Wednesday, April 30, 2008

Bullying, anxiety and depression

A study of 210 college undergraduates between the ages of 18 and 25 looked at the links between bullying in childhood and the continuing presence of mental-health problems in young adulthood. The study looked into the effects of 'relational victimization' ; being shunned, being excluded from social activities and having rumours spread about oneself. The researchers found that memories of these experiences were associated with depresssion and social anxiety. There was no difference between the sexes as to how childhood bullying affected people and even having friends or other positive relationships in the present didn't lessen the effect of childhood victimization.

Genes, alcohol and environment

A study of 3,546 pairs of twins in the U.S. looked into the relationship between environment, genetics and alcohol problems. 85% of the sample - who were all between 18-29 - reported having at least one drink in their lifetimes, although only 7% became alcohol dependent. The researchers found that, overall, environmental factors were more important than genetic ones. Environmental factors, such as exposure to conflict between parents and alcohol use among peers in school, exerted the largest influence on initiation of alcohol use and the study found that women who had their first drink at an earlier age were more likely to develop serious alcohol problems. The influence of genetics became more marked in deciding who went on to develop alcohol problems but was still less influential than environmental factors.

You can read more about this research at

Smoking and depression

A U.S. study of 8,556 people looked into the links between tobacco smoking and depression. The researchers found that the risk of depression was increased by 41% in smokers compared to non-smokers. An increase in tobacco use was also associated with a lessening of physical activity. Interestingly those who had given up tobacco more than a decade previously had a lesser probability of developing depression than those who had never smoked.

You can find out more about this research at

Self-esteem and security

Self-esteem has traditionally been thought of as a good thing. However, recent research has begun to paint a more subtle picture of self-esteem suggesting that it is not always necessarily a good thing. High self-esteem can sometimes be accompanied by aggression and verbal defensiveness and researchers now think that it is the security of one's self-esteem as much as its quality that contributes to happiness. A team of researchers at the University of Georgia studied self-esteem in 100 undergraduates. The researchers measured the stability of the students' self-esteem then talked to them about times in their lives when things had gone wrong or they had felt threatened. Those students who were low in self-esteem or who had fragile high self-esteem were more verbally defensive than those whose self-esteem was secure. Those students with secure high self-esteem appeared to accept themselves 'warts and all' and were less likely to become defensive by blaming others and making excuses. The study also found that greater verbal defensiveness was associated with lower psychological well-being and life satisfaction.

You can find out more about this research at

Tuesday, April 29, 2008

Attachment and anxiety

Attachment theory proposes that particular types of insecure parental care giving are reflected in dysfunctional behaviour and personality disorders such as avoidant, dependent, self-defeating and borderline. The Parental Bonding Inventory, developed in 1979, is a psychological test that aims to measure the attachment between parents and their children in terms of the two variables of caring and overprotection. Studies using this test have found that high parental care predicts lower levels of depression while overprotection leads to higher levels of anxiety. Two Greek studies looked into the effects of caring and overprotection on school performance. In the first study 230 elementary-school children were assessed on motivation, stress and mood before an important test. The results showed that paternal caring scores, and to a lesser extent maternal caring scores, were associated with lower levels of fear of failure, anxiety and depression. In the second study 58 college students were physically monitored during a class presentation to assess their anxiety levels. Those students who reported high levels of parental caring had lower levels of stress. Those who reported an overprotective parenting style, however, approached the task with significantly elevated fears, experienced more stress during the task and performed worse. Students' perceptions of their fathers' parenting style was highly predicitive of the stress response.

Sideridis, Georgios D. and Kafetsios, Konstantinos - Perceived parental bonding, fear of failure and stress during class presentations International Journal of Behavioral Development 2008, 32(2), 119-130

Self-regulation in infancy

Self-regulation is a broad concept that focuses on efforts to modify behaviour to reach goals. Between the ages of one and three children make great strides in self-regulation. They become increasingly adept at changing their behaviour to meet the demands of a situation and better understand - and are more able to meet - external standards for behaviour. Early competence in self-regulation predicts better adaptive skills and fewer problem behaviours later in childhood. A U.S. study of 100 young children studied them at 20, 27 and 34 months old. The earlier that the children understood they were independent beings whose actions were able to have an effect on their environment the better was their self-regulation. Maternal warmth was also linked to better self-regulation. Although half the toddlers had been exposed to maternal depression this was not found to be linked to self-regulation.

Jennings, Kay D. ... [et al] - Understanding of self and maternal warmth predict later self-regulation in toddlers International Journal of Behavioural Development 2008, 32(2), 108-118

Self esteem, body dissatisfaction and restrained eating

Restrained eating is defined as a persistent fixation on dieting, weight and food, such that the type and amount of food eaten is restricted for the purpose of weight loss or maintenance. Restrained eaters commonly experience weight fluctuations due to alternations between dieting and pronounced lapses in dietary adherence. Dietary restriction has been implicated as a risk factor in the development of obesity, binge-eating and eating disorders. A U.S. study of 60 female undergraduates looked into the links between self-esteem, social anxiety, body dissatisfaction and appetite. The researchers found that low self-esteem and social anxiety were linked to dietary restraint. However, these relationships were fully mediated (accounted for) by the increased levels of bodily dissatisfaction experienced by those with low self-esteem and social anxiety. These researchers concluded that 'low self-esteem is a potent risk factor for developing an overvaluation of one's body shape, which in turn may lead to restrained eating in an attempt to achieve a more satisfactory body shape and size.'

Gianini, Loren M. and Smith, Jane Ellen - Body dissatisfaction mediates the relationship between self-esteem and restrained eating in female undergraduates International Journal of Behavioral Consultation and Therapy 2008, 4(1), 48-60

Friday, April 25, 2008

The secret of a happy retirement? Stay busy!

Retirement is a major change in people's lives but studies into its effect on people's quality of life have produced mixed results with some studies suggesting that it has a negative effect, others that it has a positive effect and others portraying its effect as neutral. Participating in clubs and organizations and pursuing hobbies and interests have been found to improve people's life satisfaction in retirement but little is known as to what motivates people to take up these activities. A French study of 150 active retired people found that they were characterized by high levels of intrinsic motivation for knowledge, stimulation and accomplishment rather than for external rewards. An intrinsic motivation for accomplishment and stimulation was linked to a higher level of satisfaction with one's retirement over and above the influences of time since retirement, anticipated satisfaction with retirement and subjective health.

Stephan, Yannick, Fouquerau, Evelyne and Fernandez, Anne - The relation between self-determination and retirement satisfaction among active retired individuals International Journal of Aging and Human Development 2008, 66(4), 329-345

Don't worry, be granny (or grandad)

Over the last twenty years researchers have become increasingly interested in worry. There has been a lot of research into worry among the general population but much less into worry among older adults. A study of 217 people in Canada asked an older group of 111 people about their levels of worry now compared to when they were younger. The second part of the study compared the levels of worry in older people to that of 106 university students. The researchers found that the older people worried less than the students. They were better at coping with uncertainty and less likely to see worry as something leading to effective problem solving, increased control or a reduction in vulnerability.

Basevitz, Paul ... [et al] - Age-related differences in worry and related processes International Journal of Human Aging and Development 2008, 66(4), 283-305

Adolescent problem gamblers

A study of 2,179 adolescents in the Canadian province of Ontario looked into the prevalence of, and risk factors for, gambling problems. The researchers classified 37.9% of the sample as non-gamblers, 49.3% as social gamblers, 7.8% as at-risk gamblers and 5% as pathological problem gamblers. Boys were six times more likely to be pathological problem gamblers than girls. Lower family and school connectedness and lack of family cohesion were all found to increase the risk for problem gambling.

Dickson, Laurie, Derevensky, Jeffrey L. and Gupta, Rina - Youth gambling problems: examining risk and protective factors International Gambling Studies April 2008, 8(1), 25-47

SSRIs for social anxiety

Social anxiety disorder has been defined as anxiety owing to a marked and persistent fear of one or more social of performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. A 1994 study found social anxiety disorder to be the third most common of psychiatric disorders behind depression and alcoholism. A more recent survey found that 6.8% of people suffered from it in any one year with 12.1% of people suffering from it over the course of their lifetime. Symptoms typically begin in the mid-teens and are more common among women than men. Current treatments for social anxiety disorder involve drugs and psychotherapy. A review of studies into the effectiveness of serotonin specific reuptake inhibitors (SSRIs) in treating social anxiety disorder found that they were all more effective than a placebo. The study found that the drugs did not differ in their effectiveness although they all had different side effects and it concluded 'overall, a fair amount of evidence supports the efficacy of escitalopram, fluvoxamine, paroxetine, sertraline and venlafaxine in [treating] social anxiety disorder'.

