Thursday, January 31, 2008

ADHD and trauma

Attention Deficit Hyperactivity Disorder (ADHD) affects between 5-10% of children and adolescents and it continues into adulthood in 30-70% of cases. It has long been suspected that ADHD is associated with an increased risk of accidents and a study of 88 hospital patients in Turkey would appear to back this up. The researchers found that 62.2% of the people admitted to hospital with trauma had ADHD symptoms while only 13.2% of a control group of patients admitted to hospital with other conditions had ADHD symptoms. The researchers then divided the patients with trauma into two separate groups, high-velocity trauma (car crashes and falling off high buildings) and low-velocity trauma (falls and sports injuries). Almost twice as many patients in the high-velocity trauma group had ADHD.

Kaya, A. ... [et al] - Trauma and adult attention deficit hyperactivity disorder The Journal of International Medical Research January/February 2008, 36(1), 9-16

Wednesday, January 30, 2008

Brief words, lasting effect for writing therapy

Writing therapy has been found to improve people's physical and mental health. A review of studies into its effectiveness has found that, although the benefits are modest in absolute terms they are still very impressive in terms of the short amount of time that writing therapy takes compared to other interventions. In the vast majority of research participants write for 15-20 minutes but this is a matter of convention rather than being based on any evidence and no studies have sought to identify the minimum dosage required to reap the benefits of writing. A U.S. study of 49 students looked into the benefits of a very short (2 minutes x 2 days) writing intervention in which participants were asked to write about something they had found traumatic, or a positive experience or a neutral subject. 4-6 weeks later the students who had written about a trauma or a positive experience reported fewer health complaints than those who had written about a neutral topic.

Burton, Chad M. and King, Laura A. - Effects of (very) brief writing on health: the two-minute miracle. British Journal of Health Psychology March 2008, 13(1), 9-14

Caring for people with eating disorders

It is well established that caring for someone with a mental health problem has negative effects on both the mental and physical health of the carer and previous research has found that the carers of people with eating disorders experience a high level of distress and burden in their caregiving role. A sample of 115 individuals currently caring for someone with an eating disorder found that approximately 36% of them showed mental-health difficulties with 17% experiencing high psychological distress. A negative experience of caregiving was associated with carers' distress. The dependency of the individual with the eating disorder and the stigma associated with the illness were most highly predictive of carers' distress. Looking after someone who had recently become ill, higher levels of needs and a higher perception of the seriousness of the consequences of eating disorders also contributed to greater negative caregiving appraisals. The belief that the illness was attributable to the sufferer's personality was associated with fewer positive appraisals of caregiving.

Whitney, Jenna ..l [et al] - Caring for people with eating disorders: factors associated with psychological distress and negative caregiving appraisals in carers of people with eating disorders British Journal of Clinical Psychology 2007 46(4), 413-428

Reasoning in OCD

Most research investigating reasoning in OCD has focused on decision making and the evaluation of probabilities and has concluded that people with OCD require more information and time before making a decision. Recent research has begun to focus on the differences between deductive reasoning - based on given assumptions and premises - and inductive reasoning in which additional information and prior knowledge is needed to reach a conclusion. Some researchers have argued that people with OCD have a distinctive inductive style of reasoning in which unpleasant outcomes are reasoned to be probable on the basis of irrelevant associations. A U.K. study of 48 people compared deductive and inductive reasoning in people with and without OCD. Deductive reasoning was tested using syllogisms (e.g. All Frenchmen like cheese, He does not like cheese, He is not a Frenchman) which the participants were asked to judge as valid or invalid while inductive reasoning was tested using a game of 20 questions. In the twenty questions game the participants with OCD asked fewer direct hypothesis questions, i.e. guessing at the right answer, than the other group although their performance was more or less the same in the deductive reasoning task. In both tasks the participants with OCD's responses were characterized by the need for more information, states of uncertainty, and doubt and postponement of a final decision.

Simpson, Jane ... [et al] - Reasoning in people with obsessive-compulsive disorder British Journal of Clinical Psychology 2007, 46, 397-411

Tuesday, January 29, 2008

Eating disorders and attachment

Attachment theory, is, put very simply, the idea that how we bond with our caregivers (particularly our mothers) in early childhood can have significant and long-standing effects on our relationships with others and our mental health later in life. A study of 92 Portuguese women between the ages of 15 and 30 and their parents and - where applicable - therapists looked into their attachment styles, their memories of their parents' child-rearing and (for those undergoing treatment) the bonds between clients and their therapists. The participants were made up of 30 people with anorexia, 27 with bulimia and a 35-strong control group. The researchers found that the control group had lower levels of attachment anxiety. Their mothers exhibited higher security than mothers of anorexic patients and lower avoidance than mothers of bulimic patients. For the anorexic group a good relationship with their therapist was associated with higher levels of emotional support and lower levels of rejection from fathers. For the bulimic group a good therapeutic relationship was associated with higher maternal emotional support and lower rejection and lower paternal overprotection.

Tereno, Susana ... [et al] - Attachment styles, memories of parental rearing and therapeutic bond: a study with eating disordered patients, their parents and therapists European Eating Disorders Review January-February 2008, 16(1), 49-58

Antipsychotics for schizophrenia in children and young people

Although the prevalence of childhood-onset schizophrenia is very low with only 1 in 100 people with schizophrenia developing the condition before the age of 13 the incidence of schizophrenia rises sharply between 12 and 14 and approximately 12-33% of individuals with the condition become ill before the age of 18. Early onset schizophrenia is usually more severe, can lead to significant, chronic, functional impairment and has a poor response to antipsychotic drugs. A review of studies into the effectiveness and side effects of antipsychotic medication in this young age group found that antipsychotic medication consistently reduced the severity of psychotic symptoms compared to a placebo. Clozapine was demonstrated to be superior to haloperidol and olanzapine. However, the studies showed that young people were more vulnerable to developing side effects than adults, in particular weight gain, and could be at greater risk of diabetes. The researchers say that there is an 'urgent need to develop therapeutic strategies to prevent and/or mitigate weight gain and diabetes early in the course of treatment in this population'

Kumra, Sanjiv ... [et al] - Efficacy and tolerability of second-generation antipsychotics in children and adolescents with schizophrenia Schizophrenia Bulletin January 2008, 34(1), 60-71

Schizophrenia : cognitive deficits in relatives

Cognitive deficits, such as problems with inhibition and memory, are a central feature of schizophrenia and also occur in first-degree relatives of schizophrenia patients even though they may be unaffected by the condition themselves. In people with schizophrenia the deficits remain constant over time but little research has been done into whether this is true of their relatives as well. A study of 25 children aged between 6 and 15 who all had at least one schizophrenic parent assessed their cognitive functioning at different intervals. The researchers found that the children's inhibition and working memory were borderline to mildly impaired and that these deficits remained over time suggesting that it would be a good idea to give patients' relatives, as well as the patients themselves, therapy aimed at improving these cognitive deficits.

Ross, Randal G. ... [et al] - The stability of inhibitory and working memory deficits in children and adolescents who are children of parents with schizophrenia Schizophrenia Bulletin January 2008, 34(1), 47-51

Childhood infections and schizophrenia

It has been suggested that infections during early life can play a role in the development of schizophrenia. Most studies have looked at the effects of maternal infections on the developing fetus and of the few that have looked at the effects of childhood infections the results have been inconclusive. A study of 1.2 million children born in Sweden between 1973 and 1985 found that 2,435 of them had been admitted to hospital with bacterial infections of the central nervous system while 6,550 had been admitted with viral infections. 2,269 of the children had been admitted to hospital for treatment with non-affective psychotic illnesses. The researchers found a slightly increased risk of psychosis and schizophrenia among the children who had suffered from viral infections. Exposure to mumps or cytomegalovirus were associated with subsequent psychoses. There was no evidence of increased risk in relation to bacterial infections.

Dalman, Christine ... [et al] - Infections in the CNS during childhood and the risk of subsequent psychotic illness: a cohort study of more than one million Swedish subjects American Journal of Psychiatry January 2008, 165(1), 59-65

Sibutramine for binge-eating disorder

Binge-eating disorder is characterized by recurrent episodes of binge eating accompanied by feelings of loss of control and marked distress. The prevalence of binge-eating disorder in the general population is 2-3% and it usually occurs in conjunction with obesity which can have serious health consequences. Relative to other obese people people with binge-eating disorder have higher rates of mental-health problems, more medical complaints and psychosocial impairment and poorer quality of life. Psychological treatments, including cognitive behaviour therapy and interpersonal psychotherapy, have proved effective at reducing binge-eating but do not always lead to much weight loss so research has also concentrated on pharmacological approaches to the problem. A U.S. trial of an anti-obesity drug called sibutramine compared its effectiveness to that of a placebo in a study of 304 binge eaters over a 24-week period. Those taking sibutramine had a significantly greater reduction in weekly binge frequency, a higher weight loss, less days of bingeing and a reduction in eating pathology. However, the drug was associated with a significantly higher incidence of headache, dry mouth, constipation, insomnia and dizziness.

