Tooting from Pittsburgh - More Brain Science

Above is an illustration of the brain showing the circuitry that is attracting the attention of researchers across just about all fields of mental illness. This PowerPoint slide comes from a talk given at this morning's session at the Eighth International Bipolar Conference in Pittsburgh by Hilary Blumberg of Yale.

What you are looking at is two-way traffic between the reactive/arousal amygdala and the thinking/modulating cortical areas. Abnormalities in these circuits has been implicated in all manner of mental illnesses. Essentially, when things go wrong, the emotional amygdala is shouting too loud and the rational cortical areas fail to reassert control.

Below are two fMRI images of a bipolar brain in action, from a study currently in press. These slides were presented at the same session by Mary Phillips of the University of Pittsburgh. What we are observing are top down images of the two-way traffic between the amygdala and the orbitomedial prefrontal cortex. On the left side, in a normal reaction, you see evidence of heavy and direct traffic while the smaller arrows to the right indicate lighter traffic.

In the bottom image, the denser arrow to the right notes an over-reaction, which shows up in bipolar subjects, but is not in evidence in healthy control subjects or in unipolar depressed individuals.





























In yesterday's blog, we were looking at brain dysfunction on the "cellular level". Here, we are viewing the things that can go wrong on the "systems level". Using brain imaging, Dr Phillips has been able to distinguish between unipolar and bipolar. Dialing in the research further promises to further sharpen our diagnostic capabilities.

I asked Dr Phillips about this. On previous blogs, I showed brain scans of similar breakdowns in the circuitry between the back and front areas of the brain in patients with borderline personality disorder, a very similar picture to what you are looking at now. It's only a matter of time before we can use brain scans to separate out borderline from bipolar.

These are exciting times. John McManamy, live from Pittsburgh ...

New Imaging Studies Reveal Brains of Assholes

In a study about to be published in "Nature," researchers at the NIMH reveal the first-ever fMRI scans of assholes at work.

Said lead researcher Y Mee MD, PhD, "We've always known an asshole when we see one, but it never occurred to us to actually scan their brains. I mean, seriously, who would want to?"

Nevertheless, the researchers overcame their strong revulsion and recruited 10 assholes plus 10 control subjects.

"I mean - crap - I was ready to quit my job in the first five minutes of the study," said co-author I Hadinoff PhD. First the assholes filled out their intake forms completely wrong, then abused the staff when they had to fill them out again. Next, they kept pushing and shoving to be the first one into the MRI machine. But once in, they couldn't stop complaining.

This posed a special difficulty because study protocol required that first the assholes' brains be scanned while in a resting state.

"So here we are," said Dr Hadinoff, "having to be nice to these fucking assholes. No sooner do I get one calmed down than another one gets started, and next thing they're all setting each other off like mousetraps going off in a room."

One asshole lady complained that her no-good son-in-law refused to finish cleaning the leaves out of her gutter, as he had promised. A world-class therapist had to be called in to remind the individual that her son-in-law had fallen off the ladder while she was shaking it and had cracked nine vertebrae and would be a quadriplegic the rest of his life.

"But I'm on a fixed income," the woman retorted. "How the hell am I going to find affordable help?"

Said Dr Hadinoff: "You know that show where that guy does all those shit jobs? I'm on the short list for the Nobel Prize, but, believe me, I was ready to throw it all in and go to work standing up to my ears in cow shit. Seriously, anything had to be better than dealing with this shit."

Eventually, the researchers got the assholes settled down and were able to get images of their brains at rest. On close inspection, the scans revealed certain structural abnormalities to the posterior corpus rumpus section of the brain. (See image above.)

"It's uncanny," said Dr Y Mee. "It's as if their brains had 'asshole' written all over them."

Then the assholes were made to perform certain tasks while their brains were being scanned. In one task, the subjects were asked to imagine lying on a beach on a tropical island.

"What? I'm just supposed to lie there in the hot sun with all the mosquitoes and sandflies and who knows what?" was the typical response. "Screw you, I did that for my second honeymoon, and let me tell you, it wound up to be our first divorce."

In other tasks, the assholes were asked to imagine something good about a member of their family, any accomplishment they could be proud of, a waitress they were nice to, and something that went wrong that they were willing to accept responsibility for. They failed every task spectacularly.

As their brains were thus engaged, a certain part of the posterior corpus rumpus, known as the temporal anal cortex, lit up like a Christmas tree. (See image below.)


















"It's amazing," said Dr Y Mee. "For the first time ever, we are looking into the mind of an asshole - and the last time, I can assure you. Believe me, after what we went through, no one in their right mind is going to want to try to replicate our findings."

The findings are expected to provide valuable insights into radio talk show hosts, Fox News commentators, and antipsychiatry bloggers.

