Medical Mystery

Medical Mystery; is it a cognitive disorder? You be the judge?

After years of debate and controversy, the CDC is finally looking into the mysteries of Morgellons, an unexplained and debilitating skin condition that many doctors don't believe exists.

Jenny Hontz
Newsweek Web Exclusive
Feb 7, 2008

Deanna Odom was either delusional or she was suffering from a bizarre and devastating illness that doctors cannot treat. In December 2004 the 36-year-old mother of two teenagers started developing lesions on her arms, legs and backside. At times, she says, it felt as if needles were stinging her. And then she noticed strange, colored fibers emerging from her skin. "They would almost look like dust fibers," says Odom, who lives in Torrance, Calif. "I would put my hands together and my hands would puff off the fibers. Combing my head, you could see the fibers emerging. It's literally almost out of a sci-fi movie. You think, 'This isn't happening'."

After seeing a TV news report in February 2005, Odom became convinced she was suffering from Morgellons, an unexplained condition that has sparked debate and controversy within the medical community. Some doctors and researchers believe Morgellons is an emergent disease characterized by nonhealing skin lesions, crawling or itching sensations, fibers and black granules emerging from the skin, and neurological impairments such as short-term memory loss. The problem, for Odom and thousands of others who believe they suffer from the disease, is that most dermatologists think there is no such thing as Morgellons. They attribute the suffering of patients like Odom to delusions or anxiety-driven self-mutilation.

Now the Centers for Disease Control and Prevention (CDC) have launched their first study of Morgellons, which may provide some answers as early as next year. Michele Pearson, the CDC's principal investigator, says the agency got involved after receiving an increasing number of calls—averaging about 100 a month since November 2006—from patients, doctors, public health officials and members of Congress asking the CDC to look into Morgellons, which the agency describes as "an unexplained skin condition." Patients in the study will undergo medical, dermatological and psychological examinations, including blood tests and skin biopsies. The study will be conducted in conjunction with Kaiser Permanente's Northern California Division of Research. Any fibers collected will be analyzed by the Armed Forces Institute of Pathology, which has both forensics capabilities and an environmental research lab. "We are absolutely going into this with an open mind," Pearson says.

But many doctors have already formed their own opinions about Morgellons. Jeffrey Meffert, a dermatologist and associate clinical professor at the University of Texas Health Science Center in San Antonio, is a vocal Morgellons skeptic, often debunking the disease in presentations to colleagues. He says he sees at least one patient a month claiming to have Morgellons, but he diagnoses most of them with prurigo nodularis, a condition sometimes fueled by anxiety and characterized by chronic itching and scratching, which creates hardened nodules on the skin. More rarely, he says, patients have the mistaken belief that they are infested with parasites. "People with delusional parasitosis are very functional and rational except when it comes to this one issue," he says. "Many dermatologists would rather these patients never show up, because they don't feel they have the time to spend. No one knows how to deal with them."

That attitude is a familiar one to Odom, who visited seven doctors between January 2005 and April 2006, trying to discover what was wrong with her. By that time the lesions had spread to her head, causing her hair to fall out in patches. Some of the doctors she saw diagnosed her with dermatitis, but most thought the problem was psychological and assumed she was scratching her skin and pulling out her own hair. One prescribed Zoloft for depression, while others prescribed the anti-anxiety drug Xanax. (She refused to take the drugs.) One dermatologist (not Meffert) diagnosed her with delusional parasitosis. "He told me, 'You seem a little obsessed. Maybe you should go speak to somebody'," she says.

Odom, a former softball coach and school aide, never doubted her mental health, although she acknowledges she grew "frantic and high strung" after realizing her doctors didn't believe her. She began isolating herself, fearing she might be contagious. "The worst fear for me was whether I was going to infect my children," she says. "I stopped hugging them and kissing them. I had a hard time preparing their food, thinking whatever I'm spewing out of my body is going to get into what I'm cooking."

Odom eventually gave up on doctors, turning instead to alternative treatments, including lots of vitamins, grapeseed extract and other dietary supplements. She also moved her family out of their house, which was next to a landfill. Her lesions started to heal six months ago (though the reasons for her improvement remain a mystery), but she still wants to know why she got sick in the first place. Thanks to the CDC study, which is budgeted at $545,000, she may someday find out.

Those who believe they suffer from Morgellons hail the CDC study as a victory in their grass-roots Internet campaign to raise awareness and research funds. In fact, the name Morgellons was chosen not by a doctor but by Mary Leitao, a mother and former medical researcher who says that in 2001 she observed fibers coming out of the skin of her then two-year-old son, who also had lesions and complained of "bugs." After visiting five doctors and failing to get answers that satisfied her, Leitao created a Web site in 2002 and formed the Morgellons Research Foundation. Soon she was flooded with e-mails from people complaining of similar symptoms. To date, more than 11,000 people have registered on her site, many from California, Texas and Florida. Leitao, whose son is now "much improved," hopes the CDC study will convince doctors to take Morgellons patients seriously after years of what many describe as humiliating and dismissive encounters.

