Religion, depression and meaning in life

There has been a lot of research recently into the links between religion and mental health. Researchers at Temple University in the U.S. studied 918 people and looked into three aspects of religious belief: church attendance, religious well-being (the quality of a person's relationship with a higher power) and existential well-being, a person's sense of meaning and their purpose in life. People with high levels of religious well-being were 1.5 times more likely to have had depression than those with lower levels of religious well-being. However, people who attended church regularly were 30% less likely to have had depression in their lifetime and people who had a clear sense of meaning and purpose in their life were 70% less likely to have suffered from depression.

You can find out more about this research at

http://psychcentral.com/news/2008/10/24/spirituality-tops-religion-for-depression/3196.html

Poverty ups youth suicide risk

A study of 2,779 teenagers in Canada, carried out as part of the National Longitudinal Survey of Children and Youth looked into the risk factors for suicide attempts in this age group and in particular the impact of poverty. Poverty levels in the children's neighbourhoods were measured in early and mid-adolescence based on census data and at 18 or 19 the participants were asked whether they had seriously considered attempting suicide in the last 12 months. Among teenagers from all backgrounds hyperactivity and impulsivity, depression, substance use, low social support, exposure to suicide and negative life events all led to an increase in sucidality but in children from poorer neighbourhoods the effects of hyperactivity and impulsivity were accentuated. Youths from poorer neighbourhoods were twice as likely to report suicidal thoughts as their peers from more affluent neighbourhoods and four times as likely to actually make a suicide attempt.

You can find out more about this research at

http://psychcentral.com/news/2008/10/27/teens-in-poor-neighborhoods-at-greater-risk-for-suicide/3206.html

Earlier the better for child anxiety disorders

A study presented at the annual meeting of the American Academy of Child and Adolescent Psychiatry has suggested that it may be more beneficial for children to confront and manage their fears rather than use other techniques to deal with them. The study found that children were able to complete exercises designed to expose them to and neutralise their fears much earlier than suggested in treatment manuals for childhood anxiety disorders and that treatment that was shorter and began exposure to the child's fear earlier than usual was more effective at improving children's functioning.

You can read more about this research at

http://psychcentral.com/news/2008/10/30/confront-fears-to-reduce-child-anxiety/3233.html

Breast is best for mental health

The health benefits of breast-feeding children are well established and a new study by the American Public Health Association suggests that it may also have benefits for children's mental health. Researchers used data from the 2003 National Survey of Children's Health made up of 102,353 interviews with parents and guardians about the health of their children. The study found that parents of breastfed children were less likely to report concern over their child's behaviour and their children were less likely to have been diagnosed by a health professional with behavioural or conduct problems or to have received mental health care. Parents of breastfed children were also less likely to report concern about their child's ability to learn.

You can find out more about this research at

http://psychcentral.com/news/2008/10/30/breastfed-children-have-less-mental-health-issues/3235.html

Risk factors for methamphetamine abuse

Methamphetamine is a stimulant, also known as 'meth' or 'speed' that can be smoked, snorted or injected and which produces sensations of euphoria, lowered inhibitions, feelings of invincibility, increased wakefulness and an increase in energy. An analysis of 12 studies into the risk factors for methamphetamine abuse, carried out by researchers at the University of Alberta, Canada looked at low-risk (those not involved in any other drug abuse) and high-risk (those who had taken other drugs or who had been in a juvenile detention centre) children. Within the low-risk group a history of engaging in behaviour such as sexual activity, particularly homosexual or bisexual activity, alchohol consumption and smoking was significantly associated with methamphetamine use. Among high-risk youth the risk factors identified were growing up in a family with a history of crime, alcohol and drug use; having received treatment for a psychiatric condition and being a girl.

You can find out more about this research at

http://psychcentral.com/news/2008/10/28/meth-abuse-among-teens/3214.html

The neuroscience of hate

A brain imaging study by researchers at University College London looked at the parts of the brain that are activated by hate. They found that this 'hate circuit' was distinct from those related to threat, fear and danger although it did share a part of the brain related to aggression. The circuit was distinct from that associated with romantic love although it did share at least two common structures with it. To generate hate seventeen people had their brains scanned while looking at a picture of someone they hated. The 'hate circuit' included structures in the cortex and the sub-cortex important in generating aggressive behaviour and translating this into physical action and a part of the frontal cortex involved in predicting the actions of others. Hate activated parts of the brain called the putamen and insula which are both also involved in romantic love although love de-activated the parts of the brain associated with judgement and reasoning more than hate.

You can find out more about this research at

http://psychcentral.com/news/2008/10/29/hate-area-of-brain-identified/3225.html

Older people, risk and stress

Researchers at the University of Southern California Davis School of Gerontology looked into the way that stress affects decision making and found that following a stressful experience older people were much more averse to stress than young ones. The study compared young adults (18-33) with older ones (65-89) and used a driving game to measure their approach to risk. Participants were given points for every second they spent driving on a yellow light but lost points if the light turned red while they were driving meaning they had to take risks to score any points at all. In a control group which had not been exposed to stress the older adults had a higher score but after the participants had been exposed to stress (by putting their hands in a bucket of ice-cold water for three minutes) the older people became much more cautious. They were also jerkier drivers, braking and restarting almost three times as much as older drivers in the control group. The differences in the effects of stress were consistent even when the researchers accounted for gender, level of education, mood and health.

You can read more about this research at

http://psychcentral.com/news/2008/10/29/stress-effect-more-exaggerated-in-older-adults/3226.html

Depression and premature birth

A study of 791 women in and around San Francisco has found that those of them who were suffering with symptoms of depression were much more likely to give birth prematurely. The women were interviewed around the 10th week of their pregnancy when 41% reported 'significant' symptoms of depression and 22% reported 'severe' symptoms. Those with 'severe' symptoms had almost twice the risk of an early birth while those with 'significant' symptoms had a 60% greater risk. Women who were more likely to report depressive symptoms tended to be younger than 25, unmarried, less educated, poorer, Black and have a history of pre-term delivery. But it may not necessarily be the depression itself that leads directly to premature birth. Depression at 10 weeks could itself be a symptom of another underlying process or problem that causes premature birth. At the same time depression is known to be linked with non-compliance with prenatal care, poor nutrition, inadequate sleep and self-medication with alcohol and drugs so it could be these factors that lead to premature birth rather than depressson per se

You can find out more about this research at

http://psychcentral.com/news/2008/10/27/depression-ups-pregnancy-risk/3204.html

Depression and COPD

Depression is already known to be linked to worse outcomes for people recovering from heart attacks or with other cardiovascular problems and now new research has shown that it is also linked to worse outcomes in the lung disease chronic obstructive pulmonary disease (COPD). The study of 491 people with COPD in China found that depression was associated with a 50% worsening of COPD symptoms while anxious patients had instances of worsening symptoms that were nearly twice as long as patients without anxiety.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=114118&cn=5

Mental health and employment

On Monday this week Incapacity Benefit was replaced with Employment Support and Allowance which aims to get as many claimants back to work as possible, including people with mental-health problems. But with unemployment forecast to rise over the coming months a poll by the mental-health charity MIND has revealed the vulnerability of employment for people with mental-health problems. Of the 279 people who responded to the poll on the charity's web site 58% had had to leave a job because of a lack of mental-health support, 31% had been sacked or forced out of a job after disclosing a mental-health problem and 1 in 4 had had job offers withdrawn when they told employers about their psychological problems. Over 200,000 people with mental distress lose their jobs and have to start claiming benefit each year.