Wilfley, Denise E. - Efficacy of sibutramine for the treatment of binge eating disorder: a randomized multicenter placebo-controlled double blind study American Journal of Psychiatry January 2008, 165(1), 51-58

Monday, January 28, 2008

Body image, eating and the media : eating snack and watching beanpoles

Most women suffer from anxiety about their physical appearance, especially their weight. Even normal weight women express a desire to lose weight ; something that has been found in girls as young as nine. This can lead, in some cases, to women opting for plastic surgery (which has increased by 165% since 1992) or developing eating disorders, which can, in extreme cases, lead to death. It is often claimed that depictions of unrealistically thin women in the media contribute to this process and a Canadian study looked at the links between 'thin' images and eating behaviour. In four different mini studies young women between the ages of 18 and 21 were shown video clips which they were asked to memorize for a test later. They were then told that in their break they would be participating in a taste test of different foods before the memory test. The women were encouraged to eat as much as they liked and after a while were told the true nature of the experiment - which was to see how much food they ate after watching the video clips - by the researchers. The first study compared women watching neutral commercials with those watching thin models and found that those watching the thin models ate less. The second study included images of successful, heavier women among the thin ones and this group ate more. A third group were told before the 'thin' adverts were shown that a majority of their peers thought that the women in them were too skinny and this group ate more too. A fourth group were shown the commercials then given a psychological test designed to measure how much they associated heaviness with rejection ; the stronger the women's association between heaviness and rejection the less they ate.

Strahan, Erin J., Spencer, Steven J. and Zanna, Mark P. - Don't take another bite: how sociocultural norms for appearance affect women's eating behavior Body Image December 2007, 4(4), 331-342

Bipolar disorder, anxiety and drug use

People with bipolar disorder (BD) have higher rates of substance-abuse disorder (SUD) and anxiety than the rest of the population but it is unclear how substance problems and anxiety interact in people with bipolar disorder and how having SUD and/or anxiety problems affect people's bipolar disorder. A Canadian study of 1,411 people with bipolar disorder attempted to find some answers to these questions. The study found that among women the lifetime prevalence of SUDs was significantly greater among those with anxiety disorders but that the same link was not found in men. Anxiety disorders were significantly associated with mixed episodes, prolonged depressive episodes, 12-month prevalence of depression, BD-related health-service utilization and poorer current mental health functioning. SUDs were significantly associated with mixed episodes among females, 12-months prevalence of depression among males and with trouble with the law in both genders.

Goldstein, Benjamin E. and Levitt, Anthony J. - The specific burden of comorbid anxiety disorders and of substance use disorders in Bipolar I disorder Bipolar Disorders February 2008, 10(1), 67-78

Bipolar disorder and psychosis in children

Bipolar disorder in adults can often be accompanied by delusions and/or hallucinations (psychoses) but there has been little research into the prevalence of psychoses in children with bipolar disorder. A study of 257 children with bipolar disorder in the U.S. found that 76.3% of them had some form of psychosis. 38.9% of them had delusions, 5.1% had pathological hallucinations and 32.3% had both. The most common delusions were grandiose and the most common pathological hallucinations were visual. Benign hallucinations occured in 43.6%. Psychosis was equally prevalent in 6-9, compared to 10-16 year olds.

Tillman, Rebecca ... [et al] - Psychotic phenomena in 257 young children and adolescents with bipolar I disorder : delusions and hallucinations (benign and pathological) Bipolar Disorders February 2008, 10(1), 45-55

Lead and ADHD

Attention deficity hyperactivity disorder (ADHD) occurs in 3-7% of children, causing impairment due to extreme hyperactivity, impulsivity and/or inattention. The syndrome frequently co-occurs with other disruptive behaviours, particularly conduct and oppositional defiant disorders. Earlier studies have associated levels of lead in children's bloodstreams with ADHD but these were at levels much higher than are found today. A U.S. study of 115 children between the ages of 8 and 17 found that, even at relatively low concentrations, blood lead was associated with problems with hyperactivity and impulsivity and a lower IQ although not with inattention or disorganisation.

Nigg, Janet T. ... [et al] - Low blood levels associated with clinically diagnosed attention-deficity hyperactivity disorder and mediated by weak cognitive control. Biological Psychiatry February 2008, 63(3), 325-331

Friday, January 25, 2008

Schizophrenia : interventions to reduce emergencies

People with schizophrenia or psychosis have relatively high rates of emergency psychiatric and non-psychiatric medical service use and suicide and people with schizophrenia average more than twice the number of visits to general practitioners as those without a mental disorder. Approximately 28% of 'high users' of acute psychiatric inpatient services carry a schizophrenia diagnosis. Almost half of all patients with schizophrenia are admitted to an inpatient facility in any given 12-month period and the use of emergency medical services among those with schizophrenia exceeds that of other mental illnesses. One means of preventing excessive service use is to provide psychosocial interventions that teach skills necessary to manage life tasks. One such intervention is a behavioural skills training programme known as Functional Adaptation and Skills Training (FAST) aimed at improving functional skills in middle-aged and older patients with schizophrenia. By promoting everyday living skills patients are expected to have reduced need for emergency medical services thereby minimizing the burden on healthcare systems. A U.S. study of 240 older people with schizophrenia compared it to group sessions where people openly discussed problems that were important to them and other group members offered suggestions and support in managing these issues. Counsellors facilitated discussion but did not offer suggestions on managing problems, except in the case of a crisis. Those in the FAST group had half the likelihood of using emergency services in general and emergency psychiatric services in particular during the course of the interventions which lasted 24 weeks. However, there was little difference between the two groups after 6-18 months suggesting that there was a need for 'maintenance' sessions to encourage the continued use of skills in patients' everyday lives.

Mausbach, Brent T. ... [et al] - Reducing emergency medical service use in patients with chronic psychotic disorders: results from the FAST intervention study Behaviour Research and Therapy January 2008, 46(1), 145-153

Threat interpretation bias, and anxiety

The tendency to selectively process events as threatening is a central feature of cognitive models of anxiety. A number of studies with adults demonstrate an association between threat interpretation biases and panic disorder, social phobia and generalized anxiety disorder. Although investigations of cognitive factors in childhood anxiety disorders have lagged behind research with adults research has shown similar threat interpretation biases in relation to childhood anxiety disorders. A U.S. study of 45 7-12 year-olds presented them with three ambiguous situations and asked them how they would think, feel about and respond to them. 15 of the children suffered from anxiety disorders, 16 weren't anxious but were considered at risk because they had anxious parents and 14 were non-anxious with non-anxious parents. Compared to the other children the anxious children reported stronger negative emotions in response to the situations and felt that they had less ability to influence them. Children with anxious and non-anxious parents had similar results on the tests.

Waters, Allison M. ... [et al] - Threat interpretation bias as a vulnerability factor in childhood anxiety disorders Behaviour Research and Therapy January 2008, 46(1), 39-47

Thursday, January 24, 2008

Maternal stress and asthma

An eight-year study of nearly 14,000 children in Manitoba, Canada has found that those whose mothers were chronically stressed during their early years had a higher asthma rate than their peers regardless of their income, gender or other known risk factors. The researchers determined whether the children had current asthma at age seven by analyzing records of doctor visits, hospitalizations and medicines in the year of the child's seventh birthday and related it to maternal distress as defined by visits to the doctor, hospitalizations and medication for depression and anxiety. Even after controlling for the known risk factors of male gender, maternal asthma and urban location long-term maternal stress was still associated with an increase of nearly a third in the prevalence of childhood asthma.

You can read more about this research at

Statins and Alzheimer's disease

Some studies have shown that people taking cholesterol-lowering drugs called statins are less likely to go on to develop Alzheimer's disease. However, a long-term study of 929 Catholic priests who had an average age of 75 at the start of the study has found that statins have no effect on the development of Alzheimer's disease. The priests took annual cognitive tests and all agreed to a brain autopsy after their deaths. The study found no association between taking statins and a reduced risk of developing Alzheimer's or a slower cognitive decline and the brain autopsies found that the brains of those who had taken statins were no different to those of other people.

You can find out more about this study at

Toxoplasma and schizophrenia

A study of 712 U.S. military personnel has found that those people who had been exposed to a parasite called toxoplasma gondii had a 24% higher risk of developing schizophrenia than their unaffected colleagues. Previous studies have shown a link between toxoplasma antibodies and schizophrenia but it has proved difficult to tell which of the diseases came first. Because the U.S. military routinely tests its active personnel for toxoplasma and stores the results in a central repository researchers were able to determine the time line between infection and a diagnosis of schizophrenia. Toxoplasma gondii is a common parasite carried by cats and farm animals and most infections with it occur early in life following an exposure to the parasite in cat faeces or undercooked beef or pork. Infections rarely cause symptoms but the parasite remains in the body and can reactivate after lying dormant for years. Not everyone who was infected with toxoplasma went on to develop schizophrenia suggesting that its effect can be affected by individual differences between its human hosts.

