Prognosis: Grave

Some of our readers would psychiatry to abolish diagnoses.  I would like us to abolish prognoses.  We don't know how patients will do.  We just don't. This is why.  

The Cat Lady Really Is Crazy

In the March issue of Atlantic magazine there is a must-read story entitled "How Your Cat is Making You Crazy", an interview with neuroscience researcher Jaroslav Flegr. Flegr has been studying the effects of the parasite toxoplasma gondii upon humans. Toxoplasmosis is a parasite endemic to outdoor cats, and the reason why pregnant women are always counseled to avoid the litter box.

I had heard about this line of research before through casual reading, but until now I hadn't realized how strong some of the data actually were or the more subtle and far-reaching effects infection with toxo could have.

Flegr became curious about toxo after incidentally discovering he carried the parasite himself. He wondered if infection with toxo could explain some of his own quirks, specifically his lack of fear and irrational calmness in the face of danger. He knew that in rats toxoplasmosis caused confrontational and overtly dangerous behavior: a rat with toxo will completely lose it's natural fear of cats and will seek out interactions with them.

So he set out to study toxoplasmosis infected people. He discovered that there were subtle but significant differences in the personalities of people who carried the parasite, but the differences were based upon gender. Infected men were cautious and suspicious, socially withdrawn sloppy dressers. Women with toxo were more extroverted, meticulous dressers. Infected humans as a group were also more than two and a half times more likely to get into car accidents---a difference that might be due to both fearlessness and slower reaction times seen in infected people.

Then there was the relationship to psychiatric disorders, the aspect I had already read about. Some neuroimaging studies have shown that people with schizophrenia who show reduced grey matter volume are almost all also positive for toxoplasmosis. This is particularly striking given that toxoplasmosis has two genes which can increase the production of dopamine.

So now when I read articles purporting that psych meds shrink the brain I'll know what question to ask first: "Did they control for the cat?"

Super Bowl Psychiatry

Enough meditation. Let's move on to what people really talk about in psychotherapy: Football.

And no, I'm not kidding.

Here in Baltimore, the hype's died down as the fans remain catatonic. The purple lights have fadded and the only energy left is that which remains to cheer against the Steelers. Oh, something tells me that on Sunday, there will be lots of energy for Steeler hatred.

I don't really get it-- it's a bunch of too-big, way-too-old, guys in silly outfits chasing balls and charging at each other and they get paid millions to do this. I suppose it's an escapist thing, but I've learned never to say aloud that I don't get it, or worse, that it's just a game.

So SuperBowl Sunday, and the fans are psychiatric patients waiting to happen....the beer and the beer and the beer and maybe the fights will break out and they'll all end up on line to see ClinkShrink. Oh, and the angst and the panic, and the pre-game anxiety and the post-game euphoria/depression.

New York Times report Benedict Carey talks about treatment options in A Home Treatment Kit for Super Bowl Suffering. Mr. Carey suggests:

Breathing exercises are highly recommended and become increasingly important as the football contest nears the fourth quarter, when events on the field are likely to prompt strong physiological reactions, like a pounding heart, hyperventilation, even dizziness. These internal cues, as they’re called, can escalate the feeling of panic, a self-reinforcing cycle resulting in groans and cries that can be frightening to small children, pets and sometimes neighbors.

In the final minutes of the game, be forewarned: Many patients will move beyond the reach of therapy. Their faces may change, their breathing appear to stop. Researchers have not determined whether this state is closer to Buddhist meditation or to the experience of freefall from an airplane. All that is known is that, once in it, patients will fall back on primal coping methods, behaviors learned in childhood within the cultural context of their family.

Like emitting screams. Or leaping in an animated way, as if the floor were on fire. Or falling on their back and moving their arms and legs like an overturned beetle, in celebratory fashion.

This post is dedicated to my husband and son.

Peter Kramer on Slate.

While we're waiting on ClinkShrink, I'll steal a link to a Slate article on paranoia by Peter Kramer. He won't mind.

Fanning the flames of paranoia

A healthy wonders how a culture of Birthers and Truthers feeds the delusions of people like Jared Loughner

Dr. Kramer writes:

The experience in my training years made me comfortable with paranoia. As a result, I have always had one or two paranoid patients on the roster in my private practice here in Providence, R.I. I should stress that no one I see resembles Jared Lee Loughner. I travel a good deal, and I can't leave the covering doctor with potentially violent patients. When my patients have schizophrenia or related conditions, they tend to be the most accomplished, most reliable, and nicest people to suffer these terrible afflictions. Their needs are serious enough.

Not much specific is known about how to treat paranoid patients. Generally, they don't come in hoping to lessen their delusions, which can be wholly convincing to them. They want relief from depression or insomnia -- or from an employer who has insisted they get help. Their mood symptoms may respond to medication, and they may even become less isolative, but generally the system of thought does not budge. After months of trials of different drugs, the patient will be less agitated and less pained but still solidly convinced that he is being watched and threatened. Always, too, there are prices to be paid in terms of medication side effects.

One thing we all seem to agree on with mental illness of this magnitude is that violence of this extreme and horrific nature is rare. It's all pretty horrible.