Monday, March 31, 2008

Autism and PMS

Most menstruating women experience some pre-menstrual syndromes (PMS) with about 20-40% seeking medical attention. A study of 62 women in the UK compared women with a learning disability but not autism to those with both a learning disability and autism. The study found that while only 11% of the non-autistic group suffered from PMS 92% of the autistic group did so.

Obaydi, H. and Puri, B.K. - Prevalence of premenstrual syndrome in autism: a prospective, observer-rated study The Journal of International Medical Research March/April 2008, 36(2), 269-272

Social anxiety and insomnia

Anxiety is commonly associated with insomnia. Social anxiety disorder is one of the most common forms of anxiety and a U.S. study of 176 college students looked into the links between social anxiety and insomnia. The researchers found that social anxiety was associated with increased insomnia symptoms, sleep dissatisfaction, sleep-related functional impairment, perception of a sleep problem to others and distress about sleep problems. The relationship between social anxiety and insomnia was mediated (influenced) by depressive symptoms which were thought to play an important role in the link between social anxiety and poor-quality sleep.

Buckner, Julia D. ... [et al] - Social anxiety and insomnia : the mediating role of depressive symptoms Depression and Anxiety 2008, 25(2), 124-130

Bipolar disorder and anxiety

Bipolar disorders are characterized by mood disturbances with alternating periods of depression and mania or hypomania. Bipolar disorder can often occur alongside other mental illnesses including substance abuse, eating disorders and conduct disorder. Anxiety disorders, such as panic disorder, post-traumatic stress disorder, and obsessive-compulsive disorder are the most frequent types of co-occuring conditions and a study of 44 treatment-resistant bipolar patients in Seattle compared those with and without anxiety disorders. The researchers found that 'on several measures, bipolar patients with comorbid anxiety disorders were more significantly ill than bipolar patients without comorbid anxiety disorders'. Those bipolar patients with anxiety disorders had an earlier onset of illness, were more depressed and had a lower level of functioning. They had a more frequent history of substance abuse and were more likely to have suicidal thoughts.

Lee, John H. and Dunner, David L. - The effect of anxiety disorder comorbidity on treatment resistant bipolar disorders Depression and Anxiety 2008, 25(2), 91-97

Friday, March 28, 2008

Personality traits and treatment for depression

Certain personality traits are thought to contribute towards the development and maintenance of depression. Individuals high in self-criticism are characterized as highly competitive and judgmental towards themselves and others and are highly sensitive to stressors because of a fear of disapproval or criticism from others. People high in dependency need more emotional support but are not necessarily more satisfied with their interactions and relationships and are more likely to have problems when confronted with an interpersonal stressor. A Canadian study of 102 people with depression divided them into three groups. One group received cognitive-behavioural therapy (CBT), another group received interpersonal therapy while a third group received pharmacotherapy with clinical management. The researchers found that high levels of self-criticism led to a reduction in the effectiveness of interpersonal therapy but actually proved helpful in those being given pharmacotherapy. A tendency towards dependency predicted a worse response to CBT.

Marshall, Margarita B. ... [et al] - Self-criticism predicts differential response to treatment for major depression Journal of Clinical Psychology March 2008, 64(3), 231-244

Thursday, March 27, 2008

Genes, environment and PTSD

Post-traumatic stress disorder (PTSD) is a debilitating, stress-related psychiatric disorder with prevalence rates of about 7-8% in the U.S. population and with much higher rates among military veterans and those living in high-violence areas. PTSD suffered as a result of abuse in childhood is also a significant problem. A U.S. study of 900 black men and women who had suffered from significant levels of childhood abuse as well as other types of trauma found that variations in a gene called FKBP5 influenced the interaction between the levels of abuse in childhood and the tendency of people to develop PTSD. The gene is related to stress response and the gene-environment interaction remained significant even when depression, age, sex and levels of trauma other than child abuse were taken into account.

You can read more about this research at

Girls with ADHD fifteen years on

A study of 881 Canadian girls which followed them from the ages of six to twenty-one looked into how hyperactive or aggressive behaviour in childhood could affect early adulthood. The researchers found that one in ten of the girls monitored showed high levels of hyperactive behaviour and another one in ten showed high levels of hyperactivity and physically aggressive behaviour. Hyperactive and/or aggressive girls were more likely to take up smoking and perform poorly in school. Girls with both hyperactivity and physical aggression reported more physical and psychological aggression towards their partners, were more likely to become pregnant and were more likely to be dependent on welfare.

