Antidepressants in general practice

At any point approximately 10% of women and 7% of men are estimated to be suffering from a depressive disorder. Up to 30% of people suffer from a depressive disorder at some point in their life with around 18% experiencing chronic symptoms. Long-term use of antidepressants is beneficial for those who experience recurring depression or where there has been a prolonged, severe and disabling episode. However, little is known about the long-term use of antidepressants in general-practice settings. A study of 92 patients taking antidepressants long-term from 12 GP practices in Tayside, Scotland, found that 57.6% of them did not meet the criteria for any psychiatric diagnosis. Independent clinical assessments based upon diagnoses and other clinical data indicated that 31% of the participants had no clear clinical reason for continuing to take antidepressants.

Cruickshank, Gillian ... [et al] - Cross-sectional survey of patients in receipt of long-term repeat prescriptions for antidepressant drugs in primary care Mental Health in Family Medicine 2008, 5(2), 105-109

Sense of Coherence and the Holocaust

The Holocaust, the persecution of Jewish people which preceded it and the chaotic state of Europe after the war must have placed an almost-intolerable burden on those that survived it. Yet there are wide disparities in how well, or badly, people coped with these dreadful events. In 1979 Aaron Antonovsky put forward the idea of Sense of Coherence to explain some of these disparities. Sense of Coherence (SOC) is made up of: the ability to comprehend what happens around oneself, the ability to manage a given situation alone or with the help of others and the ability to find some meaning for what is happening. A study of 203 child Holocaust survivors born between 1935 and 1944 asked the participants about their experiences during the Holocaust, their current health, their levels of post-traumatic stress and their SOC. The study found that SOC was able to moderate the association between traumatic experiences during the Holocaust and post-traumatic stress. SOC acted as a protective factor, buffering the impact of traumatic Holocaust experiences on child survivors in old age. Survivors with a less coherent perspective on the meaning of their life showed a greater vulnerability for post-traumatic complaints.

Van der Hal-van Raalte, Elisheva A. M., van IJzendoorn, Marinus H. and Bakermans-Kranenburg, Marian J. - Sense of coherence moderates late effects of early childhood Holocaust exposure Journal of Clinical Psychology December 2008, 64(12), 1352-1367

CBT and depression, men and women

There is now a considerable amount of evidence that cognitive behaviour therapy (CBT) is effective in treating depression. It is as effective as antidepressants, safe, theoretically sound and produces long-term reductions in symptoms. However, little is known about the differences (if any) in the effectiveness of CBT for helping men and women. An Australian study of 251 people receiving group and individual CBT measured their depression, anxiety and quality of life before and after treatment. "Men and women demonstrated equivalent pre-treatment and post-treatment illness severity, a comparable gradient of improvement on outcomes, and attainment of clinically significant benchmarks."

Watson, Hunna J. and Nathan, Paula R. - Role of gender in depressive disorder outcome for individual and group cognitive-behavioural treatment Journal of Clinical Psychology December 2008, 64(12), 1323-1337

Drink and drugs on Man and the mainland

The GENACIS (Gender, Alcohol and Culture: an International Study) study involves researchers from over 40 countries who have been co-operating to examine drinking patterns and alcohol-related problems among national samples of men and women. The Isle of Man joined the project in 2005 when 1,000 adults were surveyed and the results of this survey were compared to an earlier UK one of 2,027 people. In the Isle of Man sample drinking frequency was associated with having poorer physical health. In the combined Manx and UK samples 'binge' drinkers tended to have poorer mental health than other drinkers. Low income and high levels of cigarette smoking were associated with poor physical and mental health in both countries. Cannabis use was related to poor mental health. Women appeared to have better physical health than men, but there was no gender difference in relation to mental health. Once income level and education had been taken into account there were no overall differences between the Isle of Man and the U.K.

Miller, P. ... [et al] - Gender, alcohol, drugs and health: a comparison of the Isle of Man and the U.K. Journal of Substance Use December 2008, 13(6), 389-403

Adolescents, drink, and drugs therapy

Alcohol dependence is a common problem in adolescents with both regular and binge-drinking patterns occuring. Adults often have drug treatment, along with psychotherapy, for alcohol problems but little research has been done into drug therapy for adolescents with drink problems. An Indian study of 58 adolescents divided them into two groups. One group received disulfiram while the other group received naltrexone and the study lasted for six months. The adolescents who had a relapse lasted longer (84 days on average) before relapse when taking disulfiram, than when taking naltrexone (average 51 days). Nearly 80% of participants taking disulfiram remained abstinent compared to just over 50% of those taking naltrexone. However, those taking naltrexone had less cravings for alcohol than those taking disulfiram. The researchers concluded that more research needed to be done into the effectiveness of these drugs with larger samples of participants in a variety of settings.

De Sousa, Avinash and De Sousa, Alan - An open randomized trial comparing disulfiram and naltrexone in adolescents with alcohol dependence Journal of Substance Use December 2008, 13(6), 382-388

Learning disability and health

The British learning disability charity Mencap has launched a new initiative aimed at improving physical health care for people with learning disabilities. The project called Getting it Right follows the publication of Mencap's report into inequalities in health care experienced by people with a learning disability 'Death by Indifference'.

You can find out more about Mencap's campaign and download a copy of Death by Indifference by clicking on the link in the title of this post.

MIND launches legal campaign

The mental-health charity MIND has launched a campaign called Time to Challenge which aims to help people with mental-health problems who have experienced discrimination to get their cases through the courts. The charity is looking for cases that concern points of law that, if changed, could potentially set a legal precedent and have positive implications for all mental-health service users.

You can find out more about the Time to Challenge initiative by clicking on the link in the title of this post.

Latest drug guidance

The Medicines and Healthcare products Regulatory Agency has issued its latest bulletin on the safety of drugs. This includes guidance on the use of typical (first-generation) antipsychotics in people with dementia.

You can download a copy of the guidance by clicking on the link in the title of the post.

