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Does Walking Speed Predict Dementia?

A new study published in the journal Neurology suggests that a simple test measuring how fast people walk and whether they have cognitive complaints can predict later problems with dementia. The study was conducted by researchers at Yeshiva University's Albert Einstein College of Medicine and Montefiore Medical Centre. Looking at nearly 27,000 older adults on five continents showed that one in ten met criteria for pre-dementia based on walking speed and cognitive complaints. Adults who tested positive for pre-dementia were twice as likely as control subjects to develop dementia over a twelve-year period.

To read more, check out my new contribution to the Huffington Post.

Is There a Link between Dual Trauma and Domestic Violence?

Research indicates a strong connection between a childhood trauma history and the perpetration and victimization of intimate partner violence (IPV) in both men and women. However, it is unknown whether couples in which both partners have trauma history (dual-trauma couples) differ in their experience of IPV. Therefore, a study recently published in Psychological Trauma assessed 473 heterosexual couples in which the man had been court-mandated to treatment for IPV, comparing couples with no self-reported history of trauma, couples in which only the man or only the woman had experienced childhood trauma, and dual-trauma couples. Men in dual-trauma couples reported engaging in more psychological and physical aggression against their partners than did other men, including those who also had a history of trauma but whose partners did not. Men in dual-trauma couples also acknowledged more borderline and antisocial personality features, suicidal ideation, alcohol abuse, and a tendency for more drug abuse and more general violence outside the relationship. However, their female partners described them as less psychologically aggressive than men in couples with no trauma history, as no more physically aggressive, and as less likely to have been arrested for violence or any other offense than men in all other couple categories. Women from dual-trauma couples also reported engaging in fewer help-seeking behaviors than did women without a history of trauma, suggesting their vulnerability to ongoing abuse. Implications for future research and intervention are considered.

For the abstract

Carrying Naloxone

When Constables Kevin Bohn, Richard Calabrese and Thomas Lillagore responded to a well-being check in New Jersey's Cinnaminson Township, they found an unconscious adult male lying on his back, the apparent victim of a heroin overdose.    Since the residence was on the border between Cinnaminson and nearby Riverton Township, police officers from Riverton arrived as well to renter assistance.   Along with rescue breathing, the officers had another medical tool at their disposal.   Having completed training in the use of naloxone  (brand name Narcan) just days before, Riverton patrolman Jeff Walker administered the drug which enablde the victim to awaken and begin breathing on his own.   He was then stabilized and taken to hospital by paramedics. 

"With the ongoing heroin epidemic Narcan is invaluable,” Riverton Borough Police Chief John Shaw said in an interview with local edia.  “As a responding officer it is always valuable to have additional tools to utilize to perform our jobs at the highest level possible. The team work that was demonstrated by the Cinnaminson and Riverton Police officers on scene saved the life of this individual. I’ve always respected the mutual cooperation of our local police departments and this is a fine example of that.”  

Within a few hours of this first incident,  police in nearby Riverside were called to a second incident involving a man who was deemed to have overdosed on heroin.   Narcan helped revive him as well and he was taken to hospital for observation.  Riverside Police Capt. William Eliason praised the officers who intervened.   He told local media, “The mission of our officers is to help the public in any way possible and is our highest priority. Police throughout the State of New Jersey have seen a dramatic rise in drug overdose deaths, and Riverside has not been spared. The Narcan program will undoubtedly save lives. It is the hope of the community and the Riverside Police Department that people suffering from any type of drug or alcohol addiction seek help, and for bystanders to know that they will not be charged with any type of criminal offense for calling 9-1-1 for assistance for any type of possible drug overdose they witness."

First developed in the 1960s, naloxone is an opioid antagonist which can quickly reverse the effects of a heroin or morphine overdose.  Marketed under brand names such as Narcan, Nalone, and Narcanti, naloxone in included on the World Health Organization's List of Essential Medications and is often included in emergency overdose response kits provided to heroin addicts.   Center for Disease Control statistics estimate that as many as 10,000 deaths have been prevented in the Unites States alone. As well, despite requiring a prescription in most places, naloxone education programs are becoming a regular part of paramedic and police training in many U.S. as well as in major cities in Canada, including Toronto.   While other opioid antagonists such  as naltrexone are used for helping addicts manage their long-term addictions, naloxone remains the drug of choice in emergency overdoses.  

