This document discusses problem gambling from the perspective of general practitioners. It provides context on the prevalence of problem gambling in Australia. Experts note it can be difficult to diagnose due to lack of physical signs and ability of gamblers to conceal debts. Key signs of problem gambling outlined include stress, financial issues, relationship problems and neglect. The article discusses pathological versus problem gambling and notes comorbid conditions like depression are common. Experts emphasize the important role general practitioners can play in screening for problem gambling due to often being patients' primary point of contact within the healthcare system. Educating GPs on signs, criteria and management is seen as key to early identification and treatment.

1. clinical review ondeeperpalpation 25
inside
istockphoto/mO montage
UPDaTe
stroke management 27
real caSeS
A Gp reassesses their
chance addiction
diagnostic tools after a
close call 31
Gambling is as a psychologist and co-direc- with the conflict of suffering the DSM-IV, both pathological and
prevalent a health tor of the University of Sydney consequences that arise – criti- problem gambling can be diffi-
Gambling Research Unit, says cism from family and financial cult to diagnose says Professor
problem as type 2 it is important to distinguish implications – and the excite- Blaszczynski.
diabetes. So how between pathological and prob- ment they experience.” “Unlike alcohol or substance TravellerS’ cHecKS
do you identify lem gambling. Professor Shane Thomas, abuse, the physical signs are not Health measures for
those at risk early “Pathological gambling is a director of the Primary Care evident, and often gamblers are visitors to madagascar 33
recognised psychiatric condition Research Unit at Monash quite adept at concealing the
and efficiently? and is included as a disorder of University, says the best way to debts from their partner.
Nicole Vanderkroef impulse control,” he says. understand the issue is to con- “So is it often a major shock SeXUal HealinG
investigates. “To meet the criteria for this sider the DSM-IV criteria par- to the family and that has major should older women
receive the HpV vaccine?
I
diagnosis, a patient must meet ticularly in regard to patients ramifications in terms of trust in
N our everyday lives gam- as least five out of the 10 crite- displaying some of the com- their relationships.” 34
bling is around us, even if ria for pathological gambling as mon co-morbidities of problem
we don’t particularly go outlined in the DSM-IV. gambling. PSycHOlOGical PrOBlemS
looking for it. One of the “There is also a broader cat- “There are certain conditions Professor Blaszczynski says that
JOUrnal GraB
biggest events in any office cal- egory of people who are con- that are highly co-morbid with gambling often has psychologi- the health legacy of
endar is Melbourne Cup day. We sidered ‘problem gamblers’, problem gambling but were not cal co-morbidities, and can be hormone replacement
see the lottery drawn each week. and these are people who expe- previously recognised,” he says. used by some patients as a poor therapy 37
And poker machines greet us in rience some degree of harm as “If a patient displays condi- coping mechanism to deal with
pubs and clubs. a result of their behaviour but tions such as depression and/or their depression.
So in some ways, it’s no may not necessarily evidence any hazardous alcohol use, there is “The person may be depressed
wonder that 2.5%-5% of the impaired control. a reasonable chance they could and experience stresses or peri-
Australian population display “These people may enjoy also be affected by problem ods of boredom, and then for a
at-risk gambling behaviour. gambling, and gamble more than gambling.” variety of reasons end up gam-
And some studies suggest that they can afford, but are faced But despite criteria such as the bling,” he says. “Over time they
the prevalence of problem gam- gamble more, and as a result
bling exceeds that of stroke and Key signs of problem gambling become more depressed and start
coronary heart disease.1 to chase their losses, which sends
In 1999, the AMA released a THE Victorian government’s problem gambling fact sheet for them into a downward spiral.
position statement recommend- GPs suggests a few key signs of problem gambling. These “In other cases, people see
ing that medical practitioners include: gambling as a source of income
regularly screen patients at risk • unexplained stress, anxiety or sleeplessness and believe they’ll win. They’ll
of problem gambling or display- • poor health or nutrition start to lose their money, so they
ing associated symptoms.2 • ongoing financial problems that can’t be logically explained escalate their gambling in a vain
So what exactly is the nature • relationship issues that seem to involve a lack of trust in his/ attempt to win their money back
of problem gambling as a dis- her partner and as a consequence become
order? And how can diagnosis • feelings of guilt related to mood swings, anger or frustration depressed and may get involved
and treatment be made more vented at family or friends in substance abuse.”
