Here's a site which has a good selection of free personality questionnaires:
http://similarminds.com/personality_tests.html
I find that questionnaires of this type rarely give any novel information that you wouldn't know about yourself already, and be able to describe in a short self-descriptive paragraph. Many such questionnaires are actually copyrighted, and one needs to pay a fee just to have a copy. I've always had a bit of a problem with this, as I think it exaggerates the importance of what is usually a simple set of questions, which in my opinion should usually be in the public domain. It is annoying to read a journal article about questionnaires (which are often referred to, in a somewhat aggrandizing way, as "instruments," as though we are talking about some kind of highly sophisticated engineering technology), where the copyrighted questionnaire is referred to in the article, but you can't actually see the questions!
But spending some time with these things can have a few positives:
1) a framework for reflection -- sometimes questionnaires can deal with questions or phenomena which are relevant, but rarely thought about or discussed. The questions can be a cue or a framework to contemplate issues. Some of these issues could be addressed in a therapeutic discussion.
2) entertainment -- it can be an interesting or possibly enjoyable activity to fill out questionnaires, and compare your results with others in the population.
It would be important to resist any tendency to be self-critical about your results; everyone will have a unique set of responses, some of which may change over time, or be mood-dependent, as well. Questionnaires are an imperfect way to measure any sort of characteristic anyway. But in any case, a questionnaire is a bit like a lens or a camera--it produces data which can be informative. Sometimes the information can be unique or interesting, like a clever snapshot of yourself from a camera; but other times the information may not be very unique or interesting at all (like a poorly-lit or blurry snapshot of yourself). Even if you may have issues with the way a particular questionnaire is constructed, it can be interesting to see how your responses compare on a percentile basis with others. You may find certain phenomena about yourself that you previously thought were quite extreme, are in fact really quite close to the population average. Or you might discover there are other phenomena which are farther from the mean. Any of these findings might be a subject of future therapeutic dialog.
Wednesday, September 15, 2010
Wednesday, September 8, 2010
Health Tips for the new school year
Here are some suggestions for maintaining your health during the new school year:
1) Have a healthy study schedule. You will learn much more efficiently and enjoyably if you study regularly, in a disciplined schedule. I don't believe it is possible to master any subject, much less build up an enjoyment of it, by procrastinating or cramming. Each full-year course probably deserves about 200 hours of study, to be spread out as evenly as possible. Mastery of a specific field of study probably requires about 10 000 hours of work, which would be full-time for 5 years. Even if you can get good grades without working hard, I would emphasize to you that doing the bare minimum is an extremely harmful habit--the consequence is that your potential will remain unrealized, also your enjoyment and respect for your subject will never be fully developed.
2) Have a healthy leisure schedule. Time must be reserved for pleasure (outside of the hoped-for intrinsic pleasure of studying or working). A type of "meta-subject" at university is learning to have a pleasurable and healthy lifestyle, with a sense of friendship and community, in the midst of working hard.
3) Be physically active. Exercise & sports will help you maintain your strength, sharpen your mind, relieve stress, and offer potential sources of community & friendship. A common problem, however, is excessive exercise, which drains time and energy away from other activities, and which can cause an addictive pattern leading to a psychological dependence on fitness activities alongside a diminished capacity to manage stress in other ways.
4) Don't binge drink. There is an illusion that binge drinking is an essential part of university social culture. While it may be a common phenomenon, I think many people minimize its extremely negative health impact. Anything more than 2 drinks per 24 hours is, from an epidemiologic point of view, harmful to health. For those dealing with anxiety, depression, trouble fitting in, etc., alcohol can lead to an illusory sense of relief or social belonging while insidiously deepening and entrenching the problems.
5) Eat well. It's easy to neglect this one, particularly if you're living on your own for the first time. Basic nutritional advice is not hard to find. Unfortunately, I think that unhealthy food choices are too easy to find on university campuses. I think that university cafeterias should not sell junk food, soft drinks, etc. (I also think such items should be taxed heavily, in the same way that cigarettes are). It's always disappointing to see soft drink companies or fast food restaurants as major food sponsors, with vending machines all over the place, including in hospitals and gyms, etc. Two simple changes for most people would be to increase vegetables in the diet, and to eliminate junk food. Allowing oneself to go hungry, or to be carbohydrate-deprived, is likely to substantially impair academic performance, attention, and mood.