Depression in Parkinson's disease

Depression affects up to half of people with Parkinson's disease. A study of 52 people with Parkinson's disease and depression compared the effects of nortriptyline (an older, tricyclic antidepressant), paroxetine (a selective serotonin reuptake inhibitor or SSRI) and a placebo. The study found that the participants who took nortriptyline were five times more likely to see an improvement in their depression as those who took paroxetine. SSRIs affect the level of serotonin in the brain, whereas tricyclic antidepressants affect the level of norepinephrine. However, tricyclic antidepressants can lead to an increased risk of overdose and death due to toxic effects on the heart and brain.

You can find out more about this research by clicking on the title of this post.

Nature and brainpower

Being in nature can improve people's memory and attention according to research carried out by psychologists from the University of Michigan. Participants in the research completed a task designed to test their memory and attention; they then went for a walk either in a park or in central Ann Arbor. After their walk the participants returned to the lab and were retested on the task. Those who had taken a walk in the park showed a greatly improved performance but those who had walked in the city showed no improvement. A second group of participants took part in a similar experiment but this time instead of going for a walk they were simply shown photographs of either an urban or a natural environment before retaking the tests. The group who were shown the nature photographs did much better on the second test than the other group. The authors suggested that this could be because urban environments provide a relatively complex and often confusing pattern of stimulation which requires effort to sort out and interpret.

You can find out more about this research by clicking on the link in the title of this post.

Low IQ and mental-health problems

There is increasing evidence that children and adolescents who score lower on intelligence tests may be more vulnerable to mental-health problems later in life. However, much of the evidence is based on individuals whose disorders were severe enough to require admission to hospital. A study of 3,258 men whose intelligence was measured during their military service and whose mental health was assessed when they reached middle age has found that lower cognitive ability was associated with an increased risk of a number of mental-health problems

Mental-health problem	Odds of developing it (1 = average risk, 2= double the risk) for people of lower IQ
Any mental-health problem	1.32
Depression	1.43
Anxiety	1.2
Alcohol abuse or dependence	1.39
Post-traumatic stress disorder (PTSD)	2.5

The association between lower IQ and mental-health problems remained statistically significant even after a number of other factors had been taken into account.

Gale, Catharine R. ... [et al] - Cognitive ability in early adulthood and risk of 5 specific psychiatric disorders in middle age Archives of General Psychiatry December 2008, 65 (12), 1410-1418

Diversity and the Mental Capacity Act

The Mental Health Foundation has just published a report on how the 2007 Mental Capacity Act has affected people from Black and minority ethnic communities. You can download a copy of the report by clicking on the title of this post.

Social anxiety and alcohol problems

Social anxiety disorder is associated with high rates of alcohol problems. People with social anxiety (SA) are nearly three times as likely to develop problems with alcohol and among people seeking treatment for alcohol problems 23-39% meet the diagnostic criteria for social anxiety disorder. A study of 5,877 people by researchers at the University of Michigan found that SA was related to alcohol dependence even after allowing for a number of other factors. People with social anxiety who were also alcoholics had a higher usage of health care, other mental-health problems and greater interpersonal stress than other people with SA. For the majority of people their social anxiety came before their alcohol problems, suggesting that SA increases people's vulnerability to alcohol problems.

Buckner, Julia D. ... [et al] - Implications of comorbid alcohol dependence among individuals with social anxiety disorder Depression and Anxiety December 2008, 25(12), 1028-1037

Antidepressants and activation syndrome

Serotonin selective reuptake inhibitors (SSRIs) are a type of antidepressant and, like any other drug, they can have side effects. One of the most worrying side effects is a cluster of symptoms sometimes referred to as activation syndrome. These symptoms can include: anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (extreme restlessness and fidgitiness) and mania. Apart from being unpleasant in itself activation syndrome has also been linked to an increased risk of suicide. A Japanese study of 729 patients who had been prescribed antidepressants found that 4.3% of them developed activation syndrome. The incidence of activation syndrome was not associated with gender or age but it was linked to a diagnosis of personality disorder which quadrupled the risk.

Harada, Tsuyoto, Sakamoto, Kaoru and Ishigooka, Jun - Incidence and predictors of activation syndrome induced by antidepressants Depression and Anxiety December 2008, 25(12), 1014-1019

Depression, motherhood and body clocks

Major depression during pregnancy or shortly after birth can be a devastating illness for mothers, impair the neurocognitive and socio-emotional development of the child and increase the risk of mental and medical disorders in the offspring later in life. Many people with mood disorders have disturbed body clocks. Oestrogen and progesterone are known to affect people's body clocks and it could be that changes in the levels of these substances in and around pregnancy disrupt people's body clocks and contribute towards depression. A substance called melatonin, which is secreted at night time, plays an important role in governing people's body clocks. Researchers from the University of California, San Diego, measured melatonin levels in pregnant women and new mothers with and without major depression. They found that melatonin levels were significantly lower in pregnant women with major depression but significantly higher in new mothers with major depression.

Parry, Barbara L. ... [et al] - Plasma melatonin circadian rhythym disturbances during pregnancy and postpartum in depressed women and women with personal or family histories of depression American Journal of Psychiatry 165(12), 1551-1558

Sleep disturbance in depression

Sleep disturbance is one of the most common problems facing older adults with nearly 60% of them reporting sleep problems at least a few nights a week. Unfortunately sleep problems are often considered to be a normal part of ageing despite the fact that sleep disturbance is linked to declines in health, increases in mortality and depression. People who have had depression before tend to be more at risk of having it in the future but little research has been done into whether lack of sleep contributes to a recurrence of depression. A U.S. study of 351 older adults compared 145 people with a history of depression to 206 people who had never had any mental illness. 16.9% of the people who had previously had depression developed it again over the course of the 2-year study compared to only one person in the group who had never had mental illness. Within the group who had previously had depression recurrence was predicted by sleep disturbance; a link that was independent of other depressive symptoms, chronic medical disease and antidepressant medication use.

