Thursday, February 28, 2008

Who stalks?

There has been a lot of media coverage about stalking lately, some of it very sensationalised but more rigorous scientific studies have also confirmed substantial rates of stalking in the UK. The 1998 British Crime Survey found that 12% of respondents of both sexes had suffered persistent and unwanted attention at some time over the age of 16 and the 2001 British Crime Survey found that 8% of women and 6% of men had been stalked during the past year. However, understanding of the nature of stalking behaviours has not kept pace with the increasing awareness of stalking and much of the research into it has looked at victims rather than perpetrators. A study of 362 patients admitted to Broadmoor looked at their case histories to identify incidents of stalking. The researchers found that 33 of them (9.1%) could be classified as stalkers. They were mostly male, yound, unmarried, minimally educated and unemployed. They had inflicted a wide range of unwanted intrusions and communications on their victims and both threats (55%) and assaults (45%) were common. The types of stalkers were more or less equally split between intimacy seeking, rejected suitors, resentful and predatory with only a tiny group being incompetent suitors.

Whyte, Sean ... [et al] - Who stalks? A description of patients at a high security hospital with a history of stalking behaviour Criminal Behaviour and Mental Health 2008, 18, 27-38

Wednesday, February 27, 2008

Why Americans are having less senior moments

A study of 11,000 people in the U.S. has found a significant decline in the levels of cognitive impairment between 1993 and 2002. The prevalence of cognitive impairment went down from 12.2% in 1993 to 8.7% in 2002. The researchers attributed this decline to increased rates of college education, greater personal wealth and better treatment for cardiovascular problems. In recent years research has suggested that the more education a person receives early in life the more his or her brain will be able to stay sharp later. During the time of the study the number of older people with a high-school diploma rose from 53% to 72% and the number of people with a college education rose from 11% to 17%. At the same time the use of cholesterol-lowering drugs and blood-pressure medication increased dramatically during the 1990s. This may have had the effect of reducing the incidence of vascular dementia - cognitive problems brought on by mini-strokes, strokes and decreased blood flow to and within the brain due to hardened or clogged arteries.

You can read more about this research at

Empty nests or new friends ?

Traditionally it has been thought that children leaving home had a negative effect on parent's mental health - the empty nest syndrome. However, a study of 142 sets of parents by researchers at the University of Missouri has found that the changes parents feel are more positive than once believed. The study found that there were few differences in the way mothers and fathers felt and that many of the changes parents felt were positive as they moved from looking after their children to relating to them as peers, becoming mentors to them rather than telling them what to do. At the same time the parents continued to provide financial and emotional support to their children.

You can read more about this research at

Stroke risk and memory loss

Although everyone loses some cognitive capacity as they age new research from the U.S. suggests that people at high risk for stroke also have the highest rate of cognitive decline. The study, of more than 17, 000 people found that those at high risk of stroke declined twice as fast as those at low risk. Those rated as having a 22% chance of having a stroke in the next ten years had double the rate of cognitive decline as those who were only thought to have a 2% chance. High blood pressure, diabetes and left ventricular hypertrophy were the three, specific, risk factors associated with memory loss.

You can find out more about this research at

Review casts doubt on antidepressants

A review of data from drug trials submitted to the U.S. Food and Drug Administration has found that, compared to a placebo, SSRI antidepressants appear only to help people with very severe depression. The researchers found that placebos were able to duplicate 80% of the improvements achieved by the drugs fluoxetine, venlafaxine, paroxetine and nefazodone.

You can read the full text of this review at

Adolescent depression - treating tough cases

Adolescent depression is a chronic, recurrent and impairing condition that accounts for a substantial proportion of physical injuries and premature deaths in teenagers. Untreated depression results in problems in school and interpersonal relationships and increases the risk for suicidal behaviour. Not all children respond well to antidepressant treatment so an alternative strategy is important. A U.S. study of 334 depressed 12 to 18 year olds who had not responded to SSRI* antidepressants after two months evaluated the effectiveness of four different treatment strategies: (i) switching to a different SSRI (ii) switching to a different SSRI and using cognitive behaviour therapy (iii) switching to venlafaxine (iv) switching to venlafaxine plus CBT. The results showed that adding CBT to the antidepressant treatment was more effective than simply changing drugs, either to another SSRI or to venlafaxine. There was no difference between changing to another SSRI and changing to venlafaxine.

You can read more about this research at

*Serotonin Specific Reuptake Inhibitors which work by increasing the amount of the 'feel-good' chemical serotonin in the brain.

Tuesday, February 26, 2008

Personality and schools of therapy

Recent research has looked into the links between people's personality types and the schools of counselling and psychotherapy they belong to. A mis-match between a therapist's outlook on life and the kind of therapy they practice can lead to dissatisfaction, poorer quality therapy and even to people leaving the profession. A survey of 84 people doing counselling training at universities in the UK tested them with the Myers-Briggs personality test and asked them which method of psychotherapy they were using. The survey found that those who scored highly for planning and coming to conclusions and for being practical and interested in facts and details were more likely to use cognitive-behaviour therapy. Those who were more interested in taking a broader overview, gave less weight to logic and who liked planning were more likely to use psychodynamic therapy and those who took a broad overview, gave less weight to logic and were more flexible were more likely to use person-centred therapy.

Varlami, Evi and Bayne, Rowan - Psychological type and counselling psychology trainees' choice of counselling orientation Counselling psychology quarterly December 2007, 20(4), 361-373

Depression and treatment history

Depression can be described as a chronic rather than an acute illness and single, isolated episodes of depression are rare. In fact, the risk of repeated episodes is said to exceed 80% and patients can expect an average of four episodes of depression in their lifetimes. The risk of relapse has been linked to the number of prior episodes a patient has experienced and patients who have experienced three or more prior episodes have a greatly increased risk of relapse. One study reported that with each additional episode there is an 18% increase in the risk of recurrence. However, there has been little research into people's psychotherapy 'careers' and little data regarding the relationship of these prior treatments and responsiveness to psychotherapy. An Australian study of 48 individuals with major depression turning up for treatment at a community-based psychotherapy facility found that 90% of them had received some form of prior psychotherapy or counselling, with on average 3.5 previous episodes of care. Those receiving psychotherapy at the time of intake showed higher levels of improvement over the following year suggesting that those actively engaged in some therapy experience at intake benefited more than those with an 'interrupted' psychotherapy career.

