How the brain turns reality into dreams

Tests involving Tetris point to the role played by ‘implicit memories’

By Kathleen Wren

Science

WASHINGTON, Oct. 12, 2001 - Dreams make perfect sense when you’re having them. Yet, they leave you befuddled the next morning, wondering “where did that come from?” The answer may lie in the dreams of people with amnesia, researchers report in Friday’s issue of Science.

Much of the fodder for our dreams comes from recent experiences. For this reason, scientists have tentatively supposed that the dreaming brain draws from its “declarative memory” system, which includes newly learned information.

The declarative memory stores information that you can “declare” you know, such as the square root of nine, or the name of your dog. Often, you can even remember when or where you learned something - for example, the day you discovered the harsh truth about Santa Claus. That’s called episodic memory.

People who permanently suffer from amnesia can’t add new declarative or episodic memories. The parts of their brains involved in storing this type of information, primarily a region called the hippocampus, have been damaged. Although amnesiacs can retain new information temporarily, they generally forget it a few minutes later.

If our dreams come from declarative memories, people with amnesia shouldn’t dream at all, or at least dream differently than others do. But new research directed by Robert Stickgold of Harvard Medical School suggests quite the opposite.

Just like people with normal memory, amnesiacs replay recent experiences when they fall asleep, Stickgold’s study shows. The only difference seems to be that the amnesiacs don’t recognize what they’re dreaming about.

Dreaming of Tetris
Every day, the people in the study played several hours of the computer game Tetris, which requires directing falling blocks into the correct positions as they reach the bottom of the screen. At night, the amnesiacs didn’t remember playing the game. But, they did describe seeing falling, rotating blocks while they were falling asleep.

A second group of players with normal memories reported seeing the same images.

Therefore, Stickgold’s research team concluded, dreams must come from the types of memory amnesiacs do have, which are called “implicit memories.” These are memories that scientists can measure even when individuals don’t know that they have them.

One class of implicit memories is found in the procedural memory system, which stores information that you use without really being able to say how you know what you’re doing. When you ride a bicycle for the first time in years, or type on a keyboard without looking, you’re relying on procedural memory.

Another type of implicit memory uses “semantic” knowledge, and resides in different parts of the brain, including a region called the neocortex. Semantic knowledge involves general, abstract concepts. Both groups of Tetris players, for example, only described seeing blocks, falling and rotating, and evidently did not see a desk, room, or computer screen, or feel their fingers on the keyboard.

Without help from the hippocampus, new semantic memories are too weak to be intentionally recalled. But they can still affect your behavior - for example, causing you to buy a certain brand of something you saw in an advertisement you don’t remember.

In contrast, the information in episodic memories is associated with specific times, places or events. Without these “anchors” to reality, it’s no wonder that dreams are so illogical and full of discontinuity, the study’s authors say.

Stickgold believes that dreams serve a purpose for the brain, allowing it to make necessary emotional connections among new pieces of information.

“Dreams let you consolidate and integrate your experiences, without conflict with other input from real life,” Stickgold said. “Dreaming is like saying, ‘I’m going home, disconnecting the phone, nobody talk to me. I have to do work.’”

Because the hippocampus seems to be inaccessible for this “off-line” memory processing, the brain may use the abstract information in the neocortex instead.

According to Stickgold’s theory, dreaming is like choosing an outfit by reaching into bins labeled “shirts,” “pants” and so on. You’ll rummage up something to wear, but it won’t be a perfectly matching ensemble.

Sleep's earliest messages
The period of sleep that Stickgold’s team studied is called “hypnagogia.” It’s an in-between state between being fully awake and fully asleep. Many people who have just had an intense new experience of some kind, either mental or physical, often report replays of that experience during this stage.

In his poem, “After Apple Picking,” for example, Robert Frost describes seeing the apples and apple blossoms, and feeling the ladder sway as he nods off to sleep. Stickgold’s first encounter with this phenomenon occurred after a day of mountain climbing, when he felt the sensation of rocks under his fingertips as he fell asleep.

