Why black cats might not be lucky for people with schizophrenia

In 1896 Scientific American published an article entitled 'Is insanity due to a microbe' which was the first time anyone had put forward the idea of an infectious cause for schizophrenia. The theory grew in popularity in the early years of the C20th but fell out of favour as the century wore on. Recent research has revived this theory linking schizophrenia with exposure to viruses such as influenza, rubella, herpes and polio while people are in the womb and polio, meningitis and encephalitis thereafter. The most research, however, has been done into a protozoa called Toxoplasma gondii which is hosted by cats and can be spread by inadvertently eating or breathing in infected material from litter trays. The organism can also be spread by eating undercooked meat from sheep, goats or other animals that have been infected by cats. Toxoplasma gondii can cause deafness, sight problems and brain damage in fetuses but show no symptoms in adults. A review of 42 studies carried out in 17 countries over five decades found that having been infected with Toxoplasma gondii increased people's risk of schizophrenia by a factor of 2.73. This is fairly modest compared to other risk factors for other diseases but it is more significant than any other genetic or environmental risk factor so far put forward for schizophrenia.

Torrey, E. Fuller ... [et al] - Antibodies to Toxoplasma gondii in patients with schizophrenia : a meta-analysis Schizophrenia Bulletin May 2007 33(3), 729-736

Cognitive therapy helps prevent psychosis

Early intervention in psychotic disorders has become seen as increasingly important in recent years. Increased attention has been paid to detecting individuals in the 'prodromal' stage of the condition where they show some symptoms of psychosis but have yet to develop the full-blown condition. A study of 58 patients in Manchester at 'ultrahigh' risk of developing psychosis compared one group who were given six months of cognitive behaviour therapy (CBT) with another group who were carefully monitored by health professionals. The study showed that CBT significantly reduced the likelihood of being prescribed antipsychotic medication and of developing psychosis over a three-year period.

Morrison, Anthony P. ... [et al] - Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk Schizophrenia Bulletin May 2007 33(3), 682-687

OCD and eating disorders

Numerous studies have demonstrated a link between obsessive-compulsive disorder (OCD) and eating disorders. A study of 160 women college students in Texas looked at the inter-relationship between perfectionism, obsessive beliefs, depression, OCD and disordered eating. The researchers found that perfectionism, obsessive beliefs and depression were all significantly associated with both disordered eating and OCD and that perfectionism was an important link between disordered eating behaviour and OCD symptoms although perfectionism manifested itself differently in eating disorders and OCD.

Humphreys, Joy D., Clopton, James R. and Reich, Darcy A. - Disordered eating behavior and obsessive compulsive symptoms in college students : cognitive and affective similarities Eating Disorders May-June 2007, 15(3), 247-259

Substance abuse and eating disorders

Previous studies have shown a link between eating disorders and substance abuse. People being treated for eating disorders have a higher rate of substance-abuse problems and people with substance-abuse problems have a higher-than-average rate of eating disorders. A large-scale study of 36,984 people in Canada has found that 'alchohol interference' (something short of alchoholism but where alchohol drinking interferes with one's life) and amphetamine use were both associated with the risk for an eating disorder in men and women. For women the risk of an eating disorder was associated with illicit drug use, dependence and interference.

Gadalla, Tahany and Piran, Niva - Eating disorders and substance abuse in Canadian men and women : a national study Eating Disorders May-June 2007, 15(3), 189-203

Antipsychotic drugs and heart disease

Severe mental illness is associated with a significant increase in illness and death. Although suicide is a common cause of death for people in this group heart disease (caused in part by the side effects of anti-psychotic drugs) can cause just as many problems. A study of 182 people in the North-East compared people receiving anti-psychotic drugs with people of similar ages without psychosis or schizophrenia. The study found that people taking antipsychotic drugs were much more likely to have high blood pressure, a high waist-to-hip ratio, high cholesterol and poor control of their blood sugar all of which can be risk factors for heart disease.