Meffert, for one, believes the CDC study is a waste of time and money. "This fibers business, as presented by the fiber-disease community, is nonsense," he says. "They have not convinced me, and, quite honestly, they have pissed me off." The only fibers he has seen, he says, are consistent with animal hair, human hair or textile fibers he finds on most patients. "I saw fibers stuck to the eczema scab of everyone I saw today," he says. "Every patient with oozing, weeping skin has fibers stuck to their skin. Now [nearly] half a million of my taxpayer money is going to research this. I would love to see that money go toward prurigo nodularis rather than to chase fibers."

Randy Wymore, an assistant professor of pharmacology and physiology who directs the Center for the Investigation of Morgellons Disease at Oklahoma State University's Center for Health Sciences in Tulsa, has performed extensive testing on Morgellons patient fibers and is "100 percent convinced Morgellons is a real disease." When he first heard of Morgellons, Wymore thought it would be simple to disprove its existence by examining the fibers. In 2005 he began asking patients, doctors and nurses to mail him samples. In the first week he got 10 packages from five states and was amazed by how similar the bundles of red, blue, back and translucent fibers looked. (He has since received more than a thousand fiber samples.) Over the next nine months he systematically compared them to all sorts of textile fibers, hair and dust from clothing, carpets, medical supplies and fishing and hunting supplies, but he could find nothing similar. He showed the samples to OSU colleagues, who also were baffled.

Intrigued and at loss for answers, he eventually took the samples to the Tulsa Police Department Forensics Lab, where fiber experts Mark Boese and Ron Pogue ran a series of tests on two red and two blue fibers. "In three minutes they decided it was like nothing they had seen before," Wymore says. Comparing the Morgellons fibers to a database of more than 900 known compounds used in textiles, they found no match. Next they heated a blue fiber to more than 700 degrees, which darkened but did not destroy it. They determined the fibers were not fiberglass and did not match anything in their database of 90,000 organic compounds. OSU researchers have found tangled fibers underneath even healthy, unbroken skin in Morgellons patients, which Wymore says rules out the kind of wound contamination Meffert describes.

Wymore acknowledges that some people who claim to have Morgellons may be delusional, but he says all but one of the nearly 30 patients he and his colleagues at OSU have examined do, in fact, have the disease. Like Odom and so many others, he welcomes the CDC study. "My hope is thousands of physicians will go, 'I still don't believe this Morgellons crap, but the CDC is looking into it. I'm willing to give them the benefit of the doubt'."

Sober Surprise From Alcoholism Study

Miranda Hitti

WebMD Health News

Jan. 4, 2006 -- Psychology plays a role in the success of drugs that
treat severe alcoholism, a new German study shows.

"We found an [alcohol] abstinence rate of more than 50% among the
patients studied," researcher Hannelore Ehrenreich, MD, DVM, says in a
news release.

She and her colleagues report that two alcoholism drugs -- Antabuse
and calcium carbimide -- were tied to alcohol abstinence.

The drugs seemed to be well-tolerated, even with long-term use. The
longer patients took the drugs, the more likely they were to stay
sober, even after stopping the drugs, Ehrenreich says.

She works at the Max Planck Institute of Experimental Medicine in
Gottingen, Germany.

Fake Drugs Also Counted

Fake drugs that didn't contain any medication were also associated
with alcohol abstinence.

"Sham alcohol deterrents are as efficient as [Antabuse] or calcium
carbimide, provided that the use is repeatedly explained and
continuously guided and encouraged," Ehrenreich says.

The psychological counseling given to patients may be the reason, the
researchers write. Their study appears in Alcoholism: Clinical &
Experimental Research.

Long-Term Study

The study included 180 people with severe alcoholism who were enrolled
in a two-year outpatient program to address their alcoholism through
counseling and medications.

After alcohol detoxification, participants got real alcoholism drugs
(Antabuse or calcium carbimide) or fake drugs. The sham drugs were
only given to patients with medical conditions that ruled out using
the real drugs.

Participants were followed for nine years. They didn't take the drugs
that long, tapering off the medications after a year had passed (with
some staying on Antabuse for a longer time).

Because people don't always accurately report their drinking habits,
participants got blood tests to check for signs of alcohol use.

Better Results From Psychology?

Participants' odds of not relapsing were better than half (52%) over
the nine-year period. Their odds of not drinking any alcohol during
that time were better than one in four (26%).

The fake and real drugs were both tied to alcohol abstinence and
called "alcohol deterrents" by the researchers. Antabuse causes a
person to have unpleasant effects if alcohol is consumed, thus serving
as a negative deterrent.

Besides taking the drugs, participants also got psychological
counseling. The therapists "dramatically outline[d] the danger of
drinking alcohol under the influence of the alcohol deterrent," write
the researchers.

The therapists also praised patients for staying sober and stressed
the importance of building an alcohol-free lifestyle.

If participants started drinking, they got what the researchers call
"aggressive aftercare." That included immediate steps -- including
unscheduled visits to participants' homes by the therapists -- to nip
relapses in the bud.