You can find out more about this research at

OCD : how intensive therapy can rewire the brain

A brain-scan study of people with obsessive-compulsive disorder (OCD) has shown that as little as four weeks of daily cognitive-behavioural therapy (CBT) can produce significant changes in activity in certain regions of the brain. Past brain-scan studies of people with OCD have demonstrated that elevated activity along the frontal-subcortical circuits of the brain decreases in response to treatment with serotonin reuptake inhibitors (SRIs) or CBT. However, clinical improvement of OCD symptoms was expected to require up to 12 weeks of behavioural therapy or medication. The therapy used in the trial was "exposure and response prevention" which gradually desensitizes people to things that provoke obsessional fears or worries. After four weeks of therapy the OCD patients showed significant improvements in OCD symptoms, depression, anxiety and overall functioning. The brain scans showed significant reductions in brain activity in the right and left thalamus after treatment and a significant increase in activity in an area of the brain called the right dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions.

You can find out more about this study at

Music therapy and depression

About 121 million people worldwide are believed to suffer from depression. This can be seen in disturbed appetite, sleep patterns and overall functioning as well as leading to low self-esteem and feelings of worthlessness and guilt. It can lead to suicide and is associated with a million deaths a year. Drugs and psychotherapy are the usual treatments but a review into the effectiveness of music therapy has shown that this could also be an avenue worth exploring. Four out of the five studies in the review found a beneficial effect but London art therapist Anna Maratos who was the lead author of the study warned that "we will only be able to be confident about the effectiveness of music therapy once some high quality trials have been conducted".

You can find out more about this research at

A quarrel a day keeps the doctor away

A long-term study of 192 couples in Michigan has found that in couples where both partners suppress their anger and brood about arguments the death rate is significantly higher than in couples where one or both partners express their anger and a resolution of the conflict is reached. The researchers studied the couples over 17 years and found that when both partners suppressed their anger earlier death was twice as likely. Of the 'suppressing' couples 23% both died during the study period, while in 27% of the couples one partner died in the study period compared to rates of 6% and 19% in the other couples. The study adjusted for age, smoking, weight, blood pressure, bronchial problems, breathing and cardiovascular risk.

You can find out more about this study at

Major new study on ADHD reports

A large-scale, long-term study of Attention Deficit Hyperactivity Disorder (ADHD) has prompted experts to re-evaluate how they diagnose and treat the condition. ADHD is a common, chronic, behavioural disorder characterized by inattention, hyperactivity and impulsivity that is though to affect some 5-10% of school-age children worldwide. It has been associated with cognitive defects, particularly with working memory and inhibition which have been linked to overall intelligence and academic achievement. However, the study showed that these deficits were only present in about half of the adolescents diagnosed with ADHD. The study of 457 children in Finland tracked them from the early fetal period to adolescence (16 to 18). Despite the fact that children in Finland are rarely given medicine for the condition its prevalence, symptoms, psychiatric comorbidity (other mental-health problems experienced by the children) and cognition was the same as in the U.S. where children are much more likely to get drug treatment for the condition leading the researchers to pose questions about the effectiveness of pharmacological treatment. Other findings from the study included the fact that hyperactivity and impulsivity declined with age while inattention became more prominent. Two-thirds of the children continued to exhibit significant levels of inattentiveness and impairment into adolescence. ADHD was associated with increased rates of other psychiatric problems such as depression, anxiety, oppositional behaviour and conduct disorders and the rate of post-traumatic stress disorder was also higher in the children with ADHD. The researchers argued that ADHD should be regarded not as a discrete medical condition but as being at one end of a spectrum of behaviour in the same way that variables such as IQ, height and weight vary across a spectrum.

You can find out more about this research at

Wednesday, January 23, 2008

Childhood fears

Childhood fears are relatively common and can have a number of different causes. The onset and course of phobias and anxiety disorders have been associated with a concept known as anxiety sensitivity - subjectively-held beliefs about the negative consequences of being or becoming anxious, a 'fear of fear'. As well as factors in the children themselves their parents' problems and style of child-rearing can also influence children's levels of fear. Heightened parental anxiety is related to the onset and course of phobic and anxiety disorders in children and several studies have shown that children whose parents have panic disorder and/or agoraphobia are at high risk for the development of these disorders. Other studies have shown that parenting strategies typified by overprotection and overcontrol are related to the presence of fear and anxiety in children and parents of anxiety-disordered and phobic children have been rated by observers as granting less autonomy to their children than parents of non-anxious children. A U.S. study of 156 children found that overall age, gender, anxiety sensitivity and maternal ratings of an overly controlling parenting strategy were significant predictors of levels of fear but that maternal phobic anxiety was not a significant predictor. Anxiety sensitivity was a significant predictor of fear levels for both older and younger children and boys and girls. However, having an overly-protective mother was significant only for younger children and only for girls. Younger children and girls were more likely to be fearful than older children and boys.

Ollendick, Thomas H. and Horsch, Laura M. - Fears in clinic-referred children: relations with child anxiety sensitivity, maternal overcontrol, and maternal phobic anxiety. Behaviour Therapy December 2007, 38(4), 402-411

CBT and headaches

A study into the use of psychological therapies to relieve headaches compared the effectiveness of cognitive-behavioural therapy to that of temporal pulse amplitude (TPA) biofeedback training. In biofeedback training people are shown a visual representation of a physiological process e.g. heartbeat, blood pressure, brainwaves etc and asked to make a conscious effort to manipulate it in the right direction. The study found that CBT was highly effective with an average reduction of headaches from pre- to post- treatment of 68%, compared to 56% for biofeedback and 20% for a control group. Headaches continued to decrease up to a 12 month follow-up period for the CBT group. Improvement with CBT was associated with people's level of coping skills at the start of the study, their social support and physiological measures at rest and in response to stress.

Martin, Paul R., Forsyth, Michael R. and Reece, John - Cognitive-behavioural therapy versus temporal pulse amplitude biofeedback training for recurrent headache. Behavior Therapy December 2007, 38(4), 350-363

CBT for suicide prevention

Suicide and suicidal behaviour are serious public health issues. Suicide is among the 10 leading causes of death in most countries, and, for every suicide it is estimated that there are more than 30 non-fatal episodes of self-harm. A review of 28 studies looked into the effectiveness of cognitive-behavioural therapies in reducing suicide behaviour. Overall CBT had a highly significant effect but only for adults and only for individual rather than group treatments. There was also evidence for treatment effects, albeit reduced, over the medium term. However, the authors concluded that "although these results appear optimistic in advocating the use of CBT in ameliorating suicidal thoughts, plans and behaviours, evidence of publication bias [the tendency to publish only 'positive' studies) tempers such optimism".

Tarrier, Nicholas, Taylor, Katherine and Gooding, Patricia - Cognitive-behavioural interventions to reduce suicide behaviour: a systematic review and meta-analysis Behavior Modification January 2008, 32(1), 77-108

Autism : getting people to ask the right questions

Deficits in social and communication skills are characteristic of people with autism spectrum disorders. One of these deficits is an impairment in the ability of question asking and interventions for improving this ability are especially recommended for people with autism. A Dutch study looked at small-group training consisting of feedback and self-management aimed at improving question-asking skills in nine high-functioning adolescents with autism spectrum disorder. The training lasted six weeks with sessions being conducted once a week and lasting about an hour. The training consisted of verbal feedback and role-play during short simulated conversations and a table game. The therapy was found to be effective in improving question-asking skills, raising the percentage of 'correct' questions during conversation and increasing response efficiency. Participants and personal coaches evaluated the training as effective and acceptable.

Palmen, Annemiek, Didden, Robert and Arts, Marieke - Improving question asking in high-functioning adolescents with autism spectrum disorders: effectiveness of small-group training. Autism January 2008, 12(1), 83-98

Connectedness and depression down under

Connectedness is a sense of being cared for, personally accepted, valued and supported by others as well as enjoyment of and feeling attached to family, friends, school or workplace and the wider community. The four main protective factors promoting resilience in young people are family connectedness, school connectedness, religious affiliation or spirituality and beliefs in the norms of society. The more a young person has a sense of connectedness to their family, peers and school the less likely it is that they will engage in high-risk behaviours such as alcohol or drug abuse, or to develop anxiety, depression or suicidal thoughts. A study of 941 final-year (year 12) students in Victoria, Australia found high levels of depression, anxiety and stress with higher negative affect being associated with lower levels of family, peer and school connectedness. Negative affect 1 year after leaving school was predicted by negative affect and peer connectedness at year 12. The results of the study suggested that there were significant numbers of at-risk young people in their final year of school who felt lonely and disconnected from their peers and who maintained worrying levels of depression, anxiety and stress in their first year at university.