Mackin, Paul ... [et al] - Metabolic disease and cardiovascular risk in people treated with antipsychotics in the community British Journal of Psychiatry July 2007, 191, 23-29

Theory of mind and schizophrenia

'Theory of mind' is the ability to work out what other people are thinking. This is something that most of us - to a greater or lesser extent - do naturally but problems with theory of mind have been linked with autism (where lack of empathy for others is one of the most important symptoms) and schizophrenia. A review of 29 studies into the link between theory of mind and schizophrenia has found that there is a 'large and statistically significant' link between problems with people's theory of mind and their chances of developing the condition. Interestingly people who had recovered from schizophrenia still had problems in working out what other people were thinking suggesting that theory of mind difficulties contribute to schizophrenia rather than vice versa.

Sprong, Mirjam ... [et al] - Theory of mind in schizophrenia : meta-analysis British Journal of Psychiatry July 2007, 191, 5-13

Vending machines reduce infection risk

Drug users are at risk of contracting HIV and hepatitis through sharing contaminated needles. A lot of countries run needle exchange programmes which allow drug users to bring in used needles and swap them for new, clean ones. This is usually done by coming in to see a mental-health professional who can often counsel people at the same time. However, in order to preserve drug users' anonymity and extend the hours of the service some countries have introduced syringe vending machines. A review of studies into the use of syringe vending machines has found that the machines increase access to sterile needles, reach drug addicts who might not otherwise use needle exchange services and help to reduce the unsafe disposal of needles.

Islam, M.M. and Conigrave, K. M. - Syringe vending machines as a form of needle syringe programme : advantages and disadvantages Journal of Substance Use June 2007, 12(3), 203-212

Repossession and depression

Since 1991 more than half a million households have had their homes repossessed and more than one million eviction orders have been made by landlords on their tenants. A study of 8,185 people over thirteen years used a questionnaire called the General Health Questionnaire to measure people's mental health and correlate this with their housing situation. The researchers found that for both men and women housing payment problems and getting into arrears with rent or mortgages had significant detrimental effects on mental health over and above the effects of general financial hardship.

Taylor, Mark P., Pevalin, David J. and Todd, Jennifer - The psychological costs of unsustainable housing commitments Psychological Medicine July 2007 37(6), 1027-1036

Cannabis and psychosis

There is increasing evidence that cannabis use and psychosis are linked with people who use cannabis in adolescence or young adulthood being more likely to suffer from psychotic symptoms later in life. People with psychosis are also more likely to suffer from other mental-health problems the most common of which is depression. An Australian study of 101 people with psychosis looked at the effect cannabis use had on their psychotic symptoms and their levels of depression. The researchers found that cannabis caused a small but statistically significant increase in symptoms of psychosis but not depression. The relationship did not work the other way insofar as people who were suffering from psychotic symptoms or depression were not more likely to use cannabis. This goes against the self-medication hypothesis which argues that people use cannabis to relieve their mental-health problems.

Degenhardt, Louisa ... [et al] - The temporal dynamics of relationships between cannabis, psychosis and depression among young adults with psychotic disorders : findings from a 10-month prospective study Psychological Medicine July 2007, 37(7), 927-934

Brothers, sisters and depression

Poor interpersonal relationships in childhood have long been seen as a risk factor for adult depression. However, most of the research has been done on children's relationships with their parents not their relationships with their brothers and sisters. A long-term study of 229 men in the U.S. looked at the quality of their relationships with their siblings and parents and their family history of depression and examined the links between these factors and their likelihood of developing depression, alcoholism and drug abuse later in life. The researchers found that poorer relationships with siblings before the age of 20 and a family history of depression independently predicted both the occurence of depression and the frequency of use of mood-altering drugs by the age of 50, even after allowing for the quality of childhood relationships with parents. However, poor relationships with parents in childhood did not predict the occurence of depression by age 50 once the family history of depression and the quality of sibling relationships were taken into account. The quality of sibling relationships and a family history of depression did not predict later alcohol abuse or dependence.