Hansen, Richard A. ... [et al] - Efficacy and tolerability of second-generation antidepressants in social anxiety disorder International Clinical Psychopharmacology May 2008, 23(3), 170-179

Venlafaxine and citalopram for depression

Major depression is a chronic, disabling disorder with an estimated lifetime prevalence of 16.6% in the U.S. Recent findings from a major research study indicate that up to 50% of patients do not recover after treatment with one selective serotonin reuptake inhibitor (SSRI). For patients who do not respond to SSRI treatment the next step is to switch to a non-SSRI drug or to try another SSRI. A study of 396 patients in the U.S. compared the effectiveness of the non-SSRI drug venlafaxine to the SSRI citalopram. The researchers found that overall both drugs had a similar level of effectiveness but that venlafaxine was more effective in severely depressed people. 57.8% of people taking venlafaxine suffered from side effects whereas 63.4% of people taking citalopram did. 24.5% of the people taking venlafaxine dropped out of the trial compared to 20.9% of those taking citalopram.

Lenox-Smith, Alan J. and Jiang, Qin - Venlafaxine extended release versus citalopram in patients with depression unresponsive to a selective serotonin reuptake inhibitor. International Clinical Psychopharmacology May 2008, 23(3), 113-119

Thursday, April 24, 2008

Home Start in Holland

Bringing up babies and toddlers is not easy and some parents can feel unable to cope with the demands placed upon them. Parents can lose confidence and become depressed which in turn can lead to less positive and more punitive parenting. The first five years are of crucial importance in a child's development and unpredictable parental behaviour, physical abuse, harsh discipline and a lack of supervision/monitoring of the child's behaviour during this period can lead to the development of antisocial behaviour, social rejection, academic failure and membership of deviant peer groups later on in life. Concerns about this have led to the development of early intervention programmes designed to support healthy development in families with young children. One such programme is Home Start which works with volunteers who visit mothers for half a day once a week. The provision of social support by the volunteers is aimed at improving maternal well-being which, it is hoped, will lead to more positive parenting and a reduction in problem behaviour. A Dutch study of 105 sets of parents and children compared those who had taken part in Home Start with a control group. The results showed that the Home Start group had a significant increase in perceived parenting competence but no effect on maternal depressive mood. Parental consistency and observed sensitivity improved in the Home Start group although no effects were found for other parenting variables. Child behaviour problems diminished over time in both groups and there was no supplementary effect for Home Start as far as this was concerned.

Asscher, Jessica J., Hermanns, Jo M.A. and Dekovic, Maja Infant Mental Health Journal March/April 2008, 29(2), 95-113

Together, apart or a bit of both? What works best for mums and babies?

There has been much debate in the media as to whether parents should sleep with or seperately from their parents. Developmental researchers and paediatric professionals are divided on the issue leaving many new parents confused about the potential risks and benefits of different sleeping arrangements. A study of 70 mothers and children in the U.S. compared those who always slept together, those who never slept together and those who were inconsistent. The researchers found that those mothers who were consistent with their children (either always sleeping together or always sleeping apart) were characterized by more positive infant and maternal behaviour and a higher quality of interaction at 9 months. A greater amount of sleeping together per week was associated with an increased duration of breastfeeding, mothers working fewer hours, less infant temperamental intensity and less maternal depression.

Taylor, Nicole, Donovan, Wilberta and Leavitt, Lewis - Consistency in infant sleeping arrangements and mother-infant interaction Infant Mental Health Journal 2008, 29(2), 77-94

Depression and dysthymia in mothers

Dysthymia is a mood disorder characterized by chronic mildly depressed or irritable mood often accompanied by other symptoms such as eating and sleeping disturbances, fatigue and poor self-esteem. A study of 72 mothers with prenatal depression compared those with dysthymia to those with major depression. Previous studies have found that while women with major prenatal depression feel worse women with dysthymia had higher prenatal cortisol (a substance associated with stress) levels and smaller children. The study, by researchers in the U.S. found that the children of dysthymic mothers had a shorter gestational age, a lower birthweight, more obstetric complications and lower orientation and motor scores than the children of mothers with major depression.

Field, Tiffany, Diego, Miguel and Hernandez-Reif, Maria - Prenatal dysthymia versus major depression effects on the neonate Infant Behavior and Development April 2008, 31(2), 190-193

Olanzapine: new ways around weight gain

Olanzapine is an effective antipsychotic drug and the only one, so far, to be demonstrated to minimize grey matter loss. However, it can lead to significant weight gain which can put people at risk of cardiovascular problems and diabetes. Previous trials have shown that switching from standard oral tablets to orally-disintegrating tablets can lead to weight loss but these have only been short-term studies. A study of 26 patients in Canada who switched tablets found that, on average, they had lost 2.7kg after a year. The peak weight loss was observed at 6 months although significant weight loss was achieved after only three. The majority of patients (81.9%) had lost weight after a year while 18.1% showed no change or a weight gain.

Bharat, Chawla and Luxton-Andrew, Heather - Long-term weight loss observed with olanzapine orally disintegrating tablets in overweight patients with chronic schizophrenia. A 1-year, open-label prospective trial Human Psychopharmacology March 2008, 23(3), 211-216

Sexual dysfunction in schizophrenia

Sexual dysfunction is a common problem in people with schizophrenia affecting both treated and untreated patients alike. It affects between 30-80% of women and 45-80% of men. There are a number of possible reasons for this, one of them being the side effects of antipsychotic drugs. Sexual dysfunction is considered to be one of the worst side effects of medication and is a major cause of poor quality of life, a negative attitude to therapy and treatment non-compliance. A review of studies, published since 2002, into the side effects of antipsychotic drugs found that risperidone produced the worst side effects, followed in descending order by haloperidol, olanzapine, quetiapine and aripiprazole.

Baggeley, Martin - Sexual dysfunction in schizophrenia: focus on recent evidence Human Psychopharmacology March 2008, 23(3), 201-209

Wednesday, April 23, 2008

Cholesterol and dementia

A study of 9,752 people in northern California who underwent health evaluations between 1964 and 1973 when they were between the ages of 40 and 45 and which then followed them up between 1994 and 2007 has found that those people who had high cholesterol in their early 40s were more likely to develop Alzheimer's disease. Those with cholesterol levels between 249-500 mg were one-and-a-half times more likely to develop the condition while those with cholesterol levels of 221-248 mg were one-and-a-quarter times as likely. The study took into account the effects of type 2 diabetes, high blood pressure, obesity, smoking and late-life stroke.

You can find out more about this research at

Psychological costs of Iraq and Afghanistan

A survey of 1,965 U.S. servicemen who had served in Iraq or Afghanistan aimed to assess their exposure to traumatic events and possible brain injury while deployed, evaluate current symptoms of psychological illness and gauge whether they had received care for combat-related problems. Servicemen reported exposure to a wide range of traumatic events while deployed. Half said they had had a friend who was seriously wounded or killed, 45% said they had seen dead or seriously-injured non-combatants and over 10% said they were injured themeselves and required hospitalization. Rates of post-traumatic stress disorder (PTSD) were highest among army soldiers and marines and among service members who were no longer on active duty. Women, Hispanics and enlisted personnel were all more likely to report symptoms of PTSD and major depression although the single best predictor of depression and PTSD was exposure to combat trauma while deployed. Just 53% of the servicemen with PTSD or depression had sought help over the past year and of those who sought care only half got 'minimally adequate treatment'.

You can find out more about this research at

Depression and stigma down under

For people suffering from depression the stigma associated with the disease often impedes diagnosis and treatment. A survey of over 6,000 people by researchers from the Australian National University looked into personal stigma - the negative attitude a person has towards depression - and perceived stigma, which describes the stigma felt by a person with depression. People who had come into contact with depression and those who knew most about it had lower levels of personal stigma. Men, older people, those with less education, those born overseas and people in greater psychological distress all had higher levels of personal stigma. One in five people in the survey said that they would not work with someone with depression.

You can find out more about this research at

Suicide and support in Sweden

A team of researchers looking into unnatural teenage deaths in northern Sweden analysed 10 cases of suicide to see their effect on family members left behind. They examined post-suicidal reactions, impacts on daily living and the families' need for support after the event. At the time of the research the participants were still struggling to explain why the suicide had occured. Although most had returned to an ostensibly normal life they were still profoundly affected by their loss. They said that post-suicide support was often badly-timed and insufficient, especially for younger siblings, and said that they would welcome earlier assistance from friends, family and the clergy.