McGraw, Karen ... [et al] - Family, peer and school connectedness in final year secondary school students. Australian Psychologist March 2008, 43(1), 27-37

Parental bonding, anorexia nervosa and borderline personality disorder

It is generally agreed that the quality of parenting experienced in childhood affects personality development and is related to the development of mental-health problems in adulthood. Because specific problems might be linked to differences in the quality of maternal and paternal bonding between parent and child this aspect of the parent-child relationship is of particular interest. Researchers in Canada used a three-factor model of child-rearing to look into the links between parental bonding and borderline personality disorder (BPD) and parental bonding and anorexia nervosa. The first factor was care - the presence or absence of behaviours reflecting affection, warmth, empathy, understanding and closeness. The second was protectiveness or denial of psychological autonomy which ranged from overprotective, infantilising and intrusive child rearing at one extreme to over-permisiveness at the other and the third was authoritarianism or denial of behavioural freedom characterised by lack of parental encouragement of the child's independent behaviour at one end of the scale and permission for the child to exercise age-appropriate autonomous behaviour at the other. The researchers looked at the participants' ratings of their parents' behaviour on these three factors and compared 35 women with BPD, 34 with anorexia and 33 with no mental-health problems. Women with BPD reported very low levels of biparental care and significantly more paternal denial of behavioural freedom. Those with anorexia experienced more maternal denial of behavioural freedom. In terms of maternal bonding, lack of maternal care was the only factor to predict BPD ; for paternal bonding a combination of father's lack of care and denial of behavioural freedom predicted BPD.

Laporte, Lise and Guttman, Herta - Recollections of parental bonding among women with borderline personality disorder as compared with women with anorexia nervosa and a control group. Australian Journal of Psychology December 2007, 59(3), 132-139

Tuesday, January 22, 2008

Long-term prognosis for eating disorders

Anorexia nervosa and bulimia nervosa are serious mental illnesses. Follow-up studies of people with eating disorders suggest a spectrum of outcomes ranging from recovery to death but there is no consensus definition of remission, recovery or relapse. Estimates of remission or recovery from anorexia range from 31% to 76% while estimates of remission or recovery from bulimia range from 21% to 75%. A long-term study of 901 people with eating disorders which defined recovery as three consecutive years without symptoms found that after 10 years 11% of people with anorexia and 10% of people with bulimia had made a full recovery. After 15 years 16% of people with anorexia and 25% of people with bulimia had recovered. Initially the probability of recovery was greater for those with anorexia but as time went on people with bulimia had a higher probability of recovery.

Von Holle, Ann ... [et al] - Temporal patterns of recovery from eating disorder subtypes Australian and New Zealand Journal of Psychiatry February 2008, 42(2), 108-117

Clozapine : service users more positive than clinicians

The antipsychotic drug clozapine has been recognised to be particularly effective in the treatment of treatment-resistant schizophrenia and schizoaffective disorder. There are monitoring programmes and protocols to manage clozapine's potentially life-threatening side effects but the constant monitoring involved can be very intrusive. There are also other minor side-effects of the drug which can be unpleasant, inconvenient, and, at times, extremely embarassing. An Australian study of 27 people taking clozapine looked at their experience and perceptions of the drug and compared it to the perceptions of their treating clinicians. Consumers reported drooling mouth as the most prevalent and severe side effect whereas clinicians saw difficulty staying awake as the most prevalent side effect and sleeping too much as the most severe one. Most clinicians overestimated the prevalence and severity of clozapine side effects. Most clinicians and consumers agreed that clozapine lifted mood. Only 19% of consumers were unhappy about blood tests whereas 52% of clinicians estimated that consumers were unhappy about them. The study suggests that despite significant side effects and regular blood tests most stable consumers taking clozapine were happier and more satisfied with their treatment than many of the clinicians believed they were.

Hodge, Kay and Jespersen, Sean - Side-effects and treatment with clozapine: a comparison between the views of consumers and their clinicians. International Journal of Mental Health Nursing January 2008, 17(1), 2-8

Unemployment and suicide

Unemployment can damage psychological well-being by causing stress, triggering mental health problems and reducing self esteem. Involuntary and prolonged unemployment can induce suicide-related factors such as depression and a sense of hopelessness among the affected individuals and previous studies have consistently concluded that unemployment, directly or indirectly, leads to suicidal behaviour. A Hong Kong study compared 76 unemployed people who had killed themselves with 15 living unemployed people to see what factors led to some unemployed people being more at risk than others of commiting suicide. The researchers found that those who had killed themselves were more likely to be male, to have suffered from psychiatric illness and to have attempted suicide before. They also had acquired less competent social-problem-solving skills.

Wincey, S.C. Chan ... [et al] - Suicide and unemployment: what are the missing links? Archives of Suicide Research November 2007, 11(4), 327-335

Suicide post mortems : how accurate are friends' and families' memories ?

Post-mortem data about people who have commited suicide is usually gathered from a variety of available sources including friends and family (informants), medical and psychiatric records. While previous research has shown that informants can supply reliable information about patients' recent stressful life events it is unknown whether informants and patients provide concordant (in agreement) data about adverse early life experiences such as childhood sexual abuse. A U.S. study compared the accounts of 88 depressed patients over 50 with those of their informants who both completed items from the Childhood Trauma Questionnaire. Informants' reports of patients' severe sexual abuse histories were in high agreement with patients' reports, however, the level of agreement was significantly lower for 'milder' forms of sexual abuse.

Gamble, Stephanie A. ... [et al] - Concordance about childhood sexual abuse among depressed patients 50 and over and their family and friends. Archives of Suicide Research November 2007, 11(4), 321-326

Eating disorders and emotional responses to food

There are now thought to be strong links between emotions and eating disorders. People with anorexia have an intense fear of gaining weight and anorexics and obese women who binge eat have been found to have higher rates of alexithymia which is the inability to identify and express emotions. Negative emotions such as shame, guilt and disgust surround binge-eating and purging behaviours and eating disorders are often accompanied by mood and anxiety disorders. However, there have been fewer studies of people's responses to food per se. An Australian study of 629 secondary-school pupils and university students found that with increasing age people felt less emotion regarding food (either happiness, fear and disgust) but more dissatisfaction with their bodies. Compared to females males showed significantly higher levels of a 'happy' response to food. In adult females a 'fear' response to food was associated with increase levels of eating concern and body dissatisfaction.

McNamara, Caroline ... [et al] - Emotional responses to food, body dissatisfaction and other eating disorder features in children, adolescents and young adults. Appetite January 2008, 50(1), 102-109

Overweight and eating problems in recovering drug addicts

Overweight and dysfunctional eating patterns have been observed in people in recovery from drug and alcohol addictions. Overeating, binge eating, and the use of foods, especially those high in fats and sugars, as substitutes for alcohol and drug use have been reported. High rates of eating disorders have also been reported in this population but little is known about how substance users themselves experience food and eating in recovery and the roles that food plays during the recovery process. A qualitative study of 25 men recovering from drug and alcohol addiction in the U.S. found that the men's body mass index went up from 26 to 29 over the course of their recovery. Data analysis of interviews with the men revealed three main themes: excess weight gain, meaningful use of food, and disordered eating and a struggle to eat healthily that differed by recovery stage. Men in early recovery described dysfunctional eating practices such as mood and binge eating, the use of food as a substitute for drug use and the use of food to satisfy cravings. Men in mid-to-late recovery were concerned about their weight and distressed about efforts to lose weight. While food as a substitute for drugs, to regulate moods, alleviate boredom or satisfy cravings dominated early recovery, food and meals that provided structure and preparation for future living situations dominated later recovery.

Cowan, Jennifer and Devine, Carol - Food, eating and weight concerns of men in recovery from substance addiction. Appetite 50 (2008), 33-42

Monday, January 21, 2008

Alchohol and assaults in adolescence

Previous research based on college students has documented a strong relationship between alcohol and sexual assault but there has been limited research on the association between alcohol and sexual assault among adolescents. A U.S. survey of 1,037 teenagers found that alcohol was involved in approximately 12-20% of sexual assault cases. For girls the presence of alchohol during assault differed significantly based on the location at which the assault occured ranging from 6% at the victim's home to 29% at parties or at someone else's home. Alcohol-related assault among females was more likely to involve physical force than non-alcohol related assault.

Young, Amy ... [et al] - Alcohol-related sexual assault victimization among adolescents: prevalence, characteristics and correlates Journal of Studies on Alchohol and Drugs January 2008, 69(1), 39-48

Sober friends and drinking networks

Network support for drinking has been defined as the extent to which an individual's social network is supportive of his or her drinking behaviour. In contrast to general social support - which is often a predictive factor for many addictive disorders - network support for drinking has been consistently shown to predict negative outcomes for people dealing with alcohol problems. Interventions for people whose social networks are geared around drink have aimed at either decreasing the support for drinking or increasing the support for abstinence. A study of 952 outpatients being treated for drinking problems in Chicago compared the effects of cognitive behaviour therapy, motivational enhancement therapy and twelve-step facilitation (Alchoholics Anonymous) on preventing relapse in people with a high network support for drinking. Only twelve-step facilitation was effective in reducing drinking in this group suggesting that the social network of Alcoholics Anonymous meetings went some way to replacing the previous drinking network.

Wu, Johnny and Witkiewitz, Katie - Network support for drinking : an application of multiple groups growth mixture modeling to examine client-treatment matching Journal of Studies on Alcohol and Drugs January 2008, 69(1), 21-29

Attachment, aggression and borderline personality disorder

There has been a lot of research recently into the causes, course and treatment of borderline personality disorder (BPD) which is typically, but not always, characterized by impulsive aggression, sucidality and self-harm, extreme dysphoria, abandonment sensitivity, identity disturbance and unstable, angry affect. People with BPD have a high risk of suicide and self-harm. Attachment theory (and you can find out more about this by clicking on the link below) provides a useful framework for understanding and predicting critical aspects of personality disorder and anxious and avoidant attachment styles have been linked with both aggression and BPD. A study of 92 people diagnosed with BPD looked into the links between the disorder, attachment styles and aggression. There was a significant association between the more fearful forms of attachment and the more reactive form of aggression involving expectation of hostility from others. Self-harm was significantly associated with relational avoidance while anger and irritability were associated with relational anxiety.

