-mediated modulation of key brain networks through leveraging our developing knowledge of its neuronal mechanisms. Our ultimate goal is to understand how TMS works clinically. It is therefore important to note that our motor protocol differs from clinical protocols in pulse number, intensity, train duration, intertrain interval as well as cortical region. The prolonged clinical protocol could have opposing (homeostatic) effects []. The critical next step, therefore, is to test these NMDA receptor-mediated effects with rTMS in the appropriate population and cortical target.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

Brown J.C.

Higgins E.S.

George M.S.

Synaptic plasticity 101: the story of the AMPA receptor for the brain stimulation practitioner.

Neuromodulation, 2021

Teo J.T.

Swayne O.B.

Rothwell J.C.

Further evidence for NMDA-dependence of the after-effects of human theta burst stimulation.

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Acknowledgements

The authors would like to thank Prayushi Sharma, Jee Won Kang, and Eric Tirrell for technical support and Nicole Armstrong, PhD for statistical support. Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number P20GM130452, Center for Biomedical Research Excellence, Center for Neuromodulation.

Appendix A. Supplementary data

The following are the Supplementary data to this article:

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A replication study of NMDA receptor agonism sufficiency to enhance 10-Hz rTMS-induced motor cortex plasticity

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Clinical applications of repetitive transcranial magnetic stimulation (rTMS) have advanced without complete understanding of its mechanisms of action. Pharmacology can help unravel the neuronal-level actions of rTMS in humans by blocking or targeting molecular mechanisms and examining the impact on neurophysiology measures such as motor-evoked potentials (MEPs).

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I was already planning on updating my site due to the next round of lectures coming, but some recent, um, unfortunate events on social media have pushed me to update earlier and potentially change how I do things.

So - check out my new Linktree to various accounts!

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Also check out the good summary of the issues with the "Bystander Effect"

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Content warning: This article contains frequent references to suicide and later mentions murder. Please proceed with caution.

To say that the world of video game academia is interesting would be the understatement of the century. It is a world where research is retracted for "mathematically impossible" statistics, where distinguished professors send haughty, harassing emails to other professors, and where interviewees are obligated to have a pocket answer for the eventual question on video games and violence.

But underneath the drama and spectacle are people who truly care about the integrity of their field. This passion can lead to academics banding together for their cause and telling the world "Enough. This is a problem and we need to be better".

This is exactly what has happened with the publication of ' Researchers should avoid causally attributing suicide to video game play as a single factor', a letter which challenges a research paper detailing suicides in Pakistan attributed to PlayerUnknown's Battlegrounds (PUBG).

To give you the full story of what is happening and why this is important, I will be dividing this article into three sections: a summary of the paper on video games and suicide, a summary of the letter criticising this paper, and my own input on why relying on the data used in the original study is such a bad idea. Spoiler alert: it has historically led to one of the biggest and most frequently repeated lies in the history of psychology.

As usual, there will be a summary at the bottom if you do not wish to read everything. Now, let's begin.

Contents

The Study

The paper being placed under scrutiny is 'PUBG-related suicides during the COVID-19 pandemic: Three cases from Pakistan' by Mamun et al. (2020). In this paper, three suicides are detailed that occurred in Lahore, Pakistan within the span of a few days. The main concern outlined in this paper is that free time during lockdown and isolation may be spent indulging in excessive gaming that can lead to negative consequences - the three cases provided acting as extreme examples.

Reading through the paper can be an exercise in whiplash at times. The summary of the paper tentatively says "It is likely that all three individuals experienced other predisposing factors related to psychological instability", then the body of text makes bold statements such as "The present-report highlights what appears to be the first online gaming suicides during the COVID-19 pandemic globally...". Perhaps this is just me, but the juxtaposition of those two terms makes me very uncomfortable.

Alongside the whiplash, the paper can generally be a frustrating read. I hinted at the beginning that the source of the data for this publication is a source of controversy, so allow me to elaborate. Rather than using data collected according to the scientific method, this paper relies on news and media reports. When doing this, just enough crumbs of information are left in the text to be suspicious of the circumstances. For example, one person had had a heated argument with their father prior to the tragic event, and another person had made a phone call to an unidentified person beforehand.

While it would be foolish of me to blame these things in isolation (more on this later), it is a good example of why relying on media reports is so frustrating - there simply isn't enough room for elaboration or investigation. If you are setting out to write a report on video games and suicide, everything else gets sidelined and there isn't enough time to accurately portray the lives these young people led.

There are many other problems with this paper, but they are much more eloquently explained in the letter - so let's get to it.

The Letter

Four months after the above paper was published, a letter to the publisher was penned criticising it in three main ways.

Firstly, the authors are critical of the poor quality of the data used in the paper. Minimal effort was made to adapt media reports into an academic publication, simply changing or adding a few words which borders on plagiarism. When details were changed, it seemed to be done to add further sensationalism. For example, one of the teenagers was "said by those who knew him to be addicted to the game". However, when you go back and check the media text, the statement about the teenager playing PUBG for many hours a day comes from a police superintendent, not someone 'who knew him'.

You may have noticed that my description of the publication was suspiciously short. This was a deliberate choice due to the second critique - the original paper violates guidance from the World Health Organisation (2008) not to describe completed or attempted suicides in detail, nor to attribute suicide to one particular factor. The original paper is guilty of both of these factors, so I didn't want to be guilty of the same ethical dilemmas being critiqued.