Despite increasing use of naloxone by police and paramedics, the U.S.  government has been slow to recommend nationwide implementation of naloxone training programs for police.   State legislation can also prevent police officers from carrying naloxone or discourage witnesses from reporting heroin overdoses due to fear of arrest.   In New Jersey, the Opioid Antidote and Overdose Prevention Act was passed last year to permit police use of naloxone and also providing immunity for overdose victims and witnesses.   Governor Chris Christie has promised that law enforcement agencies in all New Jersey counties would receive training.  

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Revisiting Tarasoff

In 1976, the California Supreme Court ruled that psychotherapists have a duty to protect potential victims if their patients made threats or otherwise behaved as if they presented a "serious danger of violence to another."    In ruling on the case of Tarasoff v. Regents of the University of California, the court determined that the need for therapists to protect the public was more important that protecting client-therapist confidentiality.  

Guided by the court decision, the state of California later passed a law stating that all therapists have a duty to protect intended victims by either warning victims directly, notifying law enforcement directly, or taking whatever other steps to prevent harm might be needed.    Despite the controversy over the circumstances for breaching confidentiality, Tarasoff laws have been adopted across many U.S. states and have guided similar legislation in countries around the world.

The Tarasoff case is based on the 1969 murder of a university student named Tatiana Tarasoff.    The perpetrator, Prosenjit Poddar was an Indian graduate student at the University of California, Berkeley who had met Tarasoff at a folk dancing class on campus.   While they went on several dates, they soon disagreed on the seriousness of their relationship and Poddar became obsessed with her.   When Tatiana rebuffed him, Poddar began stalking her and underwent an emotional crisis for which he began psychological counseling at the university medical centre. 

To read more, check out my new Psychology Today blog post.

Weeding out the Immigrants (Part One of Two)

“Give me your tired, your poor,
Your huddled masses yearning to breathe free,
The wretched refuse of your teeming shore.
Send these, the homeless, tempest-tossed, to me:
I lift my lamp beside the golden door.”

While the famous lines by Emma Lazarus inscribed on the Statue of Liberty continue to proclaim the welcome offered to immigrants coming to the United States, the reality has always been somewhat different.  

Even though potential immigrants traveling in first- or second-class often managed to enter the country with only a rudimentary assessment, passengers traveling in steerage were processed through the immigration station at New York Harbour's Ellis Island.   First opened in 1892, the inpection stations of Ellis Island acted as the central processing point for  millions of immigrants arriving from Europe and other parts of the world    Thorough medical  examinations by physicians appointed by the Public Health Service were required to check for contagious diseases or other medical problems  and immigration officials often relied on medical evidence to weed out "unsuitable" candidates. Based on an 1882 immigration law, any immigrant deemed to be "likely to become a public charge" could be blocked from entering the United States.    That included any medical deformity or condition that would make an immigrant unable to earn a living.   While many physicians objected to their medical findings being used to screen potential immigrants, immigration officials often justified their decision to exclude "unsuitable" immigrants.

In that same legislation, "imbeciles" and the "feeble-minded" were included as being unfit to enter the United States.   Not only were the feebleminded considered to be prone to various social problems including drug abuse and crime, but they also pose a daner to the genetic health of the nation (due to their inferior genes being passed on to future generations).   Immigrants from southern and eastern Europe were regarded as a particular concern for Americans worried about the eugenics of immigration.  

Due to widespread concerns about "feebleminded" immigrants,  having the physicians who examined immigrants test for low intelligence seemed to make good sense to the immigration officials and politicians imposing limits on who could be allowed into the countery.  Except for the problem of how to test for intelllectual problems, that is.  Though early intelligence scales had already been developed for use with children needing special education, providing something equivalent for rimmigrants, many of whom could not even speak Enlish. was more difficult.

It was psychologist, Henry Goddard, who first  traveled to Europe in 1908 to learn how to use the new intelligence test first developed by Alfred Binet and Theodore Simon.  After returning to the United States, Goddard translated and revised Binet's test for use at the training school where he worked.  He also developed an early classification system for the intellectually impaired children at his school, i.e., any children with an intelligence quotient (IQ) of less than 70.   For children with a score between 51 and 70, the term moron was used.   All children with scores btween 26 and 50 were labelled imbeciles and any child with an IQ of 25 or less was labelled an idiot.   Though these are considered offensive terms today, Goddard's classification system matched his own theories about eugenics andhow low intelligence should be dealt with. 