Critchfield, Kenneth L. ... [et al] - The relational context of aggression in borderline personality disorder: using adult attachment style to predict forms of hostility Journal of Clinical Psychology January 2008, 64(1), 67-82

More information about attachment style can be found at

Emetophobia and locus of control

Emetophobia is the fear of vomiting and can be triggered by seeing other people being sick or feelings of nausea in oneself. It can affect people's social, home and work life, can significantly affect leisure activities and may lead to women delaying becoming pregnant. A study of 149 people compared emetophobics, people with other phobias and people with no phobias. People with emetophobia were found to have a significantly higher internal locus of control than the other groups. People with a high internal locus of control are more likely to think that what happens to them in life and the state of their health are within their control than that they are affected by external factors, fate or genetics. The researchers suggested that emetophobics may have a fear of losing control and that their emetophobia is just a reflection of this alternative, underlying problem.

Davidson, Angela L., Boyle, Christopher and Lauchlan, Fraser - Scared to lose control ? General and health locus of control in females with a phobia of vomiting Journal of Clinical Psychology January 2008, 64(1), 30-39

Friday, January 18, 2008

9/11, stress and heart problems

Studies in the U.S. have documented a substantial short-term psychological response to the 9/11 attacks but their effect on physical health has received little attention. Extremely stressful events can increase people's risk of cardiovascular problems and in the weeks following 9/11 rates of heart problems increased significantly in New York City and the surrounding areas and comparable findings were reported in Florida suggesting that direct exposure to the attacks wasn't necessary to precipitate health problems. A U.S. study of people who had completed a health survey before 9/11, a web-based assessment of their stress levels 9-14 days after the attacks and follow-up surveys 1, 2 and 3 years later found that acute stress responses to the attacks were associated with a 53% increased incidence of cardiovascular problems over the following three years even allowing for other factors such as smoking, body mass index and diabetes. Individuals reporting high levels of acute stress immediately following the attacks reported an increased incidence of heart problems and high blood pressure. Among people reporting ongoing worry about terrorism after 9/11 high 9/11 related acute stress symptoms predicted an increased risk of heart problems 2-3 years after the attacks.

Holman, E. Alison ... [et al] - Terrorism, acute stress, and cardiovascular health : a 3-year national study following the September 11th attacks Archives of General Psychiatry January 2008, 65(1), 73-80

Mood disorders and substance abuse

Previous studies have shown a link between mood disorders and substance abuse but it is hard to untangle whether the mood disorders cause people to take drugs or their drug taking leads to mood disorders and it has also been hard to find out which particular types of mood disorders cause problems with which particular types of drugs. A study of 591 people in Switzerland which followed them from young adulthood over a twenty-year period looked into the links between different types of mood disorders and substance abuse problems. The researchers found that people with manic symptoms were at greater risk of developing problems with alcohol, cannabis and benzodiazepines later. Bipolar II disorder predicted alcohol and benzodiazepine problems while depression was only linked to problems with benzodiazepines.

Merikangas, Kathleen R. ... [et al] - Specificity of bipolar spectrum conditions in the comorbidity of mood and substance use disorders Archives of General Psychiatry January 2008, 65(1), 47-52

Thursday, January 17, 2008

Negative affectivity and stress

Failure to cope with stress at work has been linked with a range of physical health problems such as gastrointestinal malfunction, musculo-skeletal problems and cardiovascular diseases as well as psychological problems such as anxiety, depression and burn out. Stress is a function of the relationship between an individual and his/her environment and individual differences can play an important part in this. One factor that is thought to be important in this is negative affectivity. People high in negative affectivity are more likely to report negative mood and emotional reactivity, have a negative view of themselves, have higher levels of emotionality and focus more on the negative aspects of situations. A study of 256 students in Australia measured their levels of negative affectivity and gave them tasks to do to see how well they coped with stress. They were given different amounts of time to do the task (high and low demand) and different amounts of freedom in the way they approached it (high and low control). Those participants with higher levels of negative affectivity had higher levels of post-task negative mood in response to high-demand conditions and had lower task satisfaction in response to high demand/low control situations. Participants with high levels of negative affectivity were more likely to use emotion-focused coping strategies such as minimizing the emotional threat posed by the stressor, wishful thinking and self-blame rather than problem-focused coping strategies.

O'Brien, Anne, Terry, Deborah J. and Jimmieson, Nerina L. - Negative affectivity and responses to work stressors: an experimental study Anxiety, stress and coping January 2008, 21(1), 55-83

School teachers and stress

Across different countries school teachers are among those professionals with the highest levels of job stress and burn out and many teachers retire early because of this. As well as contextual factors such as job demands and job resources research has now started to look at personality characteristics which may predict differences in teachers' stress and burn out and one characteristic that researchers believe plays an important role in creating stress is perfectionism. Perfectionism is a personality style characterized by striving for flawlessness and the setting of excessively high standards for performance accompanied by tendencies for overly critical evaluation of one's behaviour. Perfectionists often put great importance on the evalution of others and may perceive a great deal of pressure to excel because they have to live up both to their own high standards and to those of others. A study of 118 secondary school teachers in Germany found that there was a difference between striving for perfection and having a negative reaction to imperfection. Those teachers who strove for perfection tended to see things as a challenge rather than as a threat, to tackle problems constructively rather than trying to avoid them and were less prone to burn out. Those who had negative reactions to imperfection were more likely to see things as threats, not challengs, tended to aviod problems and were more likely to suffer from burn out. Pressure from students or students' parents was linked to burnout whereas pressure from colleagues was associated with a reduced sense of threat and a lower level of burnout.

Stoeber, Joachim and Rennert, Dirk - Perfectionism in school teachers: relations with stress appraisals, coping styles and burnout Anxiety, stress, and coping January 2008, 21(1), 37-53

Death, depression and drugs in the South of France

A study of 7,363 older people (average age 74) in the French cities of Bordeaux, Dijon and Montpellier looked into the links between depression, antidepressant use and mortality. The study found that depressed men using antidepressants had the greatest risk of dying with increasing depression severity leading to increased risk. Among women only severe depression in the absence of treatment was significantly associated with mortality.

Ryan, Joanne ... [et al] - Late-life depression and mortality: influence of gender and antidepressant use British Journal of Psychiatry 192: 12-18

Psychosocial interventions for relapse in bipolar disorder

Although drugs are the main method of treating bipolar disorder psychosocial interventions are also important to address issues such as medication adherence, awareness and understanding of the disorder, early identification of symptoms and coping skills. When combined with drug treatment they enable individuals to take a more active role in the management of their disorder and lead to improvements in mood stability, occupational and social functioning and quality of life. A review of psychosocial interventions found that cognitive behaviour therapy or group psychoeducation may be effective in relapse prevention in stable individuals. Family therapy was no more or less effective than individual psychosocial therapy or crisis management. There was no evidence that care management or integrated group therapy were effective in the prevention of relapse.

Beynon, Suzanne ... [et al] - Psychosocial interventions for the prevention of relapse in bipolar disorder: systematic review of controlled trials British Journal of Psychiatry 192: 5-11

Juvenile offenders and PTSD

Juvenile offenders often have high rates of mental illness and have often experienced trauma in their lives. A Japanese study of 64 female juvenile offenders aimed to describe the nature and extent of post-traumatic stress disorder (PTSD) and trauma exposure and its links with other psychosocial factors and mental-health problems. The prevalence for PTSD was 33% and 77% of the sample had been exposed to trauma. The offenders with PTSD had significantly higher risks of other mental illnesses. Depression and adverse parenting were associated with PTSD development and abnormal eating was also correlated with PTSD symptoms. Marked differences in the frequency and intensity of PTSD evaluation depending on the type of trauma experienced and other mental-health problems the offenders were suffering from were observed.

Ariga, Michi0 ... [et al] - Trauma exposure and posttraumatic stress disorder in delinquent female adolescents Journal of Child Psychology and Psychiatry January 2008, 49(1), 79-87

Inner speech and autism

Inner speech has been linked to higher-order cognitive processes including 'theory of mind', self-awareness and executive functioning all of which are impaired in people with autism who tend to report using visual rather than verbal thinking. A study of 45 children looked at whether they used visual or verbal methods in their short-term memory and compared autistic children with children with learning disabilities. The children were given a recall task involving some objects that looked alike and others which sounded alike. The idea was that those children who used verbal methods would get most confused with objects that sounded alike while those children who used visual methods would get most confused over objects that looked alike. The researchers found that mental age was more important than whether the children were autistic or not. Those children with a mental age over 7 used inner speech while those with a mental age of less than 7 used visual stimuli.