You can read more about this research at

ADHD drugs and heart risk

Studies have shown that stimulant medications - like those used to treat Attention Deficity Hyperactivity Disorder (ADHD) - can increase heart rate and blood pressure. These side effects are insignificant for most children but can lead to sudden cardiac death in those children who already have a heart condition. The American Heart Association has called for children to receive careful evaluation and monitoring - including an ECG - before beginning treatment with ADHD drugs. Once stimulant treatment begins children should have their heart health monitored periodically with a blood pressure check within one to three months, then again at routine follow-ups every 6-12 months. ADHD appears to be more common in children with heart conditions with 33-42% of paediatric cardiac patients having ADHD. In the U.S., between 1999 and 2004, 19 children taking ADHD medication died suddenly and 26 had cardiovascular problems such as strokes, cardiac arrests and heart palpitations.

You can find out more about this research at

Tuesday, April 22, 2008

STEPPS for Borderline Personality Disorder

The treatment of Borderline Personality Disorder is challenging. The use of medication has increased but while several drugs have proved useful their benefit has been modest. A range of psychotherapies has been developed and several have shown good results including dialectical behaviour therapy, mentalization-based therapy, cognitive-behavioural therapy (CBT), schema-focused therapy and transference-focused therapy. Systems Training for Emotional Predictability and Problem Solving (STEPPS) was developed in 1995 and combines CBT and skills training with a systems component for individuals with whom a patient regularly interacts. A U.S. study of 124 patients compared those taking part in the STEPPS programme with those receiving treatment as usual. Those taking part in STEPPS showed a greater overall improvement and became less impulsive, had less negative affectivity and mood, and functioned better. They also had less visits to emergency departments during treatment and follow-up. However, there were no differences between the groups in terms of sucide attempts or self-injury.

Blum, Nancee ... [et al] - Systems Training for Emotional Predictability and Problem Solving (STEPPS) for outpatients with borderline personality disorder: a randomized controlled trial and 1-year follow-up American Journal of Psychiatry April 2008, 165(4), 468-478

Fluoxetine and relapse prevention in childhood depression

Major depressive disorder is a serious problem among young people with between 2-8% of children and adolescents affected. Young people with depression often have significant impairments in relationships, school and work and are at an increased risk for substance abuse, attempted and completed suicide and depression in adulthood. As many as 50-75% of children with major depression have recurrent episodes with recurrence most often occuring within 6-12 months after remission. A U.S. study of 102 children recovering from depression compared a group being given fluoxetine to a group being given a placebo. The group being given fluoxetine were significantly less likely to have a relapse and went longer between relapses than the control group.

Emslie, Graham J. ... [et al] - Fluoxetine versus placebo in preventing relapse of major depression in children and adolescents American Journal of Psychiatry April 2008, 165(4), 459-467

Anger, disgust and eating disorders

Recent research has suggested that anger and disgust play an important part in eating disorders. One study found that women diagnosed with an eating disorder had higher levels of inherent anger and anger suppression than other women. Higher levels of anger were associated with bingeing and vomiting while anger suppression is associated with laxative use. There is a theory that women with anorexia suppress their anger in order to preserve interpersonal relationships and this inability to express emotions has been associated with body dissatisfaction. At the same time disgust is linked to the rejection of foodstuffs or undesirable personal characteristics and disgust at one's body shape. A study of 50 students in Manchester compared those with and without eating problems. The participants were asked to recall an event that made them angry. In comparison to the control group the bulimic group demonstrated a much greater increase in anger and a higher score on the Disgust Sensitivity Scale.

Fox, John R. E. and Harrison, Amy - The relation of anger to disgust: the potential role of coupled emotions within eating pathology Clinical Psychology and Psychotherapy March-April 2008, 15(2), 86-95

Bibliotherapy for depression

Bibliotherapy involves reading text for the treatment of emotional and physical problems. It has been defined as standardized treatment in book form that an individual works through, independent of any assistance from healthcare professionals. The books or manuals have a psychotherapeutic approach that provides information and outlines strategies that the patient can use to generate insight, stimulate awareness of negative emotions and cognitions and provide solutions to problems that can be used in everyday life. An Australian study of 84 mildly to moderately depressed adults compared a control group to a group using bibliotherapy with minimal assistance and a group using bibliotherapy with telephone support. Both treatment groups had significant reductions in their levels of depression compared to the control group, gains which were maintained at a 1-month follow-up.

Bilich, Linda L. ... [et al] - Effectiveness of bibliotherapy self-help for depression with varying levels of telephone helpline support Clinical Psychology and Psychotherapy March-April 2008, 15(2), 61-74

Sense of coherence and stress in caregivers

Sense of Coherence is a perception of the world as comprehensible, manageable and meaningful. It develops during childhood and youth and is thought to be fully developed by the age of 30 after which it remains stable unless radical changes in living or social surroundings take place. Sense of Coherence is believed to be important to people's mental health and has been found to be low in neurotic patients and even lower in depressed patients. A U.S. study of 60 women family members of adults with severe mental illness looked into the links between caregiving, stress and Sense of Coherence. The study found that higher levels of stress decreased people's Sense of Coherence and quality of life. But, a greater Sense of Coherence enhanced people's quality of life and helped to ameliorate some of the effects of stress.

Suresky, M. Jane, Zauszniewski, Jaclene A. and Bekhet, Abir K. - Sense of coherence and quality of life in women family members of the seriously mentally ill Issues in Mental Health Nursing March 2008, 29(3), 265-278

Monday, April 21, 2008

Stigma and help-seeking

Many people do not seek the help they need for their mental-health problems. One theory as to why this might be is that the stigma associated with mental illness puts people off looking for help. A survey of 2,782 college students in the U.S. found that perceived stigma was higher among men, older students, students from lower socio-economic backgrounds and students with current mental-health problems. Perceived stigma was also higher among those whose friends and family had not used mental-health services and among those who believed that therapy or medication are not very helpful. Those who saw the most stigma in mental illness thought that they were the least likely to need help. Among those people with depression and anxiety there was no link between perceived stigma and the propensity to seek help.

Golberstein, Ezra, Eisenberg, Daniel and Gollust, Sarah E. - Perceived stigma and mental health care seeking Psychiatric Services April 2008, 59(4), 392-399

Helping mixed-race children in Sheffield

'Multiple heritage' or 'mixed race' is one of the fastest growing ethnic categories in British society, and, because of its high concentration in the younger age groups is set to expand rapidly in the next decade. Studies have shown that people of mixed race suffer disproportionately from social exclusion, experience high levels of family breakdown, underachieve in school attainment and experience distinct patterns of racism. Sheffield's Multiple Heritage Service aims to help mixed-race children by carrying out group work aimed at increasing children's understanding of their cultural heritage and raising their self-esteem and by providing one-to-one mentoring for children at risk of school exclusion and/or having serious problems with identity or self-confidence. A study evaluating the work of the Multiple Heritage Service found that the group work had led to: improvements in the children's self-esteem, with more improvement among younger children and boys; improvements in well-being, with more improvement among older children and an improvement in problem behaviour among boys. Two-thirds of mothers commended the mentoring service on its positive impact on the children's well-being and happiness; a half reported positive impacts on identity. The mothers commended the positive-role-model effect same-sex mentors had on their children's behaviour, but only a third said mentoring had boosted their children's self-esteem.

Phillips, David ... [et al]- Exploring the impact of group work and mentoring for multiple heritage children's self-esteem, well-being and behaviour Health and Social Care in the Community May 2008, 16(3), 310-321

Decision-making in depression

When patients with depression actively engage in decision making they are less likely to withdraw from treatment prematurely and more likely to adhere to medication, receive treatment according to practice guidelines and show improvements in clinical outcomes. A study of 94 people with depression in Ottawa, Canada looked into their decision making. 67 of them were uncertain about their treatment decision. Common decisions identified were whether or not to take medications, attend support groups or receive electro-convulsive therapy (ECT) and the location of treatment. 40 patients who had made a decision about their treatment in the recent past were uncertain about it. The 'uncertain' group felt less informed, less supported and less clear about how they valued the benefits and risks of options. Other influential factors included concerns about confidentiality, distress from depression, embarrassment, panic attacks and lack of energy. However, few patients wanted to hand over decision making to their family or their doctor. To support decision making participants identified the need for: discussions with their psychiatrist, nurse or doctor; access to printed information; and information provided by health professionals and health societies.

Stacey, D. ... [et al] - Decision-making needs of patients with depression: a descriptive study Journal of Psychiatric and Mental Health Nursing May 2008, 15(4), 287-295

Very young suicides - what are the risk factors?

In the 5-14-year-old age group the average worldwide annual rates of suicide per 100,000 in 2000 were 0.4 for girls and 1.5 for boys. Though this rate is statistically very low the impact on families, friends and classmates can be terrible. A U.S. study of 179 children between the ages of 9 and 12 found that sixteen of them had contemplated killing themselves. Those children most at risk felt less connected to their school, used more internalizing behaviours (becoming depressed and/or anxious rather than talking about their problems) and reported less cohesion, open communication, supervision and family caring than the other children.