Hypnagogic sleep is different from REM sleep, the period marked by rapid eye movement, when standard dreams most often occur. According to Stickgold, other studies suggest that the hippocampus isn’t active during REM sleep either. Therefore, he proposes, the brain activity responsible for the Tetris images is probably similar to the dreaming that occurs in REM sleep.

Interpreting REM sleep dreams, however, is a highly subjective process.

“What’s so nice about the images in our experiments is that they are so accurately re-creating the Tetris experience. There’s no interpretation necessary,” Stickgold said.

Segway inventor reveals 'toughest question'

By Thom Patterson
CNN

Segway scooter inventor Dean Kamen freely admits it: He often suffers sleepless nights wrestling over whether to quit a project that's not panning out.

"You end up lying there saying, 'I'm not stopping. It would be an act of shallow cowardice. Or you decide to quit and you say, 'This is one of those ideas that just isn't going to work,' " said Kamen, speaking by phone from his home office in Manchester, New Hampshire.

When to quit -- said Kamen, also the inventor of health care technologies and the Slingshot water purifier -- is "the toughest question there is" for any entrepreneur who survives on creativity and instinct.

"It's not nearly as glamorous as people think to keep working on something and to keep hitting roadblocks and to keep going," he said.

Stubborn, delusionally optimistic, creative, fearless, flexible and focused are some of the ways psychologists and business people describe the personality of an entrepreneur. Surprisingly, another word is ignorant. Quiz: Do you have the right stuff for entrepreneurship? »

"You need to be in denial or in ignorance about the huge challenges you face," laughs Guy Kawasaki, a former Apple executive and entrepreneur who's starting the self-described "magazine rack" alltop.com. "You have to believe that it wouldn't be hard for you to succeed."

Research by Harvard Business School psychology professor emeritus Abraham Zaleznik has unveiled a darker side to the entrepreneur's psyche.

"Entrepreneurs tend to have a singular weakness that allows them to do things without checking their conscience," Zaleznik said. "Juvenile delinquents act and then try to sort things out afterward. I think entrepreneurs have this tendency."

Another academic researcher on the topic, professor Kelly Shaver of the College of William & Mary, told Forbes magazine in 2002 that successful entrepreneurs "really don't care as much" about what other people think. "They're just happy to go ahead and do what they're doing."

In a recession that has forced employers to eliminate 2.6 million jobs in 2008, people who might otherwise start a business at a time of their own choosing find themselves being pushed into entrepreneurship.

"More people often become self-employed in tough times like this," said John Challenger, CEO of a top employment firm for executives and middle managers.

Between 5 percent and 7 percent of clients at Challenger, Gray & Christmas are choosing to start their own businesses, he said. Workers are more open to starting a small business in the dot-com era, Challenger said. "I think we're in a more entrepreneurial period than we were in the '80s and '90s," he said.

Recessions can be "crucibles" for at-home start-ups. "Some of the best new businesses start in recessions because what they have really makes a difference if the market is interested in it," Challenger said. "There's not a lot of easy money to go around, and they have to fight their way forward."

Great entrepreneurs, said Kawasaki, do more than just fight hard to win their market share. They have vision. They ask what he calls the "fundamental question": Wouldn't it be neat if ... ?

Kawasaki said Apple would have failed without the unique contributions of its co-founder, Steve Jobs. "He asked the question, 'Wouldn't it be neat if people could carry all their music with them wherever they went?' " Result: the iPod.

Psychologist Lynn Friedman, whose clients often include entrepreneurs, said many of them are "tuned into consumer needs." They tend to grow up in nurturing families and learned to value the concept of trying new things.

Jobs described fond memories of his California childhood during an 1995 interview with the Smithsonian Institution, saying his father "spent a lot of time with me . . . teaching me how to build things, how to take things apart, put things back together."