Waldinger, Robert J., Vaillant, George E. and Orav, E. John - Childhood sibling relationships as a predictor of major depression in adulthood : a 30-year prospective study American Journal of Psychiatry 164(6), 949-954

Duloxetine and depression in old people

Depression is a common problem among elderly people and can be linked with physical health problems and mental decline. However, some studies show that physical and intellectual problems can be reversed if people's depression is treated effectively. A trial of a new drug called duloxetine on 311 elderly people in Canada compared its effectiveness to a placebo. At the end of the eight-week trial those people taking duloxetine showed an improvement in their verbal learning and memory compared to those people taking a placebo. They were also less depressed and suffered from less pain than the placebo group. This was a rigorous study but it was partly funded by the Eli Lilly drugs company.

Raskin, Joel ... [et al] - Efficacy of duloxetine on cognition, depression, and pain in elderly patients with major depressive disorder : an 8-week, double-blind, placebo-controlled trial American Journal of Psychiatry 164(6), 900-909

Psychotherapy - why people drop out

People dropping out of treatment is a common problem in psychotherapy with different studies showing that between 35 and 55% of people drop out of talking therapies. However, there is a limited amount of information as to how many people drop out of cognitive-behaviour therapy treatments which are now seen by many people as the most effective form of psychotherapy. A study of 203 patients in Barcelona found that 43.8% of them dropped out mostly in the early stages of treatment. The most common reasons for people dropping out were their own low motivation and/or dissatisfaction with the treatment or the therapist which accounted for 46.7% of the drop-outs. Personal problems made up 40% of the drop-outs and patients feeling that they were better made up 13.3%. Patients who drop out were more likely to suffer from mood or eating disorders or have problems with being too impetuous.

Bados, Arturo, Balaguer, Gemma and Saldana, Carmina - The efficacy of cognitive-behavioral therapy and the problem of drop-out Journal of Clinical Psychology June 2006, 63(6), 585-592

Religion, coping and mental illness

Being a member of an organised religion has been found to have many mental and physical health benefits but at the same time many bouts of severe mental illness feature religious delusions. A year long study of 48 young adults with schizophrenia and bipolar disorder in the U.S. looked at the way people interpreted their mental illness in the light of their religious beliefs to see how this affected their mental health. The researchers found that those people who saw their mental illness as part of God's plan or as an opportunity for spiritual growth had better mental health than those people who saw their illness as a punishment from God or who felt that God was unable to help them in their distress.

Phillips III, Russell E. and Stein, Catherine H. - God's will, God's punishment, or God's limitations ? Religious coping strategies reported by young adults living with serious mental illness Journal of Clinical Psychology June 2007, 63(6), 529-540

Untangling the links between depression and anxiety

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are very closely linked. There is a strong body of literature to suggest that anxiety generally precedes depression and that most people who are anxious eventually become depressed. Some researchers even suggest that GAD should be seen as a precursor to and subtype of MDD. However, a study of 972 people in New Zealand had found that the relationship between the two conditions may be more complicated than first thought. Anxiety began before depression in 37% of depression cases but depression began before anxiety in 32% of anxiety cases. 72% of people who experienced anxiety at some time in their lives had a history of depression whereas 48% of people who experienced depression at some time in their lives suffered from anxiety. During adulthood 12% of the sample had GAD and MDD at the same time (comorbid) of whom 66% had recurrent MDD and 47% had recurrent GAD. The researchers concluded that depression was just as likely to lead to anxiety as vice versa. The link between the two conditions was - in the researchers' view strong enough to justify there being a new diagnosis of GAD/MDD.

Moffitt, Terrie E. ... [et al] - Depression and generalized anxiety disorder : cumuluative and sequential comorbidity in a birth cohort followed prospectively to age 32 years Archives of General Psychiatry 64(6), 651-660

Cognition in schizophrenia - older drugs just as good

People's thought processes are severely impaired in schizophrenia and the more impaired people's functioning is the worse their prognosis. Many studies and literature reviews have suggested that newer 'second-generation' antipsychotics provide greater improvements in people's cognition than older drugs but many of these studies have methodological weaknesses, not least their being funded by the drug industry. A study of 817 people in the U.S. looked into the effectiveness of the newer drugs olanzapine, quetiapine, risperidone and ziprasidone and compared them to the older drug perphenazine. After 2 and 6 months of treatment the results for all the drugs showed a broadly similar improvement in patient's cognitive abilities while after 18 months the older drug perphenazine showed a greater improvement than the newer (more expensive) second-generation drugs.

