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The Royal College of Psychiatrists Improving the lives of people with mental illness

Kaleidoscope June 2017

Win a College mug in our June Kaleidoscope’s Quiz – Take the Quiz!

Read the Kaleidoscope Column in the BJPsych

BJPsych June 2017

July’s Kaleidoscope column in the British Journal of Psychiatry asks what’s the deal with red hair.  Well, sort of. More precisely it looks at the phenomenon of epistasis. If genes didn’t interact with each other, and they all acted independently, mutation rates would increase - and evolutionary fitness decrease - at an exponential rate. However, genes do impact each other – which is the process known as epistasis. Hair colour is the classic teaching example: analogous to skin complexion, ever greater quantities of the pigment eumelanin creates blonde, brown, and black hair successively. Except in one group… they have a variant in a different gene that impacts this by preventing the conversion of pheomelanin to eumelanin: they are the red heads. There is a proper point to this beyond being interesting pop-science nugget, and Kaleidoscope discusses a paper from Science that explains how humans are subject to synergistic epistasis, which helps remove deleterious alleles from the population. It does not infer that having red hair should be viewed as a mutation.

Long-term effects of antipsychotics is a hot-button issue. We already know that those with psychoses face a considerable loss of average life-expectancy – do medications add to this?Two major potential pathological processes have been proposed. One is dopamine sensitization: use of medication purportedly creating a vicious cycle of changes to receptors that can only be managed by on-going antipsychotic treatment. The second is of medication-induced reductions in brain volume, a possible direct neurotoxic effect that has the obvious potential to exacerbate negative and cognitive symptoms. Problematically, it’s a difficult area to study, as so few individuals with psychosis are not on treatment, and it’s realistically not possible to ethically undertake such work. With those caveats in mind, an impressive expert group investigated the best current evidence. Their conclusions are that there are few data to support the neurotoxicity hypothesis, with multiple confounders to such work; further, although dopamine sensitization is recognised, it is not clearly linked with worsened outcomes. We suggest it’s an important read for those of us who prescribe such medication.

Finally, the guys and gals at UCL have been tempting us with some corking recent publications. You may recall their recent paper on cat ownership and psychosis; well now the same team have evaluated how students rated a cross-sectional, anonymised, set of photos of medics from different specialities. The principle was to look at preconceptions, and who looked professional, trustworthy, and aspirational; the topic matters, especially when we think of the issues around recruitment. Scrubs were a clear and helpful identifier of emergency medics, but problematically, no women were identified as surgeons, something pinned to men in suits. However, to cheer us up – or at least half of us – male psychiatrists were identified as the most fashionable of all doctors. Not something that surprised the Kaleidoscope boys.

Win a College mug in our June Kaleidoscope’s Quiz – Take the Quiz!

Read the Kaleidoscope Column in the BJPsych

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