But obviously, Kawasaki said, everybody's not always right about the "wouldn't it be neat" question.

He cited Webvan, the online grocery store that served as many as 10 U.S. cities before going bankrupt in 2001.

"Somebody asked the question, 'Wouldn't it be neat if I could buy lettuce online and they'll deliver lettuce to my house?' "

Webvan failed with sales of $178.5 million in 2000 partly because it was buried in $525.4 million in expenses, according to a 2001 CNNMoney.com article.

"They went about it in a grand way," Kawasaki said. "Sometimes it helps to start small."

Webvan entrepreneur Louis Borders, who stepped down as CEO in 1999, told the San Francisco Chronicle four years later, "I get the strategy set, the operation running, the team in place. That's my role as an entrepreneur."

According to Friedman, entrepreneurs "live in the world of action," and they "often need help with slowing down and thinking several steps ahead."

Kamen, who works hard to inspire future innovators with his FIRST program to promote high school math and science, said every entrepreneurial innovator he's ever seen shares a few characteristics.

"It's not that they're brilliant or well-educated," Kamen said. "They work all the time. They don't let failure demoralize or destroy them. They pick themselves up and keep going and eventually, every once in a while, one of your ideas actually breaks through and works, and it makes all that stuff seem worthwhile."

New Study: Autism Linked to Environment

Research links soaring incidence of the mysterious neurological disorder to fetal and infant exposure to pesticides, viruses, household chemicals

By Marla Cone

California's sevenfold increase in autism cannot be explained by changes in doctors' diagnoses and most likely is due to environmental exposures, University of California scientists reported Thursday.

The scientists who authored the new study advocate a nationwide shift in autism research to focus on potential factors in the environment that babies and fetuses are exposed to, including pesticides, viruses and chemicals in household products.

"It's time to start looking for the environmental culprits responsible for the remarkable increase in the rate of autism in California," said Irva Hertz-Picciotto, an epidemiology professor at University of California, Davis who led the study.

Throughout the nation, the numbers of autistic children have increased dramatically over the past 15 years. Autistic children have problems communicating and interacting socially; the symptoms usually are evident by the time the child is a toddler.

More than 3,000 new cases of autism were reported in California in 2006, compared with 205 in 1990. In 1990, 6.2 of every 10,000 children born in the state were diagnosed with autism by the age of five, compared with 42.5 in 10,000 born in 2001, according to the study, published in the journal Epidemiology. The numbers have continued to rise since then.

To nail down the causes, scientists must unravel a mystery: What in the environment has changed since the early 1990s that could account for such an enormous rise in the brain disorder?

For years, many medical officials have suspected that the trend is artificial--due to changes in diagnoses or migration patterns rather than a real rise in the disorder.

But the new study concludes that those factors cannot explain most of the increase in autism.

Hertz-Picciotto and Lora Delwiche of the UC Davis Department of Public Health Sciences analyzed 17 years of state data that tracks developmental disabilities, and used birth records and Census Bureau data to calculate the rate of autism and age of diagnosis.

The results: Migration to the state had no effect. And changes in how and when doctors diagnose the disorder and when state officials report it can explain less than half of the increase.

Dr. Bernard Weiss, a professor of environmental medicine and pediatrics at the University of Rochester Medical Center who was not involved in the new research, said the autism rate reported in the study "seems astonishing." He agreed that environmental causes should be getting more attention.

The California researchers concluded that doctors are diagnosing autism at a younger age because of increased awareness. But that change is responsible for only about a 24 percent increase in children reported to be autistic by the age

"A shift toward younger age at diagnosis was clear but not huge," the report says.

Also, a shift in doctors diagnosing milder cases explains another 56 percent increase. And changes in state reporting of the disorder could account for around a 120 percent increase.

Combined, Hertz-Picciotto said those factors "don't get us close" to the 600 to 700 percent increase in diagnosed cases.