Bipolar below the radar

Bipolar disorder, or manic depression, is a recurrent and long-term mental illness that can seriously affect the lives of sufferers and their relatives. It is characterized by the alternating occurence of manic, hypomanic, depressive and possibly mixed episodes and has been estimated to have a lifetime prevalence of 1.5-2% in the E.U. When service users are in remission they can still be suffering from subsyndromal symptoms which are not quite severe enough for a diagnosis of full-blown bipolar disorder. While subsyndromal manic symptoms can improve functioning subsyndroman depressive ones can lead to impairment and disability. A survey of 157 bipolar outpatients in the Netherlands found that they had fewer symptoms of psychopathology than psychiatric outpatients in general but a significantly lower quality of life than the rest of the population. The more bipolar symptoms they had the worse was their quality of life.

Goossens, Peter J.J. ... [et al] - Self-reported psychopathological symptoms and quality of life in outpatients with bipolar disorder Perspectives in Psychiatric Care October 2008, 44(4), 275-284

Older gamblers' other problems

There has been a steady increase in gambling over the last few years with a deregulation of betting shops, state lotteries and online gambling. The growth in gambling participation has included older adults who have more time on their hands and, if they are lucky, a good disposable income. 35% of older adults reported lifetime gambling in 1975, a figure that had increased to 80% by 1998. In 1975 23% reported having gambled in the past year compared to 50% in 1998. The increase in gambling behaviour among older adults was more dramatic than in all other age groups. While most older adults gamble for recreation and do so responsibly a minority develop problem gambling or pathological gambling. A survey of 40 older adults with lifetime pathological gambling in Illinois and Iowa used established mental-health screening tools to see what other mental-health problems they might have. The results indicated a high level of other mental illnesses including depression, alcohol dependence, panic disorder, anxiety, obsessive-compulsive and avoidant personality disorders.

Kerber, Cindy Sullivan, Black, Donald W. and Buckwater, Kathleen - Comorbid psychiatric disorders among older recovering pathological gamblers. Issues in Mental Health Nursing 2008, 29(9), 1018-1028

Compulsive hoarding and OCD

Compulsive hoarding is a problem that is characterized by excessive collecting and the failure to discard excessive amounts of collected items, in addition to the cluttering of living space and significant distress or impairment caused by the hoarding. Between 15-40% of OCD sufferers report saving and hoarding compulsions but there is some uncertainty about the relationship between hoarding and OCD. A study of 52 people by researchers at the Institute of Psychiatry in London compared 25 people with severe compulsive hoarding and OCD and 27 people with compulsive hoarding without OCD. Overall the nature of hoarding behaviour was similar between the two groups with the majority of the participants in both groups reporting hoarding common items as a result of their emotional and/or intrinsic value. However, about a quarter of the hoarders with OCD hoarded bizarre items and had other obsessions and compulsions related to their hoarding such as a fear of catastrophic consequences, the need to perform checking rituals and the need to perform mental compulsions before discarding any items and these people had a much more severe and disabling form of the disorder. The researchers concluded that in most individuals compulsive hoarding appeared to be a syndrome separate from OCD but that in otheer individuals it is a symptom of OCD and has unique clinical features.

Pertusa, Alberto ... [et al] - Compulsive hoarding: OCD symptom, distinct clinical syndrome or both? American Journal of Psychiatry October 2008, 165(10), 1289-1298

Olanzapine for anorexia

Olanzapine is an antipsychotic drug, mostly used to treat people suffering from psychosis or schizophrenia. However, there has recently been some research into the use of olanzapine in treating people with anorexia. One of the side effects of olanzapine is weight gain and it is also thought to have some effectiveness in combating obsessional thoughts and depression. People whose anorexia involves restricting their calorie intake tend to have obsessional traits while those who binge and then purge often suffer from dysphoric (depressed) mood. A small study of 34 people with anorexia compared a group taking olanzapine with another group taking a placebo. The group taking olanzapine was found to have a greater rate of increase in weight, an earlier achievement of their target body mass index and a greater rate of decrease of obsessive symptoms. No differences in adverse effects were observed between the two treatment conditions.

Bissada, Hany ... [et al] - Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-controlled trial American Journal of Psychiatry October 2008, 165(10), 1281-1288

CBT and theories of depression

There is now a lot of evidence for the effectiveness of cognitive behaviour therapy (CBT) as a treatment for major depression but there is still some uncertainty as to how it actually works. The cognitive mediation model says that it works by changing people's dysfunctional attitudes; maladaptive, inflexible and extreme assumptions by which the self or the world is judged. Dysfunctional attitudes are more prevalent in depressed people and decline with treatment but the complication model holds that it is depression that produces dysfunctional attitudes and not vice versa. Other theories are that depression and dysfunctional attitudes contribute to one another or that there is a third, underlying factor, common to both. A study of 130 people with major depression in Canada divided them into three groups. One group received CBT, another group received interpersonal therapy and a third group received pharmacotherapy. A comparison of CBT with interpersonal therapy showed that a reduction in dysfunctional attitudes explained the effectiveness of CBT. However when CBT was compared to pharmacotherapy the complication model was found to fit the facts better.

Quilty, L.C., McBride, C. and Bagby, R.M. - Evidence for the cognitive mediational model of cognitive behavioural therapy for depression Psychological Medicine November 2008, 38(11), 1521-1530

Computerized CBT and patient satisfaction

Cognitive behaviour therapy (CBT) is used to treat a variety of mental-health problems including depression and anxiety. However, it is not always available to service users because of a shortage of therapists and long waiting times. Alternative methods of provision have been developed including group therapy, bibliotherapy and computerized CBT (CCBT). There is evidence about the clinical effectiveness of CCBT but little information about its acceptability to service users. A review of 16 studies on the use of CCBT for depression found that although drop-out rates from CCBT were comparable to other forms of treatment, take-up rates were much lower. Overall there was limited information on patient satisfaction with CCBT but when treatment was completed several studies reported positive expectancies and high satisfaction.

Kattenthaler, E. ... [et al] - The acceptability to patients of computerized cognitive behaviour therapy for depression: a systematic review Psychological Medicine November 2008, 38(11), 1521-1530

Shame and eating disorders

Eating-disorder symptoms are associated both with negative emotionality in general and specific negative emotions, in particular chronic feelings of shame. Symptoms of eating disorders are also thought to be linked to problems with regulating emotions. A study of 154 undergraduates at Duke University in the U.S. looked at the relationship between shame, emotional regulation and eating disorder symptoms. The results showed that chronic shame predicted eating disorder symptoms over and above the general effects of negative emotions. Problems with emotional regulation were found to have an influence on the link between chronic shame and eating disorder symptoms; the worse people's emotional regulation the more their shame led on to eating disorder symptoms.