Riesch, S.K. ... [et al] - Suicide ideation among later elementary school-aged youth Journal of Psychiatric and Mental Health Nursing May 2008, 15(4), 263-277

Friday, April 18, 2008

Disordered eating in Israel

Disordered eating behaviours are commonly reported by adolescents, particularly girls. Whereas some dieting behaviours such as taking more exercise and eating less fat may be healthy for overweight or obese adolescents unhealthy weight control behaviours such as fasting, vomiting or using laxatives are not and run the risk of developing into a full-blown eating disorder. A study of 2,978 Israeli schoolgirls with an average age of 14.7 found that 30% met the criteria for disordered eating. Being Jewish or underweight protected against disordered eating but dieting, early puberty, being overweight or obese and being constipated all increased the risk. Socio-economic status, physical activity and smoking had no effect of people's risk of developing disordered eating.

Kaluski, Dorit Nitzan ... [et al] - Determinants of disordered eating behaviors among Israeli adolescent girls Eating Disorders March-April 2008, 16(2), 146-159

Child abuse and obesity

Past research has found a reasonably consistent association between various forms of childhood abuse and the development of eating pathology and a number of studies indicate a relationship between childhood abuse and obesity. A study of 121 people in the U.S. seeking surgical treatment for obesity found that 43% of them reported emotional abuse, 39% had witnessed violence, 19% had suffered sexual abuse, 17.4% physical abuse and 9.1% physical neglect.

Sansone, Randy A. ... [et al] - The prevalence of childhood trauma and parental caretaking quality among gastric surgery candidates Eating Disorders March-April 2008, 16(2), 117-127

Recovery and relapse in bipolar disorder

Bipolar disorder tends to come and go throughout people's lives. Most treatment tends to focus on treating acute episodes of the condition but it is just as important to prevent, or delay, relapses between acute episodes. Some people recover completely between acute episodes while others have 'residual' symptoms of the condition. A U.S. study of 223 people with bipolar disorder found that those with residual symptoms experienced relapses three times as quickly as those who were symptom-free between episodes. The researchers concluded that 'stable recovery in bipolar disorder is achieved only when asymptomatic status is achieved'.

Lewis, L. Judd ... [et al] - Residual symptom recovery from major affective episodes in bipolar disorders and rapid episode relapse/recurrence Archives of General Psychiatry April 2008, 65(4), 386-394

Inflammation, depression and childhood maltreatment

Inflammation is a necessary part of the body's defences. However, inflammation which runs unchecked can lead to a host of diseases such as hay fever, atherosclerosis and rheumatoid arthritis. Inflammation has been associated with depression and a New Zealand study of 1,000 people, which followed them from birth to 32 years looked into the links between depression, childhood maltreatment and inflammation. The researchers found that those people with depression and a history of childhood maltreatment were twice as likely to have higher levels of a substance called high-sensitivity C-reactive protein which is seen as indicative of the body's level of inflammation. However people suffering from depression who had not been maltreated as children did not have elevated levels of the chemical. The elevated inflammation levels in the depressed/maltreated group were not explained by other risk factors such as low socioeconomic status, poor health or smoking.

Danese, Andrea ... [et al] - Elevated inflammation levels in depressed adults with a history of childhood maltreatment Archives of General Psychiatry April 2008, 65(4), 409-416

Family relations and paediatric bipolar disorder

Paediatric bipolar disorder (PBD) is often characterized by a more severe, remitting and chronic course of illness than adult onset bipolar disorder. Common features of PBD include increased irritability, elated moods and mixed states (of mania and depression) and a high rate of other mental-health problems such as Attention Deficit Hyperactivity Disorder (ADHD), oppositional defiant disorder, conduct disorder and anxiety disorders. Recent research has started to pay attention to the impact of parent-child relations on PBD with some studies finding significantly less warmth and greater tension and hostility than in other parent-child relationships. Researchers have also found that lower maternal warmth predicts a faster relapse after recovery from PBD. A U.S. study of 60 families compared 30 with a child with PBD to 30 unaffected families. Compared to the control group parent-child relationships in the PBD group were characterized by significantly less warmth, affection and intimacy and more quarreling and forceful punishment. Among the group with PBD elevated symptoms of mania, co-occuring ADHD, an earlier age of illness onset, living in a single-parent home and the presence of a parental mood disorder were associated with greater parent-child relationship difficulties.

Schenkel, Lindsay S. ... [et al] - Parent-child interactions in pediatric bipolar disorder Journal of Clinical Psychology April 2008, 64(4), 422-437

Temperament and bipolar disorder

A child's temperament is defined as the combination of an underlying biological tendency towards responding to the environment in a particular way and the behavioural responses produced by these tendencies. Children are said to have a difficult temperamental style when they have a high anxiety level; distractibility; withdrawal from, or poor reaction to, new and unfamiliar things; poor adaptability (reacting badly to changes in routine); negative persistence (strong-willed, whiny, rigid) and negative mood (cranky, irritable). More difficult temperaments in childhood have been associated with increased risks for a number of problems including anxiety and mood disorders, early delinquent behaviour, substance abuse, inattention, hyperactivity and aggression. A team of researchers in the U.S. looked into whether there was a link between a difficult childhood temperament and childhood bipolar disorder. They compared 25 children with bipolar disorder, 25 children with Attention Deficit Hyperactivity Disorder (ADHD) and 25 other children with no problems. They found that the children with bipolar disorder had shown more signs of a difficult temperament in childhood than those with ADHD, who had, in turn, shown more signs than the children with no problems. The children with bipolar disorder had had less adaptability to new situations, fewer pleasurable mood states and more irregular body rhythyms than the other children.

West, Amy E., Schenkel, Lindsay S. and Pavuluri, Mani N. - Early childhood temperament in pediatric bipolar disorder and attention deficit hyperactivity disorder Journal of Clinical Psychology April 2008, 64(4), 402-421

Wednesday, April 16, 2008

Ethnicity and suicide in the U.S.

In the U.S. the suicide rate among older White people is significantly higher than that among older Black people. For men the rates are 27.8 per 100,000 in Whites versus 11.1 per 100,000 in Blacks and for women the rates are 5.1 per 100,000 versus 1.1 per 100,000 respectively. A study of 1,074 people in Brooklyn, New York looked at the levels of suicidality (thoughts about wanting to kill oneself) in both races. Whites were more likely than Blacks to display suicidality currently (5.8% vs 2.3%) and over the course of their lifetime (14.8% vs 10.2%) although neither of these differences were statistically significant. Four variables were associated with suicidality in both races: depression, anxiety, coping by using medication and lower religiosity. Two variables were associated with suicidality only among Whites: a higher use of spiritualists and coping by keeping calm. One variable, a greater use of doctors for mental-health problems, was significant only among Blacks.

Cohen, Carl I. ... [et al] - Racial differences in suicidality in an older urban population The Gerontologist 2008, 48(1), 71-78

Polypharmacy and psychosis

In psychiatry, polypharmacy (people being described more than one drug) is more the rule than the exception. A German study of 429 people attending a psychiatric outpatient care unit looked into which people were being prescribed drugs for which conditions and how many of them were being prescribed more than one drug. Patients with an initial diagnosis of schizophrenic psychosis were most frequently treated, followed by patients with affective (mood) disorders. 57% of the patients received at least one psychotropic drug, 20% receiving one drug and the remainder more than one. People with schizophrenic psychosis most frequently received a combination therapy, followed by patients with affective disorders. Atypical, antipsychotic drugs were most often prescribed.

Bruggemann, Bernd R., Elgeti, Hermann and Ziegenbein, Marc - Patterns of drug prescription in a psychiatric outpatient care unit: the issue of polypharmacy German Journal of Psychiatry 2008, 11, 1-6

Internet CBT for depression

Internet-based CBT is a promising new approach in the treatment of depression. There have been studies which have proved its short-term effectiveness but little research into its long-term effects. A Dutch study of 301 people over the age of 50 divided them into three groups. One group received internet-based CBT, one group received group CBT and the third group was placed on a waiting list as a control group. After a year the internet-based therapy was found to be superior to the control group and as effective as group CBT.

Spek, V. ... [et al] - One-year follow-up of results of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years Psychological Medicine May 2008, 38(5), 635-639

Behaviour therapy and depression

Depression causes substantial disability, is set to become the second-largest cause of disease burden by 2020, affects between 5-10% of the population and is the third most common reason for people seeing their GP. Cognitive behavioural therapy (CBT) is recommended to treat depression although less than 10% of affected people receive such treatment. As its name implies CBT combines cognitive therapy, aimed at changing people's negative thoughts, with behavioural therapy which is aimed at modifying their behaviour. Recent research has suggested that 'pure' behavioural therapy could be as effective as CBT. A review of 17 trials, made up of 1109 subjects found that behaviour therapy was superior to brief psychotherapy and equal in effectiveness to CBT.

