Category: Psychiatry

University of Iowa Psychiatrists Publish Huntington Disease Study Results

I ran across a fascinating story about a study on Huntington’s disease published by members of the University of Iowa Health Care. The study examined how the Huntington’s disease gene might enhance brain development and function early in life prior to the onset of the devastating disease. It was published in The Annals of Neurology:

I also found an abstract for a paper about Woody Guthrie, a famous American musician and activist who was very creative in his early life, but sadly succumbed to the ravages of Huntington’s disease when he was 55 years old. I couldn’t access the full article without paying for it but the abstract was intriguing because I wondered whether the author suspected something similar to the premise of the study:

Ringman JM. The Huntington disease of woody guthrie: another man done gone. Cogn Behav Neurol. 2007 Dec;20(4):238-43. doi: 10.1097/WNN.0b013e31815cfee4. PMID: 18091075. Abstract: Woody Guthrie was an American songwriter, musician, writer, and political activist who died with Huntington disease (HD) in 1967 at age 55. His relatively brief creative life was incredibly productive with countless songs and a tremendous volume of letters to his name. His personal life was similarly driven with Woody having had 3 wives and at least 9 children and an insatiable appetite for traveling the United States. In this essay, I explore Guthrie’s art in relation to the development of the overt behavioral changes and chorea that characterized his illness. Woody’s most productive time artistically was in the 5 years immediately preceding the onset of overt symptoms of HD. I hypothesize that subclinical HD may have been an important driving force behind Woody Guthrie’s creativity.

If anybody knows, please comment.

Woody Guthrie was certainly an important figure in the American history of activism as well as music.

Usually, I would share the music of some of the artists I mention on this blog. On the other hand, one of the co-authors of the University of Iowa paper mentioned above is Doug Langbehn, my former colleague, who’s an accomplished musician and statistician. So instead, I thought I’d share the talent of Doug and his band.

Reading My Old Book in a New Light

Sena bought me a wonderful new lamp to read by and it improves on the ceiling fan light I wrote about the other day (And Then a Light Bulb Went Off).”

The new lamp even has a nifty remote control with which you can choose the ambient feel. There are several selections, one of which is called “breastfeed mode,” a new one on me. There’s a light for that?

The lamp arrived at about the same time I got a notice from my publisher for my one and only book, “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry,” that people are still buying—after 14 years! My co-editor was my former psychiatry department chair, Dr. Robert G. Robinson. As far as I know, Bob has dropped off the face of the earth. I hope he’s well.

Consultation-Liaison Psychiatry is probably about the same as I left it when I retired 4 years ago. I walked all over the hospital trying to help my colleagues in medicine provide the best possible care for their patients. I put in several miles and stair steps a day. I saw myself as a fireman of sorts, putting out fires all over the hospital. I got a gift of a toy fire engine from a psychiatrist blogger in New York a long time ago.

Now I walk several miles on the Clear Creek Trail, like I did yesterday and the day before that. I have shin splints today, which tells me something—probably overdid it.

So, I’m taking a break from walking and reading an old book in a new light.

U.S. News & World Report Ranks Iowa City Hospital in 9 Specialties

The University of Iowa Stead Family Childrens Hospital in Iowa City has ranked in 9 pediatric specialties, including pediatric behavioral health by U.S. News & World Report!

Thoughts on the Big Mo Pod Show “Funkin’ Down the Highway”

This is a post about the Big Mo Pod Show we heard last night on the KCCK FM radio dial 106.9. Incidentally, the KCCK fund drive was enormously successful this year, earning $100,000 in donations, according to Big Mo (aka John Heim) himself.

One item is the cover by Buddy Miles of the song “Tobacco Road.” This rendition was different from performances by other artists. Big Mo liked it and so did I. I did a little web search on it because I couldn’t catch all the lyrics. It was originally done by John D. Loudermilk in 1960. Miles’ version is essentially the same.

What interested me even more about “Tobacco Road” are the associations I have about it with specific literary works. I’ll admit I’ve never read nor seen the film adaptations of Erskine Caldwell’s books, “Tobacco Road” and “God’s Little Acre.” But one of my favorite short stories by James Thurber is “Bateman Comes Home,” which was published in a collection entitled “The Thurber Carnival,” in a hardcover edition in 1945. You’ve got to read it to get a sense of how comical the parody is of the regional dialect used in Caldwell’s novels. In fact, Thurber himself gives the game away about his intent in writing “Bateman Comes Home” by adding a wry comment as a subtitle:

Written after reading several recent novels about the deep south and confusing them a little—as the novelists themselves do—with “Tobacco Road” and “God’s Little Acre.”