Gupta, Sumati ... [et al] - Emotion regulation skills mediate the effects of shame on eating disorder symptoms in women Eating Disorders October-December 2008, 16(5), 405-417

Eating disorders in the military

Elite athletes often develop eating disorders as they are under constant pressure to meet demanding weight and fitness standards. Members of the U.S. armed forces have also got to meet strict weight and fitness standards and can be placed on a remedial fitness programme and be denied promotion if they fail to match up to them. There have been a few surveys into this issue but because these are filled in by servicemen themselves they have produced unreliable results. The U.S. services' medical records are on a database and a survey of this database from 1998 to 2006 found that in any one year 0.3% of service personnel had an eating disorder. Eating disorders were diagnosed significantly more in 2006 than in 1998 and women were diagnosed significantly more than men. The majority of anorexia cases were in the Marines.

Antczak, Amanda J. and Brininger, Teresa L. - Diagnosed eating disorders in the U.S. military: a nine year review Eating Disorders October-December 2008, 16(5), 363-377

Dementia: out of the shadows

700,000 people are estimated to be suffering from dementia in the UK. The Alzheimer's Society has produced a report, Dementia: out of the shadows in which people with dementia speak out about the impact it has had on their lives and the stigma that goes with the condition. People report losing friends after their diagnosis, neighbours crossing the street to avoid them and professionals dismissing their symptoms as old age.

You can download a full copy of the report at

http://www.alzheimers.org.uk/downloads/Out_of_the_Shadows.pdf

Ethnicity and learning difficulties

It has long been recognised that people from different ethnic groups receive different levels of care from mental-health services. People from ethnic minorities have higher rates of compulsory admission, longer average lengths of stay and are more likely to be prescribed drugs or ECT rather than psychotherapy or counselling. They are also less likely to use mental-health services in the first place. Ethnicity and learning disability is an under-researched area although what research there is suggests that services often offer a 'tokenistic' approach in meeting individual needs, resulting in under usage of service and creating a general environment of 'lack of engagement'.

You can read more about the existing research on this topic and plans for future research at

http://www.library.nhs.uk/ethnicity/viewResource.aspx?resid=296479&code=13e349d0c83a1a920e3672f92df146f0

Cognitive adaptation training for schizophrenia

People with schizophrenia also have cognitive problems which, as well as generally making life more difficult, can also affect how well they adhere to their medication. Cognitive adaptation training (CAT) is an intervention that uses compensatory strategies and supports such as pill containers with alarms, organization of belongings and activity checklists to prompt and sequence adaptive behaviours in an individual's home environment. A Texan study of 95 outpatients with schizophrenia allocated them to three groups: full-CAT which focused on many different aspects of looking after oneself such as grooming, care of living quarters, leisure skills, social and role performance and medication adherence; pharm-CAT which just concentrated on medication adherence and treatment as usual. The treatment lasted for 9 months and participants were followed for 6 months after the withdrawal of home visits. Both full-CAT and pharm-CAT were superior to treatment as usual for improving adherence to medication even after the home visits were withdrawn. Full-CAT had a greater impact on outcome compared to the other two groups but only as long as the home visits were being made. Survival time to relapse was significantly longer in both the full-CAT and pharm-CAT groups compared to treatment as usual.

Velligan, Dawn I. ... [et al] - The use of individually tailored environmental supports to improve medication adherence and outcomes Schizophrenia Bulletin May 2008, 34(3), 483-493

Information campaign key to early intervention for psychosis

How long someone is ill with psychosis before they receive treatment, the duration of untreated psychosis (DUP) is a risk factor for a poorer response to treatment and a poorer outcome of treatment. A Scandinavian study used an intensive information campaign targeting the general public, schools and GPs and low-threshold emergency detection teams to reduce the duration of untreated psychosis and this proved successful compared to service as normal in other areas which acted as a control group. At the end of the trial the publicity campaign stopped but one of the areas still kept its early-detection team allowing researchers to see what the effect of the information campaign had been. They found that once the information campaign had stopped the DUP reverted back to its pre-existing levels and service users were iller by the time they came into contact with health professionals.

Joa, Inge ... [et al] - The key to reducing duration of untreated psychosis: information campaigns Schizophrenia Bulletin May 2008, 34(3), 466-472

Gender and coping strategies

Research studies have shown that women are twice as likely to suffer from anxiety and major depression than men. This could be because women are biologically more vulnerable to stress or because men and women use different coping strategies to deal with problems. Men are more likely to use problem-focused coping, seeking practical ways to deal with the root cause of the problem whereas women are more likely to use emotion-focused coping to try and change the way they feel about difficult and stressful situations. Emotion-focused coping is predictive of higher levels of psychopathology and functional impairment. A study of 107 people in the U.S. looked into the relationships between gender and coping strategies and depression and anxiety. Women who used less positive reframing (attempting to see problems in a positive light) had higher levels of depression than other women and higher levels of depression than men irrespective of what coping strategy the men used. Women who were more prone to blame themselves had higher levels of anxiety although men who blamed themselves did not.

Kelly, Megan M. ... [et al] - Sex differences in the use of coping strategies: predictors of anxiety and depressive symptoms Depression and Anxiety 2008, 25(10), 839-846

Gender differences in OCD

In the last two decades there has been a growing interest in gender differences in obsessive-compulsive disorder (OCD) and in the different aspects of the condition which researchers now suspect may have different causes. A study of 186 people with OCD in Barcelona looked not only at the links between gender and different aspects of OCD but also at the links between tic disorders and OCD and the effect of the age of onset of OCD on which symptoms were experienced. The study found that a preoccupation with contamination and cleaning was more common in women than men whereas a preoccupation with religious and sexual obsessions was more common in men than women. Symptoms of checking, symmetry/ordering and hoarding were equally common in both sexes. Patients who were obsessed with symmetry and ordering were more likely to have a history of tic disorders. Obsessions with symmetry/ordering and sexual and/or religious obsessions were both associated with an earlier onset of OCD.

Labad, Javier ... [et al] - Gender differences in obsessive-compulsive symptom dimensions Depression and Anxiety 2008, 25(10), 832-838

Vitamin B and Alzheimer's

A substance called homocysteine is known to be involved in neurological diseases, including Alzheimer's. Vitamin B is known to reduce levels of homocysteine in the body so some scientists wonder whether vitamin B supplements might help to stave off the condition. A study of 340 people by scientists from the Alzheimer's Disease Cooperative Study compared those participants taking a high-dose vitamin B supplement and those taking a placebo. Unfortunately the study found no differences in cognitive performance between the two groups and those taking the vitamin supplement were more likely to show symptoms of depression.

You can find out more about this research at

http://psychcentral.com/news/2008/10/16/vitamin-b-does-not-help-alzheimers/3146.html

Churches unsympathetic to mental illness

A survey of 293 people, all of whom had previously been diagnosed with a serious mental illness, by researchers at Baylor University in the U.S. has found that participants did not always get a sympathetic response when they approached members of the clergy for help. Nearly a third of the participants were told by their church pastor that they or their loved ones did not really have a mental illness but that their problem was solely spiritual in nature such as personal sin, a lack of faith or demonic involvement. Women were more likely than men to have their mental-health problems dismissed by the church and conservative churches were more likely than liberal ones to take an unsympathetic attitude towards mental distress.