Ekers, D., Richards, D. and Gilbody, S. - A meta-analysis of randomized trials of behavioural treatment of depression Psychological Medicine May 2008, 38(5), 611-623

Tuesday, April 15, 2008

Alcohol problems in hospital patients

Alcohol-related problems are highly prevalent among hospital inpatients. The proportion of inpatiens with current alcohol use disorder has ranged between 7.4% and 18.3% in studies but little is known about the percentage of patients who binge drink or drink at an unhealthy level. A study of 14,332 people, between the ages of 18 and 64 admitted as hospital inpatients in North-Eastern Germany found that 9% of them were identified as having a current drinking problem. 5.3% had alcohol use disorder and 3.6% drank above the recommended levels. Men were much more likely to be problem drinkers than women and rural areas had a higher proportion of problem drinkers than urban ones.

Coder, Beate ... [et al] - Alcohol problem drinking among general hospital inpatients in northeastern Germany General Hospital Psychiatry January-February 2008, 30(1), 127-137

Unhealthy minds and unhealthy bodies

Smoking, poor diet, lack of exercise and excess alcohol consumption are the leading causes of preventable death and evidence suggests that the risk of engaging in these behaviours is higher among people with certain psychiatric conditions, particularly depression and anxiety. A large-scale U.S. study of 217,379 people found that, overall, adults with current depression or who had been diagnosed with depression or anxiety at some point in their lives were significantly more likely to smoke, to be obese, to be physically inactive, to binge drink and to drink heavily. The more severe people's depression the more likely they were to smoke, to be obese and to be physically inactive.

Strine, Tara W. ... [et al] - The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling U.S. adults General Hospital Psychiatry January-February 2008, 30(1), 127-137

Monday, April 14, 2008

Social anxiety in adolescence - what are the risk factors?

A U.S. study of 770 adolescents looked into the risk factors for the development of social anxiety disorder in this group. They found that social anxiety disorder remained constant over time. Childhood negative effect, shyness and chronic illness during childhood were all associated with adolescent social anxiety. Childhood shyness was more likely to turn into social anxiety disorder in girls than in boys. Childhood shyness and childhood chronic illness combined had a much stronger impact on the risk of adolescent social anxiety disorder than their individual effects.

Hayward, Chris ... [et al] - The developmental psychopathology of social anxiety in adolescents Depression and Anxiety, 2008, 25(3), 200-206

Duloxetine for generalized anxiety disorder

Generalized anxiety disorder (GAD) is characterized by pervasive worry that is difficult to control leading to exhausting hypervigilance, multiple somatic symptoms and impaired social and occupational functioning. Recent estimates suggest that GAD affects 3% of the population in any one year and 5-8% of the population over the course of their lifetimes. A study of 327 people in the U.S. looked at the effectiveness of the Selective Serotonin Reuptake Inhibitor (SSRI) duloxetine on GAD. Over ten weeks 168 of the participants were given duloxetine and 159 a placebo. By the end of the trial those patients given duloxetine were less anxious and showed a higher response rate and greater improvement than those participants who had been given a placebo. They also suffered from less impairment in work, family and social situations. However, people were more likely to stop taking duloxetine because of side effects which included nausea, dizziness and somnolence.

Rynn, Moira ... [et al] - Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible dose, progressive-titration, placebo-controlled trial Depression and Anxiety 2008, 25(3), 182-189

Alcohol, anxiety and aggression

The relationship between alcohol and aggression is well documented. Alchohol has been implicated in approximately 50% of violent crimes worldwide and crime statistics indicate that the prevalence of intoxicated aggression has increased steadily over the past 50 years. Alcohol consumption is strongly associated with a number of aggressive behaviours including violent threats, domestic violence, child abuse, sexual aggression, homicide and suicide. Three of the most well-accepted theories of alcohol-related aggression contend that alcohol facilitates aggression by (i) impairing anxiety and fear responses, (ii) disrupting higher-order cognitive functions important in maintaining people's inhibitions and (iii) increasing psychological and physiological arousal. Researchers in Kentucky looked at the first theory by studying 80 healthy male social drinkers between the ages of 21 and 33. The participants were divided into four groups. One group received alcohol plus a task designed to make them feel anxious, one group received a placebo plus the anxiety-inducing task, one group received alcohol and weren't made to feel anxious while a fourth group received a placebo and were not made anxious. (The anxiety-inducing task was to give a videotaped talk about what the participants liked and disliked about their bodies). Then the participants' levels of aggression were measured by getting them to play a game in which they could give electric shocks to an opponent that they thought was real but in fact was imaginary. The results showed that those people who had drunk alcohol but who had been made anxious were no more aggressive than their sober counterparts.

Phillips, Joshua P. and Giancola, Peter R. - Experimentally-induced anxiety attenuates alcohol-related aggression in men Experimental and Clinical Psychopharmacology February 2008, 16(1), 43-56

Red Bull really can give you wings

Caffeine is a mild psychostimulant that is particularly effective in people suffering from sleep problems or from caffeine withdrawal. Caffeinated energy drinks - such as Red Bull - have been shown to improve energy and cognition but this could be down to a placebo effect. A study of 35 people in Chicago compared the effects of a caffeine-containing supplement with a placebo on people who had been kept awake from 5pm to 5am. The participants completed subjective effects questionnaires and performed computerized attention tasks. Compared to the placebo the caffeine supplements produced stimulant-like effects and significantly improved mood and reaction times on the tasks.

Childs, Emma and deWit, Harriet - Enhanced mood and psychomotor performance by a caffeine-containing energy capsule in fatigued individuals Experimental and Clinical Psychopharmacology February 2008, 16(1), 13-21

Workplace stress and belief in a just world

The concept of Belief in a Just World (BJW) reflects a person's confidence in the idea that everyone gets what they deserve and that good people are rewarded and bad people are punished. Numerous studies have found justice to be a key issue in working life and a survey of 217 workers in Germany looked into the links between a belief in a just world and people's experience of workplace stress and adjustment to it. The researchers found that employees with a strong BJW experienced more organizational commitment and less desire to quit. They thought that they were performing better in their job and took less days sick leave and felt less emotional exhaustion and fewer symptoms of depersonalization.

Otto, Kathleen and Schmidt, Sabine - Dealing with stress in the workplace: compensatory effects of belief in a just world European Psychologist December 2007, 12(4), 272-282

The teachers are afraid of the pupils

Although bullying among pupils has received a great deal of attention violence by pupils against teachers has been less well studied. A study of 101 teachers in 7 urban high schools in the UK found evidence for student violence against teachers both from the teachers themselves and their peers and a 1998 U.S. study found that 56% of teachers did not feel safe in U.S. schools. Two studies in Slovakia looked into violence against teachers. The first surveyed 346 teachers and found that that 49% of them reported at least one experience of violence in the past 30 days with reports of violence being particularly widespread in vocational schools. The second study surveyed 108 teachers in vocational schools and found that 60 of them reported at least one experience of violence in the last 15 days. Unsurprisingly the more violence the teachers experienced the less positive and more negative was their mood and the less satisfied they were with their life. The teachers also investigated the impact of a concept called The Belief in a Just World - the idea that the world is basically a just place where people get what they deserve. The researchers found that belief in a just world had a beneficial impact on the teachers' well-being in terms of life satisfaction and positive affect. The more the teachers believed in a just world the less frequently they experienced negative affect.

Dzuka, Jozef and Dalbert, Claudia - Student violence against teachers: teachers' well-being and the belief in a just world European Psychologist December 2007, 12(4), 253-260

Friday, April 11, 2008

Family structure and personality disorders

Personality disorders are thought to be caused by an interaction between genes and environmental factors during the early years of development. Growing up in single-parent and stepfamilies, young motherhood, maternal depression and financial problems in childhood have all been considered as risk factors for children's mental health. A Finnish study of 1,588 young adults looked into the links between family structure and the later development of personality disorders. 7% of the participants had at least one probable or definite personality disorder. After adjusting for gender, parental social class and parental psychiatric disorder it was found that coming from a single-parent family was associated with cluster B (antisocial, borderline, histrionic and narcissistic) personality disorders while being an only child was associated with cluster A (paranoid, schizoid and schizotypal) disorders.