That means the rest is unexplained and likely caused by something that pregnant women or infants are exposed to, or a combination of genetic and environmental factors.

"There's genetics and there's environment. And genetics don't change in such short periods of time," Hertz-Picciotto, a researcher at UC Davis' M.I.N.D. Institute, a leading autism research facility, said in an interview Thursday.

Many researchers have theorized that a pregnant woman's exposure to chemical pollutants, particularly metals and pesticides, could be altering a developing baby's brain structure, triggering autism.

Many parent groups believe that childhood vaccines are responsible because they contained thimerosal, a mercury compound used as a preservative. But thimerosal was removed from most vaccines in 1999, and autism rates are still rising.

Dozens of chemicals in the environment are neurodevelopmental toxins, which means they alter how the brain grows. Mercury, polychlorinated biphenyls, lead, brominated flame retardants and pesticides are examples.

While exposure to some--such as PCBs--has declined in recent decades, others--including flame retardants used in furniture and electronics, and pyrethroid insecticides--have increased.

Mothers of autistic children were twice as likely to use pet flea shampoos, which contain organophosphates or pyrethroids, according to one study that has not yet been published. Another new study has found a link between autism and phthalates, which are compounds used in vinyl and cosmetics. Other household products such as antibacterial soaps also could have ingredients that harm the brain by changing immune systems, Hertz-Picciotto said.

In addition, fetuses and infants might be exposed to a fairly new infectious microbe, such as a virus or bacterium, that could be altering the immune system or brain structure. In the 1970s, autism rates increased due to the rubella virus.

The culprits, Hertz-Picciotto said, could be "in the microbial world and in the chemical world."

"I don't think there's going to be one smoking gun in this autism problem," she said. "It's such a big world out there and we know so little at this point."

But she added, scientists expect to develop "quite a few leads in a year or so."

The UC Davis researchers have been studying autistic children's exposure to flame retardants and pesticides to see if there is a connection. The results have not yet been published.

"If we're going to stop the rise in autism in California, we need to keep these studies going and expand them to the extent possible," Hertz-Picciotto said.

Funding for studying genetic causes of autism is 10 to 20 times higher than funding for environmental causes, she said. "It's very off-balance," she said.

Weiss agreed, saying that "excessive emphasis has been placed on genetics as a cause. "The advances in molecular genetics have tended to obscure the principle that genes are always acting in and on a particular environment. This article, I think, will restore some balance to our thinking," he said.

Some issues related to whether the increase is merely a reporting artifact remain unresolved. There could be other, unknown issues involving diagnosis and reporting, scientists say.

The surge in autism is similar to the rise in childhood asthma, which has reached epidemic proportions for unexplained reasons. Medical officials originally thought that, too, might be due to increased reporting of the disease, but now they acknowledge that many more children are asthmatic than in the past. Experts suspect that environmental pollutants or immune changes could be responsible.

Autism has serious effects, not just on an individual child's health but on education, health care and the economy "Autism incidence in California shows no sign yet of plateauing," Hertz-Picciotto and Delwiche said in their study.

This article originally ran at Environmental Health News, a news source published by Environmental Health Sciences, a nonprofit media company.

Virtual Reality, Psychotherapy, Show Promise in Treating PTSD Symptoms; Civilian Access to Care Remains a Concern

Science Update
May 7, 2008

WASHINGTON, DC, May 7 — Early data from an NIMH-sponsored double-blind study of 24 war veterans shows a marked reduction in acoustic startle — the reflex response to sudden loud sounds — in those treated with virtual reality exposure therapy combined with either d-cycloserine, an antibiotic that has been shown to facilitate the extinction of fear memories; pill placebo; or the anti-anxiety medication alprazolam (Xanax).