These ethical shortcomings are troublesome for two reasons. Many of us are familiar with the newly-recognised Gaming Disorder, and the authors are concerned that attributing the complex issue of suicide to video games will cause people to panic. I can't help but agree as when news outlets reported that 20 hours of gaming per week equated to video game addiction, I saw concerned Facebook mothers tagging their friends to notify them. The second reason is due to something known as suicide contagion. The authors point to a body of evidence indicating that high-profile media reports on suicide can influence suicide rates, particularly in young people (Institute of Medicine and National Research Council, 2013; Niederkrotenthaler et al., 2020).

The final point made by the researchers is simply how unscientific the paper is. No attempts were made to source additional information outside of the media reports, and they comment that a lot of research referenced in the paper is self-citation. I took a look at the reference section to work out just how egregious the self-referencing was. 19 sources were cited in total, 15 of which were academic sources such as a peer-reviewed publication or textbook. Of these 15 academic sources, 13 (87%) contained an author of this paper.

When you combine citing yourself nearly every time you cite something, failure to engage with other research on the topic, failure to go any further than surface-level media reports, breaching moral and ethical guidelines set out by the World Health Organisation, and failure to try to collect or critique or analyse any information whatsoever, I cannot help but feel that this is academia at its most disappointing. The conclusion of the letter does an excellent job of summarising my feelings:

In repackaging news articles as formal case reports, Mamun et al. appear to have breached guidelines regarding the ethical reporting of suicide, and risk confusing the public debate around video game effects...More worryingly, given that there is a clear literature showing the effects of poor reporting on population suicide rates, we are concerned that the present paper has the potential to cause harm by effectively encouraging sensationalist news stories as worthy of academic attention.

I am incredibly mindful of the final sentence - 'effectively encouraging sensationalist news stories as worthy of academic attention'. In my final section, I would like to provide an example of just how badly the world can be impacted when we rely on media reports for academic evidence. To be blunt, I sincerely feel it has made our world a more fearful place to live in.

Media Reports and Psychology: A Disheartening History

Before I proceed to the main story, I would like to remind readers that media reports on video games and suicide have historically contained errors. If you read video game news, you may be familiar with a suicide that was attributed to the visual novel Doki Doki Literature Club. In a now-deleted article, MSN describes a way in which the game may have interfered with the boy's psyche:

He said Ben inputted his mobile phone into the game and would be contacted by text message during the day and at night, often waking him up.

As you might assume, there is no way to give Doki Doki Literature Club your cellphone number, and there is no way for the game to text you. This is an example of how information may be included in media reports which has not been verified or properly followed up on, yet is repeated uncritically.

If you have an interest in psychology, you may be familiar with something known as the Bystander Effect. The Bystander Effect argues that if something bad is happening and there are several people watching, we're more likely to think 'that's not my problem' and wait for someone else to help (Latane & Darley, 1968).

The catalyst for the Bystander Effect was the death of 28 year old Kitty Genovese. In 1964, the media reported that she died alone in an alleyway following multiple stabbings. Between these stabbings, 37 people saw her from their apartment and did not call anyone for help or attempt to go help her - they assumed someone else would (New York Times, 1964). Kitty's story has been used in everything ranging from Soviet propaganda for how the western world is lazy and heartless (Baker, 2014), to a speech justifying the invasion of Iraq (Keller, 2002). Kitty's story is used as evidence of how we turn our heads and our hearts off when we think someone else has the duty of care, until eventually no one cares.

Except that's not what happened at all.

To start, the 37 people cited in the media is not the number of people who did nothing after witnessing the attack. This is the number of people interviewed by police, so this would have included people like Kitty's friends helping to establish a potential suspect and motive. So how many people did see the attack?

This could technically be divided into two: who saw Kitty in the alleyway, and who realised she had been stabbed. This is an important distinction as the night was cold, windows were closed and the street was poorly lit, but some people did report seeing a woman hunched over. So what did they do?

While media reports say no one helped, multiple people actually called the police to report a woman slumped over. However, the police didn't help. While no concrete reason was ever given, it's speculated to be due to the crime scene being close to a bar and the police simply believing she was drunk (Solomon, 2015).

We then get to the second part - who had realised she was stabbed? Based on testimonials, this seems to be two people. The first was Joseph Fink, a cruel Neo-Nazi dubbed 'Adolf' by the local children (Bregman, 2020). The second person was Karl Ross. Ross didn't immediately call the police, choosing instead to contact his neighbour Sophia Farrar.

Ross may have accidentally kickstarted speculation on the Bystander Effect by telling the New York Times that he 'didn't want to get involved', appearing potentially cruel and disinterested in Kitty (New York Times, 1964). However, the truth is that Ross was afraid of the police as a gay man living in a world where his existence was criminalised. His fear of the police drove him to contact his neighbour rather than the police, meaning that he still set out to help Kitty while trying to protect himself from police persecution (Baker, 2014).

In a complete lack of regard for her own safety, Farrar ran to Kitty and held her in her final moments as her husband called the police - yet another person who called the police to help Kitty.

Because of sensationalised media reports on Kitty's passing, the world believes that 37 people watched as she died alone and did not bother to do anything. The truth is that Kitty passed in the warm embrace of a neighbour after multiple people called the police to try to save her.

The Bystander Effect continues to be taught in psychology courses to this day, and people believe the world is a darker and colder place because of it. This is especially sad as the Bystander Effect doesn't even hold up to academic scrutiny: data from several countries shows that 90% of public incidents involve bystanders coming to help, and people are actually more likely to help when an emergency is particularly dangerous (Fischer et al., 2011; Philpot et al., 2020).