Cho, Hyong Jin ... [et al] - Sleep disturbance and depression recurrence in community-dwelling older adults: a prospective study American Journal of Psychiatry December 2008, 165(12), 1543-1550

Depression, anxiety and cardiovascular risk

A study of 6,576 men and women participating in the Scottish Health Survey looked into the links between emotional distress, lifestyle and cardiovascular problems. At the start of the study the participants completed a 12-question survey designed to measure their general happiness, symptoms of depression or anxiety and any sleep disturbances they might have. The participants were also assessed for risk factors for heart disease and asked about their lifestyles. Their health was monitored over a 7-year period. Researchers from University College London found a significant and direct link between increasing psychological distress and an increasing risk of cardiovascular illness and death. After age and sex were taken into account people with depression and anxiety had a 50% increased risk of heart problems. However, when the researchers took people's lifestyles into account they found that smoking and physical inactivity alone explained nearly two-thirds of the increased cardiovascular risk.

You can find out more about this research at

http://psychcentral.com/news/2008/12/16/depression-and-anxiety-stress-the-heart/3511.html

Blood pressure and cognition

A study into blood pressure and thinking in older adults has found that those people who already had high blood pressure saw a significant decrease in their reasoning ability when their blood pressure rose even higher temporarily. People whose blood pressure was normal most of the time didn't suffer a decline in their cognitive abilities when their blood pressure rose temporarily. The results of the study imply that older people might find it harder to think logically in stressful situations.

You can find out more about this research at

http://psychcentral.com/news/2008/12/16/high-blood-pressure-clouds-thinking/3512.html

CBT for eating disorders

Eating disorders are a major cause of physical and psychosocial impairment in young women, affecting at least one in twenty between the ages of 18 and 30. Anorexia nervosa accounts for around one in ten cases of eating disorders, bulimia about a third with the remainder of cases being made up of atypical disorders which are a combination of different features of anorexia and bulimia. In 2004 a form of cognitive behaviour therapy (CBT) developed by Professor Christopher Fairburn from the University of Oxford became recognised by the National Institute for Clinical Excellence (NICE) as the leading treatment for bulimia and was recommended for use across the NHS. Now, a new study by Professor Fairburn has shown that an enhanced version of the treatment is not only more effective than the older version but can be used to treat atypical eating disorders as well. 154 people were recruited for the study which was based in Oxfordshire and Leicestershire. The researchers found that the majority of patients responded well and rapidly to the new treatment and that the changes were sustained over the following year. Approximately two-thirds of those who completed treatment made a complete and lasting response with many of the remainder showing a substantial improvement. Another trial investigating the enhanced version of the therapy is showing promising results in people with anorexia.

You can find out more about this research by going to

http://psychcentral.com/news/2008/12/16/behavioral-therapy-for-eating-disorders/3510.html

Rose-tinted spectacles might be real

It is something of a cliche that older people tend to see the past through rose-coloured spectacles but researchers at the University of Alberta and Duke University have found that there is some truth behind it. Younger and older participants in the study were shown standardized images that depicted either neutral or strongly-negative events. Thirty minutes later they were asked to recall them and the older participants remembered fewer negative images than the younger ones. At the same time the participants underwent brain scans. Both groups had similar levels of activity in the emotional centres of the brain but the older participants had less links between the centres and the hippocampus (which involves learning and memory) when shown the negative images. However, when they were shown the negative images the older participants had stronger connections with their dorsolateral frontal cortex, a brain region involved in higher thinking processes like controlling emotions. The older people were using thinking processes rather than feeling processes to store these emotional memories. Another study by the same group of researchers found that healthy older people were able to regulate emotion better than younger people so that they were less affected by upsetting events.

You can find out more about this research at

http://psychcentral.com/news/2008/12/17/aging-mellows-negative-memories/3519.html

Genetics of borderline personality disorder

Borderline personality disorder (BPD) is characterized by pervasive instability in moods, interpersonal relationships, self-image and behaviour and can lead to suicidal behaviour, substance abuse and failed relationships. It is more common than schizophrenia or bipolar disorder and is estimated to affect 2% of the population. A Dutch study of 711 pairs of twins and 561 parents looked into the genetic influences on BPD and found evidence for a link with chromosome 9. Another study by the same group of researchers looked at 5,496 twins in the Netherlands, Belgium and Australia and found that 42% of variation in BPD features was due to genetic factors and 58% due to environmental ones. There were no significant differences in the extent to which men and women inherited BPD and young adults displayed more BPD features than older ones.

You can find out more about this research by going to

http://psychcentral.com/news/2008/12/17/genetic-link-to-borderline-personality-disorder/3520.html

Don't panic, go surfing

Cognitive-behavioural therapy is a well-established treatment for panic disorder but dropout rates of 25% are common and those offered treatment only around a half might respond. As part of CBT people are often taught panic-control strategies, such as breathing exercises and relaxation but a more recent approach called 'panic surfing' encourages people to 'ride out' the wave of anxiety in an accepting manner instead of trying to control their symptoms. An Australian study of 18 participants used the 'panic surfing' technique to treat panic disorder. Significant improvements occurred over the course of the treatment and were maintained at a 1-month follow-up.

Lamplugh, Claire ... [et al] - A pilot study of cognitive behaviour therapy for panic disorder augmented by panic surfing Clinical Psychology and Psychotherapy November-December 2008, 15(6), 440-445

CBT for health anxiety

Hypochondriasis is an excessive preoccupation or worry about having a serious illness that persists even after a doctor has examined a patient and told them that they have nothing to worry about. It is thought to affect around 3% of the population and is often characterized by fears that minor bodily symptoms may indicate a serious illness, constant self-examination and self-diagnosis and a preoccupation with ones body. Cognitive-behavioural treatments (CBT) have been shown to be effective in treating hypochondriasis and so has CBT-based, short-term psycho-educational group treatment. A Dutch study of 140 people with health anxiety looked at how different people benefited, or failed to benefit from CBT. The study found that participants with high scores for health anxiety at the start of the study tended to continue to have high scores after treatment and at follow-up tests one and six months later. People with higher "background" levels of anxiety and who were older benefited least from CBT treatment.

