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

Kaleidoscope December 2017

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BJPsych December 2017December’s Kaleidoscope notes how dopamine has been called the ‘wind of the psychotic fire’, but its role in bipolar affective disorder psychoses had been less clear. A new piece of work compared the two conditions using positron emission tomography, and interestingly, most were treatment naïve or drug free. There were no clear differences between the conditions, with striatal dopamine positively correlated with symptom severity. Patients were followed up for a year and a half, and their diagnoses remained stable. The findings support a transdiagnostic role for dopamine in the psychoses: its increased presynaptic synthesis is a tantalising target for future medications.

Adult ADHD is a growing issue. Many previously undiagnosed adults present due to greater current awareness of the condition, which wasn’t present when they were children; indeed some come forth after sitting through their own child’s assessment in school, reflecting that they’d such problems when young. However, there is a smaller cohort of those who say their symptoms started in adulthood: what to make of that? Screening questionnaires don’t help, as they pick up symptoms but not causes. A novel piece of work did detailed evaluations of the adult onset cohort (remember, not those who have had it since childhood), and found that 95% could be explained by drug use, commonly cocaine. Some snow in time for Christmas.

Finally, Kaleidoscope only ever aims to provide you with the best science, never to induce moral panic with clickbait headlines. So, will violent videogames harm your children? About a year ago the column dismissed so-called ‘internet gaming disorder’ as not really a thing, and a case of over-diagnosing everything. But, might ten straight hours on Grand Theft Auto numb one’s senses, and the ability to determine if it’s ok to shoot strangers in the head? A novel study says yes it does, with heavy users of violent video games found to have reduced levels of empathy. Not that we would find it amusing to disrupt your Christmas shopping plans, but you have been warned. The paper tells us little of the differences between individual titles, so we aim to spend my time off evaluating any differential effects between Wolfenstein II and Resident Evil 7. If our thumbs are still working, we’ll report back in January.


December 2017 Kaleidoscope monthly Quiz (True or False)

  1. A new study has suggested that almost all adult-onset ADHD can be explained by substance use.

    Answer: True.

  2. The largest double-blinded randomised controlled trial of deep brain stimulation for depression has shown a modest, but statistically significant improvement in the active treatment over placebo.

    Answer: False; it’s disheartening news for neuromodulation.

  3. A brief psychosocial intervention addressing barriers to taking medication has been shown to increase adherence to antidepressants by a factor of five in older adults.

    Answer: True, and their clinical outcomes were – unsurprisingly – also better.



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