Memory Trick Shows Brain Organization

30 Aug 2008

A simple memory trick has helped show UC Davis researchers how an area of the brain called the perirhinal cortex can contribute to forming memories. The finding expands our understanding of how those brain areas that form memories are organized.

The brain puts together different items -- the what, who, where and when -- to form a complete memory. It was previously thought that this association process occurred entirely in a brain structure called the hippocampus, but this appears not to be the case, said Charan Ranganath, a professor at the UC Davis Center for Neuroscience and the Department of Psychology who led the research.

"We want to know how the brain areas that encode memory are organized," Ranganath said. "If your memory is affected by aging or Alzheimer's disease, is there a way to learn that can capitalize on the brain structures that may still be working well?"

Ranganath, along with graduate student Andrew Logan Haskins, Andrew Yonelinas, a UC Davis psychology professor and associate director of the Center for Mind and Brain, and Joel Quamme, a former UC Davis graduate student now at Princeton University, used functional magnetic resonance imaging (fMRI) to see which parts of the brain were active when volunteers memorized pairs of words such as "motor/bear" or "liver/tree." In this experiment, the volunteers either learned the pairs as separate words that could be fitted into a sentence, or as a new compound word, for example "motorbear," defined as a motorized stuffed toy.

"It's a sort of memory trick," Ranganath said.

When volunteers memorized word pairs as a compound word, the perirhinal cortex lit up, and this activity predicted whether the volunteers would be able to successfully remember the pairs in the future. The results suggest that the perirhinal cortex probably can form simple associations, such as between the parts of a complex object. This information is probably passed up to the hippocampus, which may create more complex memories, such as the place and time a specific object was seen.

Chewing Gum May Help Reduce Stress According To New Research

01 Sep 2008

Study presented at the 2008 10th International Congress of Behavioral Medicine

WHAT: "An investigation into the effects of gum chewing on mood and cortisol levels during psychological stress," presented at the 2008 10th International Congress of Behavioral Medicine, found that chewing gum helped relieve anxiety, improve alertness and reduce stress among individuals in a laboratory setting.* The study examined whether chewing gum is capable of reducing induced anxiety and/or acute psychological stress while participants performed a battery of 'multi-tasking' activities. The use of chewing gum was associated with higher alertness, reduced anxiety and stress, and improvement in overall performance on multi-tasking activities.

WHO: Andrew Scholey, Ph.D., professor of Behavioral and Brain Sciences, Swinburne University in Melbourne, Australia led the research study and can discuss the effect of chewing gum on stress relief and focus and concentration.

Gilbert Leveille, Ph.D., executive director, Wrigley Science Institute, will also be available to discuss research on the benefits of chewing gum related to stress relief and alertness and concentration in addition to other areas including weight management and oral health.

WHEN: Study was presented orally on Saturday, August 30 at Rissho University in Tokyo, Japan at the 10th International Congress of Behavioral Medicine.

STUDY BACKGROUND:

In the 40-person study of gum chewers averaging an age of 22 years old, performed on the Defined Intensity Stressor Simulation (DISS), a multi-tasking platform which reliably induces stress and also includes performance measures, while chewing and not chewing gum. Anxiety, alertness and stress levels were measured before and after participants completed the DISS.

• Relieved Anxiety: When chewing gum, participants reported lower levels of anxiety.
  Gum chewers showed a reduction in anxiety as compared to non-gum chewers by nearly 17 percent during mild stress and nearly 10 percent in moderate stress.
  
  
• Increased Alertness: Participants experienced greater levels of alertness when they chewed gum.
  Gum chewers showed improvement in alertness over non-gum chewers by nearly 19 percent during mild stress and 8 percent in moderate stress.
  
  
• Reduced Stress: Stress levels were lower in participants who chewed gum.
  Levels of salivary cortisol (a physiological stress marker) in gum chewers were lower than those of non-gum chewers by 16 percent during mild stress and nearly 12 percent in moderate stress.
  
  
• Improved Performance: Chewing gum resulted in a significant improvement in overall performance on multi-tasking activities. Both gum-chewers and non-chewers showed improvement from their baseline scores; however, chewing gum improved mean performance scores over non-gum chewers by 67 percent during moderate stress and 109 percent in mild stress.

----------------------------
Article adapted by Medical News Today from original press release.
----------------------------

WRIGLEY SCIENCE INSTITUTE:

Wrigley is committed to advancing and sharing scientific research that explores the benefits of chewing gum. The Chicago-based Wrigley Science Institute works with independent researchers at leading institutions to learn more about the potential health and wellness benefits of chewing gum. The Wrigley Science Institute's current work is focused on four key scientific areas: how gum can help reduce situational stress; help manage weight; help increase focus, alertness and concentration; and improve oral health.

*Scholey, Andrew. An investigation into the effects of gum chewing on mood and cortisol levels during psychological stress. 10th International Congress of Behavioral Medicine. Tokyo, Japan. August 2008.

Another Kind of Addict

What exactly is sex addiction, and how are those who suffer from the disorder, like actor David Duchovny, treated?