Keefe, Richard S.E. ... [et al] - Neurocognitive effects of antipsychotic medications in patients with chronic schizophrenia in the CATIE trial Archives of General Psychiatry June 2007, 64(6), 633-647

Psychosis and dementia in elderly people

A long term study of 392 elderly people in Sweden looked at how many of them developed psychosis and whether this was linked to them going on to develop dementia. The subjects of the study were assessed between the ages of 70 and 90. In the whole sample 4.8% developed psychosis but of those people who survived to 85 19.8% showed symptoms of psychosis. 64% of people with hallucinations developed dementia, compared to 30% of people with delusions and 25% of people with no psychotic symptoms.

Ostling, S., Palsson, S.P. and Skoog, I. - The incidence of first-onset psychotic symptoms and paranoid ideation in a representative population sample followed from age 70-90 years. Relation to mortality and later development of dementia International Journal of Geriatric Psychiatry June 2006, 22(6), 520-528

Cognitive decline, depression and dementia

Most people's mental faculties tend to decline as they get older but it can be hard to disentangle what are the normal side effects of the ageing process - Mild Cognitive Impairment (MCI) - from the beginnings of dementia. A study of 105 people with MCI in Poland tested people yearly. The researchers found that after 3 years 23 of the original sample had developed dementia, 40 got worse but as a normal part of the ageing process, 34 were stable and 8 actually improved. Those people with depression were more likely to go on to develop full-blown dementia as were those who had cognitive problems as well as memory problems. A higher level of a substance called homocysteine in the bloodstream was also associated with an increased risk of going on to develop dementia.

Gabryelewicz, T. ... [et al] - The rate of conversion of mild cognitive impairment to dementia : predictive role of depression International Journal of Geriatric Psychiatry June 2007, 22(6), 563-567

Jealousy, love and marriage

Jealousy can be caused by a threat to, or the loss of, a valued relationship due to an actual or imagined rival and is associated with relationship conflict, domestic violence and divorce. It can contribute to relationship insecurity and conflict and cause the non-jealous partner to feel mistrusted and controlled. Other researchers have put a more positive interpretation on jealousy, however, seeing it as a sign that partners care for each other and value their relationship enough to protect it. A study of 961 couples in Holland has found evidence to support both these hypotheses. Couples with high levels of 'reactive' jealousy (jealousy in the face of a real and concrete threat to a relationship) had a higher quality of relationship whereas couple with high levels of 'anxious' jealousy (groundless suspicion in the absence of any evidence) had poorer relationships.

Barelds, D. P. H. and Barelds-Dijkstra, P. - Relations between different types of jealousy and self and partner perceptions of relationship quality Clinical Psychology and Psychotherapy May-June 2007, 14(3), 176-188

Virtual reality is a real help for panic sufferers

Panic disorder is one of the most prevalent mental-health problems and can have a number of adverse consequences which affect people's lives. Cognitive Behaviour Therapy (CBT) has been widely shown to be effective in treating panic disorder and one of the main ingredients of CBT is exposure, where people are gradually exposed to the kind of situations which set off their panic attacks. However exposure can cause problems when patients feel they lack privacy, and because it needs a lot of professionals' time it can also be very expensive. A trial of virtual reality exposure on 37 people in Spain has found that this can be just as effective as real-life exposure. After nine weeks of treatment the two methods were found to be equally effective raising hopes that people with panic disorder can face their demons with more privacy and in a more cost-effective manner.

Botella, C. ... [et al] - Virtual reality exposure in the treatment of panic disorder and agoraphobia : a controlled study Clinical Psychology and Psychotherapy May-June 2007, 14(3), 164-175

College women and disordered eating

Many people can have disordered patterns of eating without necessarily going on to develop the full-blown symptoms of anorexia or bulimia. Disordered eating usually peaks when women go to college with one study estimating that 28% of girls at college were obsessed with their weight. College can be a stressful time for a lot of people as they move away from home and face the burdens of studying. An in-depth study of 15 college women in America found that they chose disordered patterns of eating as a method of control when they lacked connected and close relationships with others. When they had meaningful relationships with other people they ate in a more healthy manner.

