He Might Be A Psycho

We have no idea how bad it could've gotten.

Or how bad it might get.

We're still trying to get our arms around what happened. And since it's still happening, we're miles away from the kind of understanding we're going to need if we're going to have any real chance of squaring it all up.

Modern Miracles

I've only done Ketamine twice. And I can say without fear of contradiction that they remain among my most pleasant memories of drug-induced euphoria - or they would be if I hadn't been blissfully asleep both times.

🎶 Deep and restful, sleep...sleep...sleep 🎶

PsyPost:

Ketamine may ease depression by restoring the brain’s sensitivity to prediction error, study suggests

New research suggests that electrophysiological brain signals associated with neural plasticity could help explain the rapid, antidepressant effects of the drug ketamine. The findings, European Neuropsychopharmacology, indicate that ketamine could reverse insensitivity to prediction error in depression.

In other words, the drug may help to alleviate depression by making it easier for patients to update their model of reality.

“Ketamine is exciting because of its potential to both treat, and better understand depression. This is largely because ketamine doesn’t work the way ordinary antidepressants do – its primary mechanism isn’t to increase monoamines in the brain like serotonin, and so ketamine gives us new insight into other potential mechanisms underlying depression,” said lead researcher Rachael Sumner, a postdoctoral research fellow at The University of Auckland School of Pharmacy.

“One of the major candidates for the mechanisms underlying ketamine’s antidepressant properties is how it increases neural plasticity. Neural plasticity is the brain’s ability to form new connections between neurons and ultimately underlies learning and memory in the brain.”

“Rodent studies have consistently shown that ketamine increases neural plasticity within 24 hours,” Sumner said. “However, there are major challenges when attempting to translate what we know occurs in rodents to determine if it occurs in humans. Sensory processing mechanisms of plasticity, like the auditory process we examined in this study, provide an important means to meet this challenge of translation.”

The double-blind, placebo-controlled study included 30 participants with major depressive disorder who had not responded to at least 2 recognized treatments for depression. Seven in 10 participants demonstrated a 50% or greater decrease in their depression symptoms one day after receiving ketamine.

“In this case we used what’s called an ‘auditory mismatch negativity’ task to assess short-term plasticity and predictive coding, or the brains adaptability and tendency to try to predict what’s coming next,” Sumner said.

The researchers used electroencephalogram (EEG) technology to measure brain activity as the participants listened to a sequence of auditory tones that occasionally included an unexpected noise. The brain automatically generates a particular pattern of electrical brain activity called mismatch negativity (MMN) upon hearing an unexpected noise.

Sumner and her colleagues found that ketamine increased the amplitude of the MMN several hours post-infusion, suggesting that the drug increased sensitivity to prediction error.

“We found that just 3 hours after receiving ketamine the brains of people with moderate to severe depression became more sensitive to detecting errors in its predictions of incoming sensory information,” she told PsyPost.

“To provide context, the brain creates models or predictions about the world around it and what is most likely to come next. This is largely thought to be because it is an efficient way to deal with the massive amount of information hitting our senses every moment of the day. When something is constant and stable in the world these models can become very rigid. It has been suggested that these models can become too rigid and unchanging, underlying negative ruminations and self-belief that people with depression often report.”

“As an example of how this might look in depression — it is often easy for friends and family to point out to their loved one errors or the harm in their thought patterns,” Sumner explained. “A counsellor will often work with a person to change their harmful ruminations or beliefs, such as with cognitive behavioral therapy (CBT). However, the person experiencing depression may find this difficult to see, or to take on because of how rigid their models (belief about themselves, the world around them, their future) have become.”

The participants also completed a visual task to measure long-term potentiation (LTP), the ability of neurons to increase communication efficiency with other neurons. An analysis of that data, published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, found evidence that the antidepressant effects of ketamine were associated with enhanced LTP.

“Ketamine may be working by increasing plasticity (the ability to adapt and learn new things), as well as increasing the brain’s sensitivity to unexpected external input that is signaling errors in its own rigid expectations,” Sumner said.

The main limitations of the new research are the lack of a control group and relatively small sample size. But Sumner and her colleagues hope that their future research will shed more light on whether ketamine can help to defeat harmful cognitions.

“The task we used involves presenting beeps through some headphones, and while it provides a highly controlled way to measure plasticity and sensitivity to unexpected input, it is pretty far removed from the complexity of the experience of depression itself. The next study should replicate our finding, and aim target and relate the change in the mismatch response and connectivity to higher level brain functions,” Sumner told PsyPost.