You can find out more about this research at

http://psychcentral.com/news/2008/10/16/clergy-often-downplay-mental-illness/3147.html

Silver surfers, stimulated brains

Pursuing activities that keep the mind engaged may help to preserve brain health and cognitive ability. Traditionally these have tended to be activities such as reading, card games, Scrabble etc but more and more 'silver surfers' are using the Internet and new research has shown that searching the Web may help stimulate, and possibly improve, brain function. A team of researchers at the University of California, Los Angeles studied 24 volunteers with brain scanners as they read and surfed the Web. 12 of them had previous experience of using the Internet while the others did not but the two groups were chosen to be similar in every other respect. Reading was found to produce significant brain activity in all the participants in the parts of the brain that deal with language, reading, memory and visual abilities. Surfing the Net also stimulated these areas but was also found to stimulate parts of the brain to do with decision-making and complex reasoning. However, these areas were only stimulated in the experienced web users suggesting that they approached the process of surfing the Net in a different way from the other participants.

You can find out more about this research at

http://psychcentral.com/news/2008/10/16/web-searches-may-improve-brain-function/3136.html

ADHD - a walk in the park could be a breath of fresh air

Research on children with ADHD has suggested that playing outside in a green area can help to control the condition but a lot of the evidence is anecdotal and there has been little systematic comparison with other activities. Researchers from the University of Illinois took children on three different walks: one in a park, one in a city centre and one in a suburban area. The walks were the same for all the children, none of them were on medication and they all walked with the same adult. At the end of the walks they were given a test - reciting a series of numbers backwards - designed to measure their level of attention. This particular test does not improve with practice and none of the testers knew which child had been on which walk. The walk in the park was found to be more effective than the other walks at improving concentration and its effect was as good as, if not better than, medication.

You can find out more about this research at

http://psychcentral.com/news/2008/10/17/walk-in-the-park-may-help-kids-with-adhd/3152.html

Consequences of early drug use

A long-term study of nearly 1,000 New Zealanders tracked them from birth through to 32. The study looked at those people who began drinking and using marijuana regularly before their 15th birthday. Some of the children came from abusive, criminal or substance-abusing households and had behaviour problems while others came from more stable backgrounds. The children from the more stable backgrounds who were early drug users ended up with the same problems as the at-risk children who did not take drugs and were 3.6 times more likely to be dependent on substances at 32. They were also more likely than the other children from stable backgrounds to end up with a criminal conviction and/or a herpes infection. Early pregnancies, a pattern of school failure, substance dependence, sexually-transmitted disease and criminal convictions were common patterns among the early drug users.

You can find out more about this research at

http://psychcentral.com/news/2008/10/17/early-teen-drug-use-harms-health/3155.html

ADHD ups divorce risk

A study of 488 children and their families in Pittsburgh, U.S. has found that families with young children with Attention Deficit Hyperactivity Disorder (ADHD) were almost twice as likely to divorce, although there was no difference in the divorce rate after the child reached eight. The study found that for families with children with ADHD having a father with antisocial behaviour was the biggest risk factor for divorce. Other risk factors were: mothers who had substantially less education than their fathers; children being diagnosed with ADHD at a younger age; being from an ethnic minority and children who also had serious problems with 'oppositional defiant disorder' (not doing what they were told) and 'conduct disorder' (being naughty).

You can find out more about this research at

http://psychcentral.com/news/2008/10/22/childs-adhd-increases-divorce-risk/3176.html

Depression and heart disease - measuring the extra burden

There is a well-established link between depression and heart disease and it is known that depression can impede people's recovery after a heart attack. However, there has been little research into the level of the burden that depression in heart-attack victims places on health services. A Canadian study of nearly 2,000 heart-attack patients found that depression contributed to a 9% increase in heart-related hospitalizations, a 24% increase in total re-hospitalization days and a 43% increase in non-heart-related hospitalization visits following discharge after a heart attack. The study also found that depression caused the greatest increase in those patients with a lower cardiac illness severity.

You can read more about this research at

http://psychcentral.com/news/2008/10/22/link-between-depression-and-cardiac-care/3177.html

Education and Alzheimer's disease

Better educated people have a lower risk of developing Alzheimer's disease but it is unclear whether education has a protective effect against the condition or that people with more brainpower (cognitive reserve) to begin with can cope with the ravages of Alzheimer's better. The cognitive reserve theory has been given a boost by researchers in Milan who administered brain scans to 242 people with Alzheimer's, 72 with mild cognitive impairment and 144 healthy controls. Better-educated people had less glucose metabolism (which is produced by brain activity) in the posterior temporoparietal cortex and precuneus areas of the brain than less well-educated people who had the same level of cognitive functioning suggesting that although their brains had suffered more damage the better-educated people were more able to cope with it.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=114025&cn=231

What is the future for mental health?

The Foresight Unit at the Cabinet Office looks into the future and tries to see what issues and problems might arise for the Government. One of the issues it has been looking into is mental health and you can see the results of a Powerpoint presentation on this at

http://www.cabinetoffice.gov.uk/~/media/assets/www.cabinetoffice.gov.uk/strategy/mental_capital_wellbeing_071011%20pdf.ashx

New web site for mental-health medication

A new website Choice and Medication has been set up with the aim of offering service users and their carers access to comprehensive information and advice on mental-health conditions and medication groups. The website has been produced by the United Kingdom Psychiatric Pharmacy Group, the College of Mental Health Pharmacists, the Pharmaceutical Schizophrenia Initiative and the National Institute for Mental Health in England. It contains information on over 100 mental-health drugs, 17 mental-health problems, tables comparing the main treatments used and how the drugs are thought to work.

http://www.choiceandmedication.org.uk/en/

New NICE guidance for older adults

The National Institute for Health and Clinical Excellence (NICE) has published new public-health guidance on occupational therapy interventions and physical activity interventions to promote the mental wellbeing of older people in primary and residential care.

You can download a copy of the NICE guidance at

http://www.nice.org.uk/nicemedia/pdf/PH16Guidance.pdf

Debt and mental health

Following the credit crunch it is increasingly likely that more and more people will get into debt. A survey by the mental-health charity MIND has looked into the links between mental-health problems and debt and found that 91% of people said that the experience of being in debebt had worsened their mental health. The report In the Red: debt and mental health found that people with mental-health problems were almost three times more likely to be in debt. People with bipolar disorder, which can cause extravagant spending patterns, were four times more likely to get into debt. Fewer than 1 in 3 people with problem debt informed their creditors of their mental-health problems and 83% of those who did were still harassed by them.

You can view a non-printable copy of In the Red: debt and mental health at

http://www.mind.org.uk/NR/rdonlyres/B8ACA0C3-C16C-45DE-886D-84F0745A1C9D/0/Mw08reportWeb.pdf

The pathway to recovery

The Healthcare Commission has published the results of its review of NHS acute inpatient mental health services - The Pathway to Recovery. The review identified a number of high-performing trusts where there was a therapeutic environment and patients were engaged in meaningful activities but one in four patients were being treated by trusts rated as 'weak', 50% of patients had no say as to what was included in their care plan or the treatment they received and some mental-health wards were seen as hostile and unsafe.