6) Make cultural choices with care. Developing personal culture is very important, and deserves time and energy. I don't think it is healthy to make a particular cultural choice (e.g. "let's go clubbing!") just because everyone else seems to be doing it. I see a lack of personal culture, with an ensuing lack of a sense of meaningful community, to be one of the leading problems driving loneliness and perpetuating depression on university campuses.
7) Seek medical help if you have symptoms. There are treatments and supports to be connected with, which can help address anxiety, mood problems, physical symptoms, etc. It can be better to connect with resources early, rather than wait for things to get worse.
8) Be wary of viral contagion. A single banal respiratory infection could substantially reduce your enjoyment and learning for a week or more at a time. The best preventative strategy is to wash your hands frequently, especially if handling objects which thousands of other people have handled or coughed on. It's important not to go overboard with this--which could be an obsessive-compulsive symptom-- but basic infection control techniques could save you a lot of headache.
9) If you tend to get tired or depressed in the winter months, consider trying a light box. This is an easy, safe physical treatment which can help with seasonal depression. Daylight is diminishing rapidly in September, so this is probably a good time to get out your light box.
10) Nutritional supplements. Women should have ferritin levels checked, and in general should take iron supplements if ferritin is below 50 ug/L. A daily multivitamin/mineral supplement is a good idea, especially if having abundant fruits and vegetables in the daily diet is not happening consistently. Harmless at worst. Extra vitamin D is indicated, I'd suggest 2000 IU extra per day. DHA/EPA supplements could be useful (omega-3 fatty acids, typically from fish oils). I have some references about this in other entries.
11) Addiction inventory. I'd encourage everyone to take an inventory of all addictive or compulsive behaviours, and take steps to stop or moderate them all. Alcohol or drug use are obvious examples, but other activities could include internet use, gambling, exercise, self-injury, phoning or texting, etc. Many habits consume so much time and attention, that there is much less time, energy, or enthusiasm left for other things that may be more deeply important to you.
1) Have a healthy study schedule. You will learn much more efficiently and enjoyably if you study regularly, in a disciplined schedule. I don't believe it is possible to master any subject, much less build up an enjoyment of it, by procrastinating or cramming. Each full-year course probably deserves about 200 hours of study, to be spread out as evenly as possible. Mastery of a specific field of study probably requires about 10 000 hours of work, which would be full-time for 5 years. Even if you can get good grades without working hard, I would emphasize to you that doing the bare minimum is an extremely harmful habit--the consequence is that your potential will remain unrealized, also your enjoyment and respect for your subject will never be fully developed.
2) Have a healthy leisure schedule. Time must be reserved for pleasure (outside of the hoped-for intrinsic pleasure of studying or working). A type of "meta-subject" at university is learning to have a pleasurable and healthy lifestyle, with a sense of friendship and community, in the midst of working hard.
3) Be physically active. Exercise & sports will help you maintain your strength, sharpen your mind, relieve stress, and offer potential sources of community & friendship. A common problem, however, is excessive exercise, which drains time and energy away from other activities, and which can cause an addictive pattern leading to a psychological dependence on fitness activities alongside a diminished capacity to manage stress in other ways.
4) Don't binge drink. There is an illusion that binge drinking is an essential part of university social culture. While it may be a common phenomenon, I think many people minimize its extremely negative health impact. Anything more than 2 drinks per 24 hours is, from an epidemiologic point of view, harmful to health. For those dealing with anxiety, depression, trouble fitting in, etc., alcohol can lead to an illusory sense of relief or social belonging while insidiously deepening and entrenching the problems.