Buwalde, Femke M. and Bouman, Theo K. - Predicting the effect of psychoeducational group treatment for hypochondriasis Clinical Psychology and Psychotherapy, December 2008, 15(6), 396-403

New drug for cognition in schizophrenia

Most of the drugs now used to treat schizophrenia were developed more through chance than through a targeted design of any particular brain circuit or neurotransmitter. However, researchers at the University of Pittsburgh have developed a chemical that boosts the flow of a neurotransmitter called GABA, low levels of which have been implicated in some of the cognitive deficits associated with schizophrenia. A small study of 15 men, aged between 18 and 50 divided them into two groups. One group took the chemical (MK-0777) and the other group took a placebo. Over the four weeks of the study the participants took various psychological and EEG tests to measure how well their working memory was performing. Both the psychological tests and the EEGs showed that the people taking MK-0777 had improved working memory function and the drug seemed to have few side effects. However, there will still be a lot of work to do before MK-0777 is licensed for general consumption.

You can find out more about this research by clicking on the link in the title of the post.

Low spirits and pot bellies

Having a pot belly can be associated with a number of different health complaints including cardiovascular problems and diabetes. Depression has also been linked to these conditions and a study of 2,088 adults, aged between 70 and 79 in Amsterdam, has found that depression can be linked to the development of a larger abdominal circumference. Participants in the study were screened for depression at the beginning of the research and had their overall and abdominal fat measured over a 5-year period. At the beginning of the study 4% of the participants had depression and, after adjusting for a number of other factors, this was found to be associated with an increase in abdominal fat. The researchers thought this might be because chronic stress and depression leads to the increased production of a hormone called cortisol, which promotes the accumulation of visceral (abdominal) fat. It is also possible that people with depression may have less healthy lifestyles, including a poorer diet, than other people.

You can find out more about this research by clicking on the link in the title of this post.

Coerced medication

Laws governing involuntary psychiatric treatment exist in all EU member states and in other developed countries. Under these laws an increased risk to oneself and others provides the ethical and legal justification for detaining and treating people with mental-health problems without their consent. In the U.K. this often takes the form of coerced medication (CM) whereas in the rest of Europe seclusion and mechanical restraint are more likely to be used. Researchers from the Institute of Psychiatry and City University (both London) analysed 14 papers about CM from seven different countries, published between 1987 and 2004. They found that patients receiving CM were more likely to be in their thirties with a diagnosis of schizophrenia, bipolar disorder or another psychotic disorder and most of them had been admitted to psychiatric care on an involuntary basis. Service users experienced a range of negative feelings when they received CM including fear, embarrassment, anger and helplessness, although in retrospect many said they agreed with the practice. The studies showed a lack of detailed exploration into the events leading up to CM and a complete absence of investigation into alternatives. The authors concluded that their review highlighted a lack of clinical evidence on which to base CM and point out that the practice may discourage people from seeking help from, or engaging with, mental-health services.

You can find out more about this study by clicking on the link in the title of this post.

The Happiness Bug

Happiness can be contagious, according to a study carried out by researchers at Harvard Medical School and the University of California, San Diego. The researchers used data from the Framingham Heart Study, a famous ongoing study into cardiovascular risk with participants in the town of Framingham, Massachusetts. Their study focused on 4,739 participants in the Framingham Heart Study who completed a range of information about their levels of happiness and their social networks. The researchers found that when someone became happy a friend, living within a mile, experienced a 25% increased chance of becoming happy themselves. Their spouse had an 8% increased chance, siblings living within a mile 14% and next-door-neighbours 34%. However, not only did that person's friends become happier, their friends' friends had a 10% chance of increase happiness and their friends' friends' friends had a 5.6% chance of increased happiness. The effects were limited by geographical distance from the original person and time, lasting about a year. People who were at the centre of social networks were happier than those at the fringes. Having a $5,000 boost to one's income, however, was only associated with a 2% increase in happiness. Sadness was not found to 'flow' through networks in the same way that happiness did.

You can find out more about this research by clicking on the link in the title of this post.

Depression in junior doctors

A study of 481 junior doctors in Brazil has found high levels of depression among them. The researchers carrying out the study divided depression symptoms into three clusters: affective, cognitive and somatic. Affective symptoms were the students' levels of sadness, dissatisfaction, episodes of crying, irritability and social withdrawal. The cognitive symptoms were pessimism, a sense of failure or guilt, an expectation of punishment, dislike of self, suicidal ideation, indecisiveness and a change of body image. The somatic cluster were slowness, insomnia, fatigue, weight changes and loss of sexual interest. The study found a high prevalence of depressive symptoms among the medical students, particularly female students, mainly involving the somatic and affective clusters. 38% of the students had at least 10 out of a possible 63 symptoms of depression. Depression scores were higher in the early years of participants' training as they moved into the hospital environment. Having a parent who was a doctor was found to reduce the risk of depression.

You can find out more about this study by clicking the link in the title of this post.

Tai chi and dementia

Most of the research effort into Alzheimer's disease has tended to concentrate on drug treatment but other approaches to treating the condition can also be effective. Researchers at the University of Illinois looked at the effectiveness of an intensive 40-week programme of twice-weekly sessions of cognitive behaviour therapy and support groups, along with three sessions a week of qigong (Chinese meditation) and tai-chi. A control group was placed on a waiting list for the programme. After 20 weeks those taking part in the programme had improved balance and lower-leg strength, higher self-esteem and a slight improvement in their mental functioning. No additional benefits were seen after 40 weeks but participants were able to maintain their initial gains and the intervention proved very popular with the participants and their caregivers.

You can find out more about this research by clicking on the link in the title above.

Drink, drugs and ICUs

People with drug and alcohol problems already cost the health service a significant amount of money and now researchers in Salt Lake City have found that they are more likely to end up staying in an ICU as well. The researchers carrying out the study looked at the medical records of 742 patients admitted to the intensive care unit at Salt Lake City's LDS Hospital. The study found that 19% of them had a history of drug and alcohol dependence prior to being admitted; twice the rate of the general population. The patients with drug and alcohol dependence were, on average, six years younger than the rest of the ICU patients.

You can find out more about this study by clicking on the link in the title of this post.