simple and clear in a time-poor • parental neglect issues in the family Dr Dan Riddle (PhD), a
environment? • very little food, utilities or furniture in the house. psychologist and professional
Professor Alex Blaszczynski, > page 26
12 september 2008

2. 26 ondeeperpalpation clinical review
> from page 25 began stealing money from her about lifestyle behaviour in a [gambling] problem.”
development officer for the workplace to pay the debts. standard consult. Dr Riddle emphasises that DSm-iv criteria for
Melbourne General Practice “So it’s important to look at They’ve developed a one-item gambling is not just a financial pathological gambling
Network, agrees that problem the root cause of the problem,” screen for general practice, and or psychological problem but
1. Preoccupation with
gambling can stem from an exist- Dr Riddle says. “And the doctor say that simply asking a patient also a health problem, and often
gambling
ing source of stress. will need to use his or her experi- “Have you ever had a problem the GP will be the first and only
2. Increasing need to
He gives the example of a ence and expertise to determine with your gambling?” could port of call.
gamble to generate
40-year-old female patient who which is the primary issue and make all the difference. “A GP might be the only
excitement
had developed a gambling prob- what is secondary.” “When people are asked this health professional that a patient
3. Repeated unsuccessful
lem with poker machines. question, they are inclined to is in touch with,” he says. “And
efforts to control, cut back
At the time, she lived across One-iTem Screen answer truthfully,” Professor often they are well trusted by the
or stop gambling
the road from her mother-in-law, Professor Thomas, along with Thomas says. patient. So the impetus is to train
4. Restlessness or irritability
who was very intrusive in her his colleges Professors Leon “They go along to their GP and empower GPs with informa-
when attempting to cut
life. She began gambling as an Piterman and Alun Jackson, feeling unwell, and in the back tion, because they are the ones
down or stop gambling
escape from the tension at home, suggest GPs include a question of their mind they kind of hope on the frontline.”
5. Escaping from problems
but this soon escalated and she about gambling when they ask that the doctor will pick up their However, he also acknow-
or of relieving a dysphoric
mood through gambling
6. “Chasing” one’s losses
7. ying to family members,
L
therapist or others to
conceal gambling
8. Committing illegal acts to
finance gambling
9. Disruption of significant
relationship
10. Relies on others to
provide money to relieve
a desperate financial
situation.
ledges that effective education
can be a “minefield” because
GPs are already overloaded with
so much information.
The trick, he says, is to pro-
vide training that gives doctors
a broad sense of the problem
and then follow this up with con-
cise, practical and easily access-
ible reference material.
Dr Riddle says a great exam-
ple of this is the Solution for
Problem Gambling program,
which was launched by the
Melbourne General Practice
Network in conjunction with the
Victorian government in June
this year. The program provides
a resource kit and training sup-
port to divisions to help GPs in
the identification and manage-
ment of patients with problem
gambling.3
Professor Blaszczynski agrees
that GPs are in an ideal position
to identify patients that may oth-
erwise go undiagnosed.
“Often patients will present at
a GP with symptoms of insom-
nia, anxiety or stress-related
problems, and because of the
social stigma associated with
gambling, they’ll often fail to
disclose that [gambling] is the
cause of it,” he says.
He says that the important
issue is not whether a patient
would or wouldn’t disclose that
they have a problem with gam-
bling, but rather being able to
give the patient an opportunity
to talk about it.
“Most patients want to talk
about their gambling,” he says.
“Sometimes all they really need
is to be asked.”
References available at
www.medicalobserver.com.au

3. Three
part
clinical review ondeeperpalpation 27
series
inside
UPDaTe
Anxiety disorders
in children and
adolescents 29
real caSeS
The tragic conclusion
to the story of refugees
maria and Francine 35
Dreamstime.com
complementary practice SKin DeeP
A patient is concerned
Complementary medicines are gaining in popularity with patients. But can doctors embrace them
and still provide optimum care? In part one of a three-part series, Nicole Vanderkroef investigates. about holes on the soles
of the feet 40
MENTION complementary and news stories about CMs, them. The majority of GPs therapy we are talking about.”