Williams, David, Happe, Francesca and Jarrold, Christopher - Intact inner speech use in autism spectrum disorder: evidence from a short-term memory task Journal of Child Psychology and Psychiatry January 2008, 49(1), 51-58

Wednesday, January 16, 2008

Antidepressants, beliefs and adherence

Although most guidelines about depression recommend continuation of medication for at least 8 months after symptom remission 50-80% of patients prescribed antidepressants either discontinue their medication prematurely or take it too inconsistently to derive any clinical benefit, which appears to increase the risk for relapse and recurrence. A large body of literature indicates that patients' beliefs and attitudes about medication predict medication adherence and treatment outcome. Despite this growing literature little is known about what underlies patients' beliefs about antidepressants. A U.S. study of 165 patients found that perceived necessity of antidepressants was associated with older age, more severe symptoms, longer anticipated duration of symptoms and the attribution of symptoms to a chemical imbalance. Perceived harmfulness was highest among patients who had not taken antidepressants before, who attributed their symptoms to random factors and who had an unclear understanding of depression. Neither belief - in the necessity or harmfulness of antidepressants - was significantly associated with sex, education, age at first depressive episode, presence of melancholia or anxiety, other mental-health problems or clinical settings.

Aikens, James E., Nease, Donald E. and Klinkman, Michael S. - Explaining patients' beliefs about the necessity and harmfulness of antidepressants Annals of Family Medicine 2008, 6: 23-29

Cortisol levels and marital satisfaction

Cortisol is a substance released by the adrenal glands under stressful conditions and is widely considered to be a reliable marker for an individual's response to, and recovery from, stress. Cortisol levels start high in the morning and steadily decline over the course of the day with intermittent rises as stressors arouse the adrenal gland. The slope of the hormone's daily decline is believed to be correlated with well-being, with steeper declines reflective of better health and shallower declines predictive of health problems. A study of 30 couples in Los Angeles asked them about their marital satisfaction, got them to monitor their stress levels throughout the day and monitored the participants' cortisol levels. The study found that cortisol levels dropped further among happily-married women than less happily married ones suggesting that those with poorer marriages didn't recover from the stresses and strains of the workplace as well. Long-term elevated cortisol levels have been associated with depression, burn-out, chronic fatigue syndrome, relationship problems and poor social adjustment. The men's cortisol levels declined just as quickly after work whether they were happily or unhappily married.

You can find out more about this research at

Religion and mental health

A study of 718 people in the U.S. looked into the links between religious activity and mental illness. The researchers found differences between men and women. Out of the 278 women who participated in the study 39% had always been religiously active whilst 51% had not been active since childhood. About 7% of the women who had always been religiously active met the criteria for generalized anxiety disorder compared to 21% of women who had stopped being religiously active. However, men who had stopped going to church were less likely to suffer from depression compared to men who were still religiously active.

You can find out more about this study at

Divorce distances fathers

A long-term study of U.S. teenagers has found that while divorce did not seem to alter the closeness between children and their mothers it did lead to an increased sense of separation between children and their fathers. The children were interviewed at the beginning and end of a five-year period and the results from those whose parents stayed married were compared to the results from those whose parents divorced over the course of the study. All the children became less close to their parents as a natural part of adolescence but the proportion of children who reported a consistently close relationship with their father was much higher among those with still-married parents than among those with divorced parents. However, there was no significant difference in the change in closeness to mothers reported by youths in either group. Those children who maintained a close relationship with their father had a stronger bond with their mothers as well and a greater sense of overall well-being.

You can find out more about this research at

Problems, problems, problems : why one diagnosis doesn't always fit all

A study of 2,300 individuals by researchers at Rhode Island Hospital, U.S. used standardized interviews to evaluate a wide range of psychiatric disorders in a general, clinical outpatient practice. The researchers found that a majority of the patients had more than one mental-health problem and a third of them had at least three. Depression was the most common diagnosis, followed by social phobia. On average patients had 1.9 diagnoses. Patients with principal diagnoses of post-traumatic stress disorder (PTSD) and bipolar disorder had the most concurrent diagnoses. Major depression was the most common reason for seeking treatment, however, while social phobia was the second most common diagnosis in the study 95% of the people suffering from it came for treatment for another mental-health problem.

You can find out more about this research at

Obesity and depression

A U.S. study of 4,641 women aged between 40 and 65 asked them about their height, weight, exercise levels, dietary habits and body image. The women also completed the Patient Health Questionnaire, a measure of depression symptoms. Women with clinical depression were more than twice as likely to be obese and obese women were more than twice as likely to be depressed. Obese women exercised the least, had the poorest body image and ate 20% more calories than thinner women. The links between obesity and depression held true even when the researchers took into account marital status, education, smoking and antidepressant use.

You can find out more about this research at

Genes, depression and Russian mothers

Recent research into the causes of mental illness suggests that genetics and environment, rather than one or the other, interact to cause psychological problems. In depression an individual's genetic make-up can predispose some people to be more susceptible to the condition when they are confronted with negative life experiences. A study of 177 male adolescents in a juvenile detention centre in Russia looked at the presence of a gene involved in the transport of the neurotransmitter dopamine (which is believed to have an important role in depression), levels of depression and the influence of rejecting child-rearing by mothers such as physical punishment, hostility, lack of respect for the child's point of view and unjustified criticism in front of others. While neither the gene or rejecting mothers on their own predicted depression the presence of both together led to a higher risk for major depression and suicidal ideation.

You can find out more about this research at

Tuesday, January 15, 2008

Child abuse, depression, PTSD and risk-taking behaviour

A study of 113 women who injected drugs in Philadelphia looked into the links between childhood physical and sexual abuse, post-traumatic stress disorder (PTSD) and depression and high-risk sex and drug taking. 56% of the sample reported childhood sexual abuse and 68% childhood physical abuse. Out of the whole sample 23% suffered from depression while 53% suffered from both PTSD and depression (co-morbid). Childhood sexual abuse was associated with an increase in risk-taking behaviour but childhood physical abuse was not. Childhood sexual abuse was also associated with developing co-morbid PTSD and depression and co-morbid depression and PTSD was associated with increased risk-taking. Once co-morbid depression and PTSD were taken into account childhood sexual abuse was no longer associated with riskier behaviour suggesting that it was the increased risk of co-morbid PTSD and depression that led to higher levels of risk taking not childhood sexual abuse per se.

Plotzker, Rosalyn E., Metzger, David S. and Holmes, William C. - Childhood sexual and physical abuse histories, PTSD, depression, and HIV risk outcomes in women injection drug users : a potential mediating pathway. The American Journal on Addictions 2007, 16: 431-438

Interventions for adherence

Research supports the effectiveness of numerous pharmacological and psychosocial interventions for helping individuals with serious mental illness reduce psychiatric symptoms and build more satisfying and productive lives. Treatment non-adherence, however, remains a major obstacle to recovery with between forty and sixty per cent of people with a severe mental illness failing to engage in aftercare treatment. Non-adherence is associated with more serious symptoms, suicidality, violent behaviour, functional limitations, higher relapse rates and hospital recidivism. A team of researchers from Chicago looked at 31 studies into interventions designed to prevent non-adherence to treatment. They found that assertive/intensive case management improved outpatient treatment retention and that behavioural therapy enhanced medication adherence.

Lehner, Renanah K. ... [et al] - Outpatient treatment adherence and serious mental illness : a review of interventions American Journal of Psychiatric Rehabilitation 10(4), 245-274

Friday, January 11, 2008

Post-traumatic stress disorder and growth in wives and partners

Post-traumatic stress disorder (PTSD) can have many negative effects, not just on the people suffering from it but on their wives and partners as well. They can suffer from tension, physical illness, anxiety, depression, low self-esteem, loneliness, confusion, loss of control and self-blame. However, most women continue to cope and stay with their husbands and recent research has been addressing how they cope with their partners' problems. Research has found that they maintain a reservoir of good feelings towards their husbands from before their mental-health problems and that the experience of watching their husbands' daily struggle can deepen their appreciation of their courage and determination and enhance their love for them. Their husbands' struggle serves as an example which facilitates their coping and their husbands' difficulties were often seen as enhancing their sensitiveness towards their wives. The women also gained a sense of strength and empowerment from their own struggle to help their husbands and keep their families together. These unexpected gains from their partners' PTSD have been called post-traumatic growth. A study of 161 wives of veterans of the Yom Kippur war in Israel compared those married to former prisoners of war (who, for the purposes of the study were assumed to have suffered from more PTSD) with those married to other veterans of the conflict. The researchers also looked at the women's attachment styles. Attachment is the way in which we make and conduct relationships with other people. Those who show avoidant attachment prefer not to rely on or open up to other people, feel uncomfortable with intimacy and are less secure with depending on others and having others depend on them. Those who show anxious attachment tend to worry about whether their partner is available to them and responsive. People with secure attachment are comfortable with intimate relationships and see their partner as being responsive. They perceive themselves in a positive and coherent way, have good problem-solving skills, tend to view stressful situations optimistically and believe that others will help them in their time of need. The study found that the wives of former prisoners of war had both higher levels of distress and of growth than the wives of former veterans. The worse their husbands' PTSD the higher the wives' levels of growth and distress were. Those women with anxious and avoidant attachment styles suffered from more distress but also experienced more growth as a result of their husbands' PTSD.