Grenyer, Brin F.S., Deane, Frank P. and Lewis, Kate L. - Treatment history and its relationship to outcome in psychotherapy for depression Counselling and Psychotherapy Research March 2008, 8(1), 21-27

Australian women - who seeks counselling ?

Despite the increasing incidence of mental-health problems in the population a growing body of research suggests that the great majority of those who are psychologically distressed receive no mental health care. Women report much higher rates of mental-health problems than men and middle-aged women report more problems than other age groups. An Australian study of 11,201 women between the ages of 50 and 55 examined which of them had consulted a counsellor, psychologist or social worker in the past 12 months. The study used data from the Australian Longitudinal Study on Women's Health and found that although studies have found 36% of the Australian population to be suffering from psychological distress only 7% of the women had consulted someone about their mental health in the previous year. The women who had had counselling were found to be more stressed and less optimistic but to have higher levels of satisfaction with their lives and a greater feeling of control. They were also more likely to have had significant life events over the previous year, changed health status, to be taking more medication, to live in urban areas, to be university educated and to live alone.

Schofield, Margot J. and Khan, Asaduzzaman - Australian women who seek counselling: psychosocial, health behaviour, and demographic profile Counselling and Psychotherapy Research March 2008, 8(1), 12-20

Monday, February 25, 2008

Anxious mothers, anxious children

It is well known that there is an increased rate of anxiety among the parents of anxious children and a recent study showed that two thirds of mothers of a sample of children being treated for anxiety suffered from it themselves. At the same time maternal anxiety has been found to predict the outcome of a child's treatment for anxiety almost halving the success rate in some studies. A study of 22 children and their mothers by researchers at the University of Reading saw them receiving cognitive behavioural therapy aimed at reducing their children's anxiety. Of the 12 mothers who met the criteria for an anxiety disorder 6 received CBT and assessments were made of the mother-child interactions of the participants. Those children whose mothers had an anxiety disorder did less well but treatment of the mothers' anxiety disorders did not, in itself, improve outcomes for their children. Maternal overinvolvement and expressions of fear were associated with poorer outcomes though suggesting that it was the anxious mothers' parenting styles rather than their anxiety per se that had the biggest effect on outcomes, and that attempting to alter these parenting styles would be more effective than tackling mothers' anxiety in helping children.

Creswell, Cathy ... [et al] - Treatment of child anxiety: an explorartory study of maternal anxiety and behaviours in treatment outcome Clinical Psychology and Psychotherapy January-February 2008, 15(1), 1-14

CBT and coming off benzodiazepines

Problems in coming off benzodiazepines can be related to rebound, where the initial problem (e.g. anxiety, sleep problems) is intensified, short-term withdrawal symptoms and re-ocurrence of the original problem for which the medication was originally prescribed. 80% of people who give up benzodiazepines subsequently relapse and even when people are weaned off the drugs gradually a significant number experience distress. For some time there has been a consensus that these problems can benefit from non-medical interventions and psychotherapy and a study of 86 people attempting to withdraw from Benzodiazepines in Montreal compared the effectiveness of cognitive behaviour therapy (CBT) and group therapy. Both were more effective than a control group although CBT did produce higher levels of self-efficacy (people's confidence that they could achieve their goals). Over all 86 participants a high initial level of psychological distress, anxiety and dosage predicted a poor outcome but increase in self-efficacy contributed towards a successful outcome. Although there was a decrease in positive mood during the course of the withdrawal there was no significant increase in negative mood.

O'Connor, Kieron ... [et al] - Cognitive-behavioral, pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine Clinical Psychology and Psychotherapy, January-February 2008, 15(1), 1-14

Panic and pregnancy

Female reproductive hormones can have a significant influence on anxiety disorders throughout a woman's life but little is known about the interactions between pregnancy and panic disorder (PD) which can affect between 1-3.8% of women over the course of their lives and is twice as frequent in women. Researchers in Turkey assessed 512 women in the third trimester of pregnancy for panic disorder and also compared 13 pregnant women with panic disorder to 19 non-pregnant controls. Among all the pregnant women the prevalence rate for PD was 2.5%. Among the 13 pregnant women with PD 7 had developed it during their pregnancy while the other 6 were suffering from it before they became pregnant. There was no difference between the pregnant and non-pregnant women as far as the severity of PD symptoms was concerned.

Guler, Ozkan ... [et al] - The prevalence of panic disorder in pregnant women during the third trimester of pregnancy Comprehensive Psychiatry 2008, 49, 154-158

Children with conduct disorder

An Italian study of 198 children with conduct disorder found that those who were referred for the condition before puberty tended to come from more deprived backgrounds. Their condition was more severe when they were referred although they responded to treatment as well as those whose conduct disorder began in adolescence. They were more aggressive and more likely to suffer from attention-deficit hyperactivity disorder (ADHD). The girls in the study tended to be older and come from more deprived backgrounds. The girls' condition was worse when they started treatment and they were more likely to harm themselves but they responded better to treatment than the boys. Rates of ADHD were lower than in the boys. Those who did not respond to treatment were worse when they were first referred, more physically and verbally aggressive, had a higher rate of drug abuse and were more likely to commit pre-meditated violence rather than lashing out impulsively. Psychosocial interventions were found to be effective for this group of children.

Masi, Gabriele ... [et al] - Conduct disorder in referred children and adolescents: clinical and therapeutic issues Comprehensive Psychiatry 2008, 49, 146-153

Consumer satisfaction with mental health services

Consumer satisfaction with mental-health services has begun to be seen as increasingly important in the last few years. A survey of 136 inpatients with psychotic or affective disorders in Maryland, U.S. looked at the modifiable factors influencing their levels of satisfaction. The study found that staff teaching patients about medication, illness management, substance abuse, outpatient treatment and living skills was significantly associated with greater levels of satisfaction with care reflecting the value service users placed on staff time, attention and communication.

Hackman, Anne ... [et al] - Consumer satisfaction with inpatient psychiatric treatment among persons with severe mental illness. Community Mental Health Journal December 2007, 43(6), 551-564

Friday, February 22, 2008

Feet in mouth on constant replay - post-event processing and social anxiety disorder

People with social anxiety disorder often conduct lengthy post-mortems after social events going over and over what they said and did wrong and castigating themselves for often imaginary faux pas mercilessly. Psychologists call this process post-event processing, or PEP for short. This reinforces people's negative beliefs about their social performance and distracts from any positive aspects of their social lives. A study of 125 people in Canada looked at 75 people attending a group therapy session for social anxiety and 50 people experiencing exposure therapy for the condition. Significant PEP occured after both events and the more anxious people were before both tasks the worse their PEP. The levels of PEP were about the same after both events and the participants' PEP was found to be specifically related to their social performance rather than being a general negative train of thought about life as a whole.

