María Inés López‐Ibor

Profiles of brain magnetic activity during a memory task in patients with Alzheimer’s disease and in non-demented elderly subjects, with or without depression

The presence of depression is common among the elderly and it often complicates the early diagnosis of Alzheimer’s disease (AD). In this study, we searched for brain activity measures that characterise AD. We compared brain magnetic activity profiles during a memory task, obtained from patients with AD, elderly patients with late onset depression, and age matched volunteers without history of neurological or psychiatric disease. AD patients showed significantly reduced activity in left temporal lobe regions during late portions of the event related magnetic response (400 ms or later after stimulus onset), compared with both groups of patients who did not present with serious cognitive decline. This finding highlights the potential usefulness of MEG protocols supporting the differential diagnosis of AD and major depression related cognitive decline in the elderly.

Pharmacogenetic testing for the guidance of psychiatric treatment: a multicenter retrospective analysis

OBJECTIVE We investigated the association between clinical outcome and the recommendations of a pharmacogenetic test (Neuropharmagen) in patients with a variety of psychiatric conditions whose previous treatment regimen had failed. METHODS This retrospective, naturalistic, multicenter study included adult psychiatric patients (depression, psychosis, anxiety, bipolar, etc.) who had been seen at 3 private clinics. All patients had received pharmacogenetic testing (Neuropharmagen) and were classified depending on whether or not their post-test treatment regimen followed the test recommendations. Clinical severity was assessed with the Clinical Global Impression of Severity (CGI-S) at baseline (pre-test) and 3-month follow-up, and adverse events were recorded. RESULTS 182 patients were available for analysis. After multivariate adjustment, patients whose treatment followed the test recommendations had odds of improvement about 4 times greater than patients whose treatment did not follow the recommendations (adjusted OR=3.86, 95%CI 1.36-10.95; p=0.011). Importantly, psychiatric diagnosis did not significantly affect the odds of improvement. Also, in the subpopulation with baseline CGI-S score >3 (N=170), the rate of stabilization at follow-up (defined as CGI-S≤3) was significantly higher in patients whose treatment followed the pharmacogenetic recommendations (p=0.033). There was no apparent difference in the incidence of adverse events (6 patients in each group). CONCLUSIONS Non-drug naïve patients whose treatment followed the recommendations of pharmacogenetic testing were more likely to improve their condition than patients whose treatment did not. These results are consistent with previous clinical research on depressed patients, and this study also suggests that this benefit can be extended to psychiatric conditions other than depression.

Disentangling complexities in the relationship between religion and psychiatry.

One of the consequences of modernity has been the separation between science and religion. This split has had positive consequences, such as the progress of scientific research and the separation of Church and State in developed societies. On the other hand, religion and science have started to ignore or despise each other, and this has had an impact especially on research and practice in psychiatry as this discipline deals with the most “spiritual” of the diseases, the Geisteskrankheiten (literally, “diseases of the spirit-mind”). Religiosity has often been regarded either as a manifestation of mental disorder or as irrelevant to clinical practice. Pargament and Lomaxs article is a precise and comprehensive summary of the new perspectives on the relationship between religion and mental illness. We want to highlight here two important aspects. The first has implications for everyday practice. According to Pargament and Lomax, religion may simply be the idiom through which mental illness is expressed. Indeed, delusions per se are not just a by-product of a brain disease, but the expression of an attempt to cope meaningfully with incomprehensible experiences. Many years ago, Sarro 1 studied in depth the themes of delusions and came to the conclusion that they correspond to the mythologems described by anthropologists in ancient myths and religions. In a similar way, Schneider 2 regarded the delusions of severe depressive states as the expression of the primeval fears of human beings: the fears of not going to be able to survive, to fall ill, or to be condemned for eternity. Considering the delusional manifestations of abnormal states of consciousness, we came to the same conclusion 3: the themes coincide with the everlasting preoccupations of human beings (where do we come from, is there a new life after death, why two sexes, and so on). What is morbid is not the preoccupation, the theme of the delusion, but the fact that it emerges untimely and out of context. In this light, the relatively common presence of religious contents in delusions should not appear surprising. The second aspect is a more general one and concerns the role of religion in the establishment of individual and collective identities and the dangers involved in this process, including religiously based violence and religious struggles within oneself, with others, and with the divine. Recently, we have considered 4 the origin of identification from an anthropologic perspective. According to Lovaglia et al 5, human evolution is the consequence of the pressures precipitated by xenophobia among primates in the past several millions of years. This xenophobia is manifested in deadly raids against individuals of other groups of the same primate kind. The immediate consequences are both intergroup conflicts and intragroup cooperation. According to the theory of social identity 6, the sense of self depends on the identification with a group. Once the identification has been produced, the individuals attribute pleasant and desirable characteristics to the group members and repellent and unpleasant characteristics to individuals outside the group. Religion may be involved in this process but just as one of the many possible elements. The xenophobia may even be oriented toward the body and the evils that come with it: for instance, anorexia nervosa can be interpreted as an identity disorder grounded on the wish to dominate and subdue the body (ascetism) and, therefore, as a sacred disease. Pargament and Lomaxs article should be welcome as a very significant contribution to the clarification of the complex relationship between religion and mental illness. Other initiatives worth mentioning are those of the WPA Section on Religion, Spirituality, and Psychiatry (http://www.religionandpsychiatry.com), the WPA publication Psychiatry and Religion: Beyond Boundaries 7, and the Handbook of Religion and Health 8. A growing interest on the religious side in topics concerning psychiatry should also be noticed. The Lopez Ibor chair on Mystical Studies and Mental Health founded by the Order of the Carmelites in Avila (Spain) is a good example (http://www.citesavila.org; http://www.fundacion lopezibor.es).