medicine (CM) in conversation they are looking to their doctors reported that they needed to Dr Kotsirilos says it is espe- TravellerS’ cHecKS
and the idea is likely to stimulate for help in wading through all look for CM information every cially crucial to assess not only What can be done to
a range of responses. the information. few months or less. When they the evidence, but also whether
At one end of the scale, it A recent study of 612 Aus- did look, it was mostly about the the treatment carries a high
prepare the last-minute
can conjure up visions of witch- tralian users of CMs found con- safety and effectiveness of CMs, or low risk for adverse reac- traveller? 39
doctors mixing exotic herbs, or sumers most frequently sought and respondents rated CM text- tions and interactions with
fortune-tellers making incanta- information from friends and books, specific websites, Internet pharmaceuticals. GP TiP
tions over crystals; at the other family on CMs but would pre- searches, CM journals and drug “Clinical experience and The bbQ system of
end, discussion might hinge on fer to get this information from information phone services as patient feedback play an impor-
grading meat has a
the latest randomised trial of an their doctor or pharmacist.2 the most useful sources. tant part,” she says. “But in my
arthritis treatment. This shift has also created a practice, I am obviously going to novel medical use 41
As the older stereotypes dis- change in attitude among some DiSTinGUiSHinG THeraPieS [use] those treatments that have
appear, the attitudes of patients doctors, and a strong demand by The sheer volume of comple- stronger supporting evidence and
and GPs are changing fast. CM GPs for reliable and easily acces- mentary therapies creates prob- pose low risk to patients.”
is becoming better understood sible information on the efficacy lems for GPs trying to determine The downside is that this
and more widely accepted, and and risks associated with com- which are backed by evidence. takes time, and Dr Kotsirilos
patients have begun to believe plementary therapies. For this reason, Dr Vicki points out that this can be a sig-
there might be benefits in using In March this year, the Kotsirilos, founding president nificant drain on doctors.
therapies such as acupuncture National Prescribing Service sur- of the Australasian Integrative “Time is a significant factor
or natural supplements to treat veyed a random sample of 4032 Medicine Association (AIMA), for doctors – time to educate
some conditions. GPs to find out exactly what says it’s important to be able to themselves about evidence-
Data on the use of comple- their attitudes were towards distinguish each category of CM based complementary therapies,
mentary therapies support this CMs, their current CM prac- and assess each individually. and the longer time required to
growing trend. Approximately tices, the type of information “There are many types of address them in a consult.”
67% of Australians used CMs they were interested in and how therapies – some are evidence- In Australia, the National
in the past year,1 and that figure they accessed it. based and some not,” she says. Institute of Complementary
is expected to continue to rise. Preliminary results showed “Bunching them all together Medicine attempts to make this
So it probably comes as no sur- that 91.8% of GPs sought in one category obscures which is easier by splitting CMs into four
prise that, while patients are fac- information about CMs when which. That’s why it’s important categories, along the lines of its
ing a barrage of advertisements patients said they were using to be clear about which type of > page 28
7 November 2008

4. 28 ondeeperpalpation clinical review
> from page 27 practices involve tactile ther- level of acceptance is evident for This growing support has
US counterpart, the National apies and structured exercise CMs such as reiki, homeopathy, also been reflected among med- CASe STuDy
Center for Complementary and regimes, such as chiropractic reflexology and applied kinesiol- ical professional organisations.
Alternative Medicine:3 medicine, yoga and tai chi. ogy, with doctors less confident In 2002, the Australian Medical DR Vicki Kotsirilos recalls a
• Mind-body medicine describes • Energy medicine involves the of their efficacy and safety.4 Association released a formal patient with dysmenorrhoea
techniques designed to enhance use of energy fields, as in reiki The literature indicates that position statement on CMs and PMS. The 22-year-
the mind’s capacity to affect and qigong. Australian doctors do recom- which recognised “that evidence- old woman had displayed
bodily function and symptoms. mend CM therapies, either by based aspects of complementary symptoms of these
These include meditation and an imPorTanT cHoice referral or, to a lesser degree, medicine are part of the reper- conditions from menarche,
therapies using creative outlets Keeping the above definitions in by practising in the area them- toire of patient care and may and required NSAIDs and
such as art, music or dance. mind, GPs have shown a prefer- selves. And, while a recent sur- have a role in mainstream medi- bed rest to manage the
• Biologically based prac- ence for certain types of CM. vey revealed it’s unlikely the use cal practice”.5 symptoms.