5) Eat well. It's easy to neglect this one, particularly if you're living on your own for the first time. Basic nutritional advice is not hard to find. Unfortunately, I think that unhealthy food choices are too easy to find on university campuses. I think that university cafeterias should not sell junk food, soft drinks, etc. (I also think such items should be taxed heavily, in the same way that cigarettes are). It's always disappointing to see soft drink companies or fast food restaurants as major food sponsors, with vending machines all over the place, including in hospitals and gyms, etc. Two simple changes for most people would be to increase vegetables in the diet, and to eliminate junk food. Allowing oneself to go hungry, or to be carbohydrate-deprived, is likely to substantially impair academic performance, attention, and mood.
6) Make cultural choices with care. Developing personal culture is very important, and deserves time and energy. I don't think it is healthy to make a particular cultural choice (e.g. "let's go clubbing!") just because everyone else seems to be doing it. I see a lack of personal culture, with an ensuing lack of a sense of meaningful community, to be one of the leading problems driving loneliness and perpetuating depression on university campuses.
7) Seek medical help if you have symptoms. There are treatments and supports to be connected with, which can help address anxiety, mood problems, physical symptoms, etc. It can be better to connect with resources early, rather than wait for things to get worse.
8) Be wary of viral contagion. A single banal respiratory infection could substantially reduce your enjoyment and learning for a week or more at a time. The best preventative strategy is to wash your hands frequently, especially if handling objects which thousands of other people have handled or coughed on. It's important not to go overboard with this--which could be an obsessive-compulsive symptom-- but basic infection control techniques could save you a lot of headache.
9) If you tend to get tired or depressed in the winter months, consider trying a light box. This is an easy, safe physical treatment which can help with seasonal depression. Daylight is diminishing rapidly in September, so this is probably a good time to get out your light box.
10) Nutritional supplements. Women should have ferritin levels checked, and in general should take iron supplements if ferritin is below 50 ug/L. A daily multivitamin/mineral supplement is a good idea, especially if having abundant fruits and vegetables in the daily diet is not happening consistently. Harmless at worst. Extra vitamin D is indicated, I'd suggest 2000 IU extra per day. DHA/EPA supplements could be useful (omega-3 fatty acids, typically from fish oils). I have some references about this in other entries.
11) Addiction inventory. I'd encourage everyone to take an inventory of all addictive or compulsive behaviours, and take steps to stop or moderate them all. Alcohol or drug use are obvious examples, but other activities could include internet use, gambling, exercise, self-injury, phoning or texting, etc. Many habits consume so much time and attention, that there is much less time, energy, or enthusiasm left for other things that may be more deeply important to you.
Friday, July 16, 2010
Dopamine Agonists in Psychiatry
The dopamine agonists pramipexole and ropinirole are drugs used in the treatment of Parkinson Disease.
These drugs are now well-established in treating restless legs syndrome (RLS) and periodic limb movement disorder of sleep (PLMS), which are frequent problems afflicting about 10% of the population, and which can negatively impact quality of life & mood symptoms.
There is a small body of evidence showing possible benefits of dopamine agonists in the treatment of depression.
Unfortunately, dopamine agonists can exacerbate addictive/compulsive behaviour: http://www.ncbi.nlm.nih.gov/pubmed/20484726
Here are some references about the role of dopamine agonists in RLS and PLMS:
http://www.ncbi.nlm.nih.gov/pubmed/20120624
Here's a good review article on the use of ropinirole to treat these conditions: http://www.ncbi.nlm.nih.gov/pubmed/20421915
Here's a recent review of dopamine agonists in general to treat RLS: http://www.ncbi.nlm.nih.gov/pubmed/20206780
Here's a 2008 meta-analysis comparing ropinirole with pramipexole for treating RLS. Pramipexole is shown to be slightly superior:
http://www.ncbi.nlm.nih.gov/pubmed/18226947
In this 2010 study, gabapentin was compared to ropinirole for treating RLS. While ropinirole was superior in reducing objective measures of periodic limb movements, subjects taking gabapentin had a higher subjective benefit:
http://www.ncbi.nlm.nih.gov/pubmed/20049491
Here's a case study showing remission of depressive symptoms with ropinirole used as an augmenting agent:
http://www.ncbi.nlm.nih.gov/pubmed/20188777
Here's a 2005 study looking at ropinirole augmentation in treating depression:
http://www.ncbi.nlm.nih.gov/pubmed/15999953
This 2010 review in Lancet showed a direct antidepressant effect of pramipexole in Parkinson Disease patients: http://www.ncbi.nlm.nih.gov/pubmed/20452823
Here's a rather weak but positive 2010 paper describing a group of patients with bipolar depression who appeared to benefit from longer-term pramipexole treatment; doses averaged about 1 mg/d: http://www.ncbi.nlm.nih.gov/pubmed/20425143
The side effects from these drugs include frequent nausea and dizziness, possibly some daytime sleepiness. Psychiatric adverse effects can include hallucinations, and increased compulsive or impulse-control problems.
