Thread by @Aldous_Ka_Ghost

Signs of #Depression [not just the temporary blues]:
1. Anhedonia : inability to feel pleasure
2. Grief,Guilt, incessant rumination loop
3. Psychomotor retardation [rare case,PS agitation]
4. Self-injury
5. Disrupted sleep/appetite
6. Social withdrawl
7. Chronic procrastination

Very often the manic phases of #Bipolar are mistaken to be evidence of recovery fm unipolar depression - that is the other thing to watch out for.

The manic [especially hyper] phases are not necessarily about constructive "energy" - quite often what we see is high risk behavior

Irrespective of whether it is Unipolar or Bipolar,this disorder is biopsychosocial. Biology [even at a genetic level], neurochemistry,thoughts,experience,environment all interact to produce a certain state.

It is as much a brain/body/environment issue, as it is a mind issue.

Medication helps but is not the final answer.Which is why treatment of severe #Depression involves pharmacology plus psychotherapy [teleological CBT/REBT/DBT etc as against Jungian/Freudian crap] plus lifestyle and mindstyle changes. Takes time - clients need lot of support.

Finally, i must say that politicians & civil servants who make/execute policies/laws that impact the life of citizens must be of sound #mentalhealth. Many of them clearly are not.

Make mental health screening mandatory before appointing someone to key political/admin positions.

#Depression if left untreated,inevitably leads to some other observable behavioral deficits in:
1. Working Memory [correlate:sensory/pfc pathways]
2. Explicit/Declarative Memory [correlate:dentate gyrus - hippocampal]
3. Moral reasoning [vmPFC]
4. Fear/Anger activation [amygdala]

There has been work arnd the genetic correlates of #Depression. Though in studies of identical twins [monozygotic], there is a 40% incidence,I look at it as glass half full - 60% absence shows genes are about predisposition & not inevitability.
So it is gene-gene-environment!

In fact, this holds true [gene-gene-environment] for a range of other disorders like #Autism, #PTSD, #Schizophrenia etc as well. Which is why a good therapist probes for environmental/developmental cues besides the typical DSM5/ICD diagnostic aids.

#Mentalhealth

However,it's "fashionable" for some of these untrained therapists to show high stickiness for psychodynamic/psychoanalytic therapy

End result in 9 cases out of 10:treatment extends to 5+ yrs because both client & therapist are "treating" one another by repeating/creating stories

There's a clear need for psychodynamic approach to get to the psychological roots of the disorder - however,the objective is to understand,reframe,derive meaning & then move to a goal-oriented therapy approach.

Gossipy therapists who themselves need help, screw up at that step.

Psychology is a science of mind,thought,behavior. And like any other science,it rests on evidential approach & not anecdotal. Jungian/Freudian approaches are purely anecdotal - even the cases mentioned by the 2 are anecdotal. We don't really hv evidence beyond what F/J claimed.

However, there is some mystic romanticism about that kind of an approach - which is probably the reason it attracts people who just don't have it in them to grasp deeper structures and the science of it all.

It is easier spinning stories and theories while pretending to help.

Unconditional Positive Regard and Empathy as espoused by Carl Rogers etc, hv been bastardised by these therapists with a Freudian/Jungian leaning - thereby screwing up both approaches. Most of these therapists mistake empathic distress for empathic concern.

Chalk and cheese.

Please realize that a client who trusts these kind of fake therapists, is in no position to discern issues like suggestibility and false memories. And this is where these untrained therapists do the most severe damage to clients. Besides of course milking them for years!

Here's another example of how precise the science & structure is -take the case of high Insular activation. Patients who show signs of this,show little improvement by therapy alone.Patients who show lower activation,show beautiful response to therapy.Fake therapists won't get it!

The insular activation is related to degree of emotional self-awareness. Besides the neurological/medical studies on this, there is also a body of statistical evidence which shows a negative correlation between attention to emotion [beyond an optimum limit] and mood repair.

In plainspeak, what this implies is that a client who shows very high degree of emotional attention and awareness [and hence rumination and DMN activation] will respond better to a pharmacological + psychotherapy combo rather than psychotherpay alone.

On the other hand, a client who shows relatively lower emotional attention, will respond to psychotherapy with minimal pharmacological support.

Huge huge difference.

How many of these "therapists" even understand this?

Being emotional is not emotional intelligence.

I will go one step further to bust this whole myth around how high emotional awareness is actually healthy - there is a statistical linkage, positive correlation between that parameter and Neuroticism fm the Big 5 Inventory.

However, #therapist after therapist gets this wrong.

