Brainhack 2013

We are thrilled to draw your attention on the upcoming Brainhack 2013, which is being held from October 23-26 at the Centre International d’Études Pédagogiques, Sèvres, France (just outside of Paris).

Brainhack 2013 is a unique workshop with the goals of fostering interdisciplinary collaboration and open neuroscience. The structure builds from the concepts of an unconference and hackathon: The term “unconference” refers to the fact that most of the content will be dynamically created by the participants — a “hackathon” is an event where participants collaborate
intensively on projects.

Participants interested in neuroimaging from any discipline are welcome. Ideal participants span in range from graduate students to professors across any disciplines willing to contribute (e.g., mathematics, computer
science, engineering, neuroscience, psychology, psychiatry, neurology, medicine, art, etc…). The primary requirement is a desire to work in close collaborations with people outside of your specialization in order to
address neuroscience questions that are beyond the expertise of a single discipline.

One should come to brainhack ready to engage into collaborative projects, and with some material (slides, ideas, data, tools) ready to start a project or a discussion panel. Brainhack will build on the successful techniques used in other unconferences to keep the meeting focused and productive. It is possible to start a project and build a team as early as today. Please have a look at the website for information on the conference and a sample of projects (from Brainhack 2012).

The Preliminary Schedule for Brainhack 2013 is available here.

***NEW*** We will be accepting and publishing Brainhack 2013 abstracts. Abstracts should be submitted when you register.

Registration is now open here

Electro-shock therapy sees a resurgence

The procedure is widely accepted by the medical community, although it lingers in the public imagination as a crude medical holdover.

The patients are rolled on gurneys into a small screened-off area at Park Royal Hospital every 15 minutes with assembly line regularity.

One is a woman in her 60s, who, like the others, gets a momentary jolt of electricity sent through her head, causing a brain seizure and her body to tense for several seconds. The hope: That this treatment — the electroconvulsive, or “electro-shock,” therapy — will ease the symptoms of her bipolar disorder that has so far not responded well to drugs.

The procedure, one of thousands performed at Park Royal since the 76-bed hospital opened last year, has worked on the woman in the past, says Dr. Ivan Mazzorana, who performs all of them on patients here. And, he said, it’s likely to do so again.

These days, the treatment goes by its more clinical-sounding acronym, “ECT.”

"When you bring it up, most people say, ‘Oh my God! Not ECT, that’s something from the past,’" Mazzorana said. "It’s a very simple procedure, safer, and it’s a lot quicker than the medication."

Electroconvulsive therapy today is a procedure widely accepted by the medical community and one, absent a rare court order, that is done with patient consent. But it is also a treatment that lingers in the public imagination as a crude medical holdover almost as dated as bloodletting. Many outside of psychiatry are surprised to learn that the procedure still exists at all.

Despite that, ECT has seen a resurgence at many health centers in recent decades, experts say.

Park Royal, the only inpatient psychiatric hospital in Lee County, Fla., has already treated nearly 200 people with ECT, most receiving multiple treatments. The number represents roughly 10 percent of all of Park Royal’s admissions since it opened in early 2012.

The hospital is a for-profit facility owned by the Tennessee-based Acadia Healthcare Co.

Most of those who have received ECT at Park Royal — patient ages have ranged from 18 years to those in their 90s — suffer from severe depression or bi-polar disorders. About 90 percent are inpatients. Others are referred from other parts of Florida, according to the hospital. A few are snowbirds who come in for ETC “maintenance” treatments.

The Mayo Clinic calls the treatment, which has a reported success rate of 70 percent to 80 percent, the “gold standard” treatment for severe depression. The most common side effect, according to proponents, is temporary short-term memory loss.

"I was afraid, to be honest with you," said Ron Spesia, a 71-year-old Fort Myers Beach retiree who suffered a deep, multiyear depression that did not respond to medication. He had 12 treatments and said he started feeling better after the third. "Then one day I decided, ‘Hey, you know what? It’s time to put the big boy pants on and pursue this.’ Smartest move I ever made."

