yale

It may be time for mental-health workers to pick up a new depression-fighting tool—the telephone. People taking antidepressant drugs for a bout of depression do particularly well, at least over a 6-month period, if they also take part in a program that includes telephone psychotherapy, a new study finds.

Evidence of telephone therapy's mood-enhancing effect raises the prospect of expanding the reach of depression treatment, says the investigation's director, psychiatrist Gregory E. Simon of Group Health Cooperative in Seattle. Many people suffering from depression don't take antidepressants—even if the drugs have been prescribed for them—and never receive psychotherapy of any kind. Feelings of discouragement when a medication doesn't work right away and the stigma associated with psychological treatment contribute to this problem, Simon holds.

"With this telephone program, we can help many depressed people who aren't reached by traditional in-person treatments," he says. Simon and his coworkers describe their results in the Aug. 25 Journal of the American Medical Association.

Between November 2000 and May 2002, the researchers recruited 600 adults who were beginning antidepressant treatment at medical clinics run by Group Health Cooperative, a prepaid health plan. Generally, primary care physicians had prescribed fluoxetine (Prozac) or related medications. The study excluded people who were already receiving in-person psychotherapy or planned to do so.

Participants were randomly assigned to one of three treatments: typical primary care follow-ups; typical care plus at least three "care-management" telephone calls over 3 months from mental-health clinicians, who checked on medication use and provided feedback from a patient to his or her primary care physician; and typical care plus care management and eight sessions of cognitive-behavioral therapy delivered by phone.

During the cognitive-behavioral therapy, the clinician and patient discussed ways to increase pleasant activities, reverse negative thoughts, and manage daily affairs. Each session lasted 30 to 40 minutes.

Six months after a person's treatment began, 80 percent of those who received telephone psychotherapy reported a marked decline in depression symptoms, compared with 66 percent of the care-management group and 55 percent of those who got only typical primary care follow-ups. Participants who received telephone psychotherapy reported the most satisfaction with their treatment.

Psychiatric interviews conducted by phone at that time also found that interviewer-detected signs of depression had diminished most sharply in the telephone-psychotherapy group. These results fit with evidence that cognitive-behavioral therapy delivered in person boosts the effectiveness of antidepressant drugs (SN: 8/21/04, p. 116: http://www.sciencenews.org/articles/20040821/fob4.asp).http://louis4j4sheehan4esquire.blogspot.com

Psychologist Alan E. Kazdin, director of Yale University's Child Conduct Clinic, regards Simon's project as part of a broad movement to make psychological treatments more easily available through sources such as the Internet and self-help manuals, as well as the telephone.http://louis4j4sheehan4esquire.blogspot.com

"Telephone psychotherapy won't replace typical psychotherapy, but it will add to what clinicians can do," he says. "We can help more people if we have a diversified portfolio of treatments for mental disorders."http://louis4j4sheehan4esquire.blogspot.com

syndrome

Among its many unusual symptoms, the genetic disorder called Williams syndrome robs people of depth perception and the ability to visualize how different parts assemble into larger objects, as in a simple jigsaw puzzle.http://louis6j6sheehan6esquire.blogspot.com

An unusual scarcity of tissue in a small corner of the visual system underlies this particular problem in individuals with Williams syndrome, a new brain-imaging study finds. It appears that, at least with respect to vision, this genetic condition creates a slight defect in an otherwise typical brain.

In contrast, some researchers have proposed that a unique course of brain development occurs in Williams syndrome, which is linked to a missing, roughly 20-gene section of chromosome 7 (SN: 2/26/00, p. 142: Available to subscribers at http://www.sciencenews.org/articles/20000226/bob11.asp).

"A very circumscribed abnormality of visual processing characterizes the brain in Williams syndrome," says neuroscientist and study director Andreas Meyer-Lindenberg of the National Institute of Mental Health (NIMH) in Bethesda, Md. He cautions, however, that other symptoms of the disorder, such as extreme gregariousness toward strangers and difficulty understanding metaphors and other forms of abstract thought, may derive from much broader neural disruptions.

Meyer-Lindenberg and his NIMH colleagues describe their findings in the Sept. 2 Neuron.

The researchers tied vision difficulties in Williams syndrome to a shortage of neurons in part of the brain network that locates objects in space and discerns spatial relationships among objects. Another brain network that identifies different objects, as well as a region that receives nerve signals from the eyes, showed no impairment in Williams syndrome, the scientists say.

Meyer-Lindenberg's team used functional magnetic resonance imaging (fMRI) to track blood flow throughout the brains of 13 adults with Williams syndrome and 11 adults with no genetic disorders. Both groups performed two tasks. One involved assessing whether pairs of puzzle pieces could fit together to form a square; the other required determining whether two images were situated at the same height on a computer screen.

Analyses of blood flow showed that the people with Williams syndrome had weaker neural activity in a marble-size section of the brain's network for making spatial judgments. Scans of brain anatomy then revealed a deficit of tissue in an adjacent area of the same network among the volunteers with Williams syndrome. Impairment of that small area partially blocks transmission of visual information to the brain region that displays weak activity in fMRI images from those participants, Meyer-Lindenberg theorizes.

Although Williams syndrome usually includes mild-to-moderate mental retardation, all participants in the new study scored in the average range on intelligence tests. This removed the possibility that retardation-related processes in the brain somehow affected the visual systems of Williams syndrome volunteers.

Preliminary evidence from the same participants also links Williams syndrome to a lack of tissue in a frontal brain area already implicated in social behavior, including fear responses to strangers, the NIMH scientist says.