Goddard also established his credentials as an authority on feeble-mindedness through two well-known books highlighting  the genetic risks associated with allowing people of low intelligence to breed.   His 1912 book, The Kallikak Family, traced the genealogy of two branches of one family, one "feeble-minded" and the other normal.    Though modern reevaluation of Goddard's findings suggest that Goddard understated the role of environmental factors, his book proved to be highly influential, especially with early eugenicists such as Madison Grant and Charles B. Davenport.  

Given the concerns over allowing potentially feeble-minded immigrants into the country, it was not surprising that Henry Goddard was invited by the Commissioner of Immigration at Ellis Island to advise staff on the best way of assessing immigrant intellligence.  Though Goddard's initial impression was that concerns about feeble-minded immigrants were likely exaggerated, he conducted tests of his version of Alfred Binet's test for use with immigrants.   Comparing his own test results with what immigration doctors were reporting, Goddard concluded that his own trained staff were more accurate in detecting immigrants with low intelligence.   On that basis, he recommended that Congress allocate funds to provide Ellis Island with staff trained in measuring feeble-mindedness. 

Many of the immigration doctors themselves objected to the use of Goddard's intelligence tests to weed out low-IQ immigrants.   One of them, Howard Andrew Knox, published an article in 1913 in the Journal of the American Medical Association which pointed out how inappropriate it was to use tests developed for schoolchildren on immigrants with limited English skills.   As he pointed out:

To the uninitiated using routine tests for defectives nearly all the peasants from certain European countries appear to be of the moron type; but of course this is a fallacy. If these peasants are questioned about conditions existing in the land from which they come most of them will show average intelligence.

But Knox and his colleagues were still eugenics supporters themslves and endorsed the political call to week out the "feeble-minded".  As he stated in another article  published that same year, it was more important to identify morons than people who were insane since morons would "immediately start a line of defectives whose progeny, like the brook, will go on forever, branching off here in an imbecile and there in an epileptic, costing the country millions of dollars in court fees and incarceration expenses."     All that remained was to come up with a reliable method of identifying these mental defectives.

When Goddard's researchers visited Ellis Island in 1913 to test 165 immigrants, they still hadto decide how to interpret those results.   When Goddard finally published his findings, he stated that a disproportionately high number of immigrants were identified as mentally defective.    In talking about his findings, Goddard stated that "one can hardly escape the conviction that the intelligence of the average ‘third class’ immigrant is low, perhaps of moron grade."  He charitably suggested that this was due to the poor environments from which they had come rather than their genetics though.

But the controversy was only just beginning...

Continue to Part Two

 

Remembering Past Lives and Creativity

Experiencing memories of past lives is anomalous in Western culture. Such experiences may signify an overinclusive cognitive style, associated with creative ability. Accordingly, are reports of past life memory (PLM) associated with creativity? Is PLM associated with measures of overinclusiveness? To investigate these issues, researchers conducted two studies which were recently published in Psychology of Consciousness. In study one, they recruited subjects who reported having recovered memories of previous lives, and compared them to demographically matched comparison subjects on measures of creativity and latent inhibition (LI). Relative to comparison subjects, those reporting PLM had significantly higher scores on a variety of creativity measures, but not significantly higher scores on creative achievement (p = .10). The PLM subjects were significantly more likely to have low LI, an indicator of overinclusive cognition associated with creativity in high-IQ subjects (Carson, Peterson, & Higgins, 2003). Partly replicating Carson et al.’s findings, low LI scores in subjects with high IQ scores predicted high scores on measures of divergent thinking and creativity, but not on a measure of creative achievement. In study two, researachers investigated the prevalence of past life beliefs and PLM among high-creative versus low-creative students. Relative to low-creative subjects, those high on creative achievement were significantly more likely to endorse both past life beliefs and report PLM. Further, both high- (relative to low-) creative achievers and those with PLM (relative to those with no PLM) scored significantly higher on a schizotypal personality measure of overinclusive thinking.