Susanna Schrobsdorff

Newsweek Web Exclusive

Updated: 3:58 PM ET Sep 2, 2008

The term "sex addict" has been used as a punch line on television so often that it's hard to believe that it can actually be a serious addiction, like alcoholism. So when "X Files" star, David Duchovny, announced last week that he was entering rehab for treatment of a sexual addiction, it almost seemed like a fictional plotline for the Showtime series "Californication," on which Duchovny plays a sex-obsessed single dad. But for those affected, the ramifications of a sexual addiction are all too real, often leaving marriages, careers and bank accounts in ruins. For celebrities who are contending with sexual problems, there's often the added humiliation of having their difficulties made public. This summer, the tabloids were filled with lurid stories of out-of-control spending on Internet porn by Peter Cook, husband of model Christie Brinkley. And of course, in Hollywood, tales of actors risking their reputations by picking up street prostitutes are too numerous to mention.

What exactly constitutes a sexual addiction? It's generally described as obsessive sexually related behavior that dominates the addict's life. The compulsive behavior can range from obsessive use of pornography or promiscuity, to use of prostitutes or even sexual violence. Still, the notion that people can be clinically addicted to sex is controversial. Sex addiction, is not recognized by the American Psychological Association as a diagnosable disorder; and when news breaks of yet another philandering celebrity or politician, the public is likely to assume the person is suffering from an extreme case of caddishness rather than a bona fide illness. To learn more about how sexual addictions are treated and diagnosed, NEWSWEEK's Susanna Schrobsdorff spoke to Jill W. Bley, a clinical psychologist and sex therapist in Cincinnati. Excerpts:

NEWSWEEK: The term "sex addiction" isn't universally accepted among psychologists, is it?
Jill Bley: It's been controversial in our field. There's one group of people who have researched this who say that label can only be applied when there's a substance involved. They wouldn't talk about a gambling addiction; they would talk about compulsive gambling behavior. Those of us who do the clinical work, we don't care what you call it. We look at the behavior. I may tell someone they have an obsessive-compulsive sexual need. The only time the label makes a difference is if you go to court or justify something with an insurance company—then you call it obsessive-compulsive behavior.

Some people see the sex-addict label as just an excuse for a guy who cheats. What's the difference between someone who needs psychological help and someone who is just a jerk?
Some are jerks. But there's a huge difference between someone who's cheating and an addict. A person who has a sexual addiction is engaging in obsessive-compulsive sexual behavior, which causes severe stress to the addicted individual and their families, and over which they do not have control.

The statistics say that more men get help for sex addiction than women. Is there a difference between male and female sex addicts?
Male and female sex addicts are pretty much the same. Women tend to get into love addictions more, though men sometimes do too. [A love addiction] may look like a sex addiction, but what they're really in it for is the high of being adored, getting attention. Women may feel they are only valued for their bodies, so they use their bodies to attract attention or love.

Are there men who say urges are normal male biology and that they can't help pursuing sex all the time?
Sometimes it is the thrill of the chase, which is normal, but not if the pursuit becomes compulsive. This one person I work with, he had about 40 women that he was involved with. He had four cell phones. He'd give different women the numbers so he could figure out which woman was calling and keep them separate. He would tell me all the time, "I can't help it. Women are hitting on me wherever I go; I get on the plane and the flight attendant starts coming on to me." This man even said that my secretary was hitting on him when he came in for a therapy appointment, and I can say definitely that she wasn't.

Are these people unusually egotistical?
There's a lot of narcissism and arrogance with people like this. In therapy you have to help them confront that. They feel like the world revolves around them. But that's really a shield, a protection for an ego that was damaged as they grew up.

Does the kind of guy you were talking about succeed with women, if everyone isn't actually hitting on them as they think?
These kinds of men do get women because they're smooth talkers and they can be very charming. They make women feel like they're the only one, even when she's not. Secrecy is very important—that's a big part of the thrill for them.

That risk-taking thrill sounds like some of the politicians who have been caught up in sex scandals.
Yes. People wonder why [those sorts of] men … would risk everything. What it is, is that they get addicted to the adrenaline flow. The riskier it gets, the more adrenaline they get. Like all addictions, the more they get, the more they need. It may seem stupid from the outside, but that's not what someone is thinking when they're caught up in the addiction cycle. It starts with a preoccupation—they're thinking and thinking of whatever their sexual compulsion is. Then they move to the next level of the cycle, which we call ritualization. It's whatever activity they do that they think will help them find what they're addicted to. Once they get to that second stage, they're probably going to go all the way. They'll get in the car and drive toward a strip club or the street where they pick up prostitutes. Afterwards they may be very ashamed. But eventually the cycle will start all over again.

What makes them seek treatment?
Usually, it's because they get caught. Or the addiction is making it impossible for them to function.

How do you help them stop that cycle of addiction?
We try to help them stop when they are in the thinking-about-it stage, the preoccupation stage. That's when we say, "You have to call your sponsor." The other thing is that there have to be no secrets, not from their sponsor and not from their significant other. It's part of the intimacy work they have to do with their partner.