"These preliminary data suggest that this type of virtual reality exposure therapy is effective in reducing the elevated startle response that was evident before treatment," says Barbara Rothbaum, PhD,^*a professor in psychiatry at Emory University School of Medicine in Atlanta. Rothbaum spoke today at a press conference involving speakers from a symposium developed by the National Institute of Mental Health (NIMH), a part of the National Institutes of Health, during the American Psychiatric Association Annual Meeting here.

PTSD is an anxiety disorder that can develop following exposure to traumatic events and includes three types of symptoms: re-experiencing the trauma, such as nightmares and flashbacks; avoidance symptoms such as avoiding reminders of the experience and feeling emotionally numb; and physical hyper arousal, such as being easily startled. An estimated 7.7 million Americans adults have PTSD.¹

At this point, all patients benefit from the virtual reality exposure therapy. The degree to which d-cycloserine coupled with virtual reality exposure therapy is more or less effective in reducing anxiety symptoms compared with placebo or alprazolam will not be known until the study is completed by the end of August, 2011.

The stimuli used for activation during the startle assessment consist of two-minute video clips of scenes depicting the Iraq theater of combat including that of a Humvee driving alone along a desert highway, a Humvee traveling within a convoy along a desert highway, and a soldier on foot patrol in an Iraqi city.

Acoustic startle, which measured hyperarousal symptoms, was assessed while patients were exposed to each of the three virtual environments at (1) pre-treatment, (2) post-treatment, (3) three months post-treatment, and (4) six months post-treatment. During treatment, the virtual reality exposure therapy was tailored to each of the patients such that they were repeatedly exposed to a virtual environment closely matched to that in which they were traumatized or injured.

At the time of pre-treatment, all subjects displayed a robust acoustic startle response within their relevant treatment environment. This robust startle magnitude decreased significantly, by 75 percent, during the course of treatment with its lowest levels at 6 months post-treatment. This reduction in acoustic startle magnitude observed in Rothbaum's study is consistent with a decrease in symptom severity in these patients as measured by scores on the Clinician Administered PTSD Scale.

"We think using virtual reality makes for a more potent and therapeutic exposure session by putting together the memories, sights, smells, feelings, and emotions and helping them to confront and cope with that complete memory," says Rothbaum. "We think that d-cycloserine specifically may facilitate the emotional learning process that takes place in exposure therapy and hopefully makes this process faster, more robust and long-lasting."

In general, exposure therapy is a technique that helps people confront what they are fearful of but in a therapeutic manner so that their fear response decreases. For PTSD, exposure therapy usually involves going over the memory of the traumatic event until it becomes less scary to think about and the physical and emotional responses to it diminish. D-cycloserine is a medication that was approved by the Food and Drug Administration more than 20 years ago for treatment of tuberculosis; it has recently been shown to enhance the learning of safety memories, helping those with phobias decrease fear faster when combined with exposure therapy.

The first patient treated with the virtual Iraq exposure therapy and d-cycloserine showed a 56 percent decrease in PTSD scores following four therapy sessions, and soon will be published as a case study. "This particular combination of treatment techniques and medication heralds a paradigm shift," says Rothbaum, explaining that such studies aim to "specifically enhance the efficacy of the emotional learning process that takes place in psychotherapy and hopefully make these new emotional memories more robust and long-lasting. We are very excited about the prospects of this combined therapy."

Access to Care for Civilians is a Concern

In a new study conducted at the University of Washington, researchers found that a very effective PTSD psychotherapy called behavioral activation reached only one percent of the hospitalized population of injured civilian survivors of assaults and motor vehicle crashes targeted for PTSD prevention. Behavioral activation is a form of cognitive psychotherapy requiring injured patients to attend four to six psychotherapy sessions within one to three months after hospitalization. It appears that acutely injured trauma survivors had many other post-traumatic concerns and competing demands that prevented them from participating in the cognitive behavioral psychotherapy trial.

