New POLL Article: Childhood Emotional Maltreatment

I'm posting a new POLL article on LinkedIn, entitled:

Childhood Emotional Maltreatment Severity Is Associated with Dorsal Medial Prefrontal Cortex Responsivity to Social Exclusion in Young Adults

Abstract

Children who have experienced chronic parental rejection and exclusion during childhood, as is the case in childhood emotional maltreatment, may become especially sensitive to social exclusion. This study investigated the neural and emotional responses to social exclusion (with the Cyberball task) in young adults reporting childhood emotional maltreatment. Using functional magnetic resonance imaging, we investigated brain responses and self-reported distress to social exclusion in 46 young adult patients and healthy controls (mean age = 19.2±2.16) reporting low to extreme childhood emotional maltreatment. Consistent with prior studies, social exclusion was associated with activity in the ventral medial prefrontal cortex and posterior cingulate cortex. In addition, severity of childhood emotional maltreatment was positively associated with increased dorsal medial prefrontal cortex responsivity to social exclusion. The dorsal medial prefrontal cortex plays a crucial role in self-and other-referential processing, suggesting that the more individuals have been rejected and maltreated in childhood, the more self- and other- processing is elicited by social exclusion in adulthood. Negative self-referential thinking, in itself, enhances cognitive vulnerability for the development of psychiatric disorders. Therefore, our findings may underlie the emotional and behavioural difficulties that have been reported in adults reporting childhood emotional maltreatment.

The study looks at reactions to the Cyberball game, in which the participant plays a game of cyber-catch with the computer and two other players, one male and one female. In the first, inclusion, part of the game, the computer throws the ball to each player an equal number of times. In the second, exclusion, part, the computer throws the ball to the subject once or twice a the beginning of the game, and then never again. The game is supposed to be a model for social exclusion.

The study examined severity of childhood emotional maltreatment using the Dutch version of something called the Childhood Trauma Questionnaire.

They looked at Mood and something called, "Need Threat", after the inclusion section, then after the exclusion, and then after the whole thing was done:

The Cyberball game didn't seem to have much differential effect between groups, and what you see is mostly a difference in baseline, unrelated to the game. The main difference seemed to be in fMRI, with greater childhood emotional maltreatment corresponding to greater dorsal medial prefrontal cortex activity:

It's hard to know how much this matters, in the grand scheme of things-whether people who suffered childhood emotional maltreatment are really more vulnerable to social exclusion, and if the difference in brain activity amounts to a difference in perceived experience, and greater vulnerability to other pathology.

But please take a look at the article and let me know what you think, either here, or on POLL.

New POLL Article! and Obit

I just posted a new article and discussion on POLL. Please check it out, and comment freely.

The article, Evidence b(i)ased medicine—selective reporting from studies sponsored by pharmaceutical industry: review of studies in new drug applications , compares the studies submitted to the Swedish regulatory agency for approval of 5 SSRI's, with the articles that were eventually published based on those studies.

They note 3 problematic areas.

1. Multiple Publication-individual studies yielded multiple publications, without acknowledging that they came from the same study. Also, subsets of data from multiple studies were pooled to create new publications.
2. Selective Publication-studies that made the drug look good were published more often than studies that showed no difference from placebo.
3. Selective Reporting-studies ignored the results of intention to treat analyses in favor of per protocol analyses, which make the drug look better.

In case you've forgotten, in an intention to treat analysis, subjects who dropped out of a study, for whatever reason, are analyzed as thought they had completed the study, with the last available result carried forward.
In a per protocol analysis, subjects who drop out are ignored in the final analysis. Since many subjects drop out due to adverse effects, or lack of effect, if you don't include those subjects, your results will look better (the subjects who tolerate the drug well and do better on it are more likely to remain in the trial).

Please check out the study and comment (I already wrote that, but it bears repeating).

On another, related note, Ann Wolpert, MIT's director of libraries since 1996, died last month. The reason this is relevant is because she was a big believer in open access, and beginning in 2000, developed DSpace,

"an open-source digital archive for research that has been adopted by more than 1,000 institutions worldwide. DSpace ensure(s) that there (is) a common, permanent platform for library material. Then, in 2009, she conceived the MIT Faculty Open Access Policy, where professors give the Institute permission to disseminate journal articles for open access through DSpace@MIT. In turn, those articles can be republished on open Web sites like the Public Library of Science or PLOS. It was the first policy of its kind in the United States, and has been imitated by other universities around the globe." (Jason Pontin, MIT Technology Review Editor)


“(Wolpert) believed in open access, but it went deeper than that...Her central insight was that in the age of the Internet, a great research library could serve not only as a window into scholarly output for given members of university and research communities, but also as a window for the world at large into the scholarly enterprise. That was a great and thrilling idea...” (Hal Abelson, Class of 1922 Professor of Computer Science and Engineering at MIT and founding director of both Creative Commons and the Free Software Foundation (source))

 POLL, our free online journal club that uses open access articles, was created in the spirit of Wolpert's work. Please make use of it.

Ann Wolpert

POLL!

We did it! Drs. James Amos and George Dawson (of the Real Psychiatry blog) and I created a LinkedIn group entitled, Psychiatry Online Lifelong Learning (POLL).  Here's the description:

This is a free Psychiatry journal club. Links to free articles, along with managers' initial comments, will be posted at regular intervals. Enthusiastic discussion is highly encouraged.
The purpose of this group is to foster professional interaction and collaboration, and to promote the principle of lifelong learning so important to continued growth as a clinician. 
The group is primarily intended for psychiatrists, but anyone with an interest in psychiatry, and a scientific bent, is welcome to apply for membership.
We ask simply that comments be respectful and relevant to the discussion at hand.

And guess what? The first discussion has already begun, kicked off by none other than Dr. James Amos of The Practical Psychosomaticist blog. There's a timely article entitled,

Collaborative Care for Patients with Depression and Chronic Illnesses, byWayne Katon, et al.

So don't delay! Head on over to LinkedIn, and apply for membership. If you don't already have a LinkedIn account, it's free and easy to set one up, and not a bad thing to have, in any case.

We're really excited about this, and we'd like it to be something good for everyone. So please help us, and yourself, out by joining and participating.

Thanks.

Follow Up Poll

Back in April, I posted a survey about the DSM-5: whether people planned to purchase it, what people thought the problems with it would be.

Now I'm following up. I want to know if people have purchased it, and whether they feel it's been helpful.

Click HERE to participate. It's completely anonymous, and you don't need to have participated in the first poll to join in on this one.

This survey will close 07.27.13, 12am. Thank you in advance for participating.