For the abstract

Why We Need Mandatory Psychological Tests For Foreign Adoptive Parents

When two-year-old Maxim Kichigin was adopted out of an orphanage in Russia's far east in 2012, it should have marked the beginning of a new life for him. Instead, the boy, whose name had been changed to Maxim Maravalle, was strangled to death on July 17 of this year at his new home in Pescara, Italy.  <a href="http://en.ria.ru/world/20140721/191066517/Adoptive-Parents-of-Russian-Boy-Strangled-in-Italy-Reported-Kid-Well-Being.html" target="_hplink"> His adoptive father, 47-year-old Massimo Maravalle has been charged with aggravated homicide</a> and police are still investigating the circumstances of the young boy's death.

While Maxim's adoptive parents submitted reports attesting that he was adapting well to his new life in Italy, Russian authorities had no idea that Massimo Maravalle had a history of psychiatric problems or that he was under a psychiatrist's care. Police have interviewed psychiatrist, <a href="http://www.iltempo.it/abruzzo/2014/07/20/maravalle-doveva-incontrare-il-medico-1.1273157" target="_hplink">Alessandro Rossi, and determined that Maravalle had chosen to discontinue his medication several days before Maxim's death as he insisted that he was feeling better</a>. Rossi also stated that he had no role in the adoption process despite being Maravalle's psychiatrist since 2006.   

Previous reports stated that Maxim had a positive relationship with Massimo Maravalle and his wife Patrizia but questions are now being raised about what signs may have been missed. Other witnesses have reported that the suspect had been seen shaking Maxim a few days before his death although it is still unknown whether psychiatric problems contributed to his actions.

To read more, check out my Huffington Post piece here.

Can Better Health Care Prevent Dementia?

Several new studies presented at the Alzheimer's Association International Conference  recently held in Copenhagen, Denmark suggest that lifestyle changes could reduce the risk of developing dementias such as Alzheimer's Disease.     According to a Finnish study, two years of exercise, diet, memory training, and related lifestyle changes can improve memory function in older adults.   As  theresearchers presenting the study results at the conference pointed out, there is no one factor that significantly reduces memory loss but rather a "cocktail" of different lifestyle changes that can help older adults live more productive lives.

As well, research studies are showing a significant decline in dementia rates for the United States, and other developed countries.    A U.S. study concluded that Americans over the age of 60 have a 44 percent lower risk of developing dementia than older adults did thirty years ago.    Possible reasons for this decease can include fewer adults smoking as well as improved outcomes for heart disease and strokes due to reduced blood pressure and cholesterol levels.    While they do not rule out the impact of increasing diabetes and obesity on health problems that can lead to dementia, these results highlight the importance of lifestyle changes.   

Despite these encouraging trends, there are more than five million people believed to have Alzheimer's Disease in the United States alone and 44 million others worldwide.   Cases of dementia are soaring in developing nations due to reduced access to health care and education.   With the number of dementia cases worldwide expected to triple by 2050,  the need for better way of identifying and treating dementia is becoming critical.

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Misdiagnosed Man Sues After 20 Years in a Psychiatric Hospital

A Florida man who was released last year from a Nebraska psychiatric hospital is now suing the hospital and staff for $22 million due to the misdiagnosis that kept him hospitalized for 20 years. John Maxwell Montin, 52, was arrested in 1992 following an incident in which he reportedly approached a southwestern Nebraska house and told the residents that he was claiming the property which had belonged to his ancestors. After an 11-hour standoff with police, which included an exchange of gunfire, Montin received more than 20 charges, including attempted murder and weapons charges.

Despite an alternate version of events read at his trial (which suggested that the homeowners had possessed the weapons), Montin was found not guilty by reason of insanity for false imprisonment and use of a weapon. The jury dismissed all of the other charges. He was then ordered confined to the Lincoln Regional Center in Lincoln, Nebraska. Relying exclusively on initial police reports, hospital staff diagnosed him as suffering from a delusional disorder and treated him with anti-psychotic medication that he eventually discontinued on his own.

To read more, check out my Psychology Today blog post.