I appreciate that this section is quite the segue from talking about video game research, but it is such a powerful example of why academics need to be rigorous with their research and not simply rely on media reports as evidence. News reports get details wrong, may sensationalise details for effect, and are in no way a good substitute for empirical evidence. We can not only see this within the world of video games with the reporting on Doki Doki Literature Club, but with the tragic legacy of Kitty Genovese and the Bystander Effect.

A Final Note

Sometimes I have the misfortune of reporting on research that isn't quite up to statistical or ethical standards. Part of me gets stressed doing this as I've previously written about how working in academia comes with a degree of original sin: people just assume you have an agenda or tamper with statistics until you get what you want, and I'm sadly no stranger to these accusations. I would hate to think that shining a spotlight on disappointing work encourages the harassment or low opinion of my colleagues.

I would like to remind my kind readers that the lack of scientific rigour and ethical dilemmas in this paper were called out by academics. Please don't throw the baby out with the bath water, people really do care and strive for academic, scientific, and ethical excellence wherever possible. Thank you for your kindness and for keeping an open heart and mind.

Summary

An academic paper was published in 2020 which attributes three suicides in Lahore, Pakistan to excessive PUBG playing. Rather than using data collected using the scientific method or psychiatric case notes, the source of this information comes from news and media reports. Statements throughout the paper such as "the first online gaming suicides during the COVID-19 pandemic" are made which seem to emphasise video games as the catalyst for these tragic events.

Four months later, a letter was published by a group of academics criticising this paper for three main reasons. Firstly, the paper borders on plagiarism due to the minimal effort in changing the original text; text that has been changed may lean further into sensationalism than the original media report. Secondly, the paper violates guidelines from the World Health Organisation not to describe suicides in detail or to attribute them to a lone reason. This is concerning due to pre-existing worries and confusion surrounding video game addiction, alongside the potential for high-profile suicide cases to have a contagious effect. Thirdly, the paper is criticised for its lack of scientific rigour due to gratuitous self-citation and lack of data collection or investigation.

Relying solely on media reports as a source of evidence is very concerning. Media reports on video games and suicide have historically contained errors, such as erroneous reporting on Doki Doki Literature Club. An extreme example of why media reports should not be used to inform psychology comes from the Bystander Effect, arguing that people will be less likely to help you in a crisis if there are others around because it's 'not their problem'. The Bystander Effect was birthed from the murder of Kitty Genovese, a woman reported to have died alone in an alleyway after 37 witnesses did not help her. However, investigative journalism uncovered that this number of witnesses was completely false, several people called the police to help her, and that she passed in the loving arms of a neighbour rather than alone in the cold. The Bystander Effect also does not stand up to academic scrutiny as it is frequently contradicted in research.

Credits

A big thank you to DECosmic for designing my header image and to LoopyGc for drawing the header art.

This hard work would not be possible without the support of my wonderful Patrons. I would particularly like to thank my Platinum Patrons: Albert S Calderon, Kyle T, redKheld, Dimelo 'Derp' Waterson, Hagbard Celine, Aprou, Austin Enright, NotGac, Shaemus, Joey Rodriguez, Marcus Lo Re-Sant, DarrenIndeed, Thomas Meszaros, Dr. Jhin, Mulgar, Tobias Svensson, RK_Rammy, Arthos and John Bauman. Thank you!

References

Baker. P. C. (2014). Missing the Story. Retrieved May 9, 2021 from https://www.thenation.com/article/archive/missing-story/

Bregman, R. (2020). Humankind: A hopeful history. Bloomsbury Publishing.

Fischer, P., Krueger, J. I., Greitemeyer, T., Vogrincic, C., Kastenmüller, A., Frey, D., ... & Kainbacher, M. (2011). The bystander-effect: a meta-analytic review on bystander intervention in dangerous and non-dangerous emergencies. Psychological Bulletin, 137(4), 517-537.

Institute of Medicine and National Research Council. (2013). Contagion of Violence: Workshop Summary. Washington, DC: The National Academies Press. https://doi.org/10.17226/13489.

Keller, B. (2002). The sunshine warrior. Retrieved May 3, 2021 from https://www.nytimes.com/2002/09/22/magazine/the-sunshine-warrior.html

Latane, B., & Darley, J. M. (1968). Group inhibition of bystander intervention in emergencies. Journal of Personality and Social Psychology, 10(3), 215-221.

Mamun, M. A., Ullah, I., Usman, N., & Griffiths, M. D. (2020). PUBG‐related suicides during the COVID‐19 pandemic: Three cases from Pakistan. Perspectives in Psychiatric Care, 1-3.

New York Times. (1964). 37 Who Saw Murder Didn't Call the Police; Apathy at Stabbing of Queens Woman Shocks Inspector. Retrieved April 19, 2021 from https://www.nytimes.com/1964/03/27/archives/37-who-saw-murder-didnt-call-the-police-apathy-at-stabbing-of.html

Philpot, R., Liebst, L. S., Levine, M., Bernasco, W., & Lindegaard, M. R. (2020). Would I be helped? Cross-national CCTV footage shows that intervention is the norm in public conflicts. American Psychologist, 75(1), 66-75. https://doi.org/10.1037/amp0000469

Soloman, J. D. (2015). The Witness. United States: FilmRise.

World Health Organization. (2017). Preventing suicide: A resource for media professionals (No. WHO/MSD/MER/17.5). World Health Organization.

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The Academics Challenging Gaming's Relationship with Suicide

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Content warning: This article contains frequent references to suicide and later mentions murder. Please proceed with caution. To say that the world of video game academia is interesting would be the understatement of the century.