Kantojarvi, L. ... [et al] - Childhood family structure and personality disorders in adulthood European Psychiatry 2008, 23, 205-211

Bipolar disorder and metabolic syndrome

The metabolic syndrome encompasses a group of metabolic risk factors that are associated with an increased risk of diabetes, heart disease, heart attacks and stroke. Several definitions have been proposed but the consensus is that the presence of any three out of impaired glucose metabolism or insulin resistance, high-blood pressure, high cholesterol and abdominal obesity is diagnostic of metabolic syndrome. Rates of metabolic syndrome have been reported at 30% in bipolar-disorder sufferers and bipolar disorder has also been linked with increased risk for obesity, diabetes and high cholesterol. A study of 718 psychiatrists from all over Europe was aimed at assessing the awareness of metabolic issues among European psychiatrists and how this awareness influenced their management of bipolar disorder. 56% of the sample had diagnosed metabolic syndrome in their patients. Respondents reported that metabolic syndrome was higher among bipolar patients (25%) than in the general population (20%). 72% felt that metabolic syndrome poses significant health risks warranting monitoring and treatment and the psychiatrists were most concerned about the medication side effects of weight gain, cognitive impairment and glucose intolerance. The participants recognised clear differences among drugs in terms of their propensity to cause weight gain and 65% of them indicated that they had made interviewing and monitoring changes in the past three years as a result of metabolic concerns.

Bauer, Michael, Lecrubier, Yves and Suppes, Trisha - Awareness of metabolic concerns in patients with bipolar disorder: a survey of European psychiatrists European Psychiatry 2008, 23, 169-177

Mental-health rehabilitation

Mental-health rehabilitation services originated during the era of asylum closures when they drove the development of community mental health services and supported accomodation for people with longer-term and complex mental-health problems. They remain an important component of the whole mental-health system providing longer-term inpatient and community-based services in most Mental Health Trusts across England. However, little is known about the profile of current users of rehabilitation services and whether these services, originally developed to re-provide for patients of the asylum and other psychiatric institutions meet the needs of their modern-day clients. A survey of 141 clients of rehabilitation services in Camden and Islington found that most of them had a diagnosis of schizophrenia or schizoaffective disorders. Around 7% had a substance-abuse problem. Over half had at least one challenging behaviour that was difficult to manage or occured frequently. Clients in longer-term, hospital-based settings had the poorest social functioning and the greatest number of needs. Compared to rehabilitation service users in 1998 clients had more unmet accomodation and money needs but fewer unmet needs in the areas of psychological distress, psychotic symptoms and social relationships.

Killaspy, Helen, Rambarran, Dolly and Bledin, Ken - Mental health needs of clients of rehabilitation services: a survey in one Trust Journal of Mental Health April 2008, 17(2), 207-218

Religious coping and ethnicity

Recent studies suggest that religious behaviour and beliefs can have a protective influence that moderates the impact of adverse interpersonal life events and social adversity on physical and mental health. An in-depth study of 116 people compared religious coping in six different ethnic groups: Bangladeshi, Caribbean, Indian, Irish, Pakistani and White British. Religious coping was most commonly practiced by Bangladeshi Muslims and African Caribbean Christians. Coping included prayer, listening to religious radio, using amulets, talking to God, having a relationship with God and having trust in God. Cultural or spiritual coping practices were indistinguishable from religious coping among Muslims. There was a greater degree of choice and personal responsibility for change among Christians who showed a less deferential and more conversational quality to their relationship with God. Religious and spiritual coping practices were frequently used, and led to changes in emotional states.

Bhui, Kamaldeep ... [et al] - Ethnicity and religious coping with mental distress Journal of Mental Health April 2008, 17(2), 141-151

Thursday, April 10, 2008

Quetiapine and borderline personality disorder

Quetiapine is a newer (atypical) anti-psychotic mainly used to treat schizophrenia and bipolar disorder. Some small studies have shown it to be effective in treating borderline personality disorder (BPD) but the research on this is limited. A Belgian study of 41 patients with BPD were given quetiapine over a period of 12 weeks and given a range of psychological tests. By the end of the study the participants' scores for impulsivity, hostility, affective lability (sudden changes of mood), depression, anxiety and anger had all decreased significantly.

Eynde, Frederique Van den ... [et al] - Efficacy of quetiapine for impulsivity and affective symptoms in borderline personality disorder Journal of Clinical Psychopharmacology April 2008, 28(2), 147-155

Antipsychotics and cholesterol

Antipsychotic treatment, in particular with some newer (second-generation) antipsychotic drugs is associated with weight gain and other metabolic side effects. However, the relationship between drug-induced weight gain and dyslipidaemia (abnormal levels of fat in the bloodstream) is not well understood. A Norwegian study of 242 people with severe mental illness compared people taking the second-generation drugs olanzapine and clozapine, people taking other anti-psychotic drugs and people taking no drugs at all. The researchers found no significant differences between the two groups in terms of obesity, high blood pressure and blood-sugar levels but those participants being treated with olanzapine or clozapine had higher levels of 'bad' cholesterol and lower levels of 'good' cholesterol than the other two groups.

Birkenaes, Astrid B. ... [et al] - Dyslipidemia independent of body mass in antipsychotic-treated patients under real-life conditions Journal of Clinical Psychopharmacology April 2008, 28(2), 132-137

Wednesday, April 09, 2008

What predicts risky behaviour in adolescence

Health-risk behaviours like substance use (alcohol, tobacco and drugs) and risky sexual behaviour become more common in adolescence. Children with behaviour problems are thought to be more likely to engage in high-risk behaviour but it is unclear which types of behaviour problems lead to risky behaviour. A Dutch study of 309 children which followed them from the ages of 4-5 to 18 found that physical aggression was the most important factor in predicting risky behaviour. 'Status violations' (e.g. running away from home and truancy) predicted an increased risk of smoking and soft drug use while 'property violations' also predicted an increased likelihood of risky behaviour.

Timmermans, Maartje, Lier, Pol A.C. van and Koot, Hans M. - Which forms of child/adolescent externalizing behaviors account for late adolescent risky sexual behavior and substance use?
Journal of Child Psychology and Psychiatry April 2008, 49(4), 386-394

Cyberbullying - the facts

Cyberbullying has received a lot of press coverage lately but research into it is at an early stage. Two studies of secondary school pupils in London looked into cyberbullying. The first study had 92 pupils and included focus groups while the second involved 533 pupils. Both studies found cyberbullying less common than traditional bullying but still significant. It happened more often outside school than inside and phone and text message bullying were the most common forms. The impact of cyberbullying was felt to be as bad as traditional bullying. 'Happy slapping' while rarer was perceived to have a more negative impact. Most cyberbullying was done by one or a few pupils usually from the same year group; it often lasted for just a week but sometimes much longer. Being a 'cybervictim' - but not a 'cyberbully' - was correlated with Internet usage. Pupils recommended blocking/avoiding messages and telling someone as the best coping strategies but many cybervictims had told nobody about it.

Smith, Peter K. ... [et al] - Cyberbullying: its nature and impact in secondary school pupils Journal of Child Psychology and Psychiatry April 2008, 49(4), 376-385

Tuesday, April 08, 2008

The power of positive thinking

How people interpret events and challenges can be very significant for their happiness and mental health. Positive affect expresses enthusiasm, activity, alertness, control, commitment and seeing difficulties as challenges with a general disposition towards a positive outlook and a satisfactory perception and appraisal of potentially stressful events. Negative affect is associated with measures of neuroticism and negative emotionality as well as marked symptoms of stress. High negative affect is associated with subjective complaints, poor coping and anxiety whereas high positive affect is associated with sociability, control, helpful behaviour, feelings of duty, accuracy, care in decision-making and positive attitude over time and circumstance. High positive affect individuals experience a greater appreciation of life, more security and self-confidence, more social relations and assertiveness and greater satisfaction with their friends. They are often described as passionate, happy, energetic and alert. Two Swedish studies looked at the influence of positive and negative affect on people's physical and psychological health. The first study was of 122 high-school students, aged between 17 and 19 and the second study was of 208 office workers aged between 27 and 61. The participants were divided into four groups on the basis of personality tests: 'self-fulfilling' - those high in positive affect and low in negative affect, 'high affective' - those high in both positive and negative affect, 'low affective' - those low in positive and negative affect and 'self-destructive' - those low in positive affect and high in negative affect. The participants were also asked about their psychological and physical health. 'Self-fulfilling' individuals were found to have 'markedly better health profiles' than the other three groups.

Archer, Trevor ... [et al] - Influence of affective personality on cognition-mediated emotional processing: need for empowerment European Journal of Psychiatry 2007, 21(4), 248-262

Adolescent immigrants - part II

A Norwegian study of 341 young immigrants from different ethnic groups looked into their mental-health problems to see which groups were most vulnerable and what the risk factors were. The immigrants came from Iran, Somalia, Sri Lanka and Vietnam. The Somalis and Tamils (from Sri Lanka) had less problems than the Iranians and Vietnamese. The most important factors in whether the youngsters experienced problems were school-related problems, self-efficacy and intergenerational conflicts.