Cognition, video games and silver surfers

Playing computer games has traditionally been seen as a young person's activity but an increasing number of older people are 'silver surfers' and a recent study has shown that playing video games can improve cognition in this group. Researchers from the University of Illinois studied 40 older adults in their 60s and 70s. Half of them received training in a video game called Rise of Nations where players have to make decisions on resource allocation to feed and employ people, maintain their military and expand their population in an imaginary country; the other half received no training. Before, during and after the training both groups of participants took a series of cognitive tests. The video gamers became better, and faster, at switching between tasks. Their working memory was improved and their reasoning ability was enhanced. Their short-term memory of visual cues was also better than the control group's. Those who performed better on the game also performed better on the cognitive tests. The results are significant as previous research has shown that training people on a particular task improved their ability to complete the task itself, without being transferable to other situations.

You can find out more about this research by copying and pasting the URL below into your browser.

http://psychcentral.com/news/2008/12/12/video-games-improve-cognitive-skills-in-older-adults/3497.html

Carbs, calories and cognition

People who cut out carbohydrates as part of a diet may be reducing their brainpower as well as their waistline according to a study by researchers at Tufts University in the U.S. The study compared nine women on a low-carbohydrate, Atkins-style diet and ten women following a low-calorie diet based on advice from the American Dietetic Association. The dieters completed five testing sessions which assessed attention, long-term memory, short-term memory, visual attention and spatial memory. The low-carb dieters showed a gradual decrease in performance on the memory-related tasks compared to the low-calorie dieters. Their reaction times were slower and their visual-spatial memory worse. However, the low-carb dieters did do better than the low-calorie ones on the attention task; perhaps because fat and protein, which tend to be consumed more on these kind of diets, can improve people's attention in the short term.

You can find out more about this research at

http://psychcentral.com/news/2008/12/12/low-carb-diets-can-affect-cognition/3498.html

Conscientiousness and life expectancy

A review of 20 studies involving more than 8,900 participants in the U.S., Canada, Germany, Norway, Japan and Sweden looked into the links between personality and life expectancy. The review found that people who scored highly on levels of conscientiousness tended to live between two and four years longer than people who had low scores for conscientiousness. The influence of contientiousness was found to be as large, or larger, than many other factors affecting longevity such as socio-economic status. Within conscientiousness the sub-factors that were particularly associated with increased life expectancy were ambition and self-discipline with responsibility and self-control being less important.

Kern, Margaret L., Friedman, Howard S. - Do conscientious individuals live longer? A quantitative review Health Psychology 2008, 27(5), 505-512

Panic disorder and heart disease

A study of 405,000 people by researchers from University College London looked into the links between panic disorder and heart problems. The study found that people who were younger than 50 when first diagnosed with panic disorder were 38% more likely to have a heart attack and 44% more likely to develop heart disease than those in the general population. People who were over 50 when first diagnosed had an 11% greater risk. However, people with panic disorder had a lower risk of dying from heart disease than the rest of the population. The researchers who wrote the study weren't sure whether the symptoms of heart disease were being misdiagnosed as panic disorder or whether panic disorder actually led to an increased risk of developing heart problems.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=115361&cn=1

Antipsychotics: is it time to end the generation game?

Antipsychotic drugs have usually been divided into first- and second-generation drugs with the latter being perceived as having fewer side effects than the former. Researchers from universities in Munich and Chicago looked at 150 studies comparing the effectiveness of antipsychotic drugs, which, altogether had 21,000 participants. They found that four second-generation drugs - amisulpride, clozapine, olanzapine and risperidone - were more effective than first-generation ones but that the rest were no better. When compared with the powerful first-generation drug haloperidol the second-generation drugs had less side effects but compared to other first-generation drugs there was little difference. Haloperidol - but not other first-generation drugs - produced less weight gain than most second-generation drugs. The authors called for an end to the division of drugs into first- and second-generation and an individualized treatment of schizophrenia based on efficacy, side effects and cost.

You can read more about this study at

http://psychcentral.com/news/2008/12/08/better-classification-of-psychotic-drugs-recommended/3466.html

Cholinesterase inhibitors for dementia

Researchers at Indiana University School of Medicine looked into the effectiveness of drugs called cholinesterase inhibitors at treating the behavioural and psychological symptoms of dementia. The drugs work by raising the level of a neurotransmitter called acetylcholine in the brain, which assists memory, thought and judgement. The researchers reviewed the results of nine clinical trials of the drugs and found that they led to a statistically-significant reduction in behavioural and psychological symptoms such as aggression, wandering and paranoia. The drugs were found to be safe and produced no side effects in contrast to the antipsychotic drugs that are sometimes used on this group of service users.

You can find out more about this study at

http://psychcentral.com/news/2008/12/10/medication-helps-alzheimers-symptoms/3481.html

Service users' siblings

Little is known about the impact of learning disabilities and mental illness on service users' siblings. Researchers from the University of Wisconsin-Madison studied 351 people over a 46-year period all of whom had at least one sibling with either a mental illness or a learning disability and compared them to 791 people with unaffected siblings. The researchers found that people who had siblings with mental illnesses were 63% more likely to report having a depressive episode during their lifetime. Siblings of people with learning disabilities were more likely to live in the same states as them but reported much less contact with their learning-disabled siblings and reported feeling less emotionally close to them. People with a brother with a mental illness had lower levels of psychological wellbeing than those in the comparison group but people with a sister with mental illness were not at increased risk of a mental-health problem.

http://psychcentral.com/news/2008/12/10/challenges-for-siblings-of-mentally-disabled/3482.html

Postnatal depression and sleep

All new mothers experience some sleep loss following childbirth as their oestrogen and progesterone levels plunge, and they typically spend 20% more of the day awake than average during the first six weeks after birth. It is estimated that between 6.5 and 13% of new mothers in the U.S. suffer from postnatal depression and a study of 46 women by researchers at Drexel University in the U.S. looked into the links between sleep problems and postnatal depression. The study found that the mothers suffering from postnatal depression took longer to fall asleep and slept for shorter periods. The worse the women's sleep quality the worse their depression.

You can read more about this research at

http://psychcentral.com/news/2008/12/11/postpartum-depression-tied-to-sleep/3489.html

Exercise and anger in children

Exercise has been shown to be effective in improving children's depression and anxiety. A study by researchers at the Medical College of Georgia School of Medicine looked at the effectiveness of a 10-15 week after-school aerobic exercise programme in reducing anger among children. The researchers found that exercise had a significant effect in reducing children's anger expression as well as helping them to lose weight.