Budd, Geraldine - Disordered eating : young women's search for control and connection Journal of Child and Adolescent Psychiatric Nursing 20(2), 96-106

Depression, childhood and gender

As well as being painful at the time depressive symptoms in childhood can be linked to a variety of different problems later in life including full-blown depression, school problems, smoking, drinking, drug use, increased sexual activity and suicidal behaviour. Adolescent girls are three to four times more likely to suffer from depression than adolescent boys but little research has been done into the different ways younger children experience depression. A study of 122 10-12 year-olds in the U.S. found that girls internalized their problems and suffered from lower self-esteem whereas boys externalized their problems by behaving badly and were more likely to have problems at school.

Bailey, Mary K. ... [et al] - Patterns of depressive symptoms in children Journal of Child and Adolescent Psychiatric Nursing 20(2), 86-95

Antiepileptic drugs and anxiety

Anxiety disorders can last for a long time and be difficult to treat. A variety of drug groups have been shown to be effective in treating anxiety and the most-favoured treatments currently are selective serotonin reuptake inhibitors (SSRIs). However, these are effective in only 50-60% of patients. Benzodiazepines are also used but they can cause drowsiness and are addictive. Recently there has been some success in using antiepileptic drugs against anxiety disorders. A review of trials into the uses of antiepileptics for anxiety disorders has found that the strongest evidence was for the use of pregabalin in social phobia and generalized anxiety disorders, lamotrigine in post-traumatic stress disorder and gabapentin in social anxiety. The review suggested that antiepileptic drugs do have the potential to be an alternative treatment in certain anxiety disorders.

Mula, Marco, Pini, Stefano and Cassano, Giovanni B. - The role of anticonvulsant drugs in anxiety disorders Journal of Clinical Psychopharmacology 27(3), 263-272

Reducing self-harm in psychiatric hospitals

A study of patients and staff in acute psychiatric wards has found that increased rates of turnover of patients on the wards may be linked to an increased incidence of self-harm. Researchers from City University received 50,000 responses to a questionnaire sent to 136 of the 500 acute care psychiatric units in England. The study found that the most effective way to reduce self-harm and suicide attempts is by regularly checking on patients, increasing the proportion of qualified nurses on wards and organising more patient activity sessions. Regular checks rather than constant observation were preferred by the patients and cost less. High volumes of admissions to a ward were linked with increased rates of self-harm among patients.

You can find out more about the research at

http://www.city.ac.uk/news/archive/2007/05_may/14052007_2.html

Mindfulness helps aggressive adolescents

'Conduct disorder' is defined as 'a repetitive and persistent pattern of behaviour in which the basic rights of others ... are violated'. Estimates suggest that between 2-10% of adolescents behave in this way, often going on to develop further problems in adult life. Mindfulness - 'the awareness and nonjudgmental acceptance by a clear, calm mind of one's moment-to-moment experience' - has been used as the basis for therapies for a wide range of different conditions and a study of three teenagers in the U.S. aimed to see whether it could be effective in dealing with 'conduct disorder' as well. The study used a programme called Meditation on the Soles of the Feet, a mindfulness technique that teaches people to shift their attention from an emotionally arousing thought, event or situation to an emotionally neutral part of the body. The children were able to learn the technique successfully and showed a considerable reduction in their levels of aggression. They were able to keep their aggression at 'socially acceptable levels' for the rest of their school days.

Singh, Nirbhay N. ... [et al] - Adolescents with conduct disorder can be mindful of their aggressive behavior Journal of Emotional and Behavioral Disorders Spring 2007, 15(1), 56-63

CBT for post-traumatic stress in Northern Ireland

A trial of cognitive therapy for people affected by the sectarian conflict in Northern Ireland had yielded promising results. A study of 58 people in the province found that after 12 weeks cognitive therapy was associated with significantly greater improvement than the control group in terms of relieving the symptoms of post-traumatic stress disorder, alleviating depression and improving people's occupational and social functioning.

Duffy, Michael, Gillespie, Kate and Clark, David M. - Post-traumatic stress disorder in the context of terrorism and other civil conflict in Northern Ireland : randomised controlled trial British Medical Journal June 2, 2007, 1147-1150