In contrast, a stepped collaborative care intervention that began with techniques to engage patients around their most pressing post-injury concerns, such as physical health and bodily pain, reached 54 percent of the target population of injured trauma survivors. This therapy eventually became more intensive and included evidence-based cognitive behavioral therapy as well as medications targeting insomnia and anxiety.

"These findings suggest that cognitive behavioral psychotherapy interventions may be highly effective in reducing PTSD symptoms in tightly controlled clinical experiments," says Doug Zatzick, MD, medical director of the psychiatric consultation liaison service at Seattle's Harborview Medical Center, a level I trauma center. "But they may require augmentation with other intervention strategies, such as the stepped collaborative care component, if they are going to reach large numbers of individuals suffering from PTSD in the real world."

In another study of 2,707 adult surgical inpatients nationwide, Zatzick and his colleagues found that PTSD and other disorders were associated not only with marked individual suffering but also substantial impairments in the ability to work, socialize, and even perform routine physical activities.

The study of adult surgical patients from 69 hospitals found that after one year, 20.7 percent of patients had PTSD and nearly seven percent had depression. Patients with both PTSD and depression had the greatest functional impairment, including inability to return to work, 12 months after injury; patients with one disorder (PTSD or depression) had high levels of impairment; and patients with neither PTSD nor depression had only modest levels of impairment. "This suggests the need for an enhanced focus on screening and intervention for PTSD and related co-morbidities in acute care settings if we are going to adequately improve functional recovery after injury" Zatzick says.

Reference

1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

^* Rothbaum is a consultant to and owns equity in Virtually Better, Inc., which is developing products related to the virtual reality research described in this presentation. The terms of this arrangement have been reviewed and approved by Emory University in accordance with its conflict of interest policies. Rothbaum is also on the scientific advisory board for Tikvah Therapeutics.

Gaza Conflict Moves to Virtual World

Friday , January 09, 2009
By Jennifer Lawinski
Fox News

A shadow war between pro-Israeli and pro-Hamas forces is taking place on the Internet — and it is getting fierce.

If you're one of millions of Americans who use social-networking sites such as Facebook and Twitter or participate in virtual worlds like "Second Life," don't be surprised if you get sucked into a war thousands of miles away in Gaza. Support groups have sprouted up on Facebook, drawing in thousands of members on both sides of the conflict. Protests erupted in "Second Life"'s virtual Israel, where demonstrators showed up to voice support for Hamas and the Palestinians.

People are using Twitter updates to tell the world what they're witnessing on the ground or how they feel about the news. And videos of the carnage in Gaza have been posted on YouTube, including some from the Israeli government. On Facebook, the pro-Hamas group "Stop Genocide in Palestine" has more than 117,500 members. On the other side, "I Support the Israel Defense Forces in Preventing Terror Attacks from Gaza" has more than 65,000 members.

Some Facebook users have changed their profile pictures to Israeli or Palestinian flags, bloody images of war or other partisan graphics to get their messages across. Facebook users can use applications to set messages in their status bars expressing affiliation with one side or the other. An application called "Qassam Count" enables users to voice their support for Israel by automatically updating their status bar when rockets are fired from Gaza into the Jewish state.

Joel Leyden, an American working in Israel, said he founded the "Support the Israel Defense Forces in Preventing Terror Attacks from Gaza" group to give members a place to voice their opinions and grievances about the conflict. "Facebook, as we all know, was created by a university student for university students, and it's turned into the number one watering hole for the international community," Leyden said. "That can't be better illustrated than how it's being used today with the war here that we have with Hamas."

Thousands of messages have been posted to the group. Moderators watch over the conversation in Israel, Europe and North America. Leyden said he's received dozens of death threats since he started the group.

