May 2017

Derek K. Tracy, Dan W. Joyce, Sukhwinder S. Shergill

Full text: The British Journal of Psychiatry May 2017, 210 (5) 375-376; DOI: 10.1192/bjp.210.5.375

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May’s Kaleidoscope column in the British Journal of Psychiatry looks at long-term outcomes in individuals who were severely neglected as children. 
We all recall the horrors of the Romanian orphanages discovered on the toppling of Ceauşescu’s regime in 1989: many were starving and had had little or no human contact – it is difficult, and distressing, to imagine what they went through in their young lives. You may also remember how numerous such children were brought to the UK (and other countries) and adopted by loving families; indeed, there were early reports of near-miraculous rapid improvements in children who hadn’t been speaking. A very moving paper from The Lancet asked ‘what next’, and reports on the well-being of those who migrated to this country: they are now in their early to mid-20s. The amount of time spent in severely deprived care appears to be an important modifier of outcome: those who spent six months or less in such an environment showed similar levels of psychological functioning to their British counterparts – in other words, no long term remnants of harm. However, those who spent more than six months (and some endured many years) had persistently greater rates of attentional deficits and disinhibited social behaviour, fewer educational attainments, and high rates of unemployment and use of mental health services. The world around us looks, if anything, even less stable in 2017 than it did in 1989, and how many children are needlessly suffering across the globe today? I remind you to look outwards, with kindness, in politically introspective times.

Neurofeedback training is a niche field, but has some strong proponents: do you know what it is? 
The principle is that individuals are trained, via a specific protocol, to recreate a particular pattern of EEG (‘brain wave’) activity. Why? Because this is particular pattern is associated with relaxation and inhibited movements: in other words, it makes individuals model a state of mind associated with relaxation. It is therefore postulated that this might help manage some problems such as inattention, insomnia, and epilepsy. A problem has been that while there have been some interesting findings in the neurofeedback field, it has faced the repeated criticism of study design, especially the blinding of researchers and participants (most people know they’re getting a ‘relaxation intervention’). A new study in Brain undertook the first double-blind protocol in insomnia, with half the participants receiving a sham intervention (it had nothing to do with producing the brain-wave pattern). The outcome? Both groups – those who had neurofeedback, and those who just had a form of relaxation training not involving changing brain-wave patterns - showed equal improvements in sleep. The authors put forward a strong case that the gains from neurofeedback are due to the softer unintentional inputs of trust, care, and empathy, not the technique itself. A tough message to neurofeedback practitioners, but in the scientific world of “null hypotheses”, the onus is now on them to answer.

Finally, are people who own cats really the same as the rest of us? “Mad cat ladies” (it’s always women, why is that?) are a cultural staple, influencing everything up to the Simpsons. 
Concerningly, there may be some science behind this. Cats host the parasite Toxoplasma gondii: this parasite can only reproduce in the cat, but it can infect other hosts, including humans. Once in the human blood stream, it can make its way to the brain and form cysts. Pretty unpleasant, and, this has been linked with several mental health sequelae, including OCD and psychosis. In fact, there is a morbidly fascinating hypothesis, worthy of a horror film, that any resultant obsessional behaviour may be behind the actions of those individuals who hoard cats: in other words, the parasite makes you get more moggies for it to infect….Casting the cold eye of science on these fervent speculations, a team from UCL undertook a large cohort study on the links with psychosis. They found…no link. Cat owners are off the hook. For now.