In summary, I think dopamine agonists have a role in selected psychiatric conditions, particularly if there are restless-legs symptoms contributing to insomnia or nocturnal discomfort. They may help treat refractory depression, but there is a risk of causing impulse control problems or hallucinations in predisposed individuals.
These drugs are now well-established in treating restless legs syndrome (RLS) and periodic limb movement disorder of sleep (PLMS), which are frequent problems afflicting about 10% of the population, and which can negatively impact quality of life & mood symptoms.
There is a small body of evidence showing possible benefits of dopamine agonists in the treatment of depression.
Unfortunately, dopamine agonists can exacerbate addictive/compulsive behaviour: http://www.ncbi.nlm.nih.gov/pubmed/20484726
Here are some references about the role of dopamine agonists in RLS and PLMS:
http://www.ncbi.nlm.nih.gov/pubmed/20120624
Here's a good review article on the use of ropinirole to treat these conditions: http://www.ncbi.nlm.nih.gov/pubmed/20421915
Here's a recent review of dopamine agonists in general to treat RLS: http://www.ncbi.nlm.nih.gov/pubmed/20206780
Here's a 2008 meta-analysis comparing ropinirole with pramipexole for treating RLS. Pramipexole is shown to be slightly superior:
http://www.ncbi.nlm.nih.gov/pubmed/18226947
In this 2010 study, gabapentin was compared to ropinirole for treating RLS. While ropinirole was superior in reducing objective measures of periodic limb movements, subjects taking gabapentin had a higher subjective benefit:
http://www.ncbi.nlm.nih.gov/pubmed/20049491
Here's a case study showing remission of depressive symptoms with ropinirole used as an augmenting agent:
http://www.ncbi.nlm.nih.gov/pubmed/20188777
Here's a 2005 study looking at ropinirole augmentation in treating depression:
http://www.ncbi.nlm.nih.gov/pubmed/15999953
This 2010 review in Lancet showed a direct antidepressant effect of pramipexole in Parkinson Disease patients: http://www.ncbi.nlm.nih.gov/pubmed/20452823
Here's a rather weak but positive 2010 paper describing a group of patients with bipolar depression who appeared to benefit from longer-term pramipexole treatment; doses averaged about 1 mg/d: http://www.ncbi.nlm.nih.gov/pubmed/20425143
The side effects from these drugs include frequent nausea and dizziness, possibly some daytime sleepiness. Psychiatric adverse effects can include hallucinations, and increased compulsive or impulse-control problems.
In summary, I think dopamine agonists have a role in selected psychiatric conditions, particularly if there are restless-legs symptoms contributing to insomnia or nocturnal discomfort. They may help treat refractory depression, but there is a risk of causing impulse control problems or hallucinations in predisposed individuals.
Potential adverse effects of group therapy
I encountered an article today about a subject I've often thought about: does group therapy actually have a risk of worsening underlying problems?
Here's a link to the article:
http://www.time.com/time/health/article/0,8599,2003160,00.html
The mechanism could typically occur in the treatment of addictions, which is the subject of this article. The same mechanism might operate in the treatment of behavioural problems, including conduct disorders, eating disorders, maybe even mood disorders.