Still, ECT has its critics. Some, including patients of decades past and anti-ECT groups, say it is little more than intentional brain damage. This, despite the psychiatric community’s endorsement of it and positive testimonials from many of the estimated 100,000 Americans who get the treatment each year.

A Fort Myers News-Press reporter was recently allowed to witness about a half dozen such procedures at Park Royal.

But even hospital administrators remain sensitive to the ECT stigma. Though a patient agreed to be photographed during one such procedure, and to have it recorded on video, the hospital overruled that consent.

The hospital also prohibited patient interviews inside the building, though other medical facilities routinely allow such interactions if patients are willing. David Edson, Park Royal’s director of business development, cited concerns about privacy and “the very delicate nature of the ECT treatment.”

Despite that, Mazzorana said he wants to demystify the treatment and those who get it.

"It seems like an extreme, dramatic treatment," Mazzorana said. "It’s a matter of really educating the psychiatric community, so then we can educate patients."

Mundane process

The treatments at Park Royal begin at 7 a.m. Mondays, Wednesdays and Fridays, and continue throughout the mornings. Staff usually see up to 10 ECT patients on these days.

The process bears little resemblance to its horrific depictions in popular culture. At Park Royal, it starts when patients come to a medical preparation area adjacent to the ECT treatment room, where staff hook them up to IVs — they will eventually get medication to paralyze their muscles during the treatment — as well as heart and brain monitors attached to their skin.

After a quick chat with medical staff, who assess their conditions, patients bite down on foam “bite blocks” before they are put fully under.

Flashlight-shaped paddles coated with a blue conductive gel are placed on each temple (bilateral treatment) or one goes on the right temple and one on the top of the head (unilateral treatment), depending on the type of ECT the patients need. Bilateral ECT is recommended in more severe cases of mental illness and may produce more memory loss, experts say.

Following a quick buzzing sound, patients’ bodies tense for about five seconds. Patients typically wake a minute or so after the procedure and are sent off to a recovery area until the anesthesia fully wears off. They remember nothing of the treatment itself.

New patients must typically stay in the hospital for the first half of the standard dozen ECT treatments.

Spesia, the former ECT patient, said the IV injection was the most painful part of the process. The most unpleasant, he said was the hospital stay. Now, months after the process, he said the only lingering side effect has been some short-term memory loss.

"All I can remember is them giving me the rubber bite block and then them putting the (anesthesia) mask on and telling me to breathe deeply." he said. "Absolutely painless."

Nancy Kish, a 74-year-old Fort Myers resident who has received dozens of treatments over the years, said her memory of treatments from years past is fuzzy but her mind is otherwise as sharp as it has ever been. She said the treatment is a better alternative to the high doses of medication she otherwise took, drugs that largely left her bed-ridden.

"I feel pretty good," said Kish. "I get upset easy, and I get anxiety attacks. But other than that, I’m better than what I was."

Much like the therapeutic mystery behind anti-depressant medication experts are not exactly sure why ECT works for some patients.

Mazzorana said two theories dominate: One says that electroconvulsive therapy enhances certain beneficial brain chemicals that are lacking in different parts of the brain. Another states that it causes the release of hormones that have a beneficial effect on mood and promote the growth of healthy brain cells, he said. Other recent research suggests that ECT works by reducing “hyper-connectivity” in the minds of severely depressed patients.

Endorsements

Whatever the exact mechanism, ECT’s endorsements include the American Psychiatric Association, the American Medical Association, and the U.S. Surgeon General.

"When you raise ECT, people’s eyes always roll up in their heads and their family says, ‘Oh my God, you’re a monster!’" said Fort Myers psychiatrist Steve Machlin, who performed the procedure more than a decade ago. "There’s always going to be people on the outside who say it’s not proven but, if you’ve looked at the science, it’s been proven to be effective."

Another Southwest Florida psychiatrist and researcher, Fred Schaerf, said opposition to the treatment is largely anti-psychiatry bias and from the treatment’s early days, when it was performed without anesthesia.

"I think there is a misconception about the treatment — that it’s barbaric, cruel," Schaerf said. "It has to do with that stigma and people’s belief system with psychiatry."