You can download the full text of the report at

http://www.healthcarecommission.org.uk/_db/_documents/The_pathway_to_recovery_-_summary.pdf

While we are waiting

The Mental Health Foundation has produced a report into the long waiting times experienced by those waiting for psychological therapy. The report called While we are waiting says that patients can often wait more than 6 months for treatment. The report says that mental-health problems, people's relationships and their work situations can all suffer terrible damage while they are waiting for treatment. The report calls for PCTs to

• make psychological therapies available within 3-10 days if urgently needed
• to tell patients about the different kinds of treatment available so they can get the right one for them
• to offer weekend and evening appointments for those who can't make it during the day
• make sure that therapy services are sensitive and accessible to children and young people

You can download the full text of the report at

http://www.mind.org.uk/NR/rdonlyres/FBC70E3F-15E5-492D-8D53-D38397409DE6/0/WhilewearewaitingJul08.pdf

Gene link to anxiety

A study by German and U.S. authors has found that people with a particular variation of a gene are more prone to anxiety disorders than others. People carrying two copies of the met158 variation of the catechol-o-methyltransferase (COMT) gene showed greater anxiety on a standard personality test and were significantly more startled than others when shown a series of unpleasant pictures.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=112300&cn=1

Bullying - what makes children victims?

Peer victimization (bullying) is increasingly recognized as a major social problem with international statistics showing that up to 1 in 10 youths are the target of physical attacks, hostile words and social aggression from their peers during their school years. The same children tend to be bullied throughout the course of their childhood and adolescence and the consequences can include depression, loneliness, low self-esteem, physical health problems, alcohol and drug abuse, self-harm and suicidal ideation. A study of 1,970 children in Quebec, Canada, tracked them from 3 to 6 and then asked them, and their teachers, about their experience of bullying at 7. The researchers found that high levels of harsh, reactive parenting, physical aggression by the children themselves and low parental income were all linked to an increase risk of children being victimized.

Barker, Edward D. ... [et al] - Predictive validity and early predictors of peer-victimization trajectories in preschool Archives of General Psychiatry October 2008, 65(10), 1185-1192

Maternal iron and schizophrenia

Although schizophrenia usually begins in adolescence or young adulthood there are a number of theories which suggest its roots are in early childhood or even before. Fetal hypoxia (a lack of oxygen for the child developing in the womb) and maternal nutritional deficiencies have both been implicated but nobody has looked at the role of mother's iron levels despite the fact that iron is essential for a number of processes within the developing brain. Researchers in the U.S. looked at blood tests from 6,872 pregnant women taken between 1959 and 1967 and looked to see whether their children had developed schizophrenia between 1981 and 1997. The children of mothers with a low concentration of iron in their bloodstream had a nearly fourfold increase in their risk of developing schizophrenia and the more iron there was in the mother's bloodstream, the less their children's chance of developing schizophrenia was.

Insel, Beverley J. ... [et al] - Maternal iron deficiency and the risk of schizophrenia in offspring Archives of General Psychiatry October 2008, 65(10), 1136-1144

Three questions to diagnose postnatal depression

Postnatal depression is the most common problem new mothers confront but is often underdiagnosed. The condition is characterized by high levels of anxiety but screening is not routinely performed due to time and other constraints. Researchers at the Colorado Adolescent Maternity Programme have developed a simple three-item questionnaire based on a sub-scale of the Edinburgh Postpartum Depression Scale. The three-item questionnaire was more accurate than two other, longer, subscales and identified 16% more mothers as depressed than the original longer questionnaire. The three questions, which were answered on a five-point scale ranging from 'Yes, most of the time' to 'No, never' were:

• I have blamed myself unnecessarily when things went wrong
• I have felt scared or panicky for no very good reason
• I have been anxious or worried for no very good reason

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=112825&cn=5

ADHD medication and drug abuse

The use of stimulants, such as Ritalin, for children with Attention Deficit Hyperactivity Disorder (ADHD) is deeply controversial with concerns about the side effects and the ethics of prescribing this medication to children. One of the worries is that treatment with these drugs may increase the risk of drug and alcohol abuse. However, several studies of boys and young men with ADHD have found that stimulant treatment actually decreases the risk and delays the onset of substance abuse in adolescence although it does not affect the risk of using tobacco, alcohol or drugs in adulthood. A study of 114 girls (aged 6-18) with ADHD by researchers at Massachusetts General Hospital assessed them for tobacco, alcohol, marijuana and other drug use five years after they enrolled in the study. They compared the 94 participants who had received the stimulants with 20 who had not. The girls who had been treated with stimulants had half the risk of smoking, drinking alcohol and drug abuse as those who had not received treatment although the researchers could not say whether the stimulants had the same protective effects as the girls moved into adulthood.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=113656&cn=3

MRIs and social phobia

MRI scans are increasingly allowing researchers to look into the links between what, physically, goes on in people's brains and how they respond to stimuli and mental-health problems. Researchers from the U.S. National Institute of Mental Health used MRI technology to investigate social phobia. Social phobia is the most common anxiety disorder in the general population and is marked by a person fearing and avoiding social situations and fearing negative judgements by others. Those with the disorder run a greater risk of depression, drug and alcohol problems and suicide attempts. The researchers found that people with social phobia experienced greater blood flow in their amygdala and prefrontal cortex - areas of the brain linked to awareness of oneself, fear, emotion and stress - when they read negative comments about themselves. However, when they read negative comments about others, or neutral or positive comments about themselves or others, there was no change in blood flow in these parts of the brain.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=113753&cn=1

Brain chemistry of seasonal affective disorder

Seasonal affective disorder is a mood disorder which occurs in winter and is linked to a lack of energy, fatigue, overeating and a tendency to sleep longer as well as depressed mood. Researchers at the University of Toronto in Canada looked into the links between the seasons and the levels of a serotonin transporter in the brain. The serotonin transporter 'mops up' serotonin in the brain leading to reduced levels of serotonin, the brain's 'feel-good' chemical so the higher the levels of serotonin transporter the higher the risk of depression. The researchers found that the serotonin transporter was significantly more active in the autumn and winter and believe that light may have a direct effect on the activity of the protein. The study was based on brain scans of 88 volunteers carried out between 1999 and 2003.

You can find out more about this research at

http://news.bbc.co.uk/1/hi/health/7591342.stm

Continued fall in suicide rate

The latest report of the National Suicide Prevention Strategy for England presents an encouraging picture of the progress being made in preventing people from killing themselves. The overall suicide rate over the last three years was 8.3 deaths per 100,000 people compared to 8.5 per 100,000 in the three-year period before that. There was also a 7.5% fall in the rate of suicide among young (20-34) men. There were 145 suicides among mental-health inpatients in 2005, compared to 157 in 2004. The number of suicides among people in contact with mental-health services also fell between 2004 and 2005, from 1308 to 1277.

You can read the press release which accompanied the publication of the strategy at

http://nds.coi.gov.uk/environment/fullDetail.asp?ReleaseID=375715&NewsAreaID=2&NavigatedFromDepartment=False

New code of practice for Mental Health Act

The deprivation of liberty safeguards were part of the 2007 Mental Health Act and provide a framework by which people who lack the capacity to consent to care or treatment can be deprived of their liberty temporarily, in their own best interest. The Department of Health has just issued a Code of Practice containing guidance on the safeguards. As well as being used by health professionals the Code is also intended to provide information for people who are, or who could become, the subject of a deprivation of liberty; for families, friends or carers and for anyone who believes that someone is being deprived of their liberty unlawfully.