Basically, the concern is that the individuals in the group might actually "teach" others in the group about tactics to engage more deeply in the problem behaviour. The social bonds formed in the group might expand a person's network to engage in addictive behaviours. If some members of an addiction treatment group are severely involved in the addiction, are perhaps ambivalently committed to therapy, and may be connected to convenient resources in the community to access their addiction, this may facilitate other less severely involved members of the group to broaden their access to addictions.
In eating disorders, members of the group might "compete" with each other to some degree with eating disorder behaviours. If there are social leaders in the group who are still highly involved in the eating disorder, this may cause a negative peer pressure on others who are starting out.
On the other hand, an opposing, positive force in group therapy is encountering others who have understanding and personal experience of similar problems. This can be especially important for problems where a person often feels judged or misunderstood. Also, members of the group can teach others tactics to deal with moment-to-moment manifestations of the addiction. In order for these positive forces to be manifest, the group itself needs to be composed of individuals who are probably similar in terms of problem severity, and where there are individuals members of the group who are progressing. This introduces a social learning effect, in which an individual can see and emulate another individual with similar problems who is starting to make progress. The similar problem severity among members of the group would hopefully reduce the likelihood of mildly afflicted group members being drawn into more severe illness behaviours.
Since progress through problems is always a dynamic, individualized process, it may be that involvements with groups ideally need to change dynamically as well. If individuals are moving quickly away from addictive behaviours, they may ideally need to nurture group connections which are similarly healthy.
This poses another problem for many with long histories of addiction or other socially dynamic health problems: relationships which have been strongly associated with the addiction may need to left behind, or at least boundaried very carefully.
Here's a link to the article:
http://www.time.com/time/health/article/0,8599,2003160,00.html
The mechanism could typically occur in the treatment of addictions, which is the subject of this article. The same mechanism might operate in the treatment of behavioural problems, including conduct disorders, eating disorders, maybe even mood disorders.
Basically, the concern is that the individuals in the group might actually "teach" others in the group about tactics to engage more deeply in the problem behaviour. The social bonds formed in the group might expand a person's network to engage in addictive behaviours. If some members of an addiction treatment group are severely involved in the addiction, are perhaps ambivalently committed to therapy, and may be connected to convenient resources in the community to access their addiction, this may facilitate other less severely involved members of the group to broaden their access to addictions.
In eating disorders, members of the group might "compete" with each other to some degree with eating disorder behaviours. If there are social leaders in the group who are still highly involved in the eating disorder, this may cause a negative peer pressure on others who are starting out.
On the other hand, an opposing, positive force in group therapy is encountering others who have understanding and personal experience of similar problems. This can be especially important for problems where a person often feels judged or misunderstood. Also, members of the group can teach others tactics to deal with moment-to-moment manifestations of the addiction. In order for these positive forces to be manifest, the group itself needs to be composed of individuals who are probably similar in terms of problem severity, and where there are individuals members of the group who are progressing. This introduces a social learning effect, in which an individual can see and emulate another individual with similar problems who is starting to make progress. The similar problem severity among members of the group would hopefully reduce the likelihood of mildly afflicted group members being drawn into more severe illness behaviours.
Since progress through problems is always a dynamic, individualized process, it may be that involvements with groups ideally need to change dynamically as well. If individuals are moving quickly away from addictive behaviours, they may ideally need to nurture group connections which are similarly healthy.
This poses another problem for many with long histories of addiction or other socially dynamic health problems: relationships which have been strongly associated with the addiction may need to left behind, or at least boundaried very carefully.
Thursday, June 10, 2010
Naturalistic study comparing quetiapine, ziprasidone, olanzapine, and risperidone
This study caught my eye recently (here's a link to the abstract:)
http://www.ncbi.nlm.nih.gov/pubmed/20334680
It's a naturalistic study, published in BMC Psychiatry in 2010, prospectively following 213 patients with symptoms of psychosis, who were randomized to receive one of four antipsychotic medications (quetiapine, ziprasidone, olanzapine, or risperidone), then apparently followed for up to 2 years.