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I haven't had time to check it out fully yet, but this looks great at first glance

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Catatonia can be challenging to assess for a variety of reasons, but perhaps the most pressing reason of all is that comprehensive educational materials on catatonia assessment simply have not existed. We at the University of Rochester Medical Center have partnered with Andrew Francis, PhD, MD, the senior author of the Bush-Francis Catatonia Rating Scale (BFCRS), to address this need by developing the online training module below.

We invite you to watch the introductory video for an overview of the training videos that follow. The first training video depicts a standardized patient without catatonia so that we can illustrate how to assess for all items on the BFCRS. The three subsequent videos depict a standardized patient illustrating three representative presentations of catatonia based on motoric subtype. Below each is a downloadable PDF of a blank BFCRS form for you to score the patient and a completed BFCRS for how we score the standardized patient's exam. We also provide a summary of the key points from each video for reference.

We would also draw your attention to the BFCRS Training Manual and Coding Guide, which provides an overview on using and scoring the BFCRS, describes each item in detail, and explains how to differentiate items that closely resemble one another. We encourage you to use this manual as a reference while watching the videos.

We are currently in the process of studying the effectiveness of this educational tool and intend to publish the results. For this ongoing study, we have developed pre- and post-module assessments to highlight subtle distinctions among closely related items on the BFCRS. These assessments will be made available on this website after the completion of this study (March 31, 2021).

Sincerely,

Joshua Wortzel, MD, MPhil
Resident Physician in Psychiatry, PGY-3
Joshua_Wortzel@URMC.Rochester.edu

Mark Oldham, MD
Assistant Professor of Psychiatry
University of Rochester
Department of Psychiatry
Mark_Oldham@URMC.Rochester.edu

Clinical assessment for the Bush-Francis Catatonia Rating Scale

Introduction

Normal Exam

Example of Hypokinetic Catatonia

BFCRS Forms

Blank BFCRS , for scoring
BFCRS completed for this patient

Review of Key Points

Withdrawal: Refusal to eat, drink or make eye contact

Includes active avoidance of eye contact

Differs from staring, which describes a fixed gaze

Rule out immobility as a cause of fasting (e.g., can test by trying to feed patient)

Immobility/Stupor: Extreme hypoactivity, unresponsiveness but not against gravity

Typically involves the whole body

Differs from posturing/catalepsy, which involves positions maintained against gravity

Differs from rigidity, which describes increased muscle tone on exam

Grimacing: Odd facial expressions, including movements

Can affect any part of face (e.g., forehead, nose, lips, tongue)

Mutism: Verbally minimally responsive

Includes unintelligible whispering

Excludes intelligible whispering, which is manneristic speech

Excludes mutism due to known neurological condition (e.g., stroke)

Negativism: Motiveless resistance to instruction

Includes doing the opposite of instructions (e.g., opens eyes when asked to close them)

Do NOT score when a patient fails to stop another catatonic feature on command (e.g., immobile patient does not sit up when asked to)

Gegenhalten: Muscle resistance proportional to the force applied

Differs from rigidity, which is consistent, increased muscle tone throughout the range of motion

Rigidity: Increased muscle tone throughout movement

Differs from waxy flexibility, which is initially increased muscle tone that quickly releases

Differs from immobility/stupor, which refers to lack of movement rather than increase in muscle tone

Stereotypy: Repetitive, non-goal-directed movement

Abnormal by virtue of excessive repetition, not in the movement itself

Differs from mannerism, which is bizarre but purposeful (e.g., walking like a chicken)

Example of Parakinetic Catatonia

BFCRS forms

Blank BFCRS , for scoring
BFCRS completed for this patient

Review of Key Points

Posturing: Spontaneous maintenance of a position against gravity

Differs from catalepsy, which is maintaining a position induced by the examiner

Differs from immobility, which describes diminished activity of the whole body

Staring: Fixed gaze, no scanning of room

Differs from withdrawal, which is specifically avoiding eye contact with others

Immobility: Extreme hypoactivity/lack of movement

Differs from rigidity, which is increased muscle tone

Differs from posturing/catalepsy, which involves positions held against gravity

Manneristic Speech: Odd but purposeful speech

Abnormal inflections, accents, or tone that differ from patient's regular speech

Verbal Perseveration: Repeating the same word or phrase or returning to the same topic

Differs from verbigeration, which sounds like a skipping record

Catalepsy: Maintaining a position induced by the examiner

Differs from posturing, which is maintaining a position assumed spontaneously

Waxy Flexibility: Initial resistance to movement that quickly releases

Differs from gegenhalten, which is resistance proportional to the force applied

Note: DSM-5 defines waxy flexibility differently, as "slight, even" resistance during repositioning; slight, even resistance is scored as rigidity on the BFCRS

Mitgehen: Patient's arm rises with light pressure despite instruction to resist

Impulsivity: Sudden inappropriate behavior

Differs from combativeness, which describes an impulsive, purposeless act to harm another person

Differs from excitement, which emphasizes the frequency or constancy of overall activity

Example of Hyperkinetic Catatonia

BFCRS Forms

Blank BFCRS , for scoring
BFCRS completed for this patient

Review of Key Points

Excitement: Constant motor movements that are apparently purposeless

Ambitendency: Motorically indecisive, "stuck" movements

Can present as either complete stoppage of movement or vacillating behaviors (e.g., stepping back and forth, in and out of a doorway)

Automatic Obedience: Exaggerated cooperation, even if the stimulus is aversive to patient