Kocovski, Nancy L. and Rector, Neil A. - Post-event processing in social anxiety disorder: idiosyncratic priming in the course of CBT Cognitive Therapy and Research February 2008, 32(1), 23-36

'There is an art to read a man's construction in his face' - emotion recognition in schizophrenia

Many studies have found that patients with schizophrenia find it more difficult to recognise facial emotions. This makes it harder to work out other people's feelings leading to problems with social interactions and a declining sense of social worth. In healthy people the basic emotions - happiness, sadness, fear, anger, disgust and surprise - tend to be perceived in a categorised way with sharp, clear-cut boundaries between them. Recent research, using sophisticated animation techniques, has shown that in schizophrenia patients the categories are less sharp with more uncertain boundaries leading to more potential for misinterpretation. A French study which compared 26 patients with schizophrenia to 26 healthy controls found that people with schizophrenia had less distinct perceptual boundaries between different emotions which in turn led to confusion between emotions and the potential for reading people's emotions in a radically wrong way. The researchers suggested that these impairments in emotional perception could lead to false perceptions of others' emotions and the development or maintenance of delusional ideas.

Vernet, Mathilde, Baudouin, Jean-Yves and Franck, Nicolas - Facial emotion space in schizophrenia Cognitive Neuropsychiatry 2008, 13(1), 59-73

Psychosocial interventions for drug abuse

A review of psychosocial treatments for substance use disorders looked at 34 diffferent studies into a variety of treatments for drug abusers. Overall the study found that psychosocial treatments had a moderate, positive effect. They were most effective at stopping people using cannabis and least effective when people were abusing a variety of different drugs. The most effective type of treatment was contingency management in which drug users were rewarded when they stopped taking drugs and passed drug tests. Approximately a third of participants dropped out before treatment completion.

Dutra, Lissa ... [et al] - A meta-analytic review of psychosocial interventions for substance use disorders American Journal of Psychiatry February 2008, 14(2), 179-187

Thursday, February 21, 2008

Behavioural activation for PTSD

Studies have found that, within the first year post-trauma 10-40% of individuals develop symptoms consistent with a diagnosis of post-traumatic stress disorder. Severely injured patients who require a standard inpatient admission are more likely to develop PTSD and benefit less from traditional cognitive-behavioural therapy (CBT) than patients who are less injured. Behavioural activation was originally developed as a treatment for depression and involves the identification and enactment of activities that are reinforcing for the individual and consistent with their long-term goals. In layman's terms this means getting people to do things which are beneficial, or part of everyday life, which they have been putting off doing because of their depression. In PTSD individuals avoid situations and experiences that may elicit trauma-related memories but such avoidance is believed to reinforce anxiety as people never confront and overcome their fears. Behavioural activation differs from exposure therapy as the emphasis is on confronting fears that prevent people from reaching their goals rather than on confronting them for their own sake. A small study of 8 PTSD patients in the U.S. compared behavioural activation with conventional treatment and found that it led to a greater improvement in symptom severity and physical functioning although not of patients' depression.

Wagner, Amy W. ... [et al] - Behavioural activation as an early intervention for posttraumatic stress disorder and depression among physically injured trauma survivors Cognitive and Behavioral Practice 2007, 14, 341-349

Drug abuse and domestic violence

Intimate partner aggression is a big problem in the U.S., as elsewhere, and surveys have found more than one in five couples reporting it within the past year. Both sexes have been found to engage in it, women more than men, although with less serious consequences. Intimate partner aggression can lead to depression, injury, shame, post-traumatic stress disorder and even suicide so much effort has been devoted to identifying its causes. Drug abuse is thought to be one of the main factors involved and a review of 96 different studies has found that increases in drug use and drug-related problems are significantly associated with increases in aggression between intimate partners. Cocaine was the drug with the strongest relationship to psychological, physical and sexual aggression although marijuana was also significant.

Moore, Todd A. ... [et al] - Drug abuse and aggression between intimate partners: a meta-analytic review Clinical Psychology Review 2008, 28, 247-274

Non-violent resistance - the way forward for parents?

Recently treatments for child-behaviour problems have shifted their emphasis from treating the children's behaviour to helping their parents to control them. Nonviolent resistance (NVR) is a new training model for parents which draws on the principles of the non-violent resistance movements of people like Gandhi and Martin Luther King and which aims to help parents deal effectively with their helplessness, isolation and escalatory interactions with their children. Parents commit themselves to restrain themselves form violent and humiliating responses to their children while at the same time not giving in to their demands. The parents are coached on how to prevent escalation by becoming aware of its signs as well as their own contribution to the process and alternative non-escalating reactions are discussed and implemented. A study of 73 parents in Israel found that in comparison with a control group parents who received training in NVR showed a decrease in parental helplessness and escalatory behaviours, an increase in social support and a decrease in their children's negative behaviour.

Weinblatt, Uri and Omer, Haim - Nonviolent resistance: a treatment for parents of children with acute behaviour problems Journal of Marital and Family Therapy January 2008, 34(1), 75-92

Attachment and family violence

Attachment - the quality of a child's relationship with its mother or principal caregiver - is being seen as increasingly important in psychology. Other factors can affect the context of the mother-child relationship including stressful family circumstances and marital conflict. Close, confiding marriages have been found to be associated with mothers being warmer and more sensitive with their children and fathers having more positive attitudes towards their offspring. Researchers from Purdue University, Indiana, looked at 45 pre-school children. The children were assessed to see how secure their attachment was and the mothers reported on marital conflict, physical aggression towards themselves, exposure of the child to aggression and the use of physical discipline. They found that all four factors were significantly and negatively associated with security and that physical aggression towards the mother was particularly significant.

Posada, German and Pratt, Dawn Marie - Physical aggression in the family and preschoolers' use of the mother as a secure base Journal of Marital and Family Therapy January 2008, 34(1), 14-27

Wednesday, February 20, 2008

It's not the cakes it's the worry ...