That sounds like Alcoholics Anonymous.
The treatment is somewhat different from alcoholism or other addiction treatments, yet very much the same. The first step is to acknowledge the problem. Then, if they work the 12 steps to recovery, they will go to 90 [group treatment] meetings in 90 days. It's important that they get a sponsor, too. That's the person you call for the purpose of helping you not act out sexually, and also help[ing] you work through the stresses and anxiety that lead to acting out sexually. Sometimes treatment means checking into a rehab center so [patients] can get out of their normal environment and habits.

But you can't give up sex forever the same way you can give up alcohol, can you?
When they start the process I will ask them for six weeks of total abstinence. Not even masturbation. It's really hard for the addicts, but you can't do anything till they get sober and abstinent. We have their partner agree. During that six weeks, the anxieties that led to the sexual acting out usually become very apparent to the therapist and the partner. Those anxieties are what you want to work on. Then after the six weeks you have them work on having all their sexual behavior directed toward their partner.

And after that?
A huge part of the treatment is to look for the trauma in the person's life that is creating the stress. You want to get at the cause and reprocess what has happened to them. Most of them have been victims of some kind of emotional abuse as children. That means having a parent who derides you, constantly criticizes you or calls you names. And 81 percent of those who come for treatment have been sexually abused, 73 percent physically abused. Most of them deny their abuse history. Or they might not remember it until they've been in therapy for a while.

Does insurance cover treatment for sex addictions?
No, not usually. But patients are often able to work out a payment plan.

High-Aptitude Minds: The Neurological Roots of Genius

Researchers are finding clues to the basis of brilliance in the brain

By Christian Hoppe and Jelena Stojanovic

Within hours of his demise in 1955, Albert Einstein’s brain was salvaged, sliced into 240 pieces and stored in jars for safekeeping. Since then, researchers have weighed, measured and otherwise inspected these biological specimens of genius in hopes of uncovering clues to Einstein’s spectacular intellect.

Their cerebral explorations are part of a century-long effort to uncover the neural basis of high intelligence or, in children, giftedness. Traditionally, 2 to 5 percent of kids qualify as gifted, with the top 2 percent scoring above 130 on an intelligence quotient (IQ) test. (The statistical average is 100. See the box on the opposite page.) A high IQ increases the probability of success in various academic areas. Children who are good at reading, writing or math also tend to be facile at the other two areas and to grow into adults who are skilled at diverse intellectual tasks [see “Solving the IQ puzzel,” by James R. Flynn; Scientific American Mind, October/November 2007].

Most studies show that smarter brains are typically bigger—at least in certain locations. Part of Einstein’s parietal lobe (at the top of the head, behind the ears) was 15 percent wider than the same region was in 35 men of normal cognitive ability, according to a 1999 study by researchers at McMaster University in Ontario. This area is thought to be critical for visual and mathematical thinking. It is also within the constellation of brain regions fingered as important for superior cognition. These neural territories include parts of the parietal and frontal lobes as well as a structure called the anterior cingulate.

But the functional consequences of such enlargement are controversial. In 1883 English anthropologist and polymath Sir Francis Galton dubbed intelligence an inherited feature of an efficiently functioning central nervous system. Since then, neuroscientists have garnered support for this efficiency hypothesis using modern neuroimaging techniques. They found that the brains of brighter people use less energy to solve certain prob­lems than those of people with lower aptitudes do.

In other cases, scientists have observed higher neuronal power consumption in individuals with superior mental capacities. Musical prodigies may also sport an unusually energetic brain [see box on page 67]. That flurry of activity may occur when a task is unusually challenging, some researchers speculate, whereas a gifted mind might be more efficient only when it is pondering a relatively painless puzzle.

Despite the quest to unravel the roots of high IQ, researchers say that people often overestimate the significance of intellectual ability [see “Coaching the Gifted Child,” by Christian Fischer]. Studies show that practice and perseverance contribute more to accomplishment than being smart does.

Size Matters
In humans, brain size correlates, albeit somewhat weakly, with intelligence, at least when researchers control for a person’s sex (male brains are bigger) and age (older brains are smaller). Many modern studies have linked a larger brain, as measured by magnetic resonance imaging, to higher intellect, with total brain volume accounting for about 16 percent of the variance in IQ. But, as Einstein’s brain illustrates, the size of some brain areas may matter for intelligence much more than that of others does.

In 2004 psychologist Richard J. Haier of the University of California, Irvine, and his colleagues reported evidence to support the notion that discrete brain regions mediate scholarly aptitude. Studying the brains of 47 adults, Haier’s team found an association between the amount of gray matter (tissue containing the cell bodies of neurons) and higher IQ in 10 discrete regions, including three in the frontal lobe and two in the parietal lobe just behind it. Other scientists have also seen more white matter, which is made up of nerve axons (or fibers), in these same regions among people with higher IQs. The results point to a widely distributed—but discrete—neural basis of intelligence.