Most insurance, including Medicare, covers the treatment.

Edson, the Park Royal Hospital business development director, said the health center generally charge insurers $500 a treatment, though that does not include the costs of the anesthesiologist and hospital stay. Mazzorana said the total cost is about $1,000.

Opposition

Medical and patient endorsements aside, some patient groups believe it does little more than cause brain damage. A quick Internet search turns up a long list of anti-ECT websites, many of which include testimonials from people claiming to have suffered negative effects from the treatments.

Among the most vocal opponents is the Philadelphia-based National Mental Health Consumers’ Self Help Clearinghouse, which urged the U.S. Food and Drug Administration in 2011 not to reduce federal oversight of ECT devices. It also sharply criticized the Surgeon General’s endorsement of ECT in 1999.

The group points to published studies suggesting that ECT leads to memory loss and may be far more dangerous for the elderly than medication alone. Susan Rogers, the organization’s director, said patients aren’t warned enough about the risks.

"People are not given the opportunity for truly informed consent," said Rogers, who has not had the procedure herself. "People are not advised of the enormous risks as well as the benefits. They’re given a whitewashed version of the facts. They’re not told it might cause permanent cognitive impairment, and I think that’s wrong."

She said she is not opposed to the treatment itself.

"Apparently about 100,000 people a year receive ECT in the United States and, I’m sure for many of those people, they’re satisfied with those results," she said. "There are also many people who feel that ECT has destroyed their lives."

The psychiatric community commonly uses the one in 10,000 patients mortality figure (or one per 80,000 treatments), figures anti-ECT groups say dramatically under-estimate the risk, particularly among older patients. A 1995 USA TODAY investigation found that it may have been as high as one in 200 among elderly patients, based on some state reports at the time and some earlier studies.

A recent Department of Veterans Affairs review of ECT between 1999 and 2010 found no ECT deaths at VA hospitals during that period. It placed the mortality risk at one per 14,000 patients, or one per 73,400 treatments.

Florida does not closely track ECT usage. But Texas, which does, reported that none of the 2,079 patients receiving ECT last year died during the procedure. Two died shortly after treatment in 2012, the state report noted, but neither case was related to the treatment.

Five years of reports show that roughly 2 percent of patients experience some level of memory loss shortly after treatment.

None of Park Royal’s ECT patients have died during the procedure, said Christina Brownwood, the hospital’s ECT coordinator. Nor have any needed emergency medical care immediately after a treatment, she said.

Think twice, speak once: Bilinguals process both languages

Bilingual speakers can switch languages seamlessly, likely developing a higher level of mental flexibility than monolinguals, according to Penn State linguistic researchers.

"In the past, bilinguals were looked down upon," said Judith F. Kroll, Distinguished Professor of Psychology, Linguistics and Women’s Studies. "Not only is bilingualism not bad for you, it may be really good. When you’re switching languages all the time it strengthens your mental muscle and your executive function becomes enhanced."

Fluent bilinguals seem to have both languages active at all times, whether both languages are consciously being used or not, the researchers report in a recent issue of Frontiers in Psychology. Both languages are active whether either was used only seconds earlier or several days earlier.

Bilinguals rarely say a word in the unintended language, which suggests that they have the ability to control the parallel activity of both languages and ultimately select the intended language without needing to consciously think about it.

The researchers conducted two separate but related experiments. In the first, 27 Spanish-English bilinguals read 512 sentences, written in either Spanish or English — alternating language every two sentences. Participants read the sentences silently until they came across a word displayed in red, at which point they were instructed to read the red word out loud, as quickly and accurately as possible. About half of the red words were cognates — words that look and sound similar and have the same meaning in both languages.

"Cognate words were processed more quickly than control words," said Jason W. Gullifer, a graduate student in psychology, suggesting that both languages are active at the same time.

Participants in the second experiment performed the same tasks as those in the first experiment, but this time were presented one language at a time. The second experiment’s results were similar to the first, suggesting that context does not influence word recognition.

"The context of the experiment didn’t seem to matter," said Gullifer. "If you look at bilinguals there seems to be some kind of mechanistic control."