He also adds another comment at the end of the short story: “If you keep on long enough it turns into a novel.”

The other thing I noticed about the podcast last night is that one of the songs which was not included in the list, “Joliet Bound,” was performed by an artist I haven’t heard of, the Reverend Shawn Amos, who is no relation to me, of course. But my background as a psychiatrist made me take special notice of details about his family, one of which is that his mother, Shirl-ee Ellis, a singer herself, had been diagnosed with schizoaffective disorder. Sadly, she eventually died by suicide. Shawn Amos is also the youngest son of the Famous Amos chocolate chip cookie founder, Wally Amos (again, no relation), although I’ve gotten a lot of friendly ribbing about that.

The song “Joliet Bound” is about a guy who expresses that he’s wrongly accused of killing a man over a woman and is on his way to Joliet prison in Joliet, Illinois. The Joliet Prison is a tourist destination nowadays and has other distinctions attached to it. It was featured in the 1980 film, the Blues Brothers. There were some famous inmates there, among them John Wayne Gacy, who was once evaluated and diagnosed with antisocial personality disorder by psychiatrists at The University of Iowa in 1968 as described in Dr. Donald Black’s book, “Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy).”

Congratulations KCCK Radio!

FDA Approves Antipsychotic with New Mechanism of Action for Treatment of Schizophrenia

I just noticed the FDA announcment of the approval of an antipsychotic with a new mechanism of action for the treatment of schizophrenia.

The drug is Cobenfy and it interacts with cholinergic rather than dopaminergic receptors. It has a number of side effects which are anticholinergic. This could lead to psychotic symptoms that consultation-liaison psychiatrists might get called to evaluate due to the anticholinergic delirium that could occur, which can mimic psychosis.

It’s easy to get alarmed about the Cobenfy side effects. I just remember all of the side effects of the one antipsychotic that has sometimes been the only effective treatment for patients with treatment resistant schizophrenia-clozapine.

Clozapine has been associated with agranulocytosis, seizures, bowel obstruction, prolonged cardiac conduction time leading to arrhythmias, liver toxicity and more. In fact, clinicians are required to enroll in a Risk Evaluation and Mitigation Strategy (REMS) program to prescribe it.

Patients who have schizophrenia and take clozapine are often admitted to general hospitals for treatment of medical problems which may or may not be directly related to clozapine itself. This requires close collaboration of internists and surgeons with consultation-liaison psychiatrists.

What do you do for patients who don’t respond to clozapine but are willing to take oral medication? There are augmenting strategies, some of which can be helpful although they could add to the side effect burden.

What do you do for a patient with treatment-resistant schizophrenia who refuses to take oral psychotropic medication? In some cases, it may be necessary to use injections of medications which also can have uncomfortable and even potentially life-threatening side effects. This difficult situation is complicated further by the lack of insight some patients have about their illness and the need for court orders to administer antipsychotics against their wishes.

I hope Cobenfy is a step forward for patients and their families.

Notes on the Blues and Rivers of Whiskey

I listened to the Big Mo Blues Show last night on KCCK radio (88.3 on your dial) as I usually do on Friday nights. It runs from 6:00 pm to 9:00 pm and you can learn a lot from Big Mo (aka John Heim) about the blues.

He also has a podcast called the Big Mo Pod Show, which is based on his blues show. He gets quizzed about some of the songs he played on Friday night by Producer Noah (as Big Mo calls him). Last night he was on target for all 5 of the songs he played and why he played them.

One of the songs I’ve never heard before but it was done by Taj Mahal and Keb Mo, artists I’m familiar with just from listening to Big Mo’s show. The title was “Diving Duck Blues. The chorus goes “If the river was whiskey and I was a diving duck, I’d dive to the bottom and I’d never come up.”

That led to a discussion of how alcoholism was sometimes (maybe more than sometimes) a part of the life of blues musicians. In fact, the lead off song last night was “Big Road Blues,” sung by Tommy Johnson. His last name just happens to be the same as Robert Johnson who made the song “Crossroads” famous because he claimed he sold his soul to the devil in order to become a great blues musician. Several blues artists made the claim, which Big Mo debunked as a ruse to get fans to pay more money to hear them perform.

But Tommy Johnson struggled with alcoholism and, according to Big Mo, was driven to the point of drinking Sterno, which was poisonous because it contained methyl alcohol.