A study of more than 150,000 adults in the U.S. found that wanting to lose weight was as important in predicting the amount of days people were ill as their weight itself. People who wanted to weigh less were more likely to be mentally or physically unhealthy than people of the same weight who were content with their body image. After controlling for actual BMI and age the researchers found that men who wished to lose 1, 10 and 20% of their body weight respectively reported 0.1, 0.9 and 2.7 more unhealthy days per month than those who were happy with their weight. Among women the corresponding increase in numbers of reported unhealthy days was 0.1, 1.6 and 4.3. People who were happy with their weight experienced fewer physically unhealthy days and fewer mentally unhealthy days than those unhappy with their weight.

You can read more about this research at

Military mental health

Mental health disorders are associated with high rates of attrition in the military which produces a significant economic impact on military organizations. A Canadian study of 8,441 soldiers looked into this problem and was the first national epidemiological survey to examine the mental health of active soldiers over a 12-month period. The study found that within the year 1,220 of the soldiers met the criteria for at least one mental disorder with the most common problems being depression, alcohol dependence and social phobia. More than half the soldiers with a mental-health problem did not use any of the mental health services available to them.

You can find out more about this research at

Depression and hopelessness - moving through the tunnel but the light's not getting closer

A feeling of hopelessness is one of the symptoms of depression and is a strong risk factor for suicide. A U.S. study of 573 patients with depression tested their response to three different antidepressants fluoxetine, paroxetine and sertraline. The study found that, overall, patients' depression responded rapidly to medication with 68% of their improvement occuring by the end of the first month and 88% by three months. However, while positive emotions, work functioning and social functioning improved most rapidly improvements in head, back and stomach pain plateaued during the first month, with little improvement thereafter. As far as hopelessness was concerned the improvement was much more gradual leading the researchers behind the study to suggest that cognitive behaviour therapy should be more specifically targeted at reducing patients' hopelessness.

You can find out more about this study at

Dosage and treatment-resistant schizophrenia

Around 30% of people with schizophrenia have a treatment-resistant form of the condition which does not respond well to antipsychotic drugs. Clozapine is the standard treatment for such patients although it can have serious side effects such as agranulocytosis (a low white blood cell count) and weight gain. However, a study of 40 schizophrenia patients in the U.S. has found that it may be the higher doses at which clozapine is prescribed rather than the drug itself which makes it effective in treating non-responsive schizophrenia. The study found that another drug, olanzapine, when used at a higher dose than usual was just as effective as clozapine. The treatment-resistant schizophrenia responded more slowly to higher doses of olanzapine and clozapine than other forms of the condition taking six months for an improvement to be felt rather than six weeks which was the case for the more treatment-responsive form of the condition.

You can find out more about this research at

Monday, February 18, 2008

Alchoholism, genes and naltrexone

Alcohol increases the release of the endogenous (produced by the body) opioids beta-endorphin and enkephalin in animals and humans. Blocking opioid receptors in the brain with naltrexone leads to less alcohol-induced pleasure, high and intoxication and ultimately less craving and relapse for alchoholics. However, not all individuals with alcohol dependence respond to naltrexone. A team of researchers in the U.S. looked at the effects of a pair of genes called Asp40 and Asn40 on the effectiveness of naltrexone for the treatment of alcoholism. People can have either two Asp40 genes, two Asn40 genes or one of each. The researchers studied 604 alcoholics and found that those with the Asp40/Asp40 combination showed an increased percentage of days abstinent and a decreased percentage of heavy drinking days when treated with naltrexone rather than a placebo. However, those with ths Asn40/Asn40 combination fared no better on naltrexone than on a placebo.

Anton, Raymond F. ... [et al] - An evaluation of u-Opioid receptor (OPRM1) as a predictor of naltrexone response in the treatment of alcohol dependence: results from the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) study Archives of General Psychiatry February 2008, 65(2), 135-144

Friday, February 15, 2008

Study supports parenting programmes

The availability of parenting support programmes has increased significantly in the UK over the last two decades. U.S. programmes such as Triple P, Incredible Years, Positive Parenting and the Noughts to Sixes Parenting Programme have all had success and they have been matched in the UK by programmes such as Sure Start and Starting Well. However, most evaluations of these programmes have focused on short-term outcomes. A U.K. study aimed to gain a longer-term perspective by interviewing 20 carers more than a year after completing a group-based programme. The interviews showed that the majority of the participants felt the programme had had lasting effects on their ability to manage their children's behaviour and empowered them as adults. The key themes to emerge in the interviews were: the maintenance of parenting skills, the need for perserverance, strengthening of support networks and encouragement for further provision of programmes.

Zeedyk, M. Suzanne, Werrity, Irene and Riach, Christine - One year on: perceptions of the lasting benefits of involvement in a parenting support programme Children and Society 2008, 22, 99-111

Rumination and depression

The degree to which someone, when they are dysphoric (feeling down), focuses attention on their symptoms and their potential causes, implications and consequences is referred to as mood-related ruminative response style (MRRS). It has been suggested that MRRS can make people more vulnerable to depression as they inappropriately use negative thoughts and memories to understand current circumstances, ruminate about their dysphoria instead of using problem-solving skills or adaptation and talk about their thoughts all the time alienating potential sources of social support. A U.K. study of 26 depressed adolescents compared the effects of using psychosocial interventions and SSRIs (antidepressants) to that of using the samet treatment but with CBT on top. The adolescents in the CBT group showed significantly greater reductions in ruminations compared to the control group and rumination was reduced to the levels of never-depressed controls in those who had recovered from depression and received CBT. However, there were no significant differences in the reduction in self-reported depressive symptoms between the two groups.

Wilkinson, Paul O. and Goodyer, Ian M. - The effects of cognitive-behavioural therapy on mood-related ruminative response style in depressed adolescents

You can find the full text of this study at

Children and mental health services - who seeks help ?

Not all children with emotional and behavioural problems get the help they require. A study of 2,461 children by researchers at the Institute of Psychiatry looked at the relationship between a variety of different factors and the use of mental health services by children over the following three years. Contact with most services was predicted by three factors: the impact of the children's mental-health problems, contact with teachers or primary health care and parents' and teachers' perceptions that the child had significant difficulties.