Dekel, Rachel - Post-traumatic distress and growth among wives of prisoners of war : the contribution of husbands' post-traumatic stress disorder and wives' own attachment American Journal of Orthopsychiatry July 2007, 77(3), 419-426

Risperidone for depression in older adults

Mood disorders are a significant health care issue in the elderly and are associated with suffering, functional decline, compromised quality of life, care-giver burden and increased rates of suicide and service utilization. Persistent depression worsens the outcome of other illnesses and increases non-suicide mortality. Only a third of depressed older adults achieve remission with another 20% showing a partial improvement. Adding an atypical antipsychotic to an antidepressant is one of the alternatives available for people who have failed to respond to drug therapy and a U.S. study of 93 people compared the effectiveness of risperidone to a placebo in terms of delaying relapse and preventing it altogether. The group taking risperidone were just as likely to suffer a relapse as those taking a placebo but they did go over twice as long before becoming ill again as the placebo group.

Alexopoulos, George S. ... [et al] - Placebo-controlled study of relapse prevention with risperidone augmentation in older patients with resistant depression American Journal of Geriatric Psychiatry January 2008, 16(1), 21-30

Disappointing results for escitalopram in older depressed people

A study into the effectiveness of escitalopram in treating depression in people over 60 has yielded disappointing results. The 12-week trial divided 264 patients into two groups one receiving escitalopram and the other a placebo. Escitalopram was no more effective at treating depression than a placebo and 11% of the people taking the drug discontinued it due to side effects of headache, nausea, diaorrhea and a dry mouth.

Bose, Anjana, Dayong, Li and Gandhi, Chetan - Escitalopram in the acute treatment of depressed patients aged 60 years or older American Journal of Geriatric Psychiatry January 2008, 16(1), 14-20

Personality and leaving therapy

How people leave group psychotherapy is often as important as what goes on in the sessions. Drop-out is characterized by frequent absences from group sessions and avoidance of the therapist's solicitations. In evasion into health the member resists the group's successful penetration of his/her defences and denies the need for further help claiming that all his/her problems have been solved. In ending of a phase the group member feels that he/she has completed a successful piece of work and is unwilling to proceed further. In saying goodbye, the best possible outcome, the group member announces his/her departure in advance, works towards the definitive date, freely discusses his/her feelings and anticipates the after-therapy period. A Swiss study of 24 older people suffering from depression looked into the links between people's personalities and the quality of their termination from group therapy. The researchers found that neuroticism was not related to the quality of the termination but agreeableness and openness to experience were strongly associated with a successful ending to therapy.

Canuto, Alessandra ... [et al] - Impact of personality on termination of short-term group psychotherapy in depressed elderly outpatients International Journal of Geriatric Psychiatry January 2008, 23(1), 22-26

Life review programmes for older people

The Life Review Group Programme is a technique used to improve the psychological health and wellbeing of older people. It consists of a series of group discussions on topics such as childhood memories, adolescence, people's families, their jobs and friends, the greatest thing people have accomplished in life and a summary of the life review and the integration of life events. The sessions include group discussion, couple work and role-playing. A study of 75 elderly men in a nursing home in Taiwan found that the Life Review Group Programme led to significant improvements in self-esteem and life satisfaction which were maintained one month after the intervention.

Chiang, Kai-Jo ... [et al] - Evaluation of the effect of a life review group program on self-esteem and life satisfaction in the elderly International Journal of Geriatric Psychiatry January 2008, 23(1), 7-10

Wednesday, January 09, 2008

Anxiety and treatment-resistant depression

The STAR*D study is a ground-breaking, large-scale study of over 4,000 adults with treatment-resistant depression at 41 different locations in the U.S. As part of the study 2,876 people received the antidepressant citalopram. In the second phase of the study those people (1,292) who had failed to improve after taking citalopram for 14 weeks were then randomly assigned to take another antidepressant or a combination of citalopram and another drug. As part of the trial participants were asked about their anxiety levels. Approximately 53% of the sample had clinical anxiety problems and for those people remission was significantly less likely and took longer to occur. Ratings of drug side effects were also significantly greater in the anxious group. Changing medication or augmenting citalopram with another drug were also significantly less effective in anxious people.

You can find out more about this research at

Depression and smell

There is a well-attested link between Alzheimer's disease and people losing their sense of smell and now researchers from Tel Aviv University have put forward the idea that depression might also be linked to a loss of the sense of smell. Research on autoimmune diseases (where the body attacks itself) such as arthritis, rheumatism and lupus shows that a particle known as an autoantibody which attacks the body's own immune system can weaken a person's sense of smell and induce feelings of depression. People who are depressed often respond well to aromatherapy and shops often use smells to improve customers' moods and get them to spend more.

You can find out more about this research at

Light therapy for bipolar disorder

People with bipolar disorder are known to be sensitive to changes in outdoor ambient light and to seasonal changes and a small-scale U.S. study has shown encouraging results for light therapy. The light therapy was used to treat the depressive part of the disorder and the women who participated in the study were given light boxes and instructions on how to use them at home. Those who received morning light developed a mixed state with symptoms of depression and mania - racing thoughts, irritability, sleeplessness, anxiety and low mood - occuring all at once but those who used their light boxes at mid-day had a much more stable response and of the nine women treated six showed some sign of improvement. Optimal response was observed with mid-day light therapy for 45-60 minutes daily.

You can find out more about this research at

Anxiety and heart attack risk

A study of 735 men by researchers at the University of Southern California has found that anxiety can increase people's risk of a heart attack by 30-40%. Each of the 735 participants in the study completed psychological tests in 1986 and was in good cardiovascular health at the time. The men completed tests for psychaesthenia (excessive doubts, obsessive thoughts and irrational compulsions), social anxiety, phobias and their tendency to experience tension and physical arousal in stressful situations. They also completed psychological tests about their hostility, anger, type A behaviour, depression and negative emotions and their smoking, alcohol consumption, daily diets and general physical health was also assessed. Regardless of all other factors those men who came in the top 15% of any of the anxiety scales faced an increase in their heart attack risk of 30-40%.

You can find out more about this research at

Regular meals and eating disorders

As children go through adolescence disordered eating behaviours, including binge eating and self-induced vomiting, become more common. Disordered eating behaviours are associated with a number of harmful behavioural, physical and psychological consequences including poor quality diets, weight gain, obesity, depressive symptoms and the onset of eating disorders. A study of 2,516 adolescents in Minnesota looked at how often children ate with their families, their weight, their feelings of family connectedness and their eating behaviour. Girls who ate five or more meals with their families a week in 1999 were significantly less likely to use self-induced vomiting or laxatives to control their weight in 2004 regardless of their sociodemographic status, body mass index or family connectedness although this did not hold true for teenage boys.

You can read more about this research at

Predicting psychosis in high-risk youth

A study of 325 youngsters in the U.S. has found that those who have a combination of different risk factors for the condition have a 65-80% chance of going on to develop full-blown psychosis. The researchers who conducted the study claim that an understanding of these combinations could help scientists predict who is likely to develop the illness within two to three years with the same accuracy that other kinds of risk factors can predict major medical diseases, such as diabetes. 35% of people with the accepted criteria for being at risk of psychosis go on to develop the illness but the figure rises to 65-80% with the following combination of risk factors :

  • deteriorating social functioning (e.g. spending increasing amounts of time alone in one's room)
  • a family history of psychosis combined with a recent decline in functioning e.g. a drop in school marks or a withdrawal from extracurricular activities)
  • an increase in unusual thoughts (e.g. thinking strangers' conversations are about one's self)
  • an increase in suspicion/paranoia
  • past or current drug abuse

The researchers also found that those who progressed to a psychotic disorder tended to do so relatively quickly. 22% developed psychosis within the first year, 11% by the end of the second year and the remaining 3% by the end of 2 1/2 years.

You can find out more about this research at

Tuesday, January 08, 2008

Alcohol, cognition and domestic violence

Recent studies suggest a strong relationship between alcohol use, physical violence and cognitive functioning. Alcohol use is involved in 40-60% of incidents of domestic violence and between 50-60% of men who seek treatment for alcoholism have assaulted their wives and partners in the year prior to starting treatment. Alcohol use has been linked to deficits in impulse control that are in turn linked with violent behaviour. However, there have been few studies into the differences in cognition between alcoholics who do, or do not, beat their wives and partners. A study of 25 alcoholics in the U.S. found that those who assaulted their partners had more severe deficits in attention, concentration and cognitive flexibility. Both groups were more impulsive and had poorer decision-making skills than a control group of smokers without a drink problem.