"I've served in [the Israeli army] in combat and in the spokesperson's office and with the border police," he said. "I've never felt more in a dangerous environment than I do here. Everyone is trying to make as much noise as they can to break through." Messages like "death to the Jews" and "we can't wait to murder you" have been posted to the group, he said, but since positing pro-peace messages to the site in Arabic, Leyden said things have toned down considerably. None of the pro-Palestinian groups on Facebook responded to a request for comment. The operators of Facebook, meanwhile, are taking pains to ensure that the online war doesn't get out of hand.

Facebook takes its "Terms of Use" policy seriously and removes groups that violate that policy from the Web site, spokeswoman Elizabeth Linder told FOXNews.com in an e-mail. "We are sensitive to and subsequently take down Groups that threaten violence towards people. We also remove groups that express hatred towards individuals and groups that are sponsored by recognized terrorist organizations," Linder wrote.

Facebook on Thursday removed a Web site called "Hitler Took the Right Decision With Jewish People," saying the group violated its policies.

"We want Facebook to be a place where people can openly discuss issues and express their views," Linder wrote. "As such, we do not aim to control the discourse on Facebook. "Rather, we take swift action to remove content that violates our policies. Our goal is to strike a very delicate balance between giving Facebook users the freedom to express their opinions and beliefs, while also ensuring that individuals and groups of people do not feel threatened or endangered."

In the virtual world "Second Life," SL Israel saw protests from virtual pro-Palestinian activists when the violence in Gaza flared up. "Lots of people yelling," the founder of SL Israel, who goes by Beth Odets in the game, told Second Life blogger Wagner James Au. "They were going on and on with slurring obscenities about murderous Israeli forces, etc."

Odets began ejecting the most offensive protesters from the area, she told Au. "I had to be careful not to boot people who didn't actually do anything wrong," she said. She temporarily had to close SL Israel to outsiders to quell the protests, but protesters kept coming. Eventually, however, people came who wanted to talk. Twitter user Ahuvah Berger, who lives in Israel, said she has been using the network to update her contacts about terrorism for years.

"I believe it is very important to help get our side of the story using a medium in which I already have a large audience who 'know' me," she wrote in an e-mail to FOXNews.com. "As we know Israel is not good at PR, and as the perceived aggressor it needs to show the world why it does and continues to do what it feels necessary to protect its citizens," she wrote. "I have encountered a lot of nasty Twitter users who believe in their own propaganda and when confronted with facts, not only facts emerging from Israel, they resort to calling me a Nazi and a perpetrator of a Palestinian holocaust." Ron Kutas of Stand With Us, a pro-Israel group, said taking the war onto the Internet has its problems.

"It's opening up the door to anybody who wants to say anything," Kutas said. "It's very hard for people to distinguish between emotional commentary about the conflict and factual journalism about the conflict ... you have an open forum and people who are not educated about the conflict are being told misinformation all the time." Kutas said he uses Qassam Count to spark discussion with friends who oppose Israel's actions in Gaza.

"People who I'm friends with who have opinions that are not the same as mine, we have dialogues about real issues and real facts. When that happens it's a great thing," he said.
Asked if any of his friends had chosen not to associate with him on Facebook because of his pro-Israel activism, Kutas replied, "I don't know of anything of that sort, but I should look into that."

Better Brain Maps for ADHD

American Psychiatric Association
January 2009

The brain structure and functioning associated with psychiatric disorders in children and adolescents are particularly important because of possible effects on neurodevelopment. Three new studies clarify brain pathology in attention deficit hyperactivity disorder (ADHD). Shaw et al. (CME, p. 58) measured change over time in the thickness of the cerebral cortex in medicated and unmedicated adolescents with ADHD and adolescents without ADHD.

Magnetic resonance imaging (MRI) scans were conducted at approximately ages 12 and 16. In several brain regions, cortical thinning between the scans was greater for the unmedicated ADHD patients than for those taking psychostimulants or the comparison group. Patients receiving stimulants had age-appropriate thinning. Qiu et al. (p. 74) applied a new tool to measurement of the basal ganglia, regions important in selecting goal-directed behavior. MRI scans of ADHD patients ages 8 to 13 were analyzed with large deformation diffeomorphic metric mapping, which provides details on the shape of brain structures. Girls with ADHD did not differ from typically developing girls, but boys with ADHD had smaller basal ganglia volumes than comparison boys.