Perseveration: Difficulty shifting topics or stopping movements

Motor perseveration differs from stereotypy and mannerisms, both of which are initiated by the patient

Verbal perseveration differs from verbigeration, which sounds like a skipping record

Echopraxia: Mimicking examiner's movements

Can be spontaneous or elicited by examiner's making exaggerated movements (e.g., scratching head or turning in a circle)

Verbigeration: Repetition of a phrase or sentence

Sounds like a skipping record

Echolalia: Mimicking examiner's speech

Mimicry is spontaneous, serves no apparent purpose, and appears automatic

Combativeness: Unprovoked, non-goal-directed aggression toward a person

Excludes actions that are purposeful or done in retaliation

Differs from impulsivity, which does not involve a potentially dangerous action done toward another person

Additional Resources

Catatonia Information Center
Directed by Andrew Francis, PhD, MD

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Bush-Francis Catatonia Rating Scale -Collaborative Care and Wellness - Our Divisions - Department of Psychiatry - University of Rochester Medical Center

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Our mission is to incorporate family oriented care, education, and research into our services to improve the health of populations in the Rochester region by developing and implementing effective behavioral health interventions in collaboration with employers and other health care providers.

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Reminds me of some conversations during residency

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I was today years old when I learned about “human wine decanting” 😱

Infectious diseases is NEVER boring!

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I was today years old when I learned about “human wine decanting” 😱

Infectious diseases is NEVER boring! https://t.co/mV95bwd48O

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I was today years old when I learned about “human wine decanting” 😱

Infectious diseases is NEVER boring! pic.twitter.com/mV95bwd48O
— Ilan Schwartz MD PhD (@GermHunterMD) December 24, 2020

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I was today years old when I learned about “human wine decanting” 😱

Infectious diseases is NEVER boring! https://t.co/mV95bwd48O

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I was today years old when I learned about “human wine decanting” 😱

Infectious diseases is NEVER boring! https://t.co/mV95bwd48O

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I was today years old when I learned about “human wine decanting” 😱

Infectious diseases is NEVER boring!

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Today In Weird Neuromod: Aesthetic Chills Generation?

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Today In Weird Neuromod: Aesthetic Chills Generation?

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It's always something new.

First seen via https://twitter.com/Neuro_Skeptic

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Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack. It could be something as simple as a run away script or learning how to better use E-utilities, http://www.ncbi.nlm.nih.gov/books/NBK25497/, for more efficient work such that your work does not impact the ability of other researchers to also use our site. To restore access and understand how to better interact with our site to avoid this in the future, please have your system administrator contact info@ncbi.nlm.nih.gov.

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Your access to the NCBI website at www.ncbi.nlm.nih.gov has been temporarily blocked due to a possible misuse/abuse situation involving your site. This is not an indication of a security issue such as a virus or attack.

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Here is my initial grand rounds on asexuality on 2015. I'm working on a new version that will hopefully be more exciting and incorporate more diverse topics instead of just the "101" level.

Also, I should have noted that the back half was a quick run-through of sexual health, the brain, etc. that was meant to demonstrate that it is inadequate, in case that sticks out.

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Veterans are at higher risk for Alzheimer's disease compared with the general population. Part of that has to do with military risk factors like PTSD or brain injury. High rates of diabetes among VA patients also play a role.

That's why learning new ways to prevent or treat Alzheimer's disease is a priority for VA research.

One recent study focused on apathy. Apathy is the most common behavioral problem in those with Alzheimer's, affecting 7 in 10 patients. Apathy involves loss of motivation and initiative, and social withdrawal.

The small pilot study at the Central Arkansas Veterans Healthcare System found that brain stimulation improved apathy. The results are online in the Journal of Alzheimer's Disease.

In the photo above, by Jeff Bowen, Dr. Prasad Padala simulates a repetitive transcranial magnetic stimulation treatment with Ashlyn Jendro, a research assistant. She's holding her thumb up to indicate the twitching caused by the pulses.

Pilot study involved 20 Veterans

Twenty Veterans with Alzheimer's disease and apathy took part. Half received repetitive transcranial magnetic stimulation (rTMS), a type of brain stimulation. The others received sham stimulation, basically a placebo.

Through patient and caregiver interviews, the VA team documented "significantly greater improvement" in apathy levels in those who received brain stimulation compared with the control group. The positive effects continued up to three months.

Besides improvements in apathy, the researchers also noted "significantly greater improvement" in memory, attention, and cognition in the rTMS patients compared with the sham treatment group.

In rTMS, doctors apply magnetic coils to the scalp at specific points. This creates an electric current in brain cells. The Food and Drug Administration has approved the therapy for depression that doesn't respond to other treatments. The technology is being studied widely for other brain disorders including Alzheimer's.

The research team concluded that repetitive transcranial magnetic stimulation "may be safely used in people with Alzheimer's disease and may improve apathy, function, and some aspects of cognition."

How long does the benefit last?

Can the effect last longer than three months? "That's the million-dollar question," says lead researcher Dr. Prasad Padala. He is a geriatric psychiatrist with VA and University of Arkansas for Medical Sciences.

"Unfortunately, no study has looked at that thus far. Ours is the first study to say that the effects persist until three months. I don't know about four months. I don't know about five months. The only thing I can say is at three months the effects were still there.

"If I have to treat somebody clinically based on this result, I would be inclined to give them a maintenance treatment, a booster dose of sorts at three months, like we do now for treating depression."