You can read more about this study at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=115089&cn=28

Valproate and autism

Previous research has shown that the anti-epilepsy drug valproate can contribute to birth defects, in particular neural tube defects, and now a study by the Liverpool and Manchester Neurodevelopment Group has suggested that it could also raise the risk of children developing autism. The study, of 632 live births from 620 women, compared those taking anti-epilepsy drugs at the beginning of their pregnancy with women unaffected by epilepsy. The children were assessed for autism, or related conditions, at 1,3 and 6 years of age. Around 6.3% of the children exposed to valproate developed autistic spectrum disorders, a rate seven times higher than that in the control group. However, another anti-seizure drug called lamotrigine was not associated with an increase in the risk of autism.

You can find out more about this study at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=115105&cn=20

Law Lords ruling on duty of care to inpatients

The Law Lords have ruled that people detained under the Mental Health Act have the same 'right to life' as those in prison. Hospitals must now be seen to take responsibility to take reasonable measures to avoid real and immediate harm to patients who have been sectioned. The ruling results from a case brought by Anna Savage against South Essex NHS Trust, concerning her mother Carol, who killed herself in July 2004 after absconding from Runwell Hospital where she was being detained. The ruling holds health authorities responsible for taking measures to properly assess and prevent the risk of suicide. The High Court had previously ruled that unless gross negligence could be established, they could not be held liable for a breach of the right to life.

You can read the MIND press release about this judgement at

http://www.mind.org.uk/News+policy+and+campaigns/Press/2008-12-11-savage.htm

Locked wards raise aggression

A leading academic has presented research suggesting that locked wards in psychiatric hospitals may actually raise levels of aggression in inpatients. Delivering the annual Eileen Skellern lecture at London South Bank University on the 2nd of December Professor Len Bowers of City University presented the results of 50,000 responses from questionnaires and interviews with staff, service users and visitors from 130 of the 500 acute psychiatric wards in England. They found that a 'locked-door' policy led to service users feeling frustrated, stigmatised and depressed. It increased the risk of physical aggression to others by 11% and self-harm by 20%. Patients in locked wards were also more likely to refuse medication.

You can read the press release sent out to accompany the lecture at

http://www.tc-of.org.uk/wiki/index.php?title=Eileen_Skellern_2008

PCOS and mental health

Polycystic ovary syndrome (PCOS) is estimated to affect between 5-10% of women of reproductive age and its symptoms include weight problems, lack of regular ovulation and/or menstruation and excessive amounts of androgenic (masculinizing) hormones. While the causes are unknown insulin resistance, diabetes and obesity are all strongly correlated with PCOS. A study of 84 women in Turkey used two common measures, the General Health Questionnaire and the Beck Depression Inventory, to compare levels of mental-health problems in women with and without PCOS. The women with PCOS had significantly higher levels of mental distress than the other women and their levels of mental distress were correlated with their Body Mass Index and their Waist-to-Hip Ratio, i.e. the heavier they were and the larger their waists the worse their mental-health was.

Adali, E. ... [et al] - The relationship between clinico-biochemical characteristics and psychiatric distress in young women with polycystic ovary syndrome The Journal of International Medical Research November/December 2008, 36(6), 1188-1196

Self-harm after hospital

The risk of suicide in the month after psychiatric inpatient care is about 100 times greater than that of the general population. Although the high risk of suicide shortly after discharge is well documented less is known about the rates of non-fatal self-harm. A study of 75,401 people discharged from psychiatric inpatient care between April 2004 and March 2005 found that 6.5% of them were admitted at least once for self-harm in the following 12 months. The risk of self-harm was greatest in the four weeks after discharge. The strongest risk factor for self-harm after discharge was an admission for self-harm in the previous 12 months. The risk of self-harm was also higher in women, younger people, those with diagnoses of depression, personality disorder and substance abuse and those with short lengths of stay.

Gunnell, David ... [et al] - Hospital admissions for self-harm after discharge from psychiatric inpatient care: cohort study British Medical Journal December 6, 2008, 1331-1334

Suicide and mental illness

People who have already tried to kill themselves are 30-40 times more likely to commit suicide than other people. A Swedish study of 39,685 people who were admitted to hospital for attempted suicide between 1973 and 1982 looked at which mental-health problems increased the risk of these people going on to kill themselves. The study lasted until 2003 and the strongest predictor of completed suicide was schizophrenia, which increased the risk by a factor of 4.1 in men and 3.5 in women. Bipolar disorder and depression increased the risk by a factor of 3.5 in men and 2.5 in women. Increased risks were also found for anxiety disorders, alcohol misuse in women, drug misuse and personality disorders.

Tidemalm, Dag ... [et al] - Risk of suicide after suicide attempt according to co-existing psychiatric disorder: Swedish cohort study with long-term follow-up British Medical Journal December 6, 2008, 1328-1331

AMHPs get sectioning powers

The Government has opened the way to nurses being able to section people. Nurses will be allowed to become approved mental-health professionals (AMHPs) as will occupational therapists, social workers and chartered psychologists. AMHPs will have to take a postgraduate diploma learning about mental-health legislation, child and adult protection, the functions of courts and mental-health review tribunals, drug abuse and risk assessment. After qualification they will specialise in assessing a person's needs, care and treatment and will have a role in decisions to detain patients.

You can download the full text of the 2007 Mental Health Act at

http://www.opsi.gov.uk/acts/acts2007/pdf/ukpga_20070012_en.pdf

Recovery Network expands web site

The Recovery Network, which helps people to recover from drug and alcohol addictions has expanded its website. The site now has a social networking and education section focusing on mental health and provides help for people suffering from depression and anxiety attacks.

You can find the new, improved site at

www.trntv.co.uk

New web site on online therapy

A new website about online therapy has been set up for mental-health professionals. The site contains articles, discussion boards and resources and will look into issues such as therapists' roles on 'virtual world' sites such as Second Life.