Oppedal, Brit - Psychosocial profiles as mediators of variation in internalizing problems among young immigrants with origins in countries of war and internal conflict European Journal of Developmental Psychology March 2008, 5(2), 210-234

Adolescent immigrants - what helps them to stay out of trouble?

A study of 1,081 adolescent, ethnically German immigrants from Russia and Kazakhstan found that about 10% of them experienced severe difficulties settling into life in Germany. They felt discriminated against in various aspects of their lives and failed at school. However, there were a few young people who functioned surprisingly well and the researchers set out to find which factors lay behind this. Financial assets, language competence and a shorter residence in Germany all protected against delinquency. The level of education of the children's fathers was also found to have an effect but the more educated the father was the more likely the children were to have problems. The researchers speculated that this might be because of the problems educated fathers experienced working in jobs below their intellectual capabilities.

Schmitt-Rodermund, Eva and Silbereisen, Rainer K. - Well-adapted adolescent ethnic German immigrants in spite of adversity: the protective effects of human, social and financial capital European Journal of Developmental Psychology March 2008, 5(2), 186-209

Monday, April 07, 2008

Why you should keep going round to see Mum and Dad

The links between social support and mental health are now well-established but less is known about specific dimensions of social support and social networks. A Europe-wide study of 15,469 people over the age of 50 looked into how their children affected older people's mental health. The study found that childless men and women had more depressive symptoms and that fewer contacts with children was associated with an increased number of depressive symptoms. Older men and women living with a spouse or partner had the lowest levels of depression and the presence of a spouse or partner was more relevant for the mental health of older people than the presence of, or contact with, their children.

Buber, Isabella, Engelhardt, Henriette - Children's impact on the mental health of their older mothers and fathers: findings from the Survey of Health, Ageing and Retirement in Europe European Journal of Ageing, 2008, 5, 31-45

Social anxiety disorder in childhood

Social anxiety disorder (SAD) is characterized by a marked and persistent fear of one or more situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The feared situations are avoided or are endured with intense anxiety or distress. In children the most feared social situations usually include those where the child is expected to speak (e.g. talking to peers, reading aloud in class, joining in a conversation) but also other situations such as musical or athletic performances. However, it is unclear whether children with SAD have a distorted perception of their own abilities or whether they do actually have worse social skills than other children. A Norwegian study of 150 children compared those with social anxiety to those with ADHD and a healthy control group. The researchers found that those children with SAD did have a lower verbal IQ and worse motor skills than other children.

Kristensen, Hanne and Torgessen, Svenn - Is social anxiety disorder in childhood associated with developmental deficit/delay? European Child and Adolescent Psychiatry March 2008, 17(2), 63-72

Autism, ADHD and facial recognition

Theory of mind comprises thought processes that enable the behaviour and experiences of others to be recognized, understood, predicted and communicated. People with autism have great problems with theory of mind and can often find it hard to recognise people's emotions from their faces. Children with Attention Deficit Hyperactivity Disorder (ADHD) also find it hard to match facial expressions to emotions. Autism can be accompanied by increased inattention, hyperactivity and impulsivity and genetic, neuropsychological and brain-imaging studies suggest links between autism and ADHD. A German study of 99 children between the ages of 6 and 18 found that 52% of the autistic children also met the criteria for a diagnosis of ADHD. The children with ADHD were worse at recognising facial expressions than a healthy control group and both the children with pure ADHD and pure autism were worse than average at recognising emotions.

Sinzig, Judith, Morsch, Dagmar and Lehmkuhl, Gerd - Do hyperactivity, impulsivity and inattention have an impact on the ability of facial affect recognition in children with autism and ADHD? European Child and Adolescent Psychiatry 2008, 17, 63-72

Detection and untreated psychosis

People suffering from their first episode of psychosis often experience long periods of untreated psychosis before coming into contact with psychiatric services. The duration of untreated psychosis (DUP) averages 1-2 years but the longer DUP is the worse people's prognosis. An early detection programme and a comprehensive information campaign have been shown to be effective in reducing DUP. A Danish study of 552 people looked at what happened in Copenhagen where an early detection team was established in 1998 without an accompanying information campaign. The study found that the mean DUP was a year and that the early-detection team on its own had had no effect in reducing it. However, more people who had some symptoms of psychosis, without the full-blown disorder, had been referred for treatment.

Nordentoft, Merete ... [et al] - Does a detection team shorten duration of untreated psychosis? Early Intervention in Psychiatry 2008, 2, 22-26

Early intervention for psychosis - long-term effects

Psychotic disorders lead to an increased risk for suicide, particularly during the early course of the illness. Up to a third of first-episode psychosis patients attempt suicide prior to commencing treatment and as many as 15% do so in the first 1-2 years of treatment. Early intervention and treatment for psychosis is, therefore, seen as very important. An Australian study of 7,760 people with psychosis aged between 15 and 29 found that 8.5 years after treatment there was no difference in suicide rates between those who had and had not received early intervention. However, after adjusting for other socio-demographic, clinical and treatment factors suicide risk was lower by 50%, in the first three years after treatment, for the group who had received early intervention. A history of inpatient treatment, more days of treatment per annum and a shorter time to establish a psychiatric diagnosis were all associated with an increased risk of suicide. People who weren't working but who weren't looking for a job either were at less risk than those who were unemployed and looking for work.

Harris, Meredith G. ... [et al] - Impact of a specialized early psychosis treatment programme on suicide. Retrospective cohort study Early Intervention in Psychiatry 2008, 2, 11-21

Friday, April 04, 2008

Drug treatment drop-outs

Studies have shown that the drop-out rate from treatment for opiate addiction is around 30-40%. A study of people dropping out of opiate treatment in Stockholm found that only 20% of them had a detailed treatment plan and only 20% participated in their own treatment planning. None of the drop-outs were enrolled in a methadone or buprenorphine programme (aimed at weaning them off heroin) at admission. Having a treatment plan at intake improved the odds of not dropping out thirteen-fold but perceiving fewer positive aspects of drug use increased the risk of dropout by a factor of 12.6. Patients with sketchy or no treatment planning at intake, no maintenance treatment and a low score on positive aspects of drug use were 7.5 times more likely to drop out. Drop-outs lacked a close maternal relationship and had insecure attachment patterns which made contact difficult with social services and substance-abuse-treatment providers.

Berman, A. H. ... [et al] - Hopeless patients? A study of illicit opiate users who drop out from in-patient detoxification Journal of Substance Use April 2008, 13(2), 121-130

Dual diagnosis in South Africa

People with drug problems often have co-occuring mental-health problems as well. A study of 419 people at a private rehabilitation centre in Johannesburg found that 57.1% of them had a mental-health problem. 155 had a mood disorder, 40 had an anxiety disorder, 39 had ADHD, 35 had an eating disorder, 8 had a conduct disorder and 5 had schizophrenia. ADHD was linked to cannabis-related disorders and polysubstance (more than one drug) dependence. Anxiety-related disorders were linked to alcohol abuse and mood disorders were linked to cocaine.

Fabricius, V., Langa, M. and Wilson, K. - An exploratory investigation of co-occuring substance-related and psychiatric disorders Journal of Substance Use April 2008, 13(2), 99-114

Attributional style and depression

A person's attributional style is the way in which they ascribe causes to events in their lives. People who regard the causes of negative events as global, stable and internal (due to their own shortcomings) are more likely to develop depression. Some researchers believe that this negative attribution is itself a symptom of depression (mood-related) while others believe it is a permanent outlook (trait-related) that may be due to genetic factors. A study of 213 people in Cardiff compared depressed people and their siblings to a control group of unaffected people and their brothers and sisters. The researchers found that attributional style had more to do with current mood than trait-related factors. However, the tendency to blame oneself for negative events was related to having had a prior episode of depression suggesting that depression can have a 'scarring' effect predisposing people towards a negative view of events. People who had experienced minor difficulties were found to have a more positive attributional style suggesting that minor life events are protective against pessimistic attributions.

Ball, Harriet A., McGuffin, Peter and Farmer, Anne E. - Attributional style and depression British Journal of Psychiatry April 2008, 192(4), 275-278

Folate and depression in older people

Low levels of folate and vitamin B12 and high levels of a substance called homocysteine have been found to be associated with depression in a number of studies although not all studies have found this link. A Korean study of 521 people aged 65 and over measured participants' levels of these substances and followed them over 2-3 years to see who developed depression. The researchers found that lower levels of folate and vitamin B12 and higher homocysteine levels at baseline were associated with a higher risk of incident depression at follow up. Incident depression was associated with a decline in vitamin B12 and an increase in homocysteine levels over the follow-up period.