Apathy keeps neurons from connecting

The main side effects from the rTMS were discomfort in the area where the magnet sat on the patient's head, and headaches. Those issues occurred only during treatment and resolved soon afterward.

Padala says those in the study who received the sham treatment were subsequently given access to the real treatment through a clinical program.

He is enthusiastic about the therapy's potential.

"I'm so interested in this area because people with pre-dementia who lose their motivation and have a lot of apathy tend to convert into dementia at much higher rates than those who keep their motivation and interest levels.

"So if you don't do anything in your daily life, you're not connecting the neurons in the brain and you're hastening the process of neuro-degeneration. To put it simply, if someone has pre-dementia and on top of that they have apathy, their brain shrinks faster."

Based on his research to date, he believes "brain stimulation may slow down the shrinking of the brain." More study is needed, he emphasizes.

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Brain stimulation for Alzheimer's on the horizon? - VAntage Point

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Veterans are at higher risk for Alzheimer's disease compared with the general population. Part of that has to do with military risk factors like PTSD or brain injury. High rates of diabetes among VA patients also play a role. That's why learning new ways to prevent or treat Alzheimer's disease is a priority for VA research.

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Negative Results for hf-tRNS for Depression

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Negative Results for hf-tRNS for Depression

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Highlights

*

High-frequency transcranial random noise stimulation (hf-tRNS) of the prefrontal cortex.

*

hf-tRNS is safe but not effective as an add-on treatment of depression.

*

Identification of effective stimulation parameters is needed.

Abstract

Background

Depressive disorders are linked to dysfunction in prefrontal cortical areas. Hence, non-invasive neurostimulation of the prefrontal cortex has demonstrated antidepressant efficacy. In the present study, we investigated the efficacy of high frequency transcranial random noise stimulation (hf-tRNS) as an add-on treatment for depression in a sham-controlled randomized trial.

Methods

Forty in-patients with depression were randomized and treated with real or sham hf-tRNS (100-650 Hz) with 0 mA offset. The electrodes were mounted over the left and right dorsolateral prefrontal cortex. The Hamilton Depression Rating Scale (primary outcome), the Major Depression Inventory, the Clinical Global Impression scale and the Global Assessment of Functioning scale were used for assessment at baseline, after 3 weeks of intervention (end of treatment), and 9 weeks after intervention. Safety parameters included cognitive functioning and reported side-effects.

Results

Comparison of real and sham treatment at the planned interim analysis showed an amelioration of symptoms in both groups for all outcomes with numeric but not statistically significant superiority of the sham arm for the primary outcome. Thus, the study was terminated prematurely after an interim analysis. There were no systematic differences with respect to safety parameters.

Limitations

The negative finding might be related to the specific stimulation parameters used in this study.

Conclusions

Our study suggests that prefrontal hf-tRNS is safe but not effective as an add-on treatment of depression. The challenge for future studies employing transcranial electric stimulation remains to identify effective stimulation parameters for the treatment of depression.

View Abstract

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Bifrontal high-frequency transcranial random noise stimulation is not effective as an add-on treatment in depression

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High-frequency transcranial random noise stimulation (hf-tRNS) of the prefrontal cortex. * hf-tRNS is safe but not effective as an add-on treatment of depression. * Identification of effective stimulation parameters is needed. Depressive disorders are linked to dysfunction in prefrontal cortical areas. Hence, non-invasive neurostimulation of the prefrontal cortex has demonstrated antidepressant efficacy.

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Take home devices, especially OTC, intrigue me - evidence is usually mediocre, but safe enough that FDA clears them? Anyway, going to look into evidence for this tomorrow.

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Worried about medication side effects? Interactions? Intolerance? No problem! CEFALY is a drug-free treatment option designed to be a primary migraine treatment or a supplement to an existing regimen.

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Migraine Prevention

The CEFALY PREVENT setting is designed to be used 20 minutes per day, by people experiencing migraine symptoms three or more times per month. This setting changes the trigger threshold of the migraine to reduce the frequency of migraine days.

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CEFALY: A Drug-Free Migraine Treatment & Prevention Device

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Order CEFALY DUAL right here, right now. Prescription no longer necessary. We'll send you new electrodes every 90 days. CEFALY is a breakthrough migraine treatment that can help improve your quality of life and free you from migraine pain.

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A section of the tabloid, US Magazine, called "Stars - They're Just Like Us", shows pictures of celebrities doing mundane activities like walking the dog or taking out the garbage. This helps to remind us that, just like the average Joe, they walk their dogs and take out the garbage and- because they are people, too-might even need medical treatment from time to time. Unfortunately, some doctors treating celebrity patients don't see them "just like us."

V.I.P. Syndrome in medicine has been defined as when influential or famous people receive special treatment. Special treatment may include access to appointments and treatment without waiting, the bending of rules and regulations and anything else to acquiesce to the request of an influential person. Being star-struck or wanting to have a positive interaction with an influential person is understandable, but physicians must be able to set aside these feelings in order to provide the best possible care and maintain their professionalism. I think Dr. Walter Weintraub said it best in his 1964 article in The Journal of Nervous Mental Disease: "The treatment of an influential man can be extremely dangerous for both patient and doctor." Quite so. Physicians "afflicted" by V.I.P Syndrome violate two of the principles of the Physician Charter:

Social justice - Providing patients with special treatment based on their status does nothing to eliminate discrimination or to promote just distribution of resources.

Primacy of the patient - Additionally, a physician may want to believe he or she is putting the patient first by acquiescing to special requests; however, by disregarding rules, regulations and guidelines, he or she may actually be putting the patient at risk.