You can download a copy of the safeguards at

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085476

The police and mental health

A new briefing paper from the Sainsbury Centre for Mental Health looks at the role of the police in dealing with people with mental-health problems. The paper says that the NHS should manage health care for people in police custody and take a more active role in diverting people with mental health problems to the service they need. The paper also calls for more training for police in dealing with people with mental-health problems and for assessment suites to be provided by mental health services so that police cells no longer have to function as 'places of safety' under the Mental Health Act.

You can read the full text of the briefing paper at

http://www.scmh.org.uk/news/2008_police_briefing.aspx

Suicide rates in Scotland

Scotland's death toll from suicide rose in 2007 after several years of falls. 620 men and 218 women killed themselves in 2007 in a country which has a suicide rate higher than in other parts of the UK. However, based on three-year rolling averages there was a 13% fall in suicide rates between 2000-2002 and 2005-2007. Men were three times more likely than women to kill themselves and suicide rates were double the Scottish average in the most deprived areas, particularly Greater Glasgow and the Highlands.

You can find out more about this report at

http://www.mentalhealth.org.uk/information/news/?EntryId17=63057

Latest statistics on drug misuse

The latest statistics on drug misuse (which relate to the year 2006/7) show that nearly 80% of the people who died from using illegal drugs in 2006/7 were men. Men were more than twice as likely as women to be admitted to hospital for drug-related mental-health and behavioural disorders and more than twice as likely to access structured drug treatment. There were 1,573 deaths related to drug misuse in 2006. 13.2% of men reported taking illegal drugs, compared to 6.9% of women. You can read the full text of the report at

http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/drug-misuse/statistics-on-drug-misuse:-england-2008-full-report

English mental health services 'best in Europe'

A report on mental health services in Europe has concluded that services in England are among some of the best available. The World Health Organization report looked at funding levels, staffing, primary and secondary provision and mechanisms for monitoring human rights. England and Wales were the only places to offer outreach support to all people with mental disorders and one of only three places - together with Germany and Luxembourg - that enabled people to access early intervention. England was the only country to provide a network of specialist early intervention teams to target young people with the early stages of psychotic disorders.

You can download the full text of the report at

http://www.euro.who.int/InformationSources/Publications/Catalogue/20081009_1

New guidelines for antidepressants

The British Association for Psychopharmacology has produced new evidence-based guidelines for the pharmacological treatment of depression.

You can see a full copy of the guidelines at

http://www.bap.org.uk/consensus/antidepressant.pdf

Smoking and schizophrenia

People with schizophrenia are much more likely to smoke than the rest of the population and people suffering from depression and anxiety are also more likely to smoke as well. A study of 100 people with schizophrenia living in the North of England asked whether those who smoked had higher levels of anxiety and depression and whether suffering from anxiety and depression made the participants more likely to smoke. The researchers found that there was no significant difference 'in anxiety and depression scores as a function of smoking status' although men with schizophrenia were much more likely to smoke than women.

Martin, C.R. ... [et al] - Mood and smoking in schizophrenia Journal of Psychiatric and Mental Health Nursing November 2008, 15(9), 703-709

Service users or destructine whirlwinds?

Borderline personality disorder (BPD) is characterized by an unstable pattern of personal relationships, changeable moods (including intense anger), poor impulse control and self-mutilating behaviour. Psychiatric nurses often see service users with BPD in negative terms as manipulative, attention-seeking or troublemakers. A qualitative study of six psychiatric nurses in London and Hampshire used interviews to explore further nurses' perceptions of people with BPD. They found that nurses saw these people as a 'destructive whirlwind'; a powerful, dangerous, unrelenting force that leaves a trail of destruction in its wake. The major themes emerging from the study were: care giving; idealized and demonized; manipulation and threatening.

Woollaston, K. and Hixenbaugh, P. - 'Destructive whirlwind': nurses' perceptions of patients diagnosed with borderline personality disorder Journal of Psychiatric and Mental Health Nursing November 2008, 15(9), 703-709

Child bipolar disorder - new research

There has been an enormous increase in diagnoses of paediatric bipolar disorder lately although there is still a large amount of scepticism as to whether this condition really exists in children. Researchers at Washington University in St Louis studied 108 children who were diagnosed with bipolar disorder between 1995 and 1998. At the beginning of the study, and again during nine follow-up visits conducted over eight years the children and their parents were interviewed seperately about their symptoms, diagnoses, daily cycles of mania and depression and interactions with others. Over the course of the study the children had mood 'episodes' in 60.2% of weeks and episodes of mania in 39.6% of weeks. 87.8% recovered from their first episode of mania but 73.3% later relapsed. The episodes of illness were characterized by psychosis, daily cycling between mania and depression and a long duration. At the end of the follow-up period 54 of the participants were 18 or over of whom 44.4% continued to have manic episodes and 35.2% had substance-abuse disorders, a rate similar to those diagnosed with bipolar disorder as adults, strongly supporting the continuity between child and adult bipolar disorder.

You can find out more about this research at

http://psychcentral.com/news/2008/10/07/childs-bipolar-may-continue-into-young-adulthood/3081.html

Narcissism and leadership

Researchers from Ohio State University at Newark have found that in groups without leaders it is often narcissists who step into the breach. This could be worrying as narcissists tend to be self-centred, exaggerate their talents and abilities and lack empathy for others. In one study 432 undergraduate students completed personality tests, which measured narcissism and were put into groups of four. They were given a hypothetical task selecting next year's director of the student union and afterwards completed a questionnaire evaluating the leadership of themselves and other group members. Those who scored highest on one dimension of narcissism - the desire for power - were more likely to say they wanted to lead the group, were more likely to say they did lead the group discussion and were more likely to be viewed as group leaders by the other group members. In another experiment 408 students were placed in groups of four and asked to choose 15 items from a list to help them survive on a desert island. Again the narcissists were more likely to emerge as leaders of the groups although when their list was compared to a list compiled by survival experts they were no more effective at choosing the best items than other students. In a third study 153 business managers enrolled on an MBA programme were given a task of assuming the role of a school board deciding how to allocate a large donation from a fictional company. This time trained observers sat in on the group and assessed who emerged as the leaders. Once again those highest in narcissism were more likely to emerge as leaders.

You can find out more about this research at

http://psychcentral.com/news/2008/10/08/narcissistic-individuals-are-often-leaders/3087.html

St John's Wort and depression

St John's Wort has long been used in folk medicine to treat depression and sleep disorders. The plant produces a number of different substances that may have anti-depressant properties although it is thought that the whole extract is more effective than its individual constituents. A review of 29 different studies, covering 5,489 participants, whose depression was assesse using the same methodology found that it was superior to placebos and as effective as standard antidepressants with fewer side effects. However, the researchers stressed that people should still see their doctor in the first instance as St John's Wort can interfere with the effectiveness of other medication and not all preparations of St John's Wort are equally effective.