“Building on this finding may help provide evidence for the use of ketamine to facilitate or enhance people’s ability to engage with and benefit from therapies like CBT, by putting the brain into a more plastic state, ready to update its models.”

The study, “Ketamine improves short-term plasticity in depression by enhancing sensitivity to prediction errors“, was authored by Rachael L. Sumner, Rebecca McMillan, Meg J. Spriggs, Doug Campbell, Gemma Malpas, Elizabeth Maxwell, Carolyn Deng, John Hay, Rhys Ponton, Frederick Sundram, and Suresh D. Muthukumaraswamy.

Maybe we should try putting this stuff in the public water supply - might could go a long way to fixing what's gone wrong with the MAGA QAnon bozos. Can you thinking of a more apt description of their moronic beliefs than "inaccurate models and predictions"?

I think it's worth a shot.

COVID-19 Update

Pandemics really dig a 3-day weekend, I guess.

• New Cases:  25,352
• New Deaths:      286

And my paranoia's really starting to kick in now. Hoping hard that there are pros at CDC and in the state health departments who won't let Cult45 fudge the numbers too badly.

The double whammy effect.

WaPo:

Recently, former first lady Michelle Obama spoke about experiencing ”low-grade depression” caused by the double pandemic of covid-19 and racial strife. It was a striking admission from a woman regarded as a strong role model. But as Black female psychiatrists, we know that even the healer needs healing sometimes.

We and our colleagues are well versed in diagnosing depression and anxiety. Some of us suffer from it ourselves. But what all Black women are facing today is something different, something additional. Black women sit squarely at the confluence of multiple systems of oppression, and are experiencing a disproportionate loss of life and livelihood in the era of covid-19.

Lately we have seen an unusual number of Black women exhibit symptoms that would normally be attributed to depression, including fatigue, sleep disturbances and hopelessness. According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), our profession’s handbook of mental disorders, consideration of any diagnosis of major depressive disorder must take into account any “underlying cause.” If one exists, it must be treated first.

In the case of Black women, the symptoms are the inevitable result of the pandemic’s impact on human psyches that are already systematically oppressed and battered. Our current mental health systems over-pathologize Black women’s experience of pain and trauma without first affirming the source of the stress: ongoing delayed justice for our community.

The pressures are easily seen: According to a report by the nonprofit organization Lean In, Black women are nearly twice as likely as White men to say that they’ve been laid off, furloughed, or had their hours and/or pay reduced because of the pandemic. Black women are more likely than White workers to work outside the home as essential workers.

Black women are also taking on more responsibility as caregivers, the study shows. Almost half of Black households with children are headed by single women, and so must face issues of child care and virtual schooling on their own. Black women report spending three times as many hours per week caring for elderly or sick relatives as do White women.

In June, a Washington Post-Ipsos poll found that 31 percent of Black adults personally knew someone who had died of covid-19, compared to 9 percent of Whites. An online survey of more than 1,000 Black women by Essence magazine had similar findings, and also noted that 63 percent of respondents felt their mental health was being affected by the pandemic.

As Black female psychiatrists, we recognize the feeling of being overwhelmed. There aren’t many of us: Roughly 2 percent of practicing physicians in the United States identify as Black women. Of those, only a small number choose psychiatry as their specialty.

Like our male counterparts, many of us choose to practice in Black communities because we know firsthand how the mental health profession overlooks Black people. We think often of the fact that only one in three African Americans who need mental health care receive it. We know that compared with the general population, African Americans who seek mental health care are less likely to be offered either evidence-based medications or talk therapy.

Even if we all saw patients 24/7, we Black female psychiatrists could never meet the mental health needs of Black women. On the rare occasion that we meet, we speak freely about the anguish we feel. We tell each other how we cried when our own therapists asked how we were holding up. We let our shoulders slump from the weight of it. We admit that we have no answers, and at times feel hopeless.

And then we get up again, and we do our jobs.

Without doubt, all Americans are at an elevated risk of mental health problems because of the stress of the pandemic. However, the tremendous social, psychological and economic load placed on Black women in particular warrants dedicated attention.

As psychiatrists, and as Black women, we believe it is imperative that our mental health is a national priority. Black women uphold households and serve the country as essential workers. We are strong. We are resilient. We persevere. But what we really need to maintain mental health is societal change, at all levels.

With everything that's piling up on us - disease, and racist/fascist cops, and racist/fascist gangs of ammosexuals, and unemployment, and raging economic disparity, and half-a-dozen other really shitty things - is it any wonder we've seen the rise of the Radical Karen?