tices use substances found in Acceptance of acupunc- of CMs could be considered a The RACGP/AIMA joint Several complementary
nature, such as herbs, foods ture, hypnosis and meditation ‘normal’ part of medical practice working party recognises that therapies were
and vitamins. by Australian doctors is rela- in Australia, a minority of GPs evidence-based aspects of CM are recommended. These
• Manipulative and body-based tively high. In contrast, a lower actively practice in the area.4 part of the repertoire of patient included regular exercise;
stress management
and muscle relaxation
techniques; a diet high
in plants, legumes, fish,
vegetables and fruits;
low doses of calcium and
magnesium; and the herb,
Vitex agnus-castus.
After two months,
the patient reported a
significant reduction in the
severity of her symptoms
and no longer required
NSAIDs to manage the pain.
care in mainstream medical prac-
tice. It also points out that it’s
essential for consumers and GPs
to have access to quality infor-
mation about CMs so that they
are empowered to make well-
informed treatment choices.
line in THe SanD
Dr Kotsirilos says it’s important
that GPs integrate evidence-
based CMs into their practices
to give patients more choice.
“[CMs] should work in con-
junction with conventional
medicine rather than opposing
it,” she says. “Treatments like
evidence-based nutritional and
herbal medicine can comple-
ment [conventional medicine]
but should not replace it.”
Professor Marc Cohen from
the School of Health Sciences
at RMIT University echoed
these views in an article for the
Medical Journal of Australia.7
“Ultimately, medicine has a
single aim: to relieve human suf-
fering. When measured against
this benchmark, different thera-
pies can be seen as either effec-
tive or ineffective, rather than
orthodox or unorthodox.
“No single professional group
has ownership of health, and the
best health care requires a multi-
disciplinary approach. Thus,
there is an imperative for all
healthcare professionals to work
together [to] benefit their patients
and the wider community.”
References available at
www.medicalobserver.com.au
NEXT WEEK: Part 2 – Herbs,
supplements and acupuncture.

5. One size fits all?
Medical Observer Friday, 21 March 2008
http://www.medicalobserver.com.au/Clinical/0,1734,2278,21200803.aspx
The mantra is eat less and exercise more to combat obesity. But are lifestyle
changes the best solution for everyone? Nicole Vanderkroef investigates.
AUSTRALIANS are on a metaphoric treadmill – and not in a good way.
For the past 20 years we have been told to eat less and exercise more, and yet the national obesity rate
continues to rise.1
For some reason, despite all the information available to the public, people are unable to successfully
lose weight.
Governments have suggested a variety of solutions with varying success. The former Howard
Government announced a funding plan of more than $37 million for 320 local programs promoting
healthy and active lifestyles last October.2
And the newly elected Rudd Government committed $1.7 million over four years in its The First 100
Days report to evaluate best practice in community-based obesity
prevention programs around the country.3
But are these programs focusing on lifestyle changes the best solution for all Australians, especially
those at the higher end of the obese range?
WHY WEIGHT?
Throughout the medical fraternity, doctors agree that there are a number of reasons why people become
obese in the first place.
Dr Tim Gill (PhD), executive officer of the Australian and New Zealand Obesity Society, says it is
simply a matter of energy balance.
“When it comes down to it, all people who put on weight are in a positive energy balance – they
consume more than they burn off,” Dr Gill says. “But the reasons why people do this are more
complex.”
Professor Joseph Proietto, head of the Weight Control Clinic at Austin Health, Melbourne, cites a fall
in the hormones leptin and cholecystokinin and a rise in ghrelin, which occur following weight loss, as
playing a major role in preventing people from losing weight.
“Bariatric surgery may do more than just reduce the physical size of the stomach,” Professor Proietto
says.
“It appears that a band around the upper part of the stomach sends a signal to the brain to suppress
hunger.”
He also says that there is more and more evidence that genes could be permanently turned off by
environmental factors. He quoted examples of studies that have shown malnourished expectant
mothers are more likely to produce obese children, and studies in rats that support the epigenetic
features of obesity.
Dr Vicki Kotsirilos, GP and founding president of the Australasian Integrative Medicine Association
(AIMA), says the relationship between hormones and weight is complicated.
