Neil Seeman

Alzheimer's disease: β-amyloid plaque formation in human brain.

Although the precise cause of Alzheimers disease is not known, the β‐amyloid peptide chains of 40–42 amino acids are suspected to contribute to the disease. The β‐amyloid precursor protein is found on many types of cell membranes, and the action of secretases (β and γ) on this precursor protein normally releases the β‐amyloids at a high rate into the plasma and the cerebrospinal fluid. However, the concentrations of the β‐amyloids in the plasma and the spinal fluid vary considerably between laboratories. The β‐amyloids adsorb in the nanomolar concentration range to receptors on neuronal and glial cells. The β‐amyloids are internalized, become folded in the β‐folded or β‐pleated shape, and then stack on each other to form long fibrils and aggregates known as plaques. The β‐amyloids likely act as monomers, dimers, or multimers on cell membranes to interfere with neurotransmission and memory before the plaques build up. Treatment strategies include inhibitors of β‐ and γ‐secretase, as well as drugs and physiological compounds to prevent aggregation of the amyloids. Several immune approaches and a cholesterol‐lowering strategy are also being tested to remove the β‐amyloids. Synapse, 2011.

World survey of mental illness stigma

OBJECTIVE To obtain rapid and reproducible opinions that address mental illness stigma around the world. METHOD Random global Web users were exposed to brief questions, asking whether they interacted daily with someone with mental illness, whether they believed that mental illness was associated with violence, whether it was similar to physical illness, and whether it could be overcome. RESULTS Over a period of 1.7 years, 596,712 respondents from 229 countries completed the online survey. The response rate was 54.3%. China had the highest proportion of respondents in daily contact with a person with mental illness. In developed countries, 7% to 8% of respondents endorsed the statement that individuals with mental illness were more violent than others, in contrast to 15% or 16% in developing countries. While 45% to 51% of respondents from developed countries believed that mental illness was similar to physical illness, only 7% believed that mental illness could be overcome. To test for reproducibility, 21 repeats of the same questions were asked monthly in India for 21 months. Each time, 10.1 ± 0.11% s.e., of respondents endorsed the statement that persons who suffer from mental illness are more violent than others, indicating strong reproducibility of response. CONCLUSION This study shows that surveys of constructs such as stigma towards mental illness can be carried out rapidly and repeatedly across the globe, so that the impact of policy interventions can be readily measured. LIMITATIONS The method engages English speakers only, mainly young, educated males.

The meaning of antipsychotic medication to patients with schizophrenia.

Objective. To explore the meaning of taking antipsychotic medication in a population with schizophrenia. Method. A literature review of publications on the meaning of medication was conducted using PsycINFO, Medline, and SOCINDEX databases (2001–2012) and search terms attitude or meaning plus antipsychotics or neuroleptics. Based on this search, 110 articles were found, 60 of which were judged relevant to the goal of this article. A recently published expert consensus guideline was also used to better understand current thinking about medication adherence issues in patients with severe mental illness. Quotations from patients attending a women’s clinic for psychosis were used to expand on themes found in the literature. Results. Themes extracted from the reviewed literature fell into three main categories: a) control by and of medication, b) dependence on medication and on the prescriber, and c) stigma resulting from medication use. These themes contrast with the usual medical associations with medication (e.g., symptom relief or side effects). Conclusion. Shared discussion of beliefs about medication between patient and care provider allows wider exploration of personal meanings that can help establish therapeutic relationships and integrate psychological therapy with psychopharmacology. (Journal of Psychiatric Practice 2012;18:338–348)

Laughing at the obese.

While the phenomenon has been studied mainly among medical students, it is well known that physicians, even seasoned ones, often make derogatory remarks about certain patients – not in the patients’ presence (it is to be hoped) but to each other. The targets of such medical locker-room humour are often the patients who, the doctors think, brought their illnesses upon themselves. In a focus group investigation of medical students by Wear and colleagues, the almost unanimous conclusion by students was that morbidly obese patients were “fair game” for mockery. Why so? The students reported that it had to do with the patients’ perceived “lack of self-control.” Other patients who fell into the same category included smokers, excessive drinkers, drug abusers, reckless drivers, those who practice unsafe sex, those who engage in unlawful behaviours, and those who do not comply with their physicians’ prescriptions. Instead of feeling empathy for such patients, many students in the focus groups reported feeling generally cynical or indifferent toward them. Mockery may be a way of “letting off steam,” reflecting physicians’ perceived inability to “cure” such patients, and their demoralization in the face of what they perceive to be the hopeless complexity of the clinical situation. John Morreall has studied the philosophy of humour. He suggests another explanation – people laugh at those to whom they feel superior. Doctors tend to feel superior to their patients and may well overestimate the actual “free” choices patients have when it comes to putting on weight. Central to this issue is an increasingly high-pitched debate across North America over what personal responsibility is, and is not. Pundits on the political right and the left (and everywhere in between) betray righteous moral certitude over knowing what constitutes moral responsibility when it comes to eating too much or exercising too little. So what is free choice when it comes to obesity? One of my first summer jobs in college was moving pianos at an elite music school in Victoria, BC. One night I was driving home a 14-year-old Russian prodigy – he could play Rachmaninoff to the awe of his young peers – and he thrust his neck out the bus window. I stopped and asked him to stick his head back in the bus. He told me he couldn’t help it: in Moscow they didn’t have clean air. In Victoria, he was breathing life for the first time. Yes, Virginia, human beings at their core possess free will, and this should be celebrated; we can choose to do good and we can (sometimes) keep away from bad temptation. But when it comes to breathing clean air (in the case of the Rachmaninoff scholar) or eating healthy foods, it depends in part on what our genes have to say and on where we live. A Soviet apparatchik could never breathe – or speak – freely. In this context, freedom of choice is slippery. Context matters. Doctors – like all of us – can be trapped by cognitive bias when judging the moral character of the obese. The heavier patients are, the less respectfully they’re treated, as if it was, somehow, their fault. This is unfortunate, because these patients may end up avoiding the healthcare system altogether. Physician biases mirror the community prejudices that obese persons struggle against every day. When we mock the obese, we show the weakness of our choices and the weakness of our own character.