Although the neural basis of the social and intellectual profile of Williams syndrome remains poorly understood, Meyer-Lindenberg and his coworkers have clarified the syndrome's visual-system defect, comments neuropsychologist Helen Tager-Flusberg of Boston University School of Medicine in an editorial published with the new study।http://louis6j6sheehan6esquire.blogspot.com

theft

Rhesus monkeys may not regard the eyes as windows to the soul, but these animals do treat a competitor's averted eyes as a license to steal his or her food, a new study suggests. Using the direction of others' gazes to determine what they can or can't see is a basic component of social reasoning in monkeys that, until now, has eluded researchers, contend Yale University researchers Jonathan I. Flombaum and Laurie R. Santos.http://ljsheehan.livejournal.com

These results suggest that rhesus monkeys "consider others' visual perspectives," says Flombaum. "Without that ability, you can't reason in more-complex ways about what others know."http://ljsheehan.livejournal.com

Monkeys' assumptions about what other animals perceive, at least when they're competing for food, represent what was perhaps an early evolutionary step toward people's capacity to reason about what others think and want, the researchers propose in the March 8 Current Biology.

However, there's less to the new study than meets the eye, argues a critic of much of the research into ape and monkey minds. Psychologist Daniel J. Povinelli of the University of Louisiana at Lafayette argues that Flombaum and Santos show only that monkeys avoid a competitor's gaze, not that they make assumptions about what others see.

This debate hinges on six new experiments, each conducted with 16 to 20 monkeys. The animals belong to groups that roam the Puerto Rican island of Cayo Santiago.

In each trial, two researchers approached a lone monkey. Each person stood by a small platform on which a grape rested. From one trial to the next, the experimenters stood in different positions—turned toward, away from, or sideways to the grape. In some trials, one researcher turned his head to the side or covered his chest, eyes, or mouth with a board or piece of foam. In each trial, a grape was visible to one experimenter but not the other.

The monkeys almost always took the grape only from the person who couldn't detect their pilfering.

Situations in which a monkey is competing for food, in this case with the experimenter, elicit a monkey's capacity for surmising what others can see, in Flombaum's view. An earlier study by other researchers had suggested that monkeys don't pay attention to where others are looking, but that test employed a non-competitive setup in which a researcher hid food and then stared at the hiding spot.

Povinelli argues that the Cayo Santiago monkeys acted so as to avoid the experimenter's direct gaze, which the animals interpreted as a threatening signal. "That doesn't have anything to do with understanding others' perceptions," he says.Louis J. Sheehan

Such a threat played no role in one of the experiments, in which one experimenter faced the grapes and the other one faced the opposite direction, Flombaum responds. Neither experimenter faced the monkey. Still, the monkeys filched grapes from the experimenter who looked away from the food.http://louis-j-sheehan.info

In further experiments, the Yale scientists plan to examine rhesus reasoning in more detail. Monkeys will watch a grape roll down a ramp to either an open platform or one with walls that block the experimenter's, but not the monkey's, view of the food. "We want to see if monkeys take only the hidden grapes," Flombaum says.

addition

The social detachment and isolation that characterize autism may stem, at least in part, from a breakdown of brain cells that have been implicated in people's ability to imitate others and to read their thoughts and feelings.

A new brain-imaging investigation tested high-functioning children with autism—kids who score in the normal range on intelligence tests and display only mild-to-moderate social difficulties. As these youngsters view and imitate facial expressions, brain cells called mirror neurons show meager activity, say neuroscientist Mirella Dapretto of the University of California, Los Angeles School of Medicine and her colleagues. Children free of developmental problems exhibit robust responses by these neurons during the same tasks.

"A dysfunctional mirror-neuron system [in autism] could account for both a lack of social motivation and deficits in understanding others' intentions and emotions," Dapretto says.

Mirror neurons, first reported in 1996, respond comparably whether an individual performs a particular action or watches someone else carry it out (SN: 5/24/03, p. 330: Available to subscribers at http://www.sciencenews.org/articles/20030524/bob9.asp). Studies since then have suggested that these neurons, which coordinate imitation, participate in a network in the brain's outer layer, or cortex. Collaboration between this network and emotion-regulating parts of the brain fosters empathy, the discernment of others' thoughts and feelings, the UCLA researchers propose.http://Louis-J-Sheehan.de

Dapretto's team used a functional magnetic resonance imaging scanner to measure blood flow in the brains of 10 high-functioning children with autism and 10 neurologically healthy children. Participants ranged in age from 10 to 14 years. The scientists determined brain-cell activity by measuring blood flow.

Each child underwent brain scanning as he or she observed a series of 80 photographs of different faces and then went through the series again to imitate the facial expression in each photo. Expressions conveyed anger, fear, happiness, sadness, or neutrality.

Children in both groups maintained good focus on the photos during the tasks and successfully imitated most facial expressions.

However, during the tasks, kids with autism displayed less blood flow in a key part of the mirror-neuron system than the other youngsters did. Autistic children with the worst social skills exhibited the smallest responses.

Dapretto's group proposes that the youngsters with autism intently scrutinized the details of each face photo in order to imitate what they saw because they were unable to discern the meaning of a facial expression and then use empathy to match it. Brain areas that control visual and motor attention showed unusually intense activity while these children observed and imitated facial expressions, the researchers note.Louis

Their report appears in the January Nature Neuroscience.

Yale University neuroscientist Robert T. Schultz calls the new study a valuable addition to evidence linking autism to scant activity in brain areas governing perception and language.

Autistic kids' striking lack of interest in social pursuits still eludes explanation, he adds. "These children have an insensitivity to social rewards that alters their brain development," Schultz remarks. "We don't know why."