Kim, Jae-Min ... [et al] - Predictive value of folate, vitamin B12 and homocysteine levels in late-life depression British Journal of Psychiatry April 2008, 192(4), 268-274

Help-seeking behaviour and depression in adolescence

It is widely recognised that adolescence is a developmental period with fluctuating levels of psychological distress often in the form of depression and anxiety. Seeking appropriate help for these psychological problems before they become severe can reduce adolescents' risk for developing more severe psychological problems such as suicidal thoughts. However, only about a third of young people with mental-health problems receive professional mental-health care. One reason for this is a phenomenon called help negation in which people become more withdrawn and less likely to seek help from others as they become more depressed. A study of 1,766 children between the ages of 12 and 18 in Australia found that the more depressed children were the less likely they were to seek help from their parents. The researchers found a 'consistent trend for students to report being more likely to seek help from no one as depressive symptoms increased'.

Wilson, Coralie Joy, Rickwood, Debra and Deane, Frank Patrick - Depressive symptoms and help-seeking intentions in young people Clinical Psychologist November 2007, 11(3), 98-107

Eating disorders, denial and deception

Denial of illness is a serious stumbling block for the detection, assessment and treatment of eating disorders. A survey by Belgian researchers of 401 ex-eating-disorder patients found that they had made a variety of attempts to conceal their eating disorder : making excuses to avoid eating together, methods to give the false impression of having eaten, avoidance of being weighed and falsifying weight. Often these methods were described as a deliberate strategy. Information about possible health risks had little or no impact on most respondents who were familiar with the notion of an eating disorder but did not apply it to themselves. Many believed that they would have recognised their eating disorder earlier if they had had a clinician who was familiar with this disorder.

Vandereycken, Walter and Humbeeck, Ina Van - Denial and concealment of eating disorders: a retrospective survey European Eating Disorders Review March-April 2008, 16(2), 109-114

Eating disorders and personality disorders

Previous research on the links between eating disorders and personality disorders has varied greatly in its findings although there is a general understanding that personality disorders are common among eating-disorder patients. A study of 545 eating-disorder patients in Denmark found that 29.5% of them had one or more personality disorders - less than the researchers were expecting to find. Personality disorders, in particular borderline personality disorder, were more common among people with bulimia.

Godt, Kristine - Personality disorders in 545 patients with eating disorders European Eating Disorders Review March-April 2008, 16(2), 94-99

Thursday, April 03, 2008

Amphetamines in Volvo country

A zero-tolerance law for driving under the influence of drugs (DUID) was introduced in Sweden in 1999. This led to a huge increase in the number of blood samples sent off for toxicological analysis and a study of 26,556 cases of DUID found that 60% of the samples contained some form of amphetamine together with either legal or illegal drugs. In just under a quarter of the cases amphetamine was the only substance found in the blood sample. 85% of the amphetamine users were men who tended to be a few years older than the women. The mean age of ecstasy users was 26 - about ten years younger than the average age of the other amphetamine users.

Jones, Alan Wayne, Holmgren, Anita and Kugelberg, Fredrik C. - Driving under the influence of central stimulant amines: age and gender differences in concentrations of amphetamine, methamphetamine and ecstasty in blood Journal of Studies on alcohol and drugs March 2008, 69(2), 202-208

Drink, drugs and driving

A survey of 27,616 people in the U.S. looked into the links between the age at which people first started drinking, alcohol dependence, drug taking and driving under the influence of drink or drugs. All the sample were drinkers. 22% of the sample had used drugs, 10% had driven under the influence of drugs and 1% had been in a crash because of their drug use. Starting to drink at a young age and being alcohol-dependent were both associated with an increased risk of using drugs and becoming drug-dependent. Being drug and alcohol-dependent were both associated with an increased risk of driving under the influence of drugs and being involved in a drug-related accident.

Hingson, Ralph W., Heeren, Timothy and Edwards, Erika M. - Age at drinking onset, alcohol dependence, and their relation to drug use and dependence, driving under the influence of drugs, and motor-vehicle crash involvement because of drugs Journal of Studies on Alcohol and Drugs March 2008, 69(2), 192-201

Facial recognition in schizophrenia

For most people recognizing a face is a natural and effortless process. Because of the importance of facial recognition a distinct and highly efficient brain system has developed for processing and utilizing facial information. In schizophrenia impairments in recognizing faces has been reported and such impairments may play a crucial role in poor social interactions in patients. Facial recognition is known to be particularly sensitive to inversion (being upside down) and a study of 57 people in the U.S. looked at facial recognition and inversion effects in people with and without schizophrenia. The researchers found that people with schizophrenia were significantly worse at recognising primitive line drawings of people's faces, either upside down or the right way up. However, they were as good at recognizing trees both ways up suggesting there was something specific to facial recognition which they had trouble with.

Chen, Yue ... [et al] - Inefficient face detection in schizophrenia Schizophrenia Bulletin 34(2), 367-374

Schizophrenia rates in different countries

It has long been thought that schizophrenia has a better prognosis in countries in the developing world than in developed countries. Evidence has come from three World Health Organization (WHO) studies: the International Pilot Study of Schizophrenia, the Determinants of Outcome of Severe Mental Disorder study and the International Study of Schizophrenia. A review of research conducted outside the auspices of WHO looked at 23 studies of schizophrenia outcomes in 11 low- and middle- income countries. The study looked at clinical, disability and social outcomes and found little difference compared to more-developed countries. The researchers concluded that 'it is time to re-examine presumed wisdom about schizophrenia outcomes in low- and middle-income countries'

Cohen, Alex ... [et al] - Questioning an axiom: better prognosis for schizophrenia in the developing world? Schizophrenia Bulletin 34(2), 229-244

Wednesday, April 02, 2008

Abdominal obesity and Alzheimer's

A study of 6,583 people in northern California measured their abdominal fat between the ages of 40 and 45 then followed them up an average of 36 years later. By that time 16% of the participants had been diagnosed with dementia. A pot belly increased the risk of dementia regardless of whether the participants were of normal weight, overweight or obese and regardless of existing health conditions including diabetes, stroke and cardiovascular disease. Those who were overweight with a large belly were at 2.3 times greater risk while those who were obese with a large belly were at 3.6 times greater risk. Women were more likely than men to have abdominal obesity, along with non-whites, smokers, people with high blood pressure, high cholesterol or diabetes and those who were less well educated.

You can read more about this research at

Genetics and schizophrenia

Emerging evidence suggests that many people with schizophrenia have small genetic abnormalities that affected their brain in childhood and adolescence. In a series of new studies on adult-onset schizophrenia scientists from the National Institute for Health in the U.S. found that people with the condition possessed high rates of rare genetic deletions and duplications that apparently disrupted their brain during youth. The genes affected in patients were involved in creating the infrastructure by which neurons communicate, neuronal growth, migration, proliferation, differentiation and cell death. The genetic abnormalities were found in 15% of the adult-onset patients and 20% of the childhood- or adolescent-onset schizophrenia sufferers compared to only 5% of a healthy control group. The mutations occured across the whole of the genome and were often specific to single cases or families ; virtually every mutation in a sample of 150 adults with schizophrenia was different.

You can find out more about this research at

Young families and happiness

It is often thought that those people who start a family early miss out on career opportunities, make poor choices of partners and can experience other problems. A study of 8,000 young adults in the U.S. compared those who set up a family over the course of a five-year period to those who remained single or who had not had children. Those who had set up a family early in their lives were more likely to come from low-income families, have less well-educated parents and to have lived in a household with one or no biological parents. However, despite these disadvantages there were very few differences in overall happiness between the two groups. Those who had broken up with a live-in partner had higher levels of depression but this group only made up 14% of the people in the 'early families' group. The researchers speculated that leaving to live together, marry or have children may provide an opportunity to escape from an unloving home and create a more positive family.

You can read more about this research at

Paranoia on the Piccadilly Line

A virtual-reality Tube ride used by researchers at the Institute of Psychiatry in London has found that suspicious and paranoid thoughts are far more common in the general population than was previously thought and are almost as common as anxiety and depression. Wearing virtual-reality headsets 200 participants walked around a virtual Tube-train carriage in a four-minute journey between station stops. The carriage contained computer-generated people who breathed, looked around and sometimes met the gaze of the participants. The participants interpreted the same computer characters very differently. The most common reaction was to find them friendly or neutral but almost 40% of the participants experienced at least one paranoid thought. Those who were anxious, worried, focused on the worst-case scenario and had low self-esteem were the most likely to have paranoid thoughts.

You can find out more about this research at