You can find out more about this research at

http://psychcentral.com/news/2008/10/08/st-johns-wort-can-help-with-depression/3089.html

Procaine for dementia

Procaine, or novocaine, is conventionally used as a local anaesthetic. However, it has also been touted as an anti-ageing drug that could improve, or even reverse, the symptoms of dementia. Procaine preparations are available in more than 70 countries and it has been estimated that more than 100 million people might use them. They are officially banned in the U.S. but people can buy them over the Internet. A review of studies into the effectiveness of procaine in treating cognitive impairment has found that 'there is no evidence that it does anything at all and even some evidence that it is toxic'. Side effects can include restlessness, dizziness, migraines and systemic lupus erythematosus, a disease in which a person's immune system attacks itself.

You can find out more about this research at

http://psychcentral.com/news/2008/10/08/procaine-does-not-relieve-dementia/3090.html

Magic magnets licensed in the U.S.

Transcranial Magnetic Stimulation therapy (TMS) has been licensed for the treatment of severe depression in the U.S. The therapy does not involve drugs or invasive procedures and works by stimulating nerve cells in an area of the brain that is linked to depression by delivering highly-focused magnetic pulses. The treatment takes around 40 minutes and does not require anaesthesia or sedation. Over 10,000 treatments performed so far have produced only minor side effects of mild-to-moderate scalp pain.

You can find out more about Transcranial Magnetic Stimulation therapy at

http://psychcentral.com/news/2008/10/13/last-chance-therapy-for-depression/3119.html

Alcohol and brain shrinkage

Moderate consumption of alcohol is known to have a protective effect against heart disease but sadly it appears that it does not have a similar protective effect on the brain. A study of 1,839 adults by researchers at Wellesley College in the U.S. who had an average age of 60 used an MRI scan to measure the size and health of participants' brains. The participants were also asked how much alcohol they consumed per week, their age, sex, education, height, weight, body-mass index and stroke risk. The more alcohol people consumed the lower their brain volume; an effect which was more pronounced in women than men.

You can read more about this research at

http://psychcentral.com/news/2008/10/13/the-more-you-drink-the-more-brain-shrinks/3123.html

I'm not anxious - I'm having a heart attack!

There is a certain amount of overlap between the symptoms of coronary heart disease (CHD) and anxiety which can both cause chest pain, shortness of breath and an irregular heartbeat. Researchers in the U.S. used clinical vignettes (fictional case studies) to see how these symptoms were interpreted by health professionals and found that if a patient was a woman their symptoms were more likely to be interpreted as anxiety than as CHD. The doctors read four vignettes about a 56-year-old woman and a 47-year-old man (the risk of CHD is the same for both). There were two vignettes each about the man and the woman; one in which they had recently experienced a certain amount of stress, the other in which they hadn't. There was no evidence of bias when the vignettes were presented without the stress but in the vignettes which included stress women were much less likely to receive a CHD diagnosis (15% vs 56%), a referral to a cardiologist (30% vs 62%) or a prescription for cardiac medication (13% vs 47%).

You can read more about this research at

http://psychcentral.com/news/2008/10/13/womens-heart-disease-misdiagnosed-as-anxiety/3118.html

Infestations, delusions and medication

Delusional parasitosis (DP) is a rare but debilitating condition characterized by the false belief that one is infested by parasites, mice and vermin. It occurs particularly in middle-aged or elderly men who live alone. Primary DP occurs on its own, whereas secondary DP occurs in conjunction with another mental or physical health problem. A review of 63 case studies looked into the effectiveness of second-generation antipsychotics (SGAs) in treating DP. It found that the drugs were effective after about 10 days with the maximum effect occuring after 6 weeks. For those people who stuck with treatment for 8 weeks all cases responded at least partially. Partial or full remission was reached in 69% of the situations where an SGA was introduced. Secondary DP was more likely to respond to SGAs than primary DP. Risperidone and olanzapine were most widely used and resulted in full or partial remission in 69 and 72% of cases respectively. More research is needed into this topic as such reviews of case studies are considered less reliable than other research.

Freudenmann, Roland W. and Lepping, Peter - Second-generation antipsychotics in primary and secondary delusional parasitosis: outcome and efficacy Journal of Clinical Psychopharmacology October 2008, 28(5), 500-508

Drugs, aggression and schizophrenia

Recent research into schizophrenia has focused on some of the cognitive deficits associated with the condition which can have a greater impact on everyday activities than psychotic symptoms and have also been associated with violence. Some studies have suggested that second-generation antipsychotics are more effective at tackling cognitive deficits than earlier drugs while others have reported no advantage. Researchers in the U.S. studied 100 physically-aggressive inpatients with schizophrenia. A third were given clozapine, a third olanzapine and a third haloperidol. Olanzapine was much more effective at reducing participants' cognitive problems. In participants taking olanzapine - but not the two other drugs - improvements in cognition were associated with a reduction in violence. Clozapine was also found to markedly reduce violence but without improving participants' cognition.

Krakowski, Menachem I., Czobor, Pal and Nolan , Karen A. - Atypical antipsychotics, neurocognitive deficits, and aggression in schizophrenic patients. Journal of Clinical Psychopharmacology October 2008, 28(5), 485-493

Long and short-term psychotherapy. Is brief always better?

Long-term psychodynamic psychotherapy (LTPP) has suffered at the expense of briefer forms of therapy, such as cognitive and family therapy. However, a review of studies into the effectiveness of LTPP has found that it can have a large and positive effect. The review looked at 11 randomised controlled trials and 12 observational studies. The pooled results suggested that psychodynamic therapy could work better for people with complex mental illnesses than briefer alternatives.

JAMA 2008; 300:1551-1565

Day hospitals for suicidal patients

It is often assumed that people who are thinking about killing themselves need to be treated in an overnight hospital. However, sometimes service users who would otherwise be treated in an inpatient ward are offered treatment in an acute psychiatric day hospital of which there are 73 in England. There have been a number of different studies into the effectiveness of psychiatric day hospitals which suggest that they are as effective as inpatient care. A study of 206 suicidal service users by researchers at the University of London compared those using a day hospital with those using conventional inpatient treatment. The study found that patients with a high level of suicidal ideation showed greater symptom reduction during a day hospital treatment although this effect did not persist 3 or 12 months after discharge. There was no significant difference in terms of days spent in readmissions after discharge and only two suicides occured during the study period; one from each treatment group.

Jones, Gemma ... [et al] - Treating suicidal patients in an acute psychiatric day hospital: a challenge to assumptions about risk and overnight care Journal of Mental Health August 2008, 17(4), 375-387

Service users' thoughts on anti-depressants

There has been a lot of research into the clinical and physiological effects of antidepressants but less into their social and psychological effects. Qualitative research aims to look into this kind of issue, looking at what service users say among themselves, in focus groups and in interviews with researchers and aiming to pull out themes from the material rather than numerical quantitative results. Researchers in the U.S. analysed 227 postings in Internet discussion groups for people taking antidepressant medication. They found that there were four main themes to the postings: general side effects, sexual side effects, giving advice and frustration with physicians. The posters saw themselves as ill and rather ineffective patients but at the same time felt that they deserved good treatment and that they had their own medical expertise.