The neural hubs of general intelligence may change with age. Among the younger adults in Haier’s study—his subjects ranged in age from 18 to 84—IQ correlated with the size of brain regions near a central structure called the cingulate, which participates in various cognitive and emotional tasks. That result jibed with the findings, published a year earlier, of pediatric neurologist Marko Wilke, then at Cincinnati Children’s Hospital Medical Center, and his colleagues. In its survey of 146 children ages five to 18 with a range of IQs, the Cincinnati group discovered a strong connection between IQ and gray matter volume in the cingulate but not in any other brain structure the researchers examined.

Scientists have identified other shifting neural patterns that could signal high IQ. In a 2006 study child psychiatrist Philip Shaw of the National Institute of Mental Health and his colleagues scanned the brains of 307 children of varying intelligence multiple times to determine the thickness of their cerebral cortex, the brain’s exterior part. They discovered that academic prodigies younger than eight had an unusually thin cerebral cortex, which then thickened rapidly so that by late childhood it was chunkier than that of less clever kids. Consistent with other studies, that pattern was particularly pronounced in the frontal brain regions that govern rational thought processes.

The brain structures responsible for high IQ may vary by sex as well as by age. A recent study by Haier, for example, suggests that men and women achieve similar results on IQ tests with the aid of different brain regions. Thus, more than one type of brain architecture may underlie high aptitude.

Low Effort Required
Meanwhile researchers are debating the functional consequences of these structural findings. Over the years brain scientists have garnered evidence supporting the idea that high intelligence stems from faster information processing in the brain. Underlying such speed, some psychologists argue, is unusually efficient neural circuitry in the brains of gifted individuals.

Experimental psychologist Werner Krause, formerly at the University of Jena in Germany, for example, has proposed that the highly gifted solve puzzles more elegantly than other people do: they rapidly identify the key information in them and the best way to solve them. Such people thereby make optimal use of the brain’s limited working memory, the short-term buffer that holds items just long enough for the mind to process them.

Starting in the late 1980s, Haier and his colleagues have gathered data that buttress this so-called efficiency hypothesis. The researchers used positron-emission tomography, which measures glucose metabolism of cells, to scan the brains of eight young men while they performed a nonverbal abstract reasoning task for half an hour. They found that the better an individual’s performance on the task, the lower the metabolic rate in widespread areas of the brain, supporting the notion that efficient neural processing may underlie brilliance. And in the 1990s the same group observed the flip side of this phenomenon: higher glucose metabolism in the brains of a small group of subjects who had below-average IQs, suggesting that slower minds operate less economically.

More recently, in 2004 psychologist Aljoscha Neubauer of the University of Graz in Austria and his colleagues linked aptitude to diminished cortical activity after learning. The researchers used electroencephalography (EEG), a technique that detects electrical brain activity at precise time points using an array of electrodes affixed to the scalp, to monitor the brains of 27 individuals while they took two reasoning tests, one of them given before test-related training and the other after it. During the second test, frontal brain regions—many of which are involved in higher-­order cognitive skills—were less active in the more intelligent individuals than in the less astute subjects. In fact, the higher a subject’s mental ability, the bigger the dip in cortical activation between the pretraining and posttraining tests, suggesting that the brains of brighter individuals streamline the processing of new information faster than those of their less intelligent counterparts do.

The cerebrums of smart kids may also be more efficient at rest, according to a 2006 study by psychologist Joel Alexander of Western Oregon University and his colleagues. Using EEG, Alexander’s team found that resting eight- to 12-hertz alpha brain waves were significantly more powerful in 30 adolescents of average ability than they were in 30 gifted adolescents, whose alpha-wave signal resembled those of older, college-age students. The results suggest that gifted kids’ brains use relatively little energy while idle and in this respect resemble more developmentally advanced human brains.

Some researchers speculate that greater energy efficiency in the brains of gifted individuals could arise from increased gray matter, which might provide more resources for data processing, lessening the strain on the brain. But others, such as economist Edward Miller, formerly of the University of New Orleans, have proposed that the efficiency boost could also result from thicker myelin, the substance that insulates nerves and ensures rapid conduction of nerve signals. No one knows if the brains of the quick-witted generally contain more myelin, although Einstein’s might have. Scientists probing Einstein’s brain in the 1980s discovered an unusual number of glia, the cells that make up myelin, relative to neurons in one area of his parietal cortex.

Hardworking Minds
And yet gifted brains are not always in a state of relative calm. In some situations, they appear to be more energetic, not less, than those of people of more ordinary intellect. What is more, the energy-gobbling brain areas roughly correspond to those boasting more gray matter, suggesting that the gifted may simply be endowed with more brainpower in this intelligence network.

In a 2003 trial psychologist Jeremy Gray, then at Washington University in St. Louis, and his colleagues scanned the brains of 48 individuals using functional MRI, which detects neural activity by tracking the flow of oxygenated blood in brain tissue, while the subjects completed hard tasks that taxed working memory. The researchers saw higher levels of activity in prefrontal and parietal brain regions in the participants who had received high scores on an intelligence test, as compared with low scorers.