“Your weight affects your hormones, and your hormones can also affect your weight – it works both
ways,” she says.
She says that stress can also be a factor for weight gain, and it has been shown that excess cortisol
levels produce weight gain. Stress can also cause emotional eating and bingeing.
Dr Kotsirilos pointed to two studies that cite the role of soft drinks and green tea in controlling weight.
Framingham Study researchers found individuals consuming ≥1 soft drink per day had a higher
prevalence of metabolic syndrome than those consuming <1 soft drink per day.
And on a four-year follow-up of patients, new-onset metabolic syndrome developed in 765 (18.7%) of
4095 participants consuming <1 drink per day and in 474 (22.6%) of 2059 persons consuming ≥1 soft
drink per day.4
A study in healthy Japanese men found 12 weeks of daily consumption of oolong tea, containing 690
mg catechins from added green tea extract, reduced body fat.5
However Dr Gill, Dr Kotsirilos and Professor Proietto all agree that each patient will have different
reasons behind their obesity and will therefore require different treatments, especially those with a BMI
higher than 35.
PLAN OF ATTACK
Dr Vicki Kotsirilos says that a patient’s lifestyle has to be assessed and changed first and foremost.
“It may take several consults to assess how much a patient has to change their lifestyle, and whether
they have any existing medical problems,” she says.

6. She adds that if she makes a plan with a patient to introduce lifestyle changes, and the patient doesn’t
lose any weight, she would then ask them to complete a food diary over 3-5 days.
“There is a lot of misinformation out there in terms of what actually are low-calorie foods and portion
control,” she says. “This is where there is a place for bariatric surgery – when lifestyle changes alone
have failed to make a difference.”
Professor Joseph Proietto agrees. “For people that are only mildly overweight, lifestyle changes should
be the only option,” he says.
“But for people that are severely overweight, with a BMI higher than 35, relying on lifestyle changes
alone is unreasonable.”
Associate Professor Xianqin Qu, from the Department of Medical and Molecular Biosciences at the
University of Technology, Sydney, says that there are two types of obesity: primary obesity, which
occurs due to lifestyle factors, and secondary obesity, which is caused by other factors, such as a
medical condition, hormone imbalance or genetics.
She says that each type of obesity needs to be treated differently, and in her experience, many of her
patients have benefited from natural and alternative therapies as a supplement to conventional
medicine.
Dr Gill says it’s strange that if a patient comes in with high blood pressure and fails to make lifestyle
changes, you don’t think twice about prescribing medication. But with obesity, we are reluctant to do
so.
Another problem Dr Gill identifies is our culture. He says that being overweight has been normalised,
and often people think that because they are not morbidly obese, that their excess weight will not
gravely affect their health.
“TV shows like The Biggest Loser reinforce the notion that only very large people have negative
outcomes from their weight,” Dr Gill says.
“It’s a case of ‘them, not me’.”
Dr Kotsirilos agrees. “The Biggest Loser gives people unrealistic expectations. In that show, people are
in a highly supported environment. But in reality, most people don’t have access to that.”
KEEPING IT OFF
Professor Proietto says there is another reason why TV shows like The Biggest Loser are a problem.
“The Biggest Loser sends the wrong message to people who are trying to lost weight,” Professor
Proietto says.
“It doesn’t show the biggest battle of all – keeping the weight off.”
Accordingly, Dr Kotsirilos argues that when treating a patient for obesity, you need to look at the
whole picture.
“We need holistic approaches to weight loss,” Dr Kotsirilos says.
“That’s what makes the real and long-lasting difference to patient’s lives.
“As GPs, we are in an ideal position to treat each person on an individual level,” she says.
“And the best way is to function as part of a team to promote the right message to patients.”
Dr Gill says offering financial benefits for GPs would make a great difference.
“At the moment, there are actually disincentives for GPs to treat obesity, because it is time consuming
and leads to over-servicing,” he says.
He adds that GPs are in a prime position to help prevent obesity because they are often the first port of
call for patients.
“The sooner we recognise the complexity of the problem on a national level,” he says, “the sooner we
will start to make some real gains in this area.”