A recent high-profile case has shone a spotlight on such egregious and risky behavior, and unfortunately, its consequences. The medical examiner's report on Joan Rivers' death was recently released and states she died from therapeutic complications which caused a lack of oxygen that resulted in brain damage. Additionally, a report released by the New York Department of Health cited Yorkville Endoscopy center (where she received treatment) for several deficiencies, including:

not recording the accurate dose of Propofol;

failing to recognize Ms. Rivers' deteriorating vital signs;

failing to provide intervention in a timely manner;

allowing a non-staff member to perform a procedure; and

allowing a staff member to take pictures while Ms. Rivers was under sedation.

Several physicians have lost their jobs with Yorkville over these allegations and the reputation of the Yorkville Endoscopy Center has been damaged beyond repair. One wonders if the physicians and staff there provided a different than usual care to Ms. Rivers. It is doubtful that Yorkville would have allowed an average patient's physician to come in and take part in a procedure when they do not have privileges at the medical center. Given that this special treatment may involve going against guidelines or bending rules, it is not surprising that this special treatment does not always result in better care.

V.I.P. Syndrome is a threat to patient safety and medical professionalism. One would like to believe that all patients are treated equally and fairly, but this is not the case. As long as V.I.P. Syndrome exists, care will never be equal for the influential and the non-influential. This gap violates the principle of social justice and can put patients in danger.

Physicians need to ensure all patients-celebrity or not-are treated equally with care and respect. Organization and system-level policies need to support physicians when they are confronted by demands for care that wouldn't normally be afforded to regular patients (e.g., Cleveland Clinic's nine principles for caring for VIPs). Perhaps the best way to avoid V.I.P. Syndrome is to remember that a V.I.P. patient is first and foremost a patient and like all other patients deserves the best and appropriate care.

Alison Brecher
ABIM Foundation

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V.I.P. Syndrome Can Lead to Bad Care - ABIM Foundation

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A section of the tabloid, US Magazine, called "Stars - They're Just Like Us", shows pictures of celebrities doing mundane activities like walking the dog or taking out the garbage. This helps to remind us that, just like the average Joe, they walk their dogs and take out the garbage and- because they are people,...

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The officers claim that they became sick when they entered a Hayward motel room during a drug raid where they reportedly "inhaled airborne fentanyl." This story is similar to reports from across the country detailing accounts of first responders having near death experiences when encountering fentanyl. None of these reports have been verified by toxicologists. The symptoms referenced in the stories are not consistent with the symptoms of an overdose on fentanyl.

Opioid toxicity (i.e., "overdose" or respiratory depression) from transdermal and airborne exposure to Illicitly Manufactured Fentanyl (IMF) is a near scientific impossibility. This is explained in a recent position paper by the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology.

Incidents where responders were treated for alleged "exposure" were exhibiting symptoms of what appear to be anxiety or panic: dizziness, rapid heartbeat, sweating, even fainting - which are not symptoms of fentanyl overdose . There are other stories where officers exhibit no symptoms and yet were "treated" as a precaution. There have been stories of officers administering it to themselves , an impossible task if one is actually experiencing fentanyl-related overdose. There have been cases where naloxone was administered to first responders who were not exhibiting any signs of opioid toxicity, and when they "felt better," it was attributed to the naloxone, a misinterpretation of the event.

Common sense also invalidates the possibility of casual exposure to fentanyl resulting in overdose. People who use, sell and transport drugs often come into environmental contact with fentanyl without incident. The authors of this op-ed provide services in the Bay Area; we interact with people at syringe exchange programs and encampments where fentanyl is present, in some cases touch samples of fentanyl the drug ourselves - all without incident.

Fentanyl has been used by the medical system for treatment of pain and anesthesia since 1968. There are some formulations of fentanyl that are specifically designed for transdermal absorption (patches), yet there is technology involved in changing the drug to be absorbed this way, and even handling transdermal patches does not cause overdose. The fentanyl in the illicit drug supply comes in powder or solid form, and must have direct contact with mucous membranes or the bloodstream via snorting (inhalation), smoking, or injection to take effect. Yes, carfentanil . IMF is handled with bare skin throughout much of its travels to the end user, and by the end users themselves, causing no adverse reaction until the drug is ingested via the above-mentioned routes-and even then, fentanyl and fentanyl analogs are used routinely and do not always result in overdose.

More recently, there has been some media refuting the veracity of these stories, including , , and , a website targeting first responders who each published myth-busting pieces about casual fentanyl exposure. The New York Times published an opinion piece about fentanyl hysteria by Drs. Jeremy Samuel Faust and Edward Boyer, both instructors at Harvard Medical School and emergency physicians and medical toxicologists at Brigham and Women's Hospital in Boston. A recent paper in the Journal of Prehospital Emergency Care clarifies proper procedure for first responders who may be exposed to fentanyl and other ultra-potent opioids.

Media accounts that are not based in evidence and journalists who fail to do their due diligence to ensure accurate reporting further perpetuate this dangerous misinformation. These stories cause very real harm-they perpetuate fear and stigma against people who use drugs resulting in negligent care, isolation, and diversion of resources toward law enforcement and away from life-saving programs.

We have been here before: In the late 1980s, doctors refused to treat HIV patients out of fear of contracting the disease, even once they knew contagion via casual contact was impossible. This shameful history is now mirrored in the reports of cases where first responders are refusing to treat overdosing people before they secure hazmat suits. This is unnecessary, fear-based, and should be considered criminal neglect. Media has the responsibility to report this story accurately and ensure that we not repeat the mistakes of the past.