In a 2005 study a team led by neuroscientist Michael O’Boyle of Texas Tech University found a similar brain activity pattern in young male math geniuses. The researchers used fMRI to map the brains of mathematically gifted adolescents while they mentally rotated objects to try to match them to a target item. Compared with adolescent boys of average math ability, the brains of the mathematically talented boys were more metabolically active—and that activity was concentrated in the parietal lobes, the frontal cortex and the anterior cingulate.

A year later biologist Kun Ho Lee of Seoul National University in Korea similarly linked elevated activity in a frontoparietal neural network to superior intellect. Lee and his co-workers measured brain activity in 18 gifted adolescents and 18 less intelligent young people while they performed difficult reasoning tasks. These tasks, once again, excited activity in areas of the frontal and parietal lobes, including the anterior cingulate, and this neural commotion was significantly more intense in the gifted individuals’ brains.

No one is sure why some experiments indicate that a bright brain is a hardworking one, whereas others suggest it is one that can afford to relax. Some, such as Haier—who has found higher brain metabolic rates in more astute individuals in some of his studies but not in others—speculate one reason could relate to the difficulty of the tasks. When a problem is very complex, even a gifted person’s brain has to work to solve it. The brain’s relatively high metabolic rate in this instance might reflect greater engagement with the task. If that task was out of reach for someone of average intellect, that person’s brain might be relatively inactive because of an inability to tackle the problem. And yet a bright individual’s brain might nonetheless solve a less difficult problem efficiently and with little effort as compared with someone who has a lower IQ.

Perfection from Practice
Whatever the neurological roots of genius, being brilliant only increases the probability of success; it does not ensure accomplishment in any endeavor. Even for academic achievement, IQ is not as important as self-discipline and a willingness to work hard.

University of Pennsylvania psychologists Angela Duckworth and Martin Seligman examined final grades of 164 eighth-grade students, along with their admission to (or rejection from) a prestigious high school. By such measures, the researchers determined that scholarly success was more than twice as dependent on assessments of self-discipline as on IQ. What is more, they reported in 2005, students with more self-discipline—a willingness to sacrifice short-term pleasure for long-term gain—were more likely than those lacking this skill to improve their grades during the school year. A high IQ, on the other hand, did not predict a climb in grades.

A 2007 study by Neubauer’s team of 90 adult tournament chess players similarly shows that practice and experience are more important to expertise than general intelligence is, although the latter is related to chess-playing ability. Even Einstein’s spectacular success as a mathematician and a physicist cannot be attributed to intellectual prowess alone. His education, dedication to the problem of relativity, willingness to take risks, and support from family and friends probably helped to push him ahead of any contemporaries with comparable cognitive gifts.

B Vitamins, Folic Acid Do Not Reduce Depression Incidence, Severity CME

Medscape Medical News

News Author: Caroline Cassels
CME Author: Désirée Lie, MD, MSEd

August 25, 2008 — Supplementation with B vitamins appears to be no better than placebo in reducing the incidence of depression or depressive symptoms, new research suggests.

A randomized, double-blind, placebo-controlled trial of 299 older men showed treatment with vitamins B12, B6, and folic acid produced no significant change in mood for 2 years.

"We investigated the association between vitamin use and depression in 3 different ways, none of which showed an advantage of B vitamins compared with placebo over 24 months: change in Beck Depression Index [BDI] scores, incidence of clinically significant depressive symptoms, and remission of depression," the authors write.

With first author Andrew H. Ford, MBBS, from South Metropolitan Health Service, in Perth, Australia, the study is published in the August issue of the Journal of Clinical Psychiatry.

Previous research has linked lower concentrations of B vitamins and folate to depression. However, many of these reports have been observational and or confounded by the fact that participants were receiving antidepressants.

Prospective Design

The purpose of the current study was to prospectively determine whether treatment with B vitamins during an extended period reduced the onset of clinically depressive symptoms in a cohort of men aged 75 years and older.

For the study, investigators recruited a random sample of 299 subjects who were participants in a large population-based study of abdominal aortic aneurysm screening.

All subjects were being treated for or had a history of hypertension. Individuals were excluded from the study if they had a BDI score of 18 or higher and significant cognitive impairment, as determined by a Mini-Mental State Examination (MMSE) score of less than 24. In addition, individuals who were already taking B vitamins were excluded from the study, which was conducted from June 2001 to June 2004.

Participants were randomized to receive a single oral capsule containing 400 µg B12, 2 mg folic acid, and 25 mg B6 or an identical-looking placebo capsule. Study subjects were told to consume 1 capsule every morning for 2 years.

Study subjects and investigators were blinded to group membership until the last follow-up assessment was completed.

The study's primary outcome was changes in BDI scores during the study period. The researchers also examined the proportion of individuals who were free of clinically significant depressive symptoms at baseline, but they became depressed during the trial.

A total of 149 and 150 subjects were in the placebo and active-treatment groups, respectively. With a 19.4% dropout rate, the final analysis was based on the 241 who completed the 2-year trial.