Drs Y Mee and I Hadinoff are at present in intensive therapy. Their prognosis is poor to miserable.

The Borderline Personality Disorder Matzoh Ball

My final (for right now) Borderline Personality Disorder Awareness Month installment:

Until just a very short time ago, psychiatry treated borderline personality disorder as one big matzoh ball on the table. Freud and his followers, of course, were to blame for the embarrassment. If only these idiots were to go away, the thinking went, they might take their matzoh ball with them.

Then, psychiatry conceded that yes, the matzoh ball was here to stay, but where to put it? In the schizophrenia casserole? In the bipolar stew?

The borderline matzoh ball didn't deserve it's own dish. A soup, maybe, but certainly not a soup of the day, and definitely not where customers could find it on the menu.

Real mental illness involved scientists talking about tangible stuff such as heritable traits and brain biology, not Freudian cultists babbling nonsense about emotional attachments and integrating aspects of one's self.

Get over it, psychiatry. The borderline matzoh ball is not only here to stay, it rates a featured place on the specials board. In 2008, the NIMH reported on a series of brain imaging studies led by Michael Minzenberg MD of the University of California, Davis.

Previous brain scan research pointed the way by linking a wide range of behaviors to heightened activity in the primitive limbic regions of the brain, most notably the amygdala which mediates arousal and fear. Thus, a hypersensitive limbic system, in response to stress or even just perceived stress, may override the thinking cortical areas of the brain.

In short, people go crazy. Depression, anxiety, mania, aggression, and psychosis are just some of the possible responses. Individuals vulnerable to stress also tend to behave destructively, such as reaching for the bottle or over-eating or sexual promiscuity or self-harm.

There is an added complication: While the limbic region of the brain appears to be overdeveloped, certain cortical regions - most prominently the anterior cingulate cortex (ACC) - appear to be underdeveloped. The ACC, it turns out, is wired into the limbic fear hub.

Perhaps you see where this is going: The ACC acts as a key modulator to limbic over-excitement, and when this part of the brain is not booting up right, the thinking parts of the brain are not only taken off-line, they remain out of commission long enough for people to notice.

In the first study, Minzenberg and colleagues compared the brain scans of borderline patients with healthy controls. While in an MRI machine, the subjects viewed images of "scary faces" (a very common experiment in functional or fMRI). Predictably, the borderline patients displayed overactivity in the amygdala and underactivity in the ACC. In the words of the NIMH:

"Since ACC activity would normally increase to dampen an overactive amygdala, this suggested weak regulation of emotion in the circuit."

Next, the researchers employed structural or anatomical MRI to compare grey matter in the same subjects. The studies found that relative to the controls, the borderline subjects showed increased grey matter density in parts of the amygdala (image below top, red areas) and decreased grey matter in parts of the ACC (image below bottom, yellow area at right). As the NIMH describes it:

"This suggested an abnormality in the number or architecture of neurons in these key components of the emotion-regulating circuit, which other evidence links to impaired functioning of the serotonin chemical messenger system."




















Some quick disclaimers here. The amygdala and the ACC and its connecting circuitry have been implicated with regard to depression and other behaviors. Thus, these studies cannot be cited as irrefutable proof of the borderline diagnosis. For that to happen, we would have to find out what is wrong in the brain that is unique to borderline (or for that matter any other mental illness) and then connect the dots.

What the brain scans do show is that borderline undeniably shares a similar pattern of underlying brain dysregulation as other illnesses regarded as biological, on the same order of magnitude as bipolar and schizophrenia and the rest.

We can even take it a step further. Think of borderline as a condition where its victims constantly view the world as threatening and unpredictable. So, when we're discussing fear factor miscues in the brain, which illness does it best apply to? So ...

Get ready, which illness then becomes the featured dish of biological psychiatry?

Holy cow! The humble Freudian matzoh ball.

Further reading from mcmanweb:

Psychiatry's Big Bang

In addition, an NIMH study under review shows the ventromedial prefrontal cortex modulating amygdala activity through the cingulate. Ah, a part of the brain associated with "thinking," your protection against lashing out like a caged beast. Thus, if you happen to be in the middle of a heated marital dispute, this is probably the time to draw in a slow breath and very calmly say, "I hear you. I think we can work something out."

If your amygdala is doing the talking, however, it may come out something like this: "And besides, you’re lousy in bed!"

At this stage, storming out the door in a huff may be your best option. The amygdala is getting through to the cortex, but the cortex is clearly having difficulty getting through to the amygdala. You probably will be sleeping on the couch tonight, but thankfully you can count on your cortex not to let your behavior escalate from regrettable to extreme. But suppose your top-down circuitry is faulty?

As Dr Meyer-Lindenberg explained, we need a breakdown in the brain’s control mechanisms to become violent. ...