This can lead you to think that maybe all blues music is gritty, played by alcoholics, and even depressing as declared by the lead character, Navin Johnson, played by Steve Martin in the movie “The Jerk” (a white guy raised by a black family).

Incidentally, this reminds me that a recent study showing that digital cognitive behavioral therapy is effective for those suffering from alcohol use disorder.

Anyway, blues musicians don’t always play sad, gritty music and die from drinking Sterno. One that is actually funny is “You Left the Water Running” by Otis Redding. You can look up the lyrics or listen to anyone who covers the song and it would be difficult not to laugh out loud.

And speaking of covering a song, Bill Withers originally wrote and sang “Lean on Me” back in 1972 which Keb Mo covered recently. I think it’s one of those uplifting examples of blues music which won’t send you diving to the bottom of any whiskey rivers.

The Incredible Shrinking Headshrinker

Last week we saw the 1957 movie “The Incredible Shrinking Man” on the Svengoolie show on the MeTV channel. We’ve never seen it before and it actually got pretty good reviews back in the day. The main character, Scott Carey, was played by Grant Williams. You can watch the movie for free on the Internet Archive.

According to some interpretations, the story uses the metaphor of diminishing size to highlight the diminishing role of masculinity in American society in the 1950s or human notions in general about one’s self-worth in society.

It got me thinking about how the challenges of adjusting to retirement as a process has been (and still is to some degree) for me. I started out with gradual reduction of my work schedule in the form of a phased retirement contract. It was difficult.

I was reminded of how difficult it was to slow down, especially as a teacher of residents and other health care trainees, when I was going through some old papers after the recent move to our new house. They included teaching awards I’d received over the years.

I was struck by how small my self-perceived role in psychiatry and medicine has gradually become in the last few years. I’ve been shrinking, similar to Scott Carey. In fact, I’m a shrinking headshrinker.

I don’t want to spend too much time ruminating about what retirement means to me. I think it’s a very common response to perceive the world gets smaller when you retire.

It doesn’t help much to intellectualize about shrinking in this way. Scott Carey eventually accepted his diminishing stature, even to the point of disappearance. Grief about this kind of loss is normal, although I’m realizing that grief might never completely disappear.

Can Artificial Intelligence Learn from My Book?

Recently the publisher of a book co-edited by me and my former psychiatry chair Dr. Robert G. Robinson asked me to sign off on a proposal to involve Artificial Intelligence (AI) in using the work.

The book, “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry,” is 14 years old now, but is still a practical tool for learners, at least in my opinion.

Interestingly, it looks like the publisher is also trying to contact Dr. Robinson about the proposal through me. I wonder if that means they’re having as much trouble finding him as I have.

I’ve made it clear that I have misgivings about AI, as I’ve indicated in at least one blog post about Google’s AI, which used to be called, Bard which I think has been renamed Gemini. I think AI is prone to spreading misinformation, which has been called “hallucinations” by some writers.

The publisher makes it clear that this proposal regarding AI involvement in our book is an “opt in” choice. I gather that means if I don’t opt in, they’ll continue to bug me about it until I do.

That’s unlikely to happen.

Thoughts on the Homeless Mentally Ill

The homeless man who lives on the sidewalk outside our hotel reminds me of a couple of things. One is Dr. Gerard Clancy, MD who is University of Iowa Health Care Professor of Psychiatry, Professor of Emergency Medicine, and Senior Associate Dean of External Affairs.

I remember Gerry, who was in the department of psychiatry when I was a resident. I saw his picture in the newspaper and hearing about him riding a bicycle around Iowa City doing a sort of outreach to the homeless mentally ill.

I found an archived article mentioning him published in 1995 in the Daily Iowan. The story starts on the bottom of the front page, entitled “I.C. opens new doors for area’s mentally ill.” It continues on page 9A.

The story mentions Dr. Clancy and what was called then the Clinical Outreach Services and the Emergency Housing Program (EHP). The challenges then sound a lot like what they are now: long waiting lists for psychiatric evaluation and treatment, a lack of funding for the treatment of mental illness, and a lack of preventive care. The most common mental illnesses in the homeless mentally ill are chronic schizophrenia, schizoaffective disorder, and bipolar disorder. The idea of reaching out to them “on their own turf” as Clancy was quoted, was to help them feel more comfortable talking about their mental illness.

The housing situation for this population of those struggling with mental illness was dismal then and it’s still dismal.