As two people who spend our lives focused on preventing overdose and increasing access to naloxone in our communities, we are concerned and frustrated by the perpetuating of this stigmatizing, inaccurate story. People with lived experience with drug use and allies who work in Harm Reduction, public health, and substance-use treatment programs have much work to do with limited resources. Unfortunately, an incredible amount of our time and energy is spent refuting inaccurate and fear-based messaging, taking away from the life-saving work that needs to be done.

Our programs in San Francisco and Alameda Counties have distributed naloxone to community members who have collectively reversed 1,502 overdoses just last year alone. We operate on limited budgets to ensure widespread naloxone access for people who use drugs, as well as their friends, family, and providers who serve them. It is more effective and humane to fund naloxone distribution programs, harm reduction services, and evidence-based substance-use treatment than to spend untold amounts of money training first responders to handle the "bioterrorism threat" of fentanyl and scaling up the War on Drugs. Yet, we are watching as money pours into the coffers of law enforcement to help protect themselves and increase criminalization and interdiction efforts, which have been wholly ineffective at curbing drug use or reducing related harms.
This is an incredibly important moment nationally, and locally, to ensure we invest in strategies that we know work and not allow hysteria to guide our solutions to the overdose crisis. These stories cause very real harm: they perpetuate fear and stigma against people who use drugs resulting in negligent care, isolation and diversion of resources towards law enforcement and away from life-saving programs. A culture of increased criminalization, hostility and shame-all while wearing expensive hazmats suits, will do nothing to save lives.
For accurate information on fentanyl, fentanyl testing strips, naloxone access, and overdose, please contact your local harm reduction program . We can direct you where to obtain naloxone in case you or someone you love may be using drugs and at risk for an overdose.

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Myths and Misinformation About Law Enforcement and Fentanyl Exposure | Harm Reduction Coalition

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The officers claim that they became sick when they entered a Hayward motel room during a drug raid where they reportedly "inhaled airborne fentanyl." This story is similar to reports from across the country detailing accounts of first responders having near death experiences when encountering fentanyl.

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tDCS for depression (or, more exciting for me, other neuropsychiatric indications) has always been one of those things that seems both flaky and potentially promising. It will be interesting to see if data is positive and if/how the device will be used (in clinic like rTMS? At home like CES?) and if it will evolve into actual good practice (like ECT, rTMS, etc.) or more shady / weak evidence (like CES, possible VNS.)

Looks like they are doing a study and the FDA is considering clearing it for depression in the US.

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Soterix Medical Inc. announces it has received FDA Investigational Device Exception (IDE) to launch a trial of transcranial Direct Current Stimulation-Limited Total Energy (tDCS-LTE) neuromodulation at-home for patients with Major Depressive Disorder (MDD). Soterix Medical developed proprietary technology supporting reliable home-based transcranial Direct Current Stimulation (tDCS) including the single-use SNAPpad™ electrodes that ensure clean and tolerated therapy at-home, and the ElectraRx™ digital healthcare platform that provides caregivers ongoing insight on patient response and full control of ongoing therapy. Mr. Jose Rodriguez, Soterix Medical's VP Regulatory Affairs, explains "The tDCS-LTE therapy is approved for treatment of Major Depression across the globe including Europe, Australia, Brazil, etc. It has been shown to be effective in trials including results published in the New England Journal of Medicine. The IDE approval for tDCS-LTE is a critical step to proving and providing treatment in the US." Dr. Abhishek Datta, CTO of Soterix Medical adds, "The home-based tDCS-LTE therapy continues our commitment to lead in the creation of innovative non-invasive neuromodulation treatments. Reliable home-use requires several unique technologies including our breakthrough mini-CT stimulator and SNAP accessories, proprietary LTE current management, and the simple and powerful ElectraRxTM portal." That Soterix Medical pioneered home-based tDCS research with by far the most extensive track record on successful use was a factor in the FDA's decision to approve the trial. Major depressive disorder is highly prevalent and a leading cause of disability worldwide, but ~30% of patients do not benefit sufficiently from existing antidepressants. The current COVID-19 pandemic has made evident the urgent need for a reliable and effective home-based intervention for patients suffering from MDD. The Soterix Medical home-based trial benefits patients for whom access to rTMS or ECT depression therapy has been limited by the pandemic. Dr. Leigh Charvet of NYU Langone Health, which is the lead clinical center for the trial explains "The NYU Department of Neurology has already established a remote tDCS therapy program based around Soterix Medical technology that address a range of brain disorders including Multiple Sclerosis, Parkinson's, and mood disorders. The use of Soterix Medical equipment is essential to ensure reliable tDCS in telemedicine setting." CAUTION: tDCS is limited by Federal (or United States) law to investigational use only. See release here
Media Contact: Mariana Shuster Tel: +1-888-990-8327 Email: contact@soterixmedical.com Trial Contact: Claudia Giselle Tel: +1-888-990-8327 Email: trials@soterixmedical.com

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FDA Grants Soterix Medical IDE Approval for Home-based tDCS-LTE Trial for Depression. - Soterix Medical - Depression LTE™

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Soterix Medical Inc. announces it has received FDA Investigational Device Exception (IDE) to launch a trial of transcranial Direct Current Stimulation-Limited Total Energy (tDCS-LTE) neuromodulation at-home for patients with Major Depressive Disorder (MDD).

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This weirdo is now on the internet and ready to psych you

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Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) Article in AJP

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Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) Article in AJP

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