Ford, Tamsin ... [et al] - Predictors of service use for mental health problems among British schoolchildren Child and Adolescent Mental Health 2008, 13(1), 32-40

Thursday, February 14, 2008

Collaborative, caring, Canadian

Homeless people have a high prevalence of physical illness, mental illness and substance abuse and a higher level of health care needs than people with housing. Between a quarter and a third of the homeless have a serious mental illness such as schizophrenia, major depressive disorder or bipolar disorder. To address their complex health needs a number of mental health programmes for the homeless have been developed. One such approach is collaborative mental health care in which teams are made up of a number of different disciplines such as psychiatrists, psychologists, mental-health nurses etc. However, there has been little research into the effectiveness of collaborative mental health care in treating homeless people or into the effectiveness of shelter-based programmes. A review of 73 clients treated by one such programme in Canada found that the prevalence of severe and persistent mental illness and substance use disorders at the start of the programme was 76.5% and 48.5% respectively. After six months 35.3% of the clients had improved clinically and 48.5% were housed. Improvements in mental health were associated with the number of visits with a psychiatrist and adherence to treatment as was being housed. The presence of a substance use disorder was associated with lower odds of housing after six months.

Stergiopoulos, Vicky ... [et al] - Collaborative mental health care for the homeless: the role of psychiatry in positive housing and mental health outcomes Canadian Journal of Psychiatry January 2008, 53(1), 61-67

Problem gambling - are the odds better than we think ?

The conventional wisdom about addictive gambling suggests that it is an enduring and progressive disorder that seldom gets better without professional help and gets worse over time with people placing larger and larger bets more and more frequently in an attempt to recoup their losses. However, recent research has found that drug and alcohol addictions are not always a one-way street with people moving backwards and forwards into different levels of addiction and some giving up their habit without any professional intervention. A review of 5 recent studies on problem gamblers who were not receiving treatment has found that this pattern also holds true for them. The study found no evidence to support the assumption that individuals cannot recover from disordered gambling, no evidence to support the assumption that people who had more severe gambling habits were less likely to improve than those who had less severe problems and that people with some gambling problems were no more likely to get worse than people currently without gambling problems were to develop them.

LaPlante, Debi A. ... [et al] - Stability and progression of disordered gambling: lessons from longitudinal studies Canadian Journal of Psychiatry January 2008, 53(1), 52-60

Finger lengths, sex hormones and SATs

Different parts of the brain control different thought processes. It is thought that the left hemisphere of the brain dominates in language processing while the right hemisphere dominates in spatial and mathematics processing. In general men are thought to have dominant right hemispheres while women have dominant left hemispheres. It is thought that these differences are due to sex hormones in the womb although it is difficult to measure these without painful, intrusive and potentially dangerous procedures. However the same hormones affect the relative length of people's 2nd and 4th fingers with male hormones producing relatively longer 4th fingers and female hormones producing relatively longer 2nd fingers. A study of 75 children between 6 and 7 in the UK compared the length of their fingers with their scores in their SATs. A significant correlation was found between digital ratios (the relative lengths of 2nd and 4th fingers) and SAT scores. The boys with longer 4th fingers scored relatively highly in their numeracy SATs while the girls with longer 4th fingers scored relatively highly in their literacy SATs.

Brosnan, Mark J. - Digit ratio as an indicator of numeracy relative to literacy in 7-year-old British schoolchildren British Journal of Psychology February 2008, 99(1), 75-85

Children taken into care and their mental health problems

Children who have been removed from their parents' care by social services because of abuse or neglect and placed into protective care are known to have a high incidence of mental-health problems. An Australian project in Melbourne aimed to assess and help children far earlier in the process. Of 161 children assessed as part of the scheme more than 60% met criteria for a major psychiatric diagnosis with post-traumatic stress disorder and adjustment disorders being the most common diagnoses. Nearly three-quarters of participants over the age of five scored in the borderline or abnormal range on the Strengths and Difficulties Questionnaire. There were more children under 1 and in adolescence in the group being taken into care.

Milburn, Nicole L., Lynch, Marell and Jackson, Jennifer - Early identification of mental health needs for children in care: a therapeutic assessment programme for statutory clients of child protection Clinical Child Psychology and Psychiatry January 2008, 13(1), 31-47

Wednesday, February 13, 2008

Childhood abuse, genes and depression

Childhood abuse and early life stress are among the strongest contributors to adult depression. However, a U.S. study of 470 people has found that those people who suffered from adverse childhoods but who carry a gene called corticotropin-releasing hormone receptor one (CRHR1) had markedly lower measures of depression, compared with people with less protective forms of the gene. The study supports previous evidence that corticotropin-releasing hormone and related hormones play a role in depression.

You can find out more about this research at

Bipolar brains

Bipolar disorder, also known as manic depression, is a debilitating condition characterized by alternating mania and depression and is thought to affect about one in a hundred people worldwide. Although it is known that the condition can be treated relatively effectively using the mood stabilizing drugs lithium and valproic acid the reasons why these treatments work are poorly understood. A post-mortem study of the brains of people with bipolar disorder looked at the concentrations of chemicals in a region of the brain called the dorsolateral prefrontal cortex which controls the processes involved in higher cognitive functioning. The researchers found higher concentrations of the chemicals glutamate, creatine and myo-inositol in the brains of bipolar patients than in a control group of brains of people without the condition. But there was less of a chemical called gamma-aminobutyric acid in the brains of the bipolar sufferes. Animal experiments showed that lithium and valproic acid were able to revers these chemical changes.

You can find out more about this research at

Spending your way out of sadness

People often go on shopping sprees to cheer themselves up and a psychological experiment has confirmed that people who are sad, do, in fact, spend more. In the experiment participants viewed either a sad video clip or one devoid of human emotion. Afterwards they could buy an ordinary commodity, such as a water bottle at various prices. Those participants who had watched the sad clip offered almost three times as much money to buy things as the other group. Among those people who were in the 'sad' group those who were highly self-focused paid more than those low in self-focus.

You can read more about this research at

Alzheimer's and money management

There are often stories in the papers about elderly people falling victim to conmen and new research from the U.S. has found that people with Alzheimer's disease have a dramatic decline in their ability to make financial decisions. The study compared 55 people with mild Alzheimer's to 63 healthy older adults assessing them on a variety of financial skills including basic monetary skills, bill payment, understanding a bank account and identifying coins and notes. The people with Alzheimer's scored 20% lower than the control group and had declined another 10% over the course of a year.