In longterm relationships, the brain makes trust a habit

After someone betrays you, do you continue to trust the betrayer? Your answer depends on the length of the relationship, according to research by sociologist Karen Cook of Stanford University and her colleagues. The researchers found that those who have been deceived early in a relationship use regions of the brain associated with controlled, careful decision making when deciding if they should continue to trust the person who deceived them. However, those betrayed later in a relationship use areas of the brain associated with automatic, habitual decision making, increasing the likelihood of forgiveness. The study appears in the Proceedings of the National Academy of Sciences.

Cook and her team wanted to understand why some people choose to reconcile after they’ve become victims of betrayal, but others don’t. They hypothesized that if the relationship formed recently, the victim will engage in conscious, deliberate problem solving when deciding how to respond to the deceit. On the other hand, if the relationship has existed for a long time, the victim will take trustworthy behavior for granted and consider a breach of trust an exception to the rule.

To test their hypothesis, the team performed an online experiment, using subjects recruited through an internet survey provider. Each subject received eight dollars and could either keep the money or give it to an unseen partner. If the subject gave the money away, its value would triple. The partner would then decide whether to keep it all or give half back to the subject.

Unbeknownst to the subject, the partner was really a computer, sometimes programmed to betray the subject early in the game and sometimes programmed to betray the subject later. Cook’s team found that after an early betrayal, the subject would be more likely to keep the money than after a late betrayal.

When the team repeated the experiment in a laboratory, with subjects hooked up to fMRI scanners, the anterior cingulate cortex, associated with conscious learning, planning and problem solving, and the lateral frontal cortex, associated with feelings of uncertainty, became more active after early betrayal. In contrast, the lateral temporal cortex, associated with habituated decision making, became more active after late betrayal.

As with the first experiment, an early betrayal increased the likelihood of the subject holding onto the money in later rounds. Early betrayal also increased the amount of time taken to make a decision, suggesting that victims of early betrayal were putting more conscious thought into their decisions than victims of late betrayal were.

The researchers hope their study will increase understanding of why some victims of deceit continue to forgive those who deceived them.

Space around others perceived just as our own

A study from Karolinska Institutet in Sweden has shown that neurons in our brain ‘mirror’ the space near others, just as if this was the space near ourselves. The study, published in the scientific journal Current Biology, sheds new light on a question that has long preoccupied psychologists and neuroscientists regarding the way in which the brain represents other people and the events that happens to those people.

"We usually experience others as clearly separated from us, occupying a very different portion of space," says Claudio Brozzoli, lead author of the study at the Department of Neuroscience. "However, what this study shows is that we perceive the space around other people in the same way as we perceive the space around our own body."

The new research revealed that visual events occurring near a person’s own hand and those occurring near another’s hand are represented by the same region of the frontal lobe (premotor cortex). In other words, the brain can estimate what happens near another person’s hand because the neurons that are activated are the same as those that are active when something happens close to our own hand. It is possible that this shared representation of space could help individuals to interact more efficiently — when shaking hands, for instance. It might also help us to understand intuitively when other people are at risk of getting hurt, for example when we see a friend about to be hit by a ball.

The study consists of a series of experiments in functional magnetic resonance imaging (fMRI) in which a total of forty-six healthy volunteers participated. In the first experiment, participants observed a small ball attached to a stick moving first near their own hand, and then near another person’s hand. The authors discovered a region in the premotor cortex that contained groups of neurons that responded to the object only if it was close to the individual’s own hand or close to the other person’s hand. In a second experiment, the authors reproduced their finding before going on to show that this result was not dependent on the order of stimulus presentation near the two hands.

"We know from earlier studies that our brains represent the actions of other people using the same groups of neurons that represent our own actions; the so called mirror neuron system", says Henrik Ehrsson, co-author of the study. "But here we found a new class of these kinds of neuronal populations that represent space near others just as they represent space near ourselves."

According to the scientists, this study provides a new perspective that could help facilitate the understanding of behavioural and emotional interactions between people, since — from the brain’s perspective — the space between us is shared.