You can find the site at

www.onlinetherapyinstitute.com

Exercise and mental health

Research suggests that exercise reduces anxiety, depression and negative mood and improves self-esteem and cognitive functioning as well as providing a number of physical-health benefits. However, there is little or no mention of exercise in most mental-health textbooks. Researchers from Leeds and Bristol universities looked into the experiences of 11 men with serious mental illness, aged between 24 and 43 who were involved in a variety of exercise activities. They found that exercise contributed strongly towards the participants' feelings of social support.

Carless, David and Douglas, Kitrina - Social support for and through exercise and sport in a sample of men with serious mental illness Issues in Mental Health Nursing December 2008, 29(11), 1179-1199

Helping sex offenders with learning disabilities

The Sex Offender Treatment Services Collaborative

www.sotsec.org

is a group of professionals who provide treatment for men with intellectual disabilities who are at risk of sexual offending. The group provides a forum for the discussion of treatment issues as well as training and support for clinicians who are delivering group cognitive behavioural treatments for men with intellectual disabilities who sexually abuse. One of the modules in the programme uses a four-stage model - motivation to abuse, overcoming internal and external inhibitions and overcoming victim resistance - to help offenders understand their steps to offending. An article in this month's British Journal of Learning Disabilities looks at the progress of four men going through this programme and discusses some of the issues around this work.

Goodman, Wendy ... [et al] - Group treatment for men with learning disabilities who are at risk of sexually offending: themes arising from the four-stage model to offending British Journal of Learning Disabilities December 2008, 36(4), 249-255

Risperidone: longer-acting for harder cases

A depot injection is given via a long-lasting injection and aims to promote compliance in people with particularly severe mental illness, thereby enhancing relapse prevention. Risperidone is the first second-generation antipsychotic to be available in a depot format. The effects of this form of the drug have been extensively studied in trials prior to its introduction but the kinds of people who might take it have not. A Dutch study, using dispensing data from 53 community pharmacies in the north-east of the Netherlands looked to see what kind of chronic antipsychotic users switched to long-acting Risperidone. They found that the predictors for switching from an oral to a depot form of drugs were: being a man, a previous use of depot antipsychotics, recent anticholinergic drug use, and a gap in 'antipsychotic dispensation history,' i.e. a patchy history of drug-taking. Predictors of switching to depot Risperidone from a depot first-generation antipsychotic were previous use of a depot antipsychotic and consulting a specialist. The researchers concluded that compared with oral antipsychotics service users receiving a depot injection were likely to be less compliant and to suffer from worse side effects. People receiving depot risperidone as opposed to a depot first-generation antipsychotic tended to be more severely ill. The researchers concluded that the long-lasting risperidone was being used for the most severely-ill people; something that will need to be borne in mind when assessing its effectiveness.

Vehof, Jelle ... [et al] - Predictors for starting depot administration of risperidone in chronic users of antipsychotics Journal of Clinical Psychopharmacology December 2008, 28(6), 625-630

Incontinence and clozapine

Urinary incontinence is an embarrassing and distressing side effect of the antipsychotic drug clozapine and a Korean study followed 87 people who had taken the drug for 2 years to see if the symptoms persisted. At the start of the study 10.9% of the sample reported incontinence with 41.6% having clinically-significant lower-urinary-tract symptoms. After two years the participants' score on the International Prostate Symptom Score scale had increased (i.e. they had got worse) and so had the number of participants with lower-urinary-tract symptoms (43.7%) although the change was not statistically significant. The prevalence of lower-urinary-tract symptoms was higher in the people who had taken clozapine than in the general population of the same age.

Jeong, Seong Hoon ... [et al] - A 2-year prospective follow-up study of lower-urinary-tract symptoms in patients treated with clozapine Journal of Clinical Psychopharmacology December 2008, 28(6), 618-624

Fathers with psychosis

One in five men with chronic mental-health problems are fathers yet despite this no research has specifically investigated fathers with psychosis. A qualitative study of 10 fathers with psychosis being treated by community mental health services in West and North London looked at some of the ways psychosis affected fatherhood. The fear of one's children inheriting psychosis was a common concern among the group but they also identified positive aspects of fatherhood including: a sense of pride in the father role, a sense of purpose to one's life, a feeling of pleasure in the creation and development of life and the motivation to change for the better.

Evenson, Erik ... [et al] - The experience of fathers with psychosis Journal of Mental Health December 2008, 17(6), 629-642

Mental-health literacy and bulimia

Mental-health literacy can be defined as "knowledge and beliefs about mental disorders that aid their recognition, management or prevention." It is thought that poor mental-health literacy is a major factor in low or inappropriate treatment-seeking among individuals affected by mental disorders and this idea has been backed up by studies involving people with anxiety, mood and substance-use disorders. Researchers in Australia looked at mental-health literacy in 158 women who had bulimia or similar conditions. The participants believed that bulimia would be difficult to treat and that even if initial treatments were successful relapse would be likely. GPs, psychologists, counsellors and close friends were all perceived to be helpful. Lifestyle changes, including taking vitamins and minerals, were also highly regarded. However, the participants were ambivalent about psychiatrists and using medication to treat the condition. Most participants believed that bulimia was common among women in the community and many had occasionally or often thought that it 'might not be too bad' to have bulimia. Low self-esteem was thought to be the most likely cause of bulimia. The study concluded that the participants held some beliefs 'likely to be conducive to lower or inappropriate treatment seeking,' and called for poor mental-health literacy to be addressed in early-intervention programmes.

Mond, Jonathan M. ... [et al] - Mental health literacy and eating disorders: what do women with bulimic eating disorders think and know about bulimia nervosa and its treatment? Journal of Mental Health December 2008 17(6), 565-575

Keeping safe in mental health

The National Patient Safety Agency has produced new guidelines on the physical safety of service users in mental-health settings. You can download copies of the guidelines at

http://www.npsa.nhs.uk/nrls/improvingpatientsafety/patient-safety-tools-and-guidance/7steps/mental-health/

http://www.npsa.nhs.uk/nrls/alerts-and-directives/rapidrr/mental-health-resuscitation/

Sex differences and violence on the wards

Although there is a large body of research into what causes aggression among psychiatric inpatients there is less research into what characteristics of staff can cause, or prevent, violence. Age, skill and experience have been shown to have an impact on aggression but there have been mixed results from studies into the effects of gender. A study of a medium secure unit in the north-west of England examined this issue in two male and two female wards and found that patients were more likely to behave aggressively towards members of the same sex.