Role as Adjunctive Therapy?

The study revealed that participants in the active-treatment group were 24% more likely to remain free of depression during the trial, but the difference between the groups was not significant.

Among 23 men — 12 in the vitamin group and 11 in the placebo cohort — who had mild to moderate depression, there was no difference between the 2 groups after 24 months of treatment.

Investigators also found that participants in the active-treatment group had increased blood levels of B12 and folate and reduced levels of plasma homocysteine. They also found that these blood levels were similar in men with and without depression, a finding that suggests the potential link between low vitamin B levels, high homocysteine, and depression is not strong.

"It remains to be determined whether vitamin supplementation would be an effective adjunctive antidepressant treatment for people with severe depression, and if women would benefit more than men from this therapeutic approach," they write.

The authors have disclosed no relevant financial relationships.

J Clin Psychiatry. 2008;69:1203-1209.
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:

1. Describe the effect of vitamin B supplementation on symptoms of depression in elderly men.
2. Describe the effect of vitamin B supplementation on the likelihood of new depressive symptoms in elderly men.

Clinical Context

Depression is a leading cause of disability, affecting 2% to 5% of the adult population. Some preliminary evidence suggests that deficiencies of vitamin B contribute to the onset and maintenance of depression and its symptoms through an effect on the risk for cerebrovascular disease, and cross-sectional studies suggest that patients with depression may have lower serum levels of B vitamins compared with adults without depression.

This is a 2-year, double-blind, randomized clinical trial conducted in elderly men who were originally recruited as part of a population-based study of abdominal aneurysm screening. The study assesses the role of vitamin B supplementation on depression and new onset depressive symptoms.
Study Highlights

* Included were 299 men aged 75 years or older with a history of hypertension from a pool of 12,203 men in the original abdominal aneurysm screening study in 1 city in Australia.
* The men had been identified from the electronic electoral roll.
* Excluded were those with a BDI score of 18 or higher or significant cognitive impairment defined as MMSE score lower than 24, those with serious illness, and those who were taking vitamin B supplements.
* 150 were randomized to treatment consisting of 1 capsule of 400 μg B12, 2 mg folic acid, and 25 mg B6 daily, previously shown to be effective in lowering homocysteine levels; and 149 were randomized to identical-looking placebo 1 capsule daily for 2 years.
* Assessments occurred at baseline, 6, 12, 18, and 24 months.
* MMSE was used to assess cognitive function.
* Hazardous alcohol intake was defined as more than 4 standard drinks at least 4 times weekly or more than 6 drinks on any single day.
* Primary outcome was BDI score consisting of 21 questions scoring from 0 to 3 each, with scores ranging from 0 to 63.
* BDI scores were categorized in 4 groups of “no to minimal depression,” “mild to moderate depression,” “moderate to severe depression,” and “severe depression.”
* Other outcomes were increase in BDI scores, scores greater than 9 (suggestive of at least mild depressive symptoms), and new onset depressive symptoms.
* Fasting samples were taken for serum B12, total plasma homocysteine, and red cell folate levels.
* Mean age was 79 years, and 8.7% to 13.4% were considered to ingest harmful levels of alcohol.
* The dropout rate was 19.4% with the final analysis based on 241 participants.
* There was no difference between the 2 groups in BDI scores over time or change of scores in each group over time.
* When proportion with BDI scores of 10 or higher were examined, the vitamin B group was 24% more likely to remain free of depressive symptoms (hazard ratio, 1.24), but this was not statistically significant.
* At the end of the study, 79.1% of those receiving vitamin B vs 84.3% of those taking placebo remained free of depression.
* There was no difference in concentrations of B12 and red cell folate or homocysteine levels among men with and without depression.
* The authors concluded that treatment with vitamin B during 2 years was not better than placebo at reducing severity of depressive symptoms or reducing new onset of depressive symptoms in elderly men.
* The authors noted that the effect of vitamin B supplementation as an adjunctive treatment in depression was not known and deserved further investigation.

Pearls for Practice

* Supplementation with vitamin B for 2 years is not associated with reduced depressive symptoms in elderly men.
* Supplementation with vitamin B for 2 years is not associated with lower risk for new onset depressive symptoms in elderly men.

According to this study, which of the following best describes the effect of vitamin B supplementation for 2 years on depressive symptoms in elderly men?
Reduces BDI score
Reduces BDI score only in the first year
No change in BDI score
Reduces BDI score only in the second year

Which of the following best describes the effect of vitamin B supplementation for 2 years on new onset depressive symptoms in elderly men?
Lower risk of new-onset depression
No effect on new-onset depressive symptoms
Lower risk for suicide
Lower risk for depressive symptoms only in those with low folate levels
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CME Author

Désirée Lie, MD, MSEd
Clinical Professor, Family Medicine, University of California, Orange; Director, Division of Faculty Development, UCI Medical Center, Orange, California

Disclosure: Désirée Lie, MD, MSEd, has disclosed no relevant financial relationships.

Brande Nicole Martin
is the News CME editor for Medscape Medical News.