The Relationship Between Sleep and Alzheimers

Oregon Health & Science University in Portland has begun a research project to better understand the how relationship between sleep and Alzheimer’s disease. The research will focus on a “key process” in the brains of sleeping humans which will be the first of its kind and will hopefully illuminate the ways in which sleep and Alzheimer’s are intertwined.

In the early stages of Alzheimer’s sleep problems are very common for patients. Sometimes even years before patients develop more noticeable cognitive problems or memory loss they will suffer from disrupted sleep.

In the last five years studies have found that people, and mice, that were suffering from poor sleep patterns had a buildup of beta amyloid plaque in their brains. Beta amyloid plaque, a sticky mixture of proteins, collects in synapses. It is also a key characteristic in people with Alzheimer’s disease.

Researchers think that sleep might sweet toxins in the brain which would prevent beta amyloid from collecting in synapses. However, it is still not clear if the disrupted sleep is caused by the beta amyloid buildup or the beta amyloid buildup causes the disrupted sleep, “It may be a vicious cycle,” Miroslaw Machiewicz from the National Institute on Aging told the AP.

In order to help further solve this mystery, the team at the Oregon Health & Science University plans to observe people’s brains in a hyper-sensitive MRI machine while they sleep. They hope to see when the sweeping in the brain occurs in the sleep cycle. This new study could further illuminate, and possibly highlight, the relationship between sleep and Alzheimer’s which could help find new treatments and preventative measures in the future. Despite this excitement, scientists do acknowledge that participants may have a hard time sleeping in a noisy and small MRI machine. Good luck sleeping!

Renaming Schizophrenia

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The name “Schizophrenia” is the subject of a new Forum in the journal Psychological Medicine. An article written by Bill George and Aadt Klijn, Foreign Affairs co-coordinators for Anoiksis (the Dutch association of and for people with a psychotic vulnerability), has been reflected on by various commentators.

Anoiksis has introduced a new name for the disease schizophrenia: psychosis susceptibility syndrome (PSS) with the aim that together with the old name, its attached prejudices, misleading significance and stigma can be thrown overboard.

Schizophrenia is a term loaded with negative connotations, since it still conveys an image of people with schizophrenia as all being unreliable, dangerous ‘lunatics’. The term consequently lends itself to stigma and self-stigma. Society stamps persons with schizophrenia with a negative hallmark; people diagnosed with schizophrenia then take the negative blueprint to themselves and this gives rise to a negative self-image. Not only does the term call up prejudices, it maintains misunderstandings, because schizophrenia means split personality and is therefore a misnomer. A split personality is in fact quite another disorder and has nothing to do with what we currently call schizophrenia.

Recently the World Health Organisation has been approached with a request to recognise the new name – currently the name PSS is not recognised either nationally or internationally.

Anoiksis has chosen the name Psychosis Susceptibility Syndrome (PSS) – the reasoning is as follows:

  • Psychosis: because of the unreality of hallucinations and delusions.
  • Susceptibility: because patients are not necessarily continually psychotic (but it is latent).
  • Syndrome: because this word includes the negative and cognitive symptoms also associated with the disease. Negative symptoms include lack of feelings and energy while cognitive symptoms may be problems with concentration and memory or a reduced capacity for problem-solving for example.

Full commentaries have been provided by several people, who generally agree with the idea of changing the name, but argue that the biggest change will come from changing the public perception of schizophrenia.

Dr Brabban and colleagues comment, “There is no doubt that for many, the diagnosis of schizophrenia can be as debilitating as the associated symptoms. The word ‘schizophrenia’ appears to do more harm than good, more frequently communicating prejudice and misinformation than fact and hope. It is indisputable that the stigma surrounding the term schizophrenia can in itself lead to misery for many with the diagnosis. Therefore, any label that removes some of these disadvantages would be a welcome change.”

Professor Bentall states, “Schizophrenia has been a contested label for many years not only because it is associated with stigma, but also because it fails to achieve any of the purposes for which it was originally designed. Rebranding schizophrenia solves none of these problems. By replacing one ill-fitting label with another, we do nothing to advance psychiatric research or to develop better treatment plans for our patients.

“It is not hard to locate some of these causes [of stigma]. Without a doubt, one is the media’s treatment of schizophrenia, which consistently over-emphasizes the risk of dangerous behaviour by patients, conveying the impression that people with psychosis are responsible for an epidemic of interpersonal violence. The reality is, of course, quite different. Whereas there is an increased risk of violence associated with psychosis, most of this is attributable to co-morbid substance abuse and most psychiatric patients pose absolutely no risk to their neighbours.