Sacrificing Edith (Part 2 of 2)

Continued from Part One

At a special session of the Supreme Court on January 1880, a sanity hearing was held and several medical experts argued that Freeman was fit to stand trial.  John Davis Long, who was governor of Massachusetts at the time, then ordered Freeman sent to the nearby Danvers Lunatic Hospital where he would be held for the next three years.   In a new sanity hearing held in 1883, Freeman insisted that he fully recognized killing his daughter in a  fit of madness.  Stating that his stay in Danvers taught him enough about mental illness to recognize it in himself, he pointed out in his testimony:

"When I got to Danvers, I found a condition of things with which I was wholly unfamiliar.  I found people there who saw God and had communication with Christ, who believe that they were with Christ, who believed they had special revelations, who interpreted signs.  The question arose in my mind, knowing as I did, that these men were insane, unreliable men, many of them filthy and others treacherous, knowing them to be insane, the question arose in my mind whether I was also not insane."  

During his testimony, Freeman wept openly on the witness stand as he described what had led him to kill his daughter.  "I was sent to the insane hospital. and, as I have just stated, I saw my error," he said. "I regret it as the most dreadful act that was ever perpetrated.  I feel that I have been victimized.  I do not blame any person or persons, but I consider it an unfortunate affair from the beginning and for which perhaps no one person has been responsible." 

The prosecutor questining him was very careful to point out the legal implication of Freeman giving in to his religious visions.  To that,  Freeman replied that "I thought we ought to obey God rather than man."   As for the question of remorse, Charles Freeman's answer was likely less than what the courts deemed acceptable: "I can not conceive of an honest man feeling remorse if he acts up to the very highest concept of his duty at the time."   He did feel that he had enough of religion and vowed never to return to Pocasset or the Second Adventists   All that his release plan involved was to find a job and to support his wife and remaiing daughter. 

Harriet Freeman described her husband as being kind to his children and being a good provider for this family.  After his religious conversion in 1879, everything changed.  Not only did he neglect his business and devote himself to Second Adventistism, he also began experiencing visions telling him to send a message  to the world.. His newfound religious enthusiasm certainly caused problems with the rest of his family (his brother-in-law threatened to shoot him at one point due to his proselytizing).  

The presiding judge declared that he had no doubt over Charles Freeman's fitness to stand trial.   That trial was then held in December of  the same year and the outcome was never in doubt.  Not only did the court hear evidence from several medical experts that Freeman had been insane at the time of the murder but even his defense attorney wholeheartedly agreed that he was insane.   

In her own testimony,  Harriet Freeman provided more details about the vision in which he had been told to sacrifice Edith came after several days of going without food and sleep.  Though she admitted to agreeing with her husband that he needed to sacrifice their young daughter, she defended herself by saying that she could not believe that he would ever hurt Edith.   She regarded it as a test of faith, much like Abraham and Isaac, and that God would stop him from going too far.  Describing how her husband had acted on previous occasions, she said that his faith had been tested in the past and that he would not be allowed to do anything to endanger their children. 

On the night that Edith died however, she was told by her husband that God had asked him to make a great sacrifice.  She then saw him "leave the room, and when he came back he had the child in his arms; it was dead; he walked the room with it and prayed and wept; he took it to bed with him and kept it with him all night; the whole scene is like a terrible dream, which one remembers, but can't distinctly connect, and which, when I try to think of it, seems like an awful recollection." 

Weighing all the evidence, Judge Morton declared that he had never seen such a case in which there was no conflict in the testimony.   Since Charles Freeman faced the death penalty for Edith's murder, the judge fully recommended that the jury find him not guilty by reason of insanity.    The jury agreed and returned that verdict after only ten minutes of deliberation.   Charles Freeman was  sentenced to the Danvers Lunatic Hospital for the rest of his life. 

What little information there is on the Freeman case seems to end with his sentencing.  During his trial, he indicated that he functioned well in the Danvers hospital and seemed resigned to work there in one of the jobs assigned to inmates.  I have been unable to find out what became of him and how long he lived after his sentencing.   As well, the fate of Harriet Freeman and her surviving daughter isn't given either.  

While religious fundamentalism is still widespread, the case of Charles Freeman continues to resonates today.   The religious hysteria that apparently drove him to kill his young daughter has its parallels in similar cases, often involving exorcism to "drive out" evil influences.  Still, the death of Edith Freeman provides important lessons in avoiding other tragedies    Not only in terms of watching for the kind of hallucinations and delusions that can lead to murder, but also the bizarre enabling behaviour shown by Harriet Freeman and her husband's fellow believers.  Would Charles Freeman have committed murder without the support provided by Harriet and the others?  And where to draw the line between religious mania and mental illness?

Questions that need to be asked, time and again.