My prediction with such a study would be that all four medications would have similar effectiveness, with a slight edge in favour of olanzapine.
In fact, the results showed a slight edge in favour of quetiapine. There were no substantial differences in tolerability.
The problems with this study, though, include the following:
1) Most of the data was actually for patients who had only been followed up for 6 weeks (not 2 years!). Only 8 of the 213 patients were followed up for 2 years. Of these 8, 5 were taking olanzapine, 2 were taking ziprasidone, and 1 was taking risperidone. Perhaps one might be tempted to conclude that olanzapine is the drug that has the highest chance of being acceptable for long-term use.
2) The results were presented in a type of "refined" fashion, for example the changes in symptom scores for each drug over time were presented as graphs with a single straight line for each drug, plotted over a 300-day period. This type of graph omits a tremendous amount of relevant data: first of all, there were very few patients who were actually followed for 300 days, most of them were only followed for 6 weeks. A graph like this implies that there are strong data points stretching out over the entire period. Secondly, the linear plots do not show the degree of scatter in the data points. There were no direct reports of the raw data in the study, only refined statistical distillations. It would be much more informative to show all of the data points plotted out over time: then one could see the times where most of the data were derived, the various courses of symptom change for each individual in the study, etc. It would be a messier graph! -- but it would not mislead the viewer to immediately conclude that one medication is obviously better than the others.
In conclusion, the study really grabbed my attention when I first looked at it, but I found it to be much weaker than I thought, after reading it closely.
It does, however, provide a little bit of support for the idea that any one of these four antipsychotic medications are reasonable to try, in the treatment of psychotic symptoms. I agree that quetiapine is a reasonable first choice, though the others could be reasonable also, depending on personal preference, past experience, side effect risks, etc. I would still lean towards olanzapine for anticipated long-term treatment of severe symptoms.
http://www.ncbi.nlm.nih.gov/pubmed/20334680
It's a naturalistic study, published in BMC Psychiatry in 2010, prospectively following 213 patients with symptoms of psychosis, who were randomized to receive one of four antipsychotic medications (quetiapine, ziprasidone, olanzapine, or risperidone), then apparently followed for up to 2 years.
My prediction with such a study would be that all four medications would have similar effectiveness, with a slight edge in favour of olanzapine.
In fact, the results showed a slight edge in favour of quetiapine. There were no substantial differences in tolerability.
The problems with this study, though, include the following:
1) Most of the data was actually for patients who had only been followed up for 6 weeks (not 2 years!). Only 8 of the 213 patients were followed up for 2 years. Of these 8, 5 were taking olanzapine, 2 were taking ziprasidone, and 1 was taking risperidone. Perhaps one might be tempted to conclude that olanzapine is the drug that has the highest chance of being acceptable for long-term use.
2) The results were presented in a type of "refined" fashion, for example the changes in symptom scores for each drug over time were presented as graphs with a single straight line for each drug, plotted over a 300-day period. This type of graph omits a tremendous amount of relevant data: first of all, there were very few patients who were actually followed for 300 days, most of them were only followed for 6 weeks. A graph like this implies that there are strong data points stretching out over the entire period. Secondly, the linear plots do not show the degree of scatter in the data points. There were no direct reports of the raw data in the study, only refined statistical distillations. It would be much more informative to show all of the data points plotted out over time: then one could see the times where most of the data were derived, the various courses of symptom change for each individual in the study, etc. It would be a messier graph! -- but it would not mislead the viewer to immediately conclude that one medication is obviously better than the others.
In conclusion, the study really grabbed my attention when I first looked at it, but I found it to be much weaker than I thought, after reading it closely.
It does, however, provide a little bit of support for the idea that any one of these four antipsychotic medications are reasonable to try, in the treatment of psychotic symptoms. I agree that quetiapine is a reasonable first choice, though the others could be reasonable also, depending on personal preference, past experience, side effect risks, etc. I would still lean towards olanzapine for anticipated long-term treatment of severe symptoms.
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