References
1. World Health Organization (WHO) 2006, Chronic Disease Information Sheets: Physical Activity,
accessed 7 March 2008
2. Former Minister for Health and Ageing Tony Abbott, Media release 12 October 2007, accessed 7
March 2008
3. Australian Government, February 2008, First 100 Days: Achievements of the Rudd Government,
accessed online 7 March 2007
4. Dhingra R, et al. Soft Drink Consumption and Risk of Developing Cardiometabolic Risk Factors and
the Metabolic Syndrome in Middle-Aged Adults in the Community. Circulation, 2007;116:480-88
5. Nagao T, et al 2005. Ingestion of a tea rich in catechins leads to a reduction in body fat and
malondialdehyde-modified LDL in men. The American Journal of Clinical Nutrition, 2005;81:122-29

7. Photosynthetic organisms found 18 m down in Antarctic lake ... http://www.cosmosmagazine.com/news/395/photosynthetic-o...
COSMOS magazine
News · Ancient worlds · Life & Environment
News
Photosynthetic organisms found 18 m down in Antarctic lake
by Nicole Yannoulatos Monday, 3 July 2006
Cosmos Online
SYDNEY, 3 July 2006 – Even in the frigid gloom of an
Antarctic lake, 18 metres below the surface, algae is
converting light into energy.
Scientists from New Zealand's National Institute of Water
and Atmospheric Research (NIWA) have been studying
the microscopic algae that live under these extreme
conditions and were excited to find that these microbes
are still able to photosynthesise in the near-dark.
"We had seen them photosynthesise in the lab," said Kay
Vopel, one of the aquatic ecologists who made the
discovery. "But we couldn't say for certain how they
would behave until we actually went down and studied
them in situ."
Vopel and fellow scientist Ian Hawes made the Related articles
measurements in November 2004 at Lake Hoare, an
Subterranean bacteria hint at life on Mars
18-metre deep ice-covered melt-water lake in the Dry
Valleys of Antarctica. Scientists have long been Space submersible gets Antarctic test
interested in the bacteria and microscopic algae that Sydney harbours missing malaria link
inhabit such lakes, because they offer insights into the
extreme conditions under which life can exist. Strange deep-sea bacteria grown in lab
NASA predicts colour of alien plants
The major issue that could affect the photosynthesis is
the light. The ice that covers the lake is so thick that the
scientists weren't sure whether the microbes would still
be able to photosynthesise with such a small amount of light reaching those depths. They found that these
algae can use what little light is available and photosynthesise quite successfully.
These are among the lowest natural light levels at which photosynthesis has ever been recorded. "There are
some tantalising observations of marine plants growing on rocks in very deep water, and of algae and
cyanobacteria growing in caves where there may be even less light, but these are certainly amongst the
lowest where field observations have been made," says Hawes.
This discovery, published in the July issue of Limnology and Oceanography, can not only help to shed light
on the past Antarctic climate, but could even glean an insight into finding life on other planets. If microbes
can survive in these harsh conditions, it may provide insight into where and how life originated on earth, and
where evidence of life might occur on other planets in our solar system.
But this is not the end of the Lake's role in understanding hostile environments. Since the photosynthesising
microbes were only measured in a certain part of the lake, Vopel and Hawes plan to return in November to
measure bacteria that use other chemicals such as hydrogen sulphide.
1 of 2 22/1/09 10:45 PM

8. Gene discovered that may explain cause of depression | CO... http://www.cosmosmagazine.com/news/416/gene-discovered...
COSMOS magazine
News · Health & Mind · Society & Culture
News
Gene discovered that may explain cause of depression
by Nicole Yannoulatos Wednesday, 12 July 2006
Cosmos Online
SYDNEY, 12 July 2006 - A gene has been discovered by
Canadian researchers that makes people more
susceptible to major depressive disorders, throwing into
question the way depression is currently being treated.
Nicholas Barden, who leads a team of researchers from
the department of Neuroscience at the Centre hospitalier
de l'Université Laval (CHUL) Medical Research Centre in
Quebec, said, "This is a major breakthrough in the realm
of psychiatry and will have groundbreaking implications
for diagnosis and the development of new
anti-depressant treatment."
According to Beyond Blue, an Australian society for
depression, around one million Australian adults and
100,000 young people live with depression each year.