Boys with ADHD also had abnormal shapes in areas associated with control circuits linking the frontal cortex and subcortical regions. Rubia et al. (p. 83) distinguished brain dysfunction specific to ADHD from that associated with conduct disorder, which commonly coexists. A test of sustained attention that included rewards was given during functional MRI imaging to boys ages 9–16 who had either conduct disorder or ADHD, as well as healthy boys. The measurement of sustained attention revealed that boys with ADHD had underactivation in the ventrolateral prefrontal cortex but high activation in the cerebellum, thalamus, and hippocampus. Those with conduct disorder had abnormalities in paralimbic regions linking emotion and cognition. In response to reward, boys with conduct disorder showed dysfunction in the orbitofrontal cortex. These disorder-specific results help differentiate the two conditions.

Placebo Response in Depressed Children

A review of antidepressant trials for patients ages 6–18 years suggests that the high rate of response to placebo is related to the increase in large, multisite studies. An inflated placebo response rate obscures the efficacy of antidepressants, which are judged by their superiority to placebo. Bridge et al. (p. 42) therefore analyzed 12 randomized, controlled trials of second-generation antidepressants for children and adolescents with major depression. The number of study sites was the best predictor of placebo response. Illness severity was an inverse predictor, suggesting the need for recruitment of patients with at least moderately severe depression.

Revolving Prison Door for Mentally Ill

Texas state prisoners with bipolar disorder who began sentences in 2006–2007 were three times as likely to have had four or more incarcerations in the preceding 6 years as those without psychiatric disorders. For all 79,211 inmates entering Texas prisons over this 12-month period, Baillargeon et al. (CME, p. 103) determined incarceration history and current diagnoses of major depressive disorder, bipolar disorder, schizophrenia, and other psychotic disorders. These illnesses affected 10% of the incoming prisoners. All four conditions were associated with more criminal recidivism; all but depression were also related to higher rates of violent crimes.

Psychiatric Disorders and Repeat Incarcerations: The Revolving Prison Door

Jacques Baillargeon, Ph.D., Ingrid A. Binswanger, M.D., M.P.H., Joseph V. Penn, M.D., Brie A. Williams, M.D., M.S., and Owen J. Murray, D.O.

OBJECTIVE: A number of legal, social, and political factors over the past 40 years have led to the current epidemic of psychiatric disorders in the U.S. prison system. Although numerous investigations have reported substantially elevated rates of psychiatric disorders among prison inmates compared with the general population, it is unclear whether mental illness is a risk factor for multiple episodes of incarceration. The authors examined this association in a retrospective cohort study of the nation’s largest state prison system.

METHOD: The study population included 79,211 inmates who began serving a sentence between September 1, 2006, and August 31, 2007. Data on psychiatric disorders, demographic characteristics, and history of incarceration for the preceding 6-year period were obtained from statewide medical information systems and analyzed.

RESULTS: Inmates with major psychiatric disorders (major depressive disorder, bipolar disorders, schizophrenia, and nonschizophrenic psychotic disorders) had substantially increased risks of multiple incarcerations over the 6-year study period. The greatest increase in risk was observed among inmates with bipolar disorders, who were 3.3 times more likely to have had four or more previous incarcerations compared with inmates who had no major psychiatric disorder.

CONCLUSIONS: Prison inmates with major psychiatric disorders are more likely than those without to have had previous incarcerations. The authors recommend expanding interventions to reduce recidivism among mentally ill inmates. They discuss the potential benefits of continuity of care reentry programs to help mentally ill inmates connect with community-based mental health programs at the time of their release, as well as a greater role for mental health courts and other diversion strategies.