You can find out more about this research at

Fathers important - official

Sometimes research can seem to lag behind common sense, or, to put it another way, it can sometimes take longer to prove something scientifically than it does to arrive at an instinctive judgement. A review of the research by Swedish psychologists has found that having an active father figure reduces the risks of behavioural problems in boys and girls and of psychological problems in young women. The review, which looked at 24 papers published between 1987 and 2007, found that regular, positive contact reduced criminal behaviour among children in low-income families and enhanced cognitive skills like intelligence, reasoning and language development. Children who lived with both a mother and a father figure also had less behavioural problems than those who lived just with their mother. Children with involved fathers were less likely to smoke and get into trouble with the police, achieved better levels of education and developed good friendships with children of both sexes. Women had better relationships with partners and a greater sense of physical well-being at the age of 33 if they had had a good relationship with their father at 16.

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Tuesday, February 12, 2008

Sensory filtering and PTSD

People with sensory filtering disruptions often report being bothered by sounds and light and feeling easily distracted by sensory events - such as machine noises - in the environment that go unnoticed by others. Sensory filtering disruptions are associated with a range of mental-health problems including post-traumatic stress disorder (PTSD). A U.S. study of 329 people compared those with PTSD, those who had been exposed to trauma but not developed PTSD and those who had been exposed to no trauma at all. The researchers found that people with PTSD reported greater filtering disruption than those in the trauma-only and no-trauma groups. People endorsing re-experiencing and numbing symptoms and women who were hyper-vigilant reported disrupted sensory filtering.

Stewart, Lorraine P. and White, Patricia M. - Sensory filtering phenomenology in PTSD Depression and Anxiety 25(1), 38-45

Depression and anxiety - who seeks help ?

Depression and anxiety are common mental-health problems and can have a substantial impact on people's functioning and quality of life. There are effective psychological and drug treatments for both these conditions but about half of the people suffering from severe depression and anxiety do not seek treatment and more than half of the people suffering from less-severe depression and anxiety do not look for help. A Finnish study of 6,005 people screened them for depression and anxiety and asked them about their use of mental-health services in the last 12 months. The researchers found 298 people with depression and 242 with anxiety disorders. Of participants with depression, anxiety or both 34%, 36 % and 59% respectively used health services. Greater severity and perceived disability, other mental-health problems and living alone predicted healthcare use for depressed people while greater perceived disability, other mental-health problems, younger age and parents' mental-health problems predicted healthcare use for people with anxiety.

Hamalainen, J. ... [et al] - Use of health services for major depressive and anxiety disorders in Finland Depression and Anxiety 25(1), 27-37

Antipsychotics for depression

Studies have found that a large percentage of depressed patients may have limited response and remission rates when treated with traditional antidepressants. There is increasing evidence in favour of the use of atypical antipsychotics in the treatment of depression and a review of the literature has found that olanzapine and risperidone have several controlled clinical trials indicating their effectiveness at doses lower than those used in treating psychoses. The review concluded that aripiprazole, olanzapine and risperidone are reasonable choices to add to anti-depressants in cases of treatment-resistant depression.

Philip, Noah S. ... [et al] - Augmentation of anti-depressants with atypical antipsychotics: a review of the current literature Journal of Psychiatric Practice January 2008, 14(1), 34-44

Childhood autism and mental-health problems

A long-term Danish study of 454 people compared the rates of mental-health problems in those who had been diagnosed with childhood autism to those free of the condition. The study found that 48.3% of the autistic group had been in contact with psychiatric hospitals over the course of the study compared to just 6% of those without the condition. 17% of the autistic group had been diagnosed with a mental illness compared to 2.7% of the control group. Those who had been diagnosed with autism in childhood were nearly four times as likely to be diagnosed with schizophrenia and nearly three times as likely to suffer from depression.

Mouridsen, Svend Erik ... [et al] - Psychiatric disorders in individuals diagnosed with infantile autism as children: a case control study Journal of Psychiatric Practice January 2008, 14(1), 5-12

Cognitive therapy for voice hearers

Most people with schizophrenia hear voices which can be insulting to them or give commands to harm themselves or other people and can contribute greatly to the distress experienced by people with mental illness. There is an emerging body of evidence that documents the efficacy of cognitive interventions for modifying appraisals linked with voice hearing. A U.S. study of 65 people with schizophrenia divided them up into two groups. One group received treatment as usual while the other group received 12, 90-minute sessions of cognitive interventions delivered by a mental-health nurse. Those who had received the cognitive intervention reported less severe hallucinations even a year after treatment and were over thirteen times as likely to maintain a reduction in their hallucinations.

England, Margaret - Significance of cognitive intervention for voice hearers Perspectives in Psychiatric Care January 2008, 44(1), 40-47

Friday, February 08, 2008


Borderline personality disorder consists of pervasive affective (mood) instability, impulsivity, unstable relationships and self-image problems. It affects 1-2% of the population and is characterised by severe psychosocial impairment and a high suicide rate. According to some researchers 60% of adults with BPD meet the criteria for childhood Attention-Deficit Hyperactivity Disorder (ADHD) but no study has investigated the prevalence and impact of adult ADHD in people with BPD. A German study of 118 women seeking treatment for BPD found that 41.5% of them had suffered from ADHD in their childhood and 16.1% still suffered from it as adults. Childhood ADHD was associated with emotional abuse in childhood and greater severity of adult BPD symptoms while adult ADHD was associated with a greater risk for other mental-health problems.

Philipsen, Alexandra ... [et al] - Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder British Journal of Psychiatry February 2008, 192(2), 118-123

Suicide and neighbourhood in Northern Ireland

Research shows that suicide risk is related both to individual characteristics such as age and gender and household ones such as marital status and socioeconomic circumstances but it is less clear whether place of residence constitutes an additional, independent risk over and above these factors. A five-year study of 1,116, 748 people in Northern Ireland found 566 suicides among the population over that time. Suicide risks were lowest for women and for those who were married or cohabiting. Indicators of individual and household disadvantage and economic and health status at the time of the census were also strongly related to the risk of suicide. There were higher rates of suicide in the more deprived and socially fragmented areas but these could be explained by individual and household factors rather than the geographical location per se. There was no significant relationship between population density and risk of suicide.

O'Reilly, Dermot ... [et al] - Area factors and suicide: 5-year follow-up of the Northern Ireland population British Journal of Psychiatry February 2008, 192(2), 106-111

Thursday, February 07, 2008

Fat talk and eating disorders

'Fat talk' can be defined as conversations with family and friends pertaining to positive or negative comments about appearance, dieting techniques and the need to lose weight and is common, though not exclusive to, teenage girls an age group particularly at risk for eating disorders. In a 2003 experiment female undergraduates exposed to a 'stooge' who, despite being thin herself, talked about how fat she felt and how much she wanted to lose weight, had significantly increased body dissatisfaction compared to a group who talked to a 'stooge' about neutral topics. A study of 272 college students - male and female - in the U.S. explored this relationship further and found that the frequency of 'fat talk' was positively related to eating pathology and body dissatisfaction in students with and without an eating disorder diagnosis. The most frequently reported topic of 'fat talk' was about other people's appearance rather than the participants'.