You can find out more about this research at

Marrriage and blood pressure

A study of 303 people in the U.S. compared the blood pressure of happily-married people, unhappily-married people and single people. The participants in the study were given portable blood-pressure monitors to wear for 24 hours. The monitors recorded blood pressure at random intervals throughout the day - even while participants were asleep. Each participant's blood pressure was recorded about 72 times. All participants drew up a list of friends in their social network and answered questions about the quality of those relationships. Married participants also completed questionnaires on the quality of the relationship with their spouses. Blood pressure at night - a risk factor for cardiovascular problems - was much lower in married people, particularly happily-married people, than in single people although overall unhappily married people had higher blood pressure than either single or happily-married people. Men and women in happy marriages scored four points lower on 24-hour blood pressure than single people and even having a supportive network of friends did not translate into improved blood pressure for single of unhappily-married people.

You can read more about this research at

Infra-red and Alzheimer's diagnosis

Although there is no cure for Alzheimer's disease treatments can slow its progress especially if they are administered early on. Because Alzheimer's affects the brain it is very difficult to make a physical diagnosis of the condition. A diagnosis is usually made on the basis of symptoms, sometimes being confirmed retrospectively via post mortem examination. However, a new technique using near-infrared light could allow Alzheimer's to be diagnosed much earlier. Near-infrared light can safely penetrate the skull and pass harmlessly through the brain. Inside the head some of the infrared light scatters, however, and how the light scatters can tell researchers about the condition of the brain. The plaques in the brain formed in Alzheimer's disease scatter the light differently from normal tissue - a difference the researchers were able to pick up and measure.

You can find out more about this research at

Depression and diabetes

A study of 2,400 residents of Saskatchewan, Canada, who were diagnosed with depression and who were taking antidepressants has found that they had a 30% increased risk of type 2 (adult onset) diabetes. The participants in the study were divided into four groups : those who took older, tricyclic antidepressants ; those who took newer SSRI antidepressants ; those who took a combination of older and newer drugs and those in the process of switching from one medication to another. The risk of developing type 2 diabetes was almost doubled for those patients who were using a combination of older and newer antidepressants. People are usually prescribed more than one type of medication if they have severe depression or if they are having a problem finding the right therapy.

You can find out more about this research at

Tuesday, March 18, 2008

Ex-forensic patients in the community

People with severe mental disorders and a history of violent offending are often seen as a difficult-to-manage population: most have schizophrenia or severe affective disorders while some suffer from severe personality disorders. They are over-represented among prisoners and are characterized by a high rate of crime recidivism, poor compliance with community programmes and aftercare and homelessness. People often go from secure units to a non-forensic residential facility and an Italian survey of 2,962 residents of such facilities compared those who had previously been in forensic units with those who had never been in one. The majority had a diagnosis of schizophrenia or a related disorder but overall the 'symptom profile' was similar between the two groups. The rate of violent behaviour of ex-forensic patients was low and limited to a very small group. The researchers concluded that the ex-forensic patients would be 'able to remain in this type of accomodation without posing a significant danger in terms of violent behaviour or threats'.

Preti, Antonio ... [et al] - A comparison between former forensic and non-forensic patients living in psychiatric residential facilities: a national survey in Italy Journal of Forensic Psychiatry and Psychology March 2008, 19(1), 108-126

Monday, March 17, 2008

Metabolic syndrome in forensic inpatients

Metabolic syndrome is a combination of disturbed glucose and insulin metabolism, being overweight with abdominal fat distribution, dyslipidaemia and high blood pressure and is often a precursor of type II diabetes and cardiovascular problems. It is particularly common in people with schizophrenia as the second generation antipsychotics used to treat the condition can lead to weight gain. A study of 221 people in Finland looked at the factors influencing metabolic syndrome in psychotic forensic inpatients. The researchers found that using clozapine, quetiapine and olanzapine increased the risk of developing metabolic syndrome by 8.1, 7.7 and 3.6 times respectively. However, increased levels of 'good' cholesterol were found in participants who were taking SSRI antidepressants and who had been diagnosed with alcohol dependence at some point, even if they were not alcohol-dependent at the time of the study.

Ojala, Kari ... [et al] - Characterization of metabolic syndrome among forensic psychiatric inpatients Journal of Forensic Psychiatry and Psychology March 2008, 19(1), 33-51

AMBR and eating disorders

The Attunement in Mind, Body and Relationships (AMBR) programme uses cognitive behaviour therapy, dialectical behaviour therapy and innovative methods such as interactive discourse, meditation and yoga to treat eating disorders. A small-