Bottom line - do not screw up a loved one's life by letting him/her fall into the clutches of these quacks.They wl inevitably damage the client in ways that u can't even begin to imagine. Lives fall apart -not just of the client, but his/her family..

Take #MentalHealth seriously

By some estimates,nearly 1 in 6 human beings at some time or other, will go through a debilitating phase of severe #Depression - with all accompanying emotional, cognitive, neural, biochemical correlates.

And I am not talking of the fashionable, escapist "i am depressed" here.

On the spectrum of Mood Disorders [loosely called neurosis] lie other variants like Anxiety,Panic,PTSD,OCD etc. And i am not talking the garden variety stuff that gets labelled - we r talking disorders where the person's life is deeply affected & limited on a/c of the disorder.

The other spectrum is that of Thought Disorders.Schizophrenia for eg.,. A completely diffrnt set of genetic,biochem,neuro correlates, very different behavioral symptoms. And often, more debilitating than Mood Ds.

Most families attribute early onset symptoms to "personality"

Will build on that on a later date.
Cheers.

Let us take the case of HM. An injury in childhood brought on repeated seizures in him.Many years later,to treat the seizures he was operated on, part of his medial temporal lobe removed. The hippocampal area largely. The case opened new dimensions in psychiatry and neurology.

Post the surgery, HM lost the capacity for forming new declarative memory. He remembered stuff from the past, but could not form new declarative memory. Each time the doctor met him he had to introduce himself all over again. It sounds both funny and sad - such is life.

Then they discovered something startling.His procedural memory was intact.He performed as well as "normal" people on tests for implicit memory [tracing star on a paper while looking at reflection in mirror for eg.,]
The hippocampal damage was NOT linked to ALL memory systems.

There are those who "believe" that psychiatric conditions don't hv material basis in the brain. Probably a belief fm the times when imaging techniques were structural [X-Ray, MRI, CT]. Captured just neurological.

fMRI,PET etc opened the door to the functional correlates as well.

So while a CT may not show up a condition,because it shows no major structural damage in certain areas, an fMRI coupled with EEG, PET etc will give insights on functional disturbances. Add to that biological markers [endocrine and other etc].

Let us take Schizophrenia as a case.

So Schizophrenia has 3 categories of symptoms - Positive, Negative and Cognitive. The functional deviations occur very early, but usually the 1st psychotic attack happens in late teens or perhaps even later at which point the structural changes can be seen in imaging studies.

So now we hv case where we can observe enlarged ventricles, thinner cortex due to excessive synaptic pruning [In autism, the pruning is below normal, on the other hand]. Perhaps also changes in hippocampus and amygdala. But the functional stuff happened way earlier in childhood.

And guess what the functional stuff was?
1.Excessive activity in dopaminergic pathways due to a over-population of a specific receptor D2
2.Excessive presence of an enzyme [over expressed corresponding gene] which actually snips unnecessary synapses as we age[from 8-9 yrs to ~25]

If u hv managed to stay w/ me so far,u would hv got an idea that gene expression and enzyme presence will not show up in structural imaging. Yet, the functioning is already diverging fm the norm -we can study that.
Some who were on antipsychotics developed Parkinson like symptoms

This was the 1st hint scientific community got that Schizophrenia has something to do with excessive activation of dopaminergic pathways.Because Parkinsons is about low dopaminergic activity [hence anti-psychotics were invoking tremor, gait change in schizo patients]

I went into slight detail on Schizophrenia. Only to present the argument that it is best to dismiss actresses, journalists, influencers, quacks, charlatans who speak on neuro & psychiatric conditions w/o having a clue on the underlying mechanism.

Take #MentalHealth seriously.

And obviously,on twitter, i can't put up everything related to the biology,genetics,structure & function, detailed notes on the 3 categories of symptoms wrt to Schizophrenia. What hs been put up is partial,to give u a clue on how precise the correlates are. How deep r the causes.

This just has to go in here.

https://twitter.com/TheHinduScience/status/1305111483915874307?s=20

Thanks for sharing, @iWeltschmerz_
#Neuroscience
#Psychiatry
#Mentalhealth

This was the thread.
And THAT's a comment on it!
Neither the 1st time,nor the last time the name "Mustapha" makes a bhakt lose his mental balance enuff for him/her to bring in something unrelated to a topic being presented

https://twitter.com/PM_Travel_Tours/status/1009043386949566464?s=20

@dhariyat007 @iWeltschmerz_

I would be quite curious to see that chap's MRI,PET,fMRI,CT etc. And a specific fMRI to see what happens in his left dlPFC, vmPFC, amygdala, HC and the connections betwn those regions whn he hears "Mustapha". Perhaps some targeted DBS can cure his dysfunctional grip on reality 😈