Easton, Caroline J. ... [et al] - Neurocognitive Performance Among Alcohol Dependent Men With and Without Physical Violence Toward Their Partners: A Preliminary Report The American Journal of Drug and Alcohol Abuse 34(1), 29 - 37

Middle schools and mental health

There is considerable evidence that middle schools (corresponding to late primary/early secondary) in the U.S. play an important role in children's adjustment, not just in terms of their school work but in other areas of life as well. Most studies into how middle school affects children have focused on their academic performance rather than on psychological or behavioural problems but the emergence of depressive symptoms, low self-esteem and behavioural difficulties often coincides with the middle-school years. A New York study of 1,451 children from 11-14 asked them to rate their school's 'climate' (teacher support, children's friendliness, students' autonomy in the classroom and clarity and consistency of school rules) and assessed their psychological and behavioural adjustment. The researchers found that all four measures of school climate declined over time and that these declines were associated with poorer psychological and behavioural adjustment. Girls experienced a sharper decline in friendliness among their peers although they still felt they got on better with their teachers and their peers than boys. The influence of teacher support, peer support and clarity of rules affected the children's psychological and behavioural adjustment but the children's psychological and behavioural adjustment did not affect how they perceived their school's climate i.e. the relationship only worked in one direction.

Way, Niobe, Reddy, Ranjini and Rhodes, Jean - Students’ Perceptions of School Climate During the Middle School Years: Associations with Trajectories of Psychological and Behavioral Adjustment American Journal of Community Psychology (2007) 40:194–213

Drinking, depression and naltrexone

People with drink problems often suffer from depression as well. People who suffer from depression are more likely to drink heavily and people who drink heavily are more likely to suffer from depression. Those people with drink problems and depression have increased treatment dropout rates, higher rates of relapse, greater levels of alcohol consumption and more use of medical services. Naltrexone is used to treat people with alcohol problems but there has not been much research into its effectiveness in drinkers with depression or how its effectiveness is affected by interactions with antidepressants. A U.S. study of 627 people being treated for alcohol problems found that there was no difference in the effectiveness of naltrexone in people taking antidepressants and that it helped to reduce the number of days' drinking in people taking depression medication.

Krystal, John H. ... [et al] - Naltrexone is associated with reduced drinking by alcohol dependent patients receiving antidepressants for mood and anxiety symptoms : results from VA cooperative study no. 425 "Naltrexone in the treatment of alcoholism" Alcoholism : clinical and experimental research January 2008, 32(1), 85-91

Social anxiety and alcoholism

There is a well-documented relationship between social anxiety and alcohol use. People with social anxiety often use alchohol to relieve their symptoms and untreated social anxiety can lead to the development, maintenance and relapse of alcohol problems. A U.S. study of people being treated for social anxiety, who were also problem drinkers, looked into whether people's drinking would decrease if their social anxiety was relieved. They divided the 42 participants into two groups one receiving paroxetine for their social anxiety and the other receiving a placebo. Neither group received any treatment for their problem drinking. Paroxetine reduced people's social anxiety and the amount they drank to relieve anxiety but did not reduce the overall frequency or quantity of people's drinking. Those people whose social anxiety improved carried on drinking as much but for different reasons.

Thomas, Suzanne E. ... [et al] - A complex relationship between co-occuring social anxietyand alcohol use disorders : what effect does treating social anxiety have on drinking ? Alcoholism : clinical and experimental research January 2008, 32(1), 77-84

Monday, January 07, 2008

Ageing and social participation

Concepts of successful ageing and active ageing both emphasize independence and participation in productive activities as being good for elderly people's health. A six-year study of 4,049 older people in Taiwan looked at their levels of participation in paid and unpaid work and compared them with levels of mortality over the course of the study. The researchers found that those people who had continuous paid work were also more likely to participate in social groups. Having paid or unpaid work at the start of the study lowered the risk of mortality six years later, especially for men. However, having unpaid work was associated with a higher risk of impaired cognitive function compared to that of non-workers. Participating in a religious group reduced the risk of mortality for women and participating in political groups reduced the risk of impaired cognitive function for men.

Hsu, H. C. - Does social participation by the elderly reduce mortality and cognitive impairment Ageing and Mental Health November 2007, 11(6), 699-707

Depression in older adults - what are the best psychosocial interventions

Depression in older adults is a frequent problem that can lead to an increased risk of illness, death and reduced quality of life. A review of 57 studies into the effectiveness of psychotherapy and other behavioural interventions on depressive symptoms in clinically-depressed older adults found that cognitive-behaviour therapy and reminiscence were the best supported by the evidence from trials. Interventions with 7-12 sessions had the best balance between optimizing effectiveness and minimizing drop-out rates. For physically and cognitively-impaired patients modifications in treatment format and/or content might be effective e.g. combining psychotherapy with social work interventions and pharmacotherapy.

Pinquart, M., Duberstein, P.R. and Lyness, J.M. - Effects of psychotherapy and other behavioral interventions on clinically depressed older adults : a meta-analysis Ageing and Mental Health November 2007, 11(6), 645-657

Friday, January 04, 2008

Social skills training and schizophrenia

People with chronic schizophrenia can lack social skills. They find it hard to hold conversations with people, make friends or solve problems. Poor social skills are closely related to repetitive recurrences of schizophrenia and rehospitalizations and have been reported as important factors affecting prognosis. Patients with chronic mental illness can also suffer from low self-esteem which impedes effective interpersonal relationships and negatively affects their abilities to cope with stress and problems. Raising self-esteem is one of the most important ways of preventing recurrence and ensuring long-term success in rehabilitation among patients with chronic schizophrenia. Social skills training has been proven to be effective when delivered by psychiatrists and psychologists but little research has been done into the effectiveness of nurse-led social-skills training. A Korean study divided 66 patients into two groups comparing a nurse-led social-skills training programme with a control group. After 16 sessions those people who had received social-skills training showed a significant improvement in their conversational, interpersonal and assertiveness skills and had higher self-esteem although their problem-solving ability had not improved.

Seo, Ji-Min ... [et al] - Social skills training as nursing intervention to improve the social skills and self-esteem of inpatients with chronic schizophrenia Archives of Psychiatric Nursing December 21(6), 317-326

Psychiatrists and religion

Historically there has often been tension between psychiatry and religion. Freud equated religion with neurosis and even called it an enemy while DSM-III was also criticized as portraying religion negatively. Several studies of psychiatrists' religious characteristics have indicated that psychiatrists are measurably less religious than the general population, their patients and other physicians. However, studies of the health effects of religion and spirituality have linked it to reduced depression and anxiety, increased longevity and other physical and psychological health benefits. A survey of 1,144 psychiatrists and physicians in the U.S. found that although psychiatrists were less religious than other doctors they generally endorsed the positive influences of religion on health. They were more likely to be aware of the negative impact of religion but they were also more likely to encounter religious issues in clinical settings and were more open to addressing religious issues with patients.

Curlin, Farr A. ... [et al] - Religion, spirituality, and medicine : psychiatrists' and other physicians' differing observations, interpretations, and clinical approaches American Journal of Psychiatry December 2007, 164(12), 1825-1831

Cognitive remediation and schizophrenia

Cognitive impairment is a core feature of schizophrenia and is strongly related to functioning in areas such as work, social relationships and independent living. The worse people's cognitive functioning the worse their response is to psychiatric rehabilitation. There has been a lot of research devoted to how to improve cognitive functioning in people with schizophrenia but pharmacological treatments have limited effects. Cognitive remediation programmes employ a variety of methods, such as drill and practice exercises, teaching strategies and compensatory strategies to reduce the effects of persistent cognitive impairments and a review of 26 studies on cognitive remediation including a total of 1,151 patients found that it was associated with significant improvements to cognitive performance, psychosocial functioning and schizophrenia symptoms. The effects of cognitive remediation were significantly stronger in studies where it was used alongside psychiatric rehabilitation.

McGurk, Susan R. ... [et al] - A meta-analysis of cognitive remediation in schizophrenia American Journal of Psychiatry December 2007, 164(12), 1791-1802

Thursday, January 03, 2008

Lithium and mood disorders in older adults

Mood disorders are a major cause of illness and disability among older people. Although lithium has been shown to be effective in preventing and treating bipolar disorder in younger people its effectiveness has not been thoroughly investigated in older adults with depression and bipolar disorder. An Israeli study of 60 people over 60 compared participants' mental health before and after beginning treatment with lithium. The researchers found that lithium brought about significant reductions in the frequency, duration and severity of depressive and manic relapses, the rate and duration of hospitalizations, and suicidal behaviour.

Lepkifker, Elie ... [et al] - Lithium therapy for unipolar and bipolar depression among the middle-aged and older adult subpopulation Depression and Anxiety 24(8), 571-576

Combination therapy, social functioning and depression

People with depression often have problems at work, in their social life and in their family life and these problems get worse the more severe their depression is. Social functioning can improve after treatment with antidepressants but seldom gets back to a 'normal' level. A Dutch study of 167 people looked into whether combination therapy (psychotherapy plus antidepressants) could improve patients' social functioning. The participants were split into two groups. One group received pharmacotherapy while the other group received pharmacotherapy plus 16 sessions of short, psychodynamic supportive psychotherapy. Severity of depression decreased significantly more in the psychotherapy group and the number of dimensions of social functioning that had improved significantly was also higher in the psychotherapy group who had a larger improvement in their overall social functioning than those taking antidepressants alone.

Molenaar, Pieter J. ... [et al] - Does adding psychotherapy to pharmacotherapy improve social functioning in the treatment of depression ? Depression and Anxiety 24(8), 553-562