We're boiling over - USAmerica Inc is 9 kinds of fucked up in the head, and we need some good old-fashioned large-group immersion therapy. Quick.

Relax

Here's a weird little thing that might be of use for us to stare at and find some small measure of calm in this tempest of political stress.

Every dot is traveling in a straight line.

So Much OCD

So many reasons to drink

Today's Tonight

My love-hate relationship with football continues.

My Donkeys play the late game Monday night.

Per Five-Thirty-Eight:

Broncos  (-7.5)   74%

Chargers            26%

Trump Is Not Well

It's difficult to accept the validity of a Long-Distance Diagnosis. So even though it seems ridiculously obvious, we've seen this before when (eg) Robert Bork was saying much the same about Bill Clinton in the 90s.

So grains of salt are in order here.  

That said, it's not just a few people running around like their hair's on fire. This is becoming a very strongly-held conviction among observers who're otherwise calm and clear-eyed about such things.

Raw Story (a year ago):

But a lack of empathy is just one part of narcissistic personality disorder. Just beneath the surface layer of overwhelming arrogance lies a delicate self-esteem that is easily injured by any form of criticism. We have all seen Trump unjustifiably lash out at a number of people with harsh and often extremely odd personal attacks. When he thought he had been treated unfairly by Fox News host and Republican debate moderator Megyn Kelly, he responded by calling her a “bimbo” and later saying that she had “blood coming out of her eyes, blood coming out of her wherever.” In response to the strange, misogynistic comments Kelly said that she “may have overestimated his anger management skills.” If the news host would have pegged him as a bona fide narcissist from the beginning she might have expected such shamelessly flagrant behavior.

To be fair, it is certainly true that not all narcissists are terrible people. Some of our most beloved celebrities and musicians have been suspected narcissists, including Elvis Presley, Marlon Brando, Kanye West, and even Alec Baldwin. Not only are these decent people, some have also done a lot of good through philanthropic work. Surely Donald Trump has more in common with these individuals than he does with a psychopath like Saddam Hussein.

There is no doubt that this has been true of the past, yet there is one critical difference between those people and Trump or Saddam. Only the latter two were in or are pursuing positions as heads of state—a role that grants enormous power over world affairs and people’s lives. While a narcissistic personality might be one of the traits that allowed Trump to be such a successful businessman and reality TV star, it is also the trait that makes him potentially dangerous as a political leader.

We were warned. People saw it coming a year ago. And since then, Trump's behavior has done nothing but reinforce the view that the guy is fucking dangerous.

And still, it seems like Congress just sits and dithers away.  I imagine they're all scrambling mightily to wrangle a deal for themselves as they work out the plan to sink Trump, but we need to get to the nut-cuttin' here, guys.

Call 'em and tell 'em. 

The Capitol Switchboard: 202-224-3121

Let The OCD Wash Over Me

Word O' The Day

stealth abs

When your ripped six pack is covered by a thick layer of fat.

"This isn't a beer belly, it's my stealth abs. I just needed to avoid attracting too many ladies with my well defined stomach."

That Guy With The Glasses

A Poem

Stay with it; the payoff is pretty interesting.

Of Says His

Three words. He can’t get them out of his head:
“of says his.” Those are the words, but those aren’t
the words. Something is not right—the order.
“His says of.” No, the other order was
better, closer somehow. “Of says his.” This
order is right, but it doesn’t make sense.
He decides to take a break, think new words:
“At ten, I shall shun the edifice.” Yes,
but what does it mean? The edifice is
clearly a symbol, representative
of some other word, some other concept.
Edifice (of says his) is a building.
Building what? This is a construction, but
what are the materials, the foundation?
How large is this, and how solid? But these
thoughts are somehow also wrong, straying from
what he is trying to grasp, which is what?
“Of says his.” This is the key. This order.
And “at ten I shall shun the edifice”
is also this order. He can’t let go
of these thoughts. It is like a compulsion.
Yes! That’s it! “Compulsion.” It still doesn’t
make sense, but it seems to fit together:
“Of says his.” “Compulsion.” “At ten I shun
the edifice.” This order. This order.
“Of says his compulsion. At ten shun the
edifice.” This order. Yes. “Of says his
compulsion. A tension, the visit.” This
order. “Of says his compulsive. Tension
deaf visit.” This order. Yes. “Of-says-his
compulsive a-tension deaf-visit this-
order.” He is very close to it now.

- Kelly Talbot, Beloit Poetry Journal, Vol. 56 No. 4, Summer 2006

The Triangle

I'm thinking, somebody's gonna tell me this is why I shoulda paid more attention in Math Class.