Knowles, Susan F., Coyne, Sarah M. and Brown, Stephen L. - Sex differences in aggressive incidents towards staff in secure services The Journal of Forensic Psychiatry and Psychology December 2008, 19(4), 620-631

The ART of reducing aggression

Aggression replacement training (ART) aims to prevent aggression by improving people's social skills, building up their impulse and anger control and developing their moral reasoning. It was originally developed for aggressive youths but is also available in a revised format for adult offenders. A study of 197 offenders by researchers at Leicester and Liverpool universities compared violent offenders who had been allocated to the programme with a control group. Those who had taken part in the training had a 13.3% reduction in reconviction. Those offenders who failed to complete the programme were more likely to reoffend than similar people who had never been on it or who had completed the course.

Hatcher, Ruth M. ... [et al] - Aggression replacement training with adult male offenders within community settings: a reconviction analysis The Journal of Forensic Psychiatry and Psychology December 2008, 19(4), 517-532

Sudden improvements, lasting gains

People going through psychotherapy often demonstrate sudden, dramatic improvements suggesting that they have had some kind of epiphany that has dramatically altered their outlook on life and way of thinking. These sudden changes represent genuine improvement in people's condition and those who show sudden improvements from one session to the next are more likely to show a greater and longer-lasting improvement after the end of therapy. A team of researchers at the University of Virginia in the U.S. looked into sudden improvement in 30 people going through a 12-week course of cognitive behaviour therapy (CBT) for panic disorder. 43% of the clients showed at least one dramatic burst of improvement during the course of therapy. Half of those who had had a dramatic improvement had had it between the first and second sessions, while the other half had experienced it later on. However, only the later improvers had better symptoms at the end of the study compared to people who had shown no dramatic improvement. The later improvers showed a greater improvement in their fear of anxiety-related symptoms at the end of their course of therapy, and at a six-month follow-up.

Clerkin, E., Teachman, B. and Janik, S. Smith - Sudden gains in group cognitive-behavioural therapy for panic disorder Behaviour Research and Therapy 2008

Depression and heart problems

Depression has long been recognised as a risk factor for cardiovascular problems in healthy people and for a worse prognosis in people with existing cardiovascular problems. A study by researchers at the VA Medical Center [sic] in San Francisco followed 1,017 outpatients with stable coronary heart disease for between 4-5 years. It measured their depression symptoms, levels of illness and behaviour over the course of the study. The researchers found that patients with depression had a 10% risk of a subsequent cardiovascular 'event' compared to only a 6.7% risk among those without depression. However, once the researchers adjusted for health behaviours (diet, smoking etc) and physical activity there was no longer a link between depression and subsequent heart problems. The researchers calculated that physical inactivity was associated with a 44% greater rate of cardiovascular 'events.'

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=114913&cn=5

Hearing deficits in autistic children

People with autism or Asperger's syndrome could hear 'slower' than other people, according to researchers in the department of radiology at the Children's Hospital of Philadelphia. The researchers exposed children to beeps, tones in pairs and vowels and sentences at different speeds, tones and frequencies. They used a technique called magnetoencephalography to measure the magnetic fields associated with brain activity and found that this occured a fraction of a second slower in autistic/Asperger's children.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=114991&cn=20

Improving health and work: changing lives

The Government has published its plans to get people off benefits and back into work. These include plans for 'fit notes' which will state what tasks people can do, rather than what they cannot. The Government's proposals are set out in 'Improving health and work, changing lives' which you can download from the link below.

http://www.workingforhealth.gov.uk/documents/improving-health-and-work-changing-lives.pdf

'Count me in' shows lack of progress

The Healthcare Commission's annual census of mental-health inpatients - 'Count Me In' - has painted a gloomy picture of a lack of progress on mixed-sex wards and racial equality. The census found that 68% of inpatients are still being housed on mixed-sex wards; no improvement on last year. Women (78%) were more likely than men (61%) to be treated in a mixed-sex ward. People from Black and minority-ethnic groups were three times more likely to be detained than average, and up to 65% more likely to be secluded. After three years of censuses there has been no sign of movement towards improving racial inequalities in mental-health care.

You can download the full report at

http://www.healthcarecommission.org.uk/_db/_documents/Count_me_in_census_2008_Results_of_the_national_census_of_inpatients_in_mental_health_and_learning_disability_services.pdf

ADHD and self-esteem

Attention Deficit Hyperactivity Disorder (ADHD) is estimated to affect between 3 and 7% of school-aged children. It can affect children's home, school and community life leading to poor peer relations, aggression and learning problems, which, in turn, can lead to academic failure and an increased risk of depression. However, there has been conflicting evidence about the relationship between ADHD symptoms and low self-esteem. A Swedish study of 1,714 children, which followed them between the ages of 8 and 13 measured their ADHD symptoms and self-esteem when they were eight and again when they were thirteen. The children with high levels of ADHD symptoms had lower scores in the aspects of self-esteem relating to "skills and talents" and "psychological well-being."

Edbom, Tobias ... [et al] - ADHD symptoms related to profiles of self-esteem in a longitudinal study of twins Journal of Child and Adolescent Psychiatric Nursing November 2008, 21(4), 228-237

Parental warmth and child psychology

Parents' psychological warmth has been consistently identified as being significantly related to psychological adjustment in children and adolescents. Regardless of culture, ethnicity or geographical location about a quarter of the variation in youths' psychological adjustment is accounted for by parents' perceived warmth. However, little research into this has been done among the U.S.'s Korean community despite the fact that this commmunity has trebled in number in the last twenty years. A study of 103 Korena Americans aged between the ages of 11 and 14 has found that low perceived maternal and paternal warmth did lead to a decline in the children's overall psychological adjustment. Low maternal warmth was particularly related to the children's poor psychological adjustment.

Kim, Eunjung ... [et al] - Psychological adjustment in young Korean American adolescents and parental warmth Journal of Child and Adolescent Psychiatric Nursing November 2008, 21(4), 195-201