Ousley, Louise, Cordero, Elizabeth D. and White, Sabina - Fat talk among college students: how undergraduates communicate regarding food and body weight, shape & appearance Eating Disorders January-February 2008, 16(1), 73-84

What makes bulimia last longer?

Some people can take a long time to recover from bulimia so it is important to know what factors make the disease last longer in some people than in others. Previous studies have found that co-occuring mental illnesses in bulimia sufferers can prolong people's bulimia and parental mental-health problems can also have an effect. A study of 94 women with bulimia in the U.S. looked at the mental-health problems and obesity of their parents to see how it affected the course of the women's illness. Substance abuse by fathers was the most common problem and this was associated with longer-lasting bulimia. Depression in mothers was also associated with a worse outcome in the long term as was mood disorder in the participants. However, obesity in mothers was associated with a better outcome at long-term follow-up.

Arikian, Aimee ... [et al] - Parental psychopathology as a predictor of long-term outcome in bulimia nervosa patients Eating Disorders January-February 2008, 16(1), 30-39

Older drinkers - when Irish eyes are seeing double

It is expected that there will be a rise in the number of older people over the course of the C21st and each successive group of older people is more likely to engage in hazardous, harmful and frequent heavy drinking. A survey of 60 older people in Southwark compared Irish pensioners with English ones as people of Irish origin drink most heavily of all the minority ethnic groups. Both groups of pensioners had reduced their drinking since their younger days but the Irish ones drank more overall, were more likely to drink at least once a week, had a higher mean alcohol intake, were more likely to binge drink and to drink above sensible limits. They were also more likely to have a family history of mental-health problems.

Rao, R., Wolff, K. and Marshall, E.J. - Alchohol use and misuse in older people: a local prevalence study comparing English and Irish inner-city residents living in the UK Journal of Substance Use February 2008, 13(1), 17-26

Drug use in Wales - there'll be a reefer in the Valleys

More young people are using drugs now than ever before and drug use among young people is widespread across Europe. After alcohol and tobacco cannabis is the most widely-used substance. A study of 3,088 children between 11 and 16 in Wales found that nearly half of the sample had used a drug in their lifetime and more than one in half had done so in the past month. Lifetime drug use was most likely to be reported by the oldest age group while recent drug use was more common among 12-13 year olds implying that the majority of young people who had used drugs in their lifetime had since given up. Inhalants were the most commonly used category of drugs while cannabis was the most commonly used individual drug. The least commonly used drugs were heroin, sedatives and ecstasy. The most important risk factors for taking drugs were antisocial behaviour and attitudes, lack of attachment to school, negative thinking, psychological problems and behavioural problems.

Case, Stephen and Haines, Kevin R. - Factors shaping substance use by young people in Wales Journal of Substance Use February 2008, 13(1), 1-15

Wednesday, February 06, 2008

Depression across the life cycle - middle age is a trough not a peak

A worldwide study of 2 million people from 80 different countries has found an extraordinarily consistent pattern in depression and happiness levels across the life cycle. The researchers found that happiness followed a U-shaped curve with happiness higher towards the start and end of people's lives and depression most common in the middle. The peak age for depression in the UK was 44. In the U.S. depression peaked at 40 for women and 50 for men and the same U-shaped curve held true for 72 other countries in the study irrespective of age, marital status, income and family status. The causes of the U-shaped curve are unclear although the researchers speculated that younger people had more hope while older people were better at counting their blessings.

You can read more about this research at

Back pain and antidepressants

Back pain affects eight out of ten adults over the course of their lifetime. For some people the pain becomes chronic and can be accompanied by depression. Doctors commonly prescribe antidepressants for patients with low back pain to provide pain relief, aid in sleep and treat co-existing depression but a review of studies into the effectiveness of antidepressants at relieving back pain has found that they are of little use. The review found no convincing evidence that antidepressants relieved back pain or depression more effectively than a placebo or that they were any more effective in improving patients' ability to function. Both tricyclic (older) antidepressants and newer SSRIs were no more effective than a placebo in reducing pain.

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Massive suicide study reports

The largest, most representative study of suicidal behaviour ever conducted has found that risk factors for suicidal thoughts, plans and attempts appear to be similar across the globe. Risk factors include having a mental disorder, being female, younger, less educated and unmarried. The study, by the World Health Organization, interviewed 84,850 adults in 17 countries. Among those interviewed 9.2% reported that they had seriously thought about suicide and 2.7% reported making a suicide attempt at some point in their lives. Rates of suicidal thoughts ranged from 3.1% of people in China to 15.9% in New Zealand. The risk of sucidal thoughts increased sharply during adolescence and young adulthood and impulse control disorders, substance use disorders and anxiety disorders were all associated with a significantly higher risk of suicidal thoughts and attempts.

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Depression in older people

Major depression affects approximately 1-2% of older adults living in the community but as many as 20% experience symptoms. Researchers from Yale University School of Medicine studied 754 people over 70, starting in 1998. At the beginning of the study, and at follow-up assessments conducted every 18 months participants were asked to provide demographic information, take cognitive tests and report any medical conditions. They were also screened for symptoms of depression during the previous week. Over the course of the study 35.7% were depressed at some point, 17.8% were depressed during two consecutive time periods, 11.2% at three time points, 6.3% at four points and 4.5% at all five. More women than men were depressed at each 18-month follow-up and women were more likely than men to experience depression at consecutive time points.

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Schizophrenia and stress in pregnancy

There is an increasing amount of evidence of a link between schizophrenia and early brain development with environmental factors, including those occuring during pregnancy, and susceptibility genes interacting to influence risk. A study of 1.38 million Danish births between 1973 and 1995 looked at women whose relatives had died or received a diagnosis of cancer, heart attack or stroke during the women's pregnancy then looked to see whether their children developed schizophrenia. The researchers found that the risk of schizophrenia and related disorders was approximately 67% greater among the children of women who were exposed to the death of a relative during the first trimester of their pregnancies. However, death of a relative up to six months before or at any other time during pregnancy was not related to an increased risk of schizophrenia and nor was exposure to serious illness in a relative. The association between a family death and risk of schizophrenia appeared to be significant only for individuals without a family history of mental illness. Chemicals released by the mother's brain in response to stress could have an effect on the fetus' developing brain and these effects may be strongest in early pregnancy when protective barriers between the mother and fetus are not fully constructed.