Related articles
"The actual gene, known as P2RX7, is found in humans
How gardening could cure depression
and animals and is responsible for depression. It has
taken many years to find," said Barden. Manic depression may be a rhythm thing
The mood disorder has often been associated with the Magnetic pulses treat depression
serotonin system in the brain, because serotonin- On nature vs nurture
boosting drugs are effective anti-depressants. "What is
DNA disease survey is biggest yet
particularly exciting is that P2RX7 has nothing to do with
serotonin," said Barden.
P2RX7 plays an important role in the brain's response to inflammation, which is known to be part of many
neuropsychiatric disorders. The activity of the gene is also affected by stress hormones, suggesting a
relationship between depression and severe stress.
"A person may have the mutated gene, but its 'default setting' means that they may not develop depression.
We don't yet know how P2RX7 works and we still believe that a multitude of genes feed into the same
pathway that may induce depression," said Barden.
Identifying this gene opens the door for anti-depressants in the future that could target the gene directly.
Because anti-depressants currently target the serotonin system, P2RX7 is largely unaffected.
But so far in animal studies, chemicals that trigger P2RX7 have an immediate anti-depressant action. This
brings hope to patients and their doctors of a new generation of anti-depressant medication, with a new
mechanism of action, and a whole new level of results.
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1 of 1 22/1/09 10:44 PM

9. Mouse study shows ultrasound affecting brain development |... http://www.cosmosmagazine.com/node/533
COSMOS magazine
News · Health & Mind
News
Mouse study shows ultrasound affecting brain development
by Nicole Yannoulatos Wednesday, 9 August 2006
Cosmos Online
SYDNEY, 9 August 2006 - The impact of ultrasounds on
embryonic brains may be more damaging that was
previously thought, according to U.S. researchers.
A study conducted by Pasko Rakic and colleagues at Yale
University in New Haven, Conneticutt, has found that a
significant number of nerve cells in the brain of
embryonic mice do not migrate to the appropriate
location following exposure to ultrasound.
"Proper migration of neurons during development is
essential for normal development of the brain's cerebral
cortex, and its function can be impaired if neuronal
migration is disrupted," said Rakic, chairman of the
Ultrasound probing of embryonic mouse brains
Department of Neurobiology at the university.
shows some disruption of normal developmental
His team analysed how effectively neurons in the brains activity, say researchers
of one 146 mouse embryos migrated to the brain's Credit: Jim Gathany/CDC
cerebral cortex once exposed to ultrasound waves.
They found that after several prolonged exposures, a
small number of neurons did not migrate to their
necessary position in the upper layers of the cerebral
cortex, and instead moved to the lower layers or became
embedded in supporting white matter in the brain.
In an accompanying commentary, Verne Caviness of
Boston's Massachusetts General Hospital and Ellen Grant
of Harvard Medical School, explain how the implications
of this research for the developing brain is unknown.
They argued that since the number of misplaced cells is
so small, their effect may be little more than minimal
background noise. The cells also appear to retain their
intended cell characteristics, despite migrating to the
wrong position.
Caviness and Grant describe how after the neurons have Related articles
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10. Mouse study shows ultrasound affecting brain development |... http://www.cosmosmagazine.com/node/533
This study does not necessarily suggest that ultrasound Paralysed rats cured; hope seen for humans
will have the same affect on human foetuses. Rakic and
Babies' internal clock development hindered by
his colleagues said there were clear diferences between
artificial lights
their research and the average pre-natal ultrasound
women would undergo during pregnancy.
The brains of the embryonic mice were exposed with a larger volume of ultrasound waves and more
frequently than a human foetus would be, they said. The authors also highlighted the differences in the
biology of mice and humans, making it difficult to predict what affect the ultrasounds may have on humans.
"It is not known whether or to what extent ultrasound waves affect migrating neurons in developing
humans," said Rakic.
He highlighted the difficulties in identifying the position of neurons, since it requires researchers to label the
DNA replication, a procedure that cannot be used in humans. This means that the misplaced cells in the
embryonic brain could be missed totally when tests are taking place.
However, they said the study serves as a reminder that we can't always take routine medical procedures for
granted. While the research does not suggest ultrasounds are anything to be concverned about, it does
highlight an area of embryonic development that calls for more study.
Rakic and his colleagues intend to extend the study to non-human primates to see if similar effects occur.
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