Pestello, Frances G. and Davis-Berman, Jennifer - Taking anti-depressant medication: a qualitative examination of Internet postings Journal of Mental Health August 2008, 17(4), 349-360

Mental-health problems and euthanasia

In 1997 the state of Oregon, in the U.S. passed the Death with Dignity Act allowing doctors to assist terminally-ill patients to die. There are several safeguards in the Act to ensure patients are competent to make the decision to end their own life including referral to a psychologist or psychiatrist if there is a concern that a patient's judgement might be impaired due to mental illness but in 2007 none of the 46 people who died in this way were evaluated by a psychiatrist or psychologist. Researchers from Oregon Health and Science University assessed 58 people who were terminally ill and who had requested physician-assisted suicide. 13 of the participants met the criteria for anxiety and 15 of them met the criteria for depression, of whom 3 eventually ended their life. The researchers called for increased vigilance for mental-health problems among people seeking euthanasia although supporters of the practice argued that depression did not automatically affect people's competence to make a decision about assisted suicide.

You can read more about this research at

http://psychcentral.com/news/2008/10/08/assisted-suicide-depressed-patients-may-be-overlooked/3095.html

Smoking and mental illness

There has long been known to be a link between smoking and mental illness and a study of 280 service users in Melbourne, Australia has found that they were more than four times as likely to smoke as the rest of the population. 62% of the sample smoked and they consumed an average of 22 cigarettes a day, 50% more than in the general population with the heaviest smokers in the group smoking up to 80 a day. 59% of the smokers said that they wanted to give up and 74% wanted to cut down. The biggest cause of death among people with mental illness is cardiovascular disease and some service users can spend more than 20% of their income on cigarettes.

You can find out more about this research at

http://psychcentral.com/news/2008/10/09/smoking-accompanies-mental-illness/3099.html

Forecasting self-harm and suicide

The accuracy of weather forecasts is about 70% but if you say the weather tomorrow is going to be the same as today then you also have a 70% chance of success. In the same way the prediction of the behaviour of people with mental-health problems uses a mixture of assessments, questionnaires, the person's own predictions of their behaviour and the past history of their behaviour. Researchers at Harvard University compared the accuracy of people's forecasts of their own likelihood of engaging in self-injurious thoughts and behaviour (SITB) with forecasts based on their past history of such behaviour. Suicide is the third leading cause of death among adolescents in the U.S. and the study involved 64 adolescents with a past history of SITB. It found that their past histories of SITB was more accurate than their own predictions in forecasting future behaviour.

Janis, Irene Belle and Nock, Matthew K. - Behavioral forecasts do not improve the prediction of future behavior: a prospective study of self-injury Journal of Clinical Psychology October 2008, 64(10), 1164-1174

Parents and grief

The death of a child can be a devastating experience that places a parent at heightened risk of psychological suffering and impairments in functioning. The death of a child is out of sequence with the 'life-cycle' of a family and can often come unexpectedly. Although the majority of bereaved parents find a way to live productive lives some do experience severe and long-lasting mental-health problems. A study of 157 parents who had lost children, by reseachers at the University of Memphis Tennessee, found that the violence of the child's death, the age of the child at death and the length of bereavement all accounted for significant differences in grief symptoms. Cause of death was the only objective risk factor that significantly predicted the intensity of complicated (or more severe) grief. The most important predictor of the severity of grief was 'sense-making' with those parents who said they had made little or no sense of their child's death being more likely to report a greater intensity of grief.

Keesee, Nancy J., Currier, Joseph M. and Neimeyer, Robert A. - Predictors of grief following the death of one's child: the contribution of finding meaning Journal of Clinical Psychology October 2008, 64(10), 1145-1163

Space Age depression treatment

Scientists at the National Space Biomedical Research Institute are developing a software programme that can provide self-guided treatment for depression. The programme is aimed at astronauts on long missions where isolation and close confinement with a limited group of people can lead to mental-health problems. The programme's multi-media approach includes graphics and a video featuring a psychologist who leads the user through a straightforward process called Problem-Solving Treatment which develops problem-solving skills, helps users plan and schedule enjoyable activities and provides preventative and educational information on depression. The system has been tried, with very positive feedback, on bases in the Antarctic and it is hoped that it can be rolled out to people in rural areas or other isolated settings such as commercial ships and oil rigs.

http://psychcentral.com/news/2008/09/25/next-generation-depression-treatment/3006.html

Brain structures and emotional regulation

The failure to successfully regulate emotions is thought to contribute to several mental-health problems but the brain processes that underly emotional regulation are not fully understood as yet. The prefrontal cortex is thought to play an important part in this process but there is relatively little evidence into how the prefrontal cortex interacts with areas deep in the brain that are responsible for our 'gut' reaction to events and people. Researchers at Columbia University in the U.S. found two pathways that linked the prefrontal cortex to these deep-brain regions. The pathway between the prefrontal cortex and the nucleus accumbens was associated with greater reductions in negative emotions while the pathway between the prefrontal cortex and the amygdala was associated with an increase in negative emotion.

You can find out more about this research at

http://psychcentral.com/news/2008/09/26/brain-activity-regulates-emotions/3014.html

NYPD blues

Researchers from the University of Buffalo in the U.S. have been looking into the effects of stress on police officers. Research so far has shown that officers are at greater risk of high blood pressure, insomnia, raised levels of stress hormones, heart problems, post-traumatic stress disorder and suicide. Officers over 40 were more at risk of heart problems than the national average, 72% of female officers and 43% of male officers had higher-than-average cholesterol levels and police officers as a group had higher-than-average pulse rates and blood pressure. Suicidal thoughts were found to be higher in women working on the day shift and in men working on the afternoon/night shift. The female police officers were found to have high cortisol levels - which have been linked to cardiovascular disease - throughout the day.

You can find out more about this research at

http://psychcentral.com/news/2008/09/29/stress-accompanies-law-enforcement/3021.html

Heart disease and depression

Depression is approximately three times more common in people with heart problems than in the general population and as many as 20% of heart patients meet the criteria for major depression with younger women in particular being at high risk. Depression is linked with increased morbidity and mortality, lower rates of cardiac rehabilitation and a poorer quality of life. The American Psychiatric Association has called for routine and frequent screening for depression in patients with chronic heart disease; help for patients with depression by a professional qualified to diagnose, and manage treatment for, depression; careful monitoring of patients to ensure adherence to their treatment plan and better coordination between healthcare professionals treating patients with combined medical and mental-health diagnoses.

You can find out more about this research at

http://psychcentral.com/news/2008/09/30/heart-patients-should-be-screened-for-depression/3035.html

Traumatic head injuries in juvenile delinquents

A study of 720 youths between the ages of 11 and 20 who were in rehabilitation facilities in Missouri has found that nearly one in five of them had suffered from a traumatic brain injury, defined as a head injury causing unconsciousness for more than 20 minutes. Fights and other assaults were a significant source of the injuries which were more common in boys than girls. The participants with the brain injury were significantly more likely to have used heroin, cocaine, crack, marijuana and ecstasy. They also had a significantly earlier onset of criminal and substance-using behaviours and more lifetime substance-abuse problems and suicidal tendencies than the other youths.

You can find out more about this research at

http://psychcentral.com/news/2008/09/30/mental-problems-among-delinquent-teens/3030.html