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Tuesday, February 05, 2008

Antipsychotics, ghrelin and weight gain

Atypical antipsychotics have become widely used since the introduction of clozapine in the U.S. in 1990. It is generally accepted that atypical antipsychotics have less side effects than older drugs but they can cause weight gain, insulin resistance and lipid abnormalities, all of which can have serious effects on health. One theory is that the atypical antipsychotics stimulate the production of a hormone called ghrelin which stimulates food intake and fat accumulation. A 2-week trial on healthy participants in the U.S. divided them up into three groups taking olanzapine, risperidone and a placebo respectively. The olanzapine group put on the most weight, followed by the risperidone group while the group taking the placebo stayed more or less the same. However, there was no significant difference in ghrelin levels between the groups and the participants' ghrelin levels did not change over the course of the study suggesting that increased levels of the hormone were not to blame for the weight gain.

Roerig, James L. ... [et al] - A comparison of the effects of olanzapine and risperidone versus placebo on ghrelin plasma levels Journal of Clinical Psychopharmacology February 2008, 28(1), 21-26

Aripiprazole and alcoholism

Dopamine is a neurotransmitter that sends messages in the brain and it is known that people with alcohol and substance abuse problems have abnormalities in the way they produce and process it. Aripiprazole is an atypical antipsychotic drug used in the treatment of schizophrenia which affects dopamine levels and a team of researchers in the U.S. conducted a trial to see whether it would be useful in treating alcoholism. The study of 295 people divided them into one group who received the aripiprazole and another who received a placebo. More people dropped out of the aripiprazole group than the placebo group and the aripiprazole group also suffered more side effects. The mean percentage of days abstinent was higher in the placebo group. The percentage of subjects without a heavy drinking day and the length of time to the first drinking day were about the same between the two groups.

Anton, Raymond F. ... [et al] - A randomized, multicenter, double-blind, placebo-controlled study of the efficacy and safety of aripiprazole for the treatment of alcohol dependence Journal of Clinical Psychopharmacology February 2008, 28(1), 5-12

Minor physical anomalies and schizophrenia

Minor physical anomalies are a range of subtle alterations of the head, hands, hair and feet which serve as indicators of altered morphogenesis during the first or early second trimester and act as timed, biological markers of developmental disturbance. An increased prevalence of these anomalies has been extensively documented in people with schizophrenia compared to healthy controls but the precise pattern of physical anomalies and their specificity for schizophrenia remains unclear. A study of 400 people in the UK compared those with first-episode psychosis to an unaffected control group. People with psychosis had more of the following anomalies: facial assymetry, assymetry of the orbital landmarks, a 'V-shaped' palate, reduced palatal ridges and ear abnormalities. There was no difference between those with affective psychoses and those with schizophrenia. The pattern of anomalies were "suggestive of an insult occuring during organogenesis in the first trimester of pregnancy".

Lloyd, T. ... [et al] - Minor physical anomalies in patients with first-episode psychosis: their frequency and diagnostic specificity Psychological Medicine January 2008, 38(1), 71-77

Psychological interventions for social phobia

Social phobia is characterized by a marked and persistent fear of social or performance situations in which the person may be scrutinized by others and fears coming across in a way that would be embarrassing or humiliating. It is a chronic disorder that usually begins in early adolescence and results in considerable impairment that increases over an individual's lifespan. A lifetime prevalence ranging from 3-13% has been reported by epidemiological and community studies. A review of 30 studies into psychological interventions for social phobia has found that cognitive behaviour therapy (CBT) involving cognitive restructuring and exposure to feared or avoided social situations or behavioural experiments is an "efficacious and specific treatment for social phobia". Exposure therapy was also found to be effective. There were mixed findings regarding the relative efficacy of CBT and in vivo exposure with some studies reporting that the interventions were equivalent while others found that CBT produced better outcomes. There was little evidence to support the use of social-skills training.

Ponniah, K. and Hollon, S. D. - Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials Psychological Medicine January 2008, 38(1), 3-14

Temperament, child rearing and bad behaviour

The role of temperament in the development of children's personalities and behaviour has been the subject of enquiry for decades. Difficult temperament includes features such as negative emotionality and mood, high reactivity, and fearfulness. Ratings of difficult temperament tend to be quite stable during infancy and early childhood and studies have shown links between difficult temperament, measured early in life, and later behaviour problems especially when other risk factors are present. A U.S. study of 985 children examined the links between difficult temperament, parenting styles and bad behaviour in the first year of school life. Three aspects of parenting style were assessed: harshness, sensitivity, and the opportunities the children were given for productive behaviour. The researchers found stronger relations between maternal sensitivity and bad behaviour and opportunities for productivity and bad behaviour in the children with difficult temperaments. Harsher parenting was associated with a fall in problem behaviour in the first grade but this was not found to be statistically significant. Those children with difficult temperaments whose mothers were sensitive to them and who gave them more opportunities to engage in productive activity were better behaved in the first grade.

Bradley, Robert H. and Corwyn, Robert F. - Infant temperament, parenting, and externalizing behavior in first grade: a test of the differential susceptibility hypothesis Journal of Child Psychology and Psychiatry February 2008, 49(2), 124-131

Cleft lips and later problems

Cleft lip and palate affects one in every 650 children. In the school years affected children are at raised risk for both socio-emotional and cognitive difficulties. An important question is the extent to which the problems of children with clefts may be explained by difficulties in parent-child interactions since these often predict poor child functioning. Giving birth to an infant with a cleft is often followed by shock and distress and this may affect parent-child interactions. A U.K. study of 190 very young children looked at the child's relationship with their mothers at two, six, twelve and eighteen months and measured their behaviour problems and mental development at eighteen months. Some of the children had clefts which were repaired early (before 3-4 months), others had clefts which were repaired later and others were unaffected by the condition. The study found that early interaction difficulties between mothers and the children who had 'late' repair for their cleft lips and palates were associated with poor cognitive functioning at 18 months.

Murray, Lynne ... [et al] - The effect of cleft lip and palate, and the timing of lip repair on mother-infant interactions and infant development Journal of Child Psychology and Psychiatry February 2008, 49(2), 115-123