Friday, July 23, 2010

Therapeutic Pets


In 1857 British novelist George Eliot wrote, “Animals are such agreeable friends. They ask no questions and they pass no criticism.”

I agree that they may be agreeable most of the time, but they most definitely ask questions (Can I eat that? Can we go now? Now? Now?), and pass criticism (If I can’t eat that, now, I will bite you).

One book on animal assisted therapy says, “And cats do have some behavioural problems.”

The therapeutic value of animals can be increased by combing it with volunteering. Some programs ask volunteers to bring their own animals in to patients and there are also programs where volunteers take working dogs out public to aid in training them.

Below are some of the positives and negatives of pet ownership.

Benefits –
* Increases exercise. Going out for walks, riding horses, or chasing kittens.
http://rileyjennifer.blogspot.com/2009/06/exercise.html
* Source of companionship. Even just the presence of something alive can be vitally invigorating.
* Helps build relationship skills. You might notice some things about how you treat yourself or others when you pay attention to how you treat your pet and learn what is and is not effective.
* Allows for meeting new people. Dog walking, clubs, going to the pet store.
* Increases responsibility and pride. It is one thing to be responsible for yourself when ill, but a great deal of worthiness can come from taking care of something else, sick or not.
* Adds structure and routine. A pet will ensure you get you out of bed in the morning to feed or walk it (and if you have a cat, very likely it will get you out of bed several times throughout the night as well). Also, especially with dogs, feeding and exercise will also be more scheduled
* Cute and furry (possibly).
* Commitment. It can be a healthy process to make a weighted decision and committing to it long-term.

Costs –
* Too much time with only your pet may cause you to lose the ability to verbally engage with other humans.
* Responsibility. Undertaking ownership of a pet that is too demanding, or having too many pets, may increase stress.
* Claws, teeth, fur, and bodily fluids.
* Abusing your pet. When you are manic or depressed or anxious and don’t want to be touch and something touches you, you may strike out. Generally speaking, it is also very easy to abuse animals verbally and physically. Though this may be on a smaller scale, it is not healthy for either animal or owner.
* Limits social outings. There might be places you can’t go because you can’t bring your pet or leave it behind for some time. Some people may be allergic and can’t come to your home.
* Commitment. Maybe not so much with fish, though they can live up to 10 years. But other animals need to be fed and cleaned. They also need a home, so moving internationally would be more difficult, though not impossible, with a pet.
* Cost. Food, litter, accessories, vet bills can add up (however, you can choose the type of pet you want based on your budget).

The scientific therapeutic value of pets is not compelling, but this may be due to flaws in study designs. Scientific American Mind has a very good article looking at anecdotal versus scientific evidence.
http://www.scientificamerican.com/article.cfm?id=is-animal-assisted-therapy

Dogs, horses, and dolphins are probably the most famous animal assisted therapy animals. Rabbits, other rodents, and birds are also used. Cats are used as well, but I am curious as to the frequency of this (there is a reason cats are not generally supposed to be out of bags).

Horses and dolphins have a particular character to them which can increase bond. I waver on the issue of swimming with dolphins, but I am not against it. More easily accessible though are stables offering trail rides which can be a casual way of engaging with a larger animal.

I have said a lot of negative things about cats here, but they are undeniably unique and wonderfully engaging animals.

Thursday, July 15, 2010

MEG


Magnetoencephalography (MEG) is an imaging technique sharing components of EEG and fMRI. It uses the fluctuating electrical activity in the brain which induces a magnetic field in the active region which can then be measured using magnetometers. The magnetometers are commonly referred to as SQUIDs (Superconducting Quantum Interference Devices). There are different orientations of the magnetometers – single, axial gradiometer, planar gradiometer – which are positioned above the head.

As with all superconductors, a very cold environment must be provided. SQUIDs are typically cooled with liquid helium which is maintained at its boiling temperature of 4K (for a reference point, liquid nitrogen freezes in liquid helium) and stored in a giant thermos called a dewar.

SQUIDs are sensitive to very small magnetic fields on the order of 5×10−18 T.
The magnetic fields generated in the brain are on the order of 10-15T. The Earth’s magnetic field is about 5.0 × 10-5T. So in order to obtain a signal clean of any ambient noise, the process must take place in a highly shielded room, including a very thick door with a strong vacuum seal (the room is similar to a vault). The walls of the room are composed of layers of aluminium and a ferromagnetic material.

In comparison to the MEG, an EEG measures electrical activity directly and requires electrodes to be applied directly to the head. Also, direct measures of electrical activity can become distorted as the signal passes through ions and the skull, whereas such distortion is not obtained with MEG.

There are fewer safety concerns with an MEG than an MRI since there is no large magnetic field involved. The images obtained can be combined with images obtained in fMRI studies by measuring specific points on the head after the MEG and then overlaying the two images.

Here is a paper that discusses in more detail MEG and EEG.
http://www.bem.fi/bem/research/eegmeg/index.htm

Thursday, July 8, 2010

Exercise Prohibition in Eating Disorders Programs


Earlier this year it had been brought to my attention that there exists eating disorder (ED) programs which prohibit exercise. Presumably, this is to encourage weight gain and discourage over-exercising. However, the idea is absurd and archaic in my opinion. Regular monitoring puts stress on patients and staff, and diverts energy from healing.

As with food, exercise can not be avoided in daily life and a complete ED program would integrate healthy exercise as it does healthy eating.

Additionally, exercise has been proven to improve mood and can also give patients a sense of responsibility and independence. http://rileyjennifer.blogspot.com/2009/06/exercise.html

Certain precautions when dealing with patients who may be physically compromised such as with low blood pressure need to be considered. However, in an ED program all exercise is monitored by a medical staff member trained to handle emergencies.

Depending on the physical status of the patient, varying degrees of intensity of exercise could be tolerated. Because of the specific nature of eating disorders, mindful engagement with the body should be encouraged in all exercise routines. This is easily accomplished with a moderate activity such as yoga (St. Paul’s Hospital in Vancouver incorporates yoga into their ED program).


References: 1, 2, 3, 4

Tuesday, June 29, 2010

Clapping Therapy


I absolutely love clapping in music (though other supposed music lovers I know detest it). As it turns out, there is a ‘clapping therapy’ also know as interactive metronome training.

Interactive Metronome® was developed in 1994 by Jim Cassily, a recording engineer … who taught piano lessons on the side, discovered that I.M. helped his autistic students. Not only did they get the timing down, it also helped them with attention, concentration, coordination, language processing, reading skills and control of aggression.
http://docs.google.com/gview?a=v&q=cache:kXTu8yB799YJ:www.interactivemetronome.com/IMPublic/Media/Happy%2520clapping%2520therapy%2520-%2520Greater%2520Baton%2520Rouge%2520Business%2520Report.pdf+clapping+therapy&hl=en&gl=ca&sig=AFQjCNE02twrkA3grUwrSsNbNuxcFG3R9w

One study on children with attention and coordination disorders found, “...Interactive Metronome training may address deficits in visuomotor control and speed, but appears to have little effect on sustained attention or motor inhibition.”
http://www.ncbi.nlm.nih.gov/pubmed/19202457?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A case study: “This child's participation in a new intervention for improving timing and coordination was associated with changes in timing accuracy, gross and fine motor abilities, and parent reported behaviors.”
http://www.ncbi.nlm.nih.gov/pubmed/16396435?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A study on children with ADHD: “The Interactive Metronome training appears to facilitate a number of capacities, including attention, motor control, and selected academic skills, in boys with ADHD.”
http://www.ncbi.nlm.nih.gov/pubmed/11761130?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A Parkinson’s study: “These results suggest that computer-based motor training
regimens might be useful for improving or retaining motor function in Parkinson’s disease.”
http://www.interactivemetronome.com/IMpublic/Research/Parkinsons%20Neurology%20Journal.pdf

Another Parkinson’s study: “This study provides evidence for the potential of cueing to improve gait in PD-CI. Only individuals with mild CI were included, and the effect with increased CI and different types of dementia requires further evaluation.”
http://www.ncbi.nlm.nih.gov/pubmed/19199354?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A Parkinson’s study which examines an alternative to the audio metronome: “Rhythmic somatosensory cueing may be a viable alternative for auditory cueing and is robust to changes in walking speed and visual distractors.”
http://www.ncbi.nlm.nih.gov/pubmed/16780887?ordinalpos=6&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A study in schizophrenic patients found that, “…patients with marked negative symptoms performed best when their actions were more stimulus-driven [marked by metronome] than willed [consciously attempting to perform well] strengthens the case that negative schizophrenic symptoms reflect a disorder of willed action.”
http://www.ncbi.nlm.nih.gov/pubmed/17292482?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

A paper published by the Institute for Applied Psychometrics looks at four different timing therapies and has a long list of references for further reading.
http://www.iapsych.com/im/iaprr9.pdf

According to a site which sells the IM, “The device can strengthen motor skills, including mobility and gross motor function, and improve many fundamental cognitive capacities such as planning, organizing and language.”
http://www.healthsouth.com/what_we_do/inpatient_rehabilitation/rehabilitation_technology/interactive_metronome.asp

Clapping itself is used in conjunction with music therapy in the treatment of autism, dementia, and Alzheimer’s.
http://www.articlesbase.com/mental-health-articles/autism-music-therapy-how-music-truly-helps-autistic-people-739429.html

http://www.myoptumhealth.com/portal/Information/item/Music+and+Art+Therapy+for+People+With+D?archiveChannel=Home%2FArticle&clicked=true

http://www.selfgrowth.com/articles/7_Tips_for_Alzheimer_s_Music_Therapy.html


As far as I can tell, there has been no clinical research investigating the specific effects of clapping on mood. But it is exercise, so I imagine a heavy regime of clapping could boost mood.

A song about clapping that refuses to let you dwell in a bad mood:
http://www.youtube.com/watch?v=OiTd_xHMEnI

Thursday, June 17, 2010

Lithium and Suicide


An article in the British Journal of Psychiatry examined the relationship between lithium levels in drinking water and risk of suicide. The analysis was done by a team in Japan.

“We found that lithium levels were significantly and negatively associated with SMR [standardised mortality ratio] averages for 2002–2006. These findings suggest that even very low levels of lithium in drinking water may play a role in reducing suicide risk within the general population.”
And UBC’s very own Dr. Allan Young had some words to say on the matter, particularly on the possible future debate of whether or not lithium should be added to drinking water:
http://bjp.rcpsych.org/cgi/content/full/194/5/466
“It would be most unfortunate if these findings became little more than a factual curiosity, of the sort that bright students sometimes use to highlight the limitations of a professor’s wisdom… It would be surprising if lithium in drinking water were not to raise a…panoply of questions… Following up on these findings will not be straightforward or inexpensive, but the eventual benefits for community mental health may be considerable.”

The following studies provide support for decreased suicidality with lithium treatment. However, all of these studies are done by the same group of authors, more or less. As well, there are some conflicts of interest between the authors and companies producing pharmaceuticals, including lithium.

2003
The findings indicate major reductions of suicidal risks (attempts > suicides) with lithium maintenance therapy in unipolar >/= bipolar II >/= bipolar I disorder, to overall levels close to general population rates. These major benefits in syndromes mainly involving depression encourage evaluation of other treatments aimed at reducing mortality in the depressive and mixed phases of bipolar disorder and in unipolar major depression.
http://www.ncbi.nlm.nih.gov/pubmed/12720484?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedreviews&logdbfrom=pubmed

2001
Results from 33 studies (1970-2000) yielded 13-fold lower rates of suicide and reported attempts during long-term lithium treatment than without it or after it was discontinued. Although greatly reduced, these rates remain above those estimated for the general population. Evidence for substantial, if incomplete, protection against suicide with lithium is supported by more compelling evidence than that for any other treatment provided for patients with mood disorders. Studies of commonly used, but incompletely evaluated, alternative treatments are required, and further protection against premature mortality can be anticipated with better protection against bipolar depression.
http://www.ncbi.nlm.nih.gov/pubmed/11411189?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_TitleSearch&linkpos=3&log$=pmtitlesearch4

2001
There is no definitive evidence from this review as to whether or not lithium has an anti-suicidal effect.
http://www.ncbi.nlm.nih.gov/pubmed/11687035?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedreviews&logdbfrom=pubmed

2000
Protection against suicide with lithium is incomplete, but rates of suicides plus attempts during lithium treatment may approach general population base rates.
http://www.ncbi.nlm.nih.gov/pubmed/10826667?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedreviews&logdbfrom=pubmed

2003
The findings indicate major reductions of suicidal risks (attempts > suicides) with lithium maintenance therapy in unipolar >/= bipolar II >/= bipolar I disorder, to overall levels close to general population rates.
http://www.ncbi.nlm.nih.gov/pubmed/12720484?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=3&log$=relatedreviews&logdbfrom=pubmed

2006
Risks of completed and attempted suicide were consistently lower, by approximately 80%, during treatment of bipolar and other major affective disorder patients with lithium for an average of 18 months. These benefits were sustained in randomized as well as open clinical trials.
http://www.ncbi.nlm.nih.gov/pubmed/17042835?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

2006
The findings support growing evidence of lower risk of suicidal acts during closely monitored and highly adherent, long-term treatment with lithium and indicate that treatment adherence is a potentially modifiable factor contributing to antisuicidal benefits.
http://www.ncbi.nlm.nih.gov/pubmed/17042834?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed

Studies done by some different people:

1995
In view of the fact that a placebo-controlled mortality study under long-term conditions is neither ethically nor practically feasable, our findings cannot prove definitively that long-term lithium treatment counteracts factors responsible for the excess suicide and cardiovascular mortality of affective disorders. However, our observations are compatible with such a notion.
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T2X-3YMWF86-K&_user=1022551&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1040649680&_rerunOrigin=scholar.google&_acct=C000050484&_version=1&_urlVersion=0&_userid=1022551&md5=bac5a02c883fd9a0fa77156c63c7e3e5

1999
The findings suggest that ongoing lithium treatment is associated with a lower suicide risk. Whether this is due to lithium's mood-stabilizing properties, to lower suicide risk per se in the patients who remain in treatment, or to a specific antisuicidal effect of the lithium ion cannot be determined since patients were not randomized to discontinue treatment. This methodological shortcoming is shared with every study in the field. All results regarding the influence of lithium on suicide rates must therefore be interpreted with extreme caution.
http://cat.inist.fr/?aModele=afficheN&cpsidt=1816513

2001
The reduction in suicide attempts, in both responders and non-responders, indicates that lithium possesses a specific anti-suicidal effect besides its mood-stabilising property.
http://cat.inist.fr/?aModele=afficheN&cpsidt=1069492