“The problem has become not whether to replace schizophrenia, but what to replace it with. Simple re-labelling will do nothing to address the many scientific and clinical limitations of the categorical approach to diagnosis. Nor is it likely to address the problem of stigma, which arises out of background assumptions about the nature of severe mental illness. To persuade the general public to be more accepting of people with mental illness, we must persuade them that psychosis arises, in part, understandably from adverse life experiences (while of course acknowledging that genetic factors must play some role), that it does not necessarily lead to violence, and that recovery is possible.”

“Forum”, can be viewed free of charge for a limited time and comprises 5 articles

View the original competition poster here.

View the winning name poster (English language) here.

Neurocognitive rehabilitation of Down syndrome

Blog post by Jean-Adolphe Rondal, Ph.D., jeanarondal@skynet.be, Emeritus Professor of Psycholinguistics at the University of Liège, Belgium, Juan Perera, Ph.D., asnimo@telefonica.net, Director of the Center Principe de Asturias, University of the Balearic Islands, Mallorca, Spain,  and Donna SPIKER, Ph.D., donna.spiker@sri.com  Program Manager of the Early Childhood Program, SRI International, Menlo Park, California, USA.

Down syndrome is one of the most commonly occurring developmental disorders, with considerable bodies of research within many different disciplines. Despite calls for strong interdisciplinary and transdisciplinary approaches to both research and treatment of developmental disorders, including Down syndrome, bringing together knowledge across disciplines in a systematic and comprehensive way is still rare.  Read more of this post

Quality of life measurement in neurodegenerative and related conditions

Blog post by Crispin Jenkinson, Professor of Health Services Research, Department of Public Health, University of Oxford, and Senior Research Fellow, Harris Manchester College, Oxford, and Michele Peters, Research Officer,  Health Services Research Unit, Department of Public Health, University of Oxford

Patient reported outcome measures (PROMs) are questionnaires that ask people questions about their current health. PROMs assess or measure patients’ quality of life, or what is sometimes referred to as health-related quality of life. Two types of PROMs exists: generic and disease-specific. Generic PROMs can be used across a broad range of diseases as well as the general population; whereas disease-specific PROMs are designed to be used in a specific patient group. Disease-specific instruments are generally regarded as potentially both more precise and sensitive to changes than more generic measures because they are intended to reflect the particular demands of specific conditions. However, generic measures allow comparing health status of (disease) groups to population norms and between disease groups. Read more of this post

Neuroanesthesia and anesthesiology

Blog Post by George A. Mashour MD, PhD, Director, Division of Neuroanesthesiology and Assistant Professor of Anesthesiology and Neurosurgery,  University of Michigan

Neuroanesthesia is a subspecialty of anesthesiology that focuses on the perioperative care of patients undergoing surgery of the brain, spine or peripheral nerves. Because the drugs routinely used for anesthesia have their therapeutic action at all of these sites, anesthesiologists and neurosurgeons must “share” the nervous system during the course of an operation. This becomes particularly important at the end of surgery, when the assessment of neurologic function is a major priority. If, for example, a patient has suffered a stroke or has brain swelling, it needs to be recognized and acted upon rapidly before permanent damage occurs. Read more of this post

Core Competencies and the Psychosomatic Medicine “Supraspecialty”

Blog Post by James J. Amos MD, University of Iowa, USA 

At the annual Academy of Psychosomatic Medicine (APM) meeting this year held on Marco Island, Florida, I heard Dr. Theodore Stern call Psychosomatic Medicine (PM) a “supraspecialty”. Usually it’s described as a subspecialty.  I couldn’t find the word in Webster’s although “supra” comes from the Latin for “above, beyond, earlier”. One of the definitions is “transcending”.  I tried to Google “supraspecialty” and came up empty. So I guess it’s a neologism. The context was a workshop on how to enhance resident and medical student education on Psychosomatic Medicine services. Dr.  Stern coined the term while talking about the scope of practice of PM. As he went through the long list, it gradually dawned on me why “supraspecialty” as a title probably fits our profession, mainly because it makes us, as psychiatrists, accountable for aspects of general and specialty medical and surgical care above and beyond that of Psychiatry alone. Read more of this post

Conversion Disorder

Blog Post by James J. Amos MD, University of Iowa, USA 

I was fascinated by the blog “The Mind in Modern Medicine” by E.S. Krishnamoorthy, et al, posted 10/21/2010. As a Psychosomatic Medicine (PM) specialist, I’m often consulted by neurologists for help managing hysteria, nowadays called conversion disorder. Although it’s been in the somatoform disorder category for many years, the opinion of many of my colleagues is that it’s more of a dissociative state. Read more of this post

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