The homeless guy I’ve been calling Bob lives on the sidewalk next to a busy street. It’s just my opinion that he’s mentally ill based on my observations of his behavior. I’ve never tried to talk to him. However, Bob gets visits from people who obviously have differing views about the way he lives.

Some of them do talk to him and, although I can’t hear their conversations, the actions tell me important things. Some bring him what I call “care packages,” often food, water, and other items. They may start by acting kind, although may get impatient with him. Others try to clean up his sidewalk, and may criticize him. The police occasionally visit and have so far not taken him into custody.

It looks like things have not changed much since 1995 regarding the homeless mentally ill based on what I write here about my observations. In fact, it’s easy to find current news stories that say things are getting worse.

At the beginning of this post, I said I found a couple of things. The other thing was a very thorough teaching presentation about the current state of formal outreach to this population. It’s available on the web as a power point presentation by another University of Iowa faculty, Dr. Victoria Tann, MD, entitled “Assertive Community Treatment 101.”

Dr. Tann is currently an IMPACT Team psychiatrist. It’s an excellent source of background on the history of this effort at outreach to the homeless mentally ill. It also summarizes what’s happening with the program now.

Alcohol is Bad for Old Guys

I took a quick peek at the study published recently in the Journal of the American Medical Association (JAMA) that a few news agencies are reporting on which says alcohol in moderation is bad for older persons. So much for moderation.

Actually, the full abstract is:

Ortolá R, Sotos-Prieto M, García-Esquinas E, Galán I, Rodríguez-Artalejo F. Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors. JAMA Netw Open. 2024;7(8):e2424495. doi:10.1001/jamanetworkopen.2024.24495

“Conclusions and Relevance: In this cohort study of older drinkers from the UK, even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. The attenuation of mortality observed for wine preference and drinking only during meals requires further investigation, as it may mostly reflect the effect of healthier lifestyles, slower alcohol absorption, or nonalcoholic components of beverages.”

Conclusions: “This cohort study among older drinkers from the UK did not find evidence of a beneficial association between low-risk alcohol consumption and mortality; however, we observed a detrimental association of even low-risk drinking in individuals with socioeconomic or health-related risk factors, especially for cancer deaths. The attenuation of the excess mortality associated with alcohol among individuals who preferred to drink wine or drink only during meals requires further investigation to elucidate the factors that may explain it. Finally, these results have important public health implications because they identify inequalities in the detrimental health outcomes associated with alcohol that should be addressed to reduce the high burden of disease of alcohol use.”

The news stories play a little fast and loose with the headlines, which tend to gloss over the effect of health-related and socioeconomic risk factors. But, there’s no doubt in my mind that most people could do without alcohol.

Personally, I would have a couple of 12-ounce bottles of beers while watching football games or listening to the Big Mo Blues Show on KCCK Blues and Jazz Radio station on Friday nights. I hardly drank at all in terms of the grams per day metric.

But I’ve not imbibed since we got so busy selling our old house and camping out in a hotel while waiting for our new house to be built. Not surprisingly, I don’t miss it. When I was a young guy, I drank more and even smoked cigarettes. That was a long time ago.

In fact, when I look back on those days, I remember the factors that tended to limit my use of those substances. Take cigarettes—to the landfill if you don’t mind. I was what you would call a “sometimey smoker” because after a few days I suffered a sore throat, blunted taste for food, stuffy nose, lower appetite (bad for a baseline skinny guy) and fatigue. I just couldn’t stick with smoking long enough to make it a habit.

I’m going to pick on wine a little because the article alludes to the idea that it might have some health benefit. When I was a kid, I once had a lot too much wine which led to a longstanding inability to even stand the smell of it for years. I still never drink wine.

There are many things that can be habit forming. I’m beginning to wonder if watching Men in Black movies might be one of my weaknesses. I don’t watch any other movies as often as I do the MIB trilogy films. I’ve watched them dozens of times and I don’t have a good explanation for it. I think they’re funny and I can always use a good laugh.

Agent K: After neuralyzing Officer James Edwards, he and Agent K are finishing a meal in a café while K is delivering the punchline to a joke, “Honey, this one’s eating my popcorn! Get it?” Agent K laughs uproariously.

Officer James Edwards: Looking dazed from the recent neuralyzer blast, asks “Who are you?”

Agent K: “You see, James, you are a nice young man, but you—need to lay off the sauce.”

The quote is probably not word for word. I didn’t look it up on the web. It’s just as I remember from seeing the movie so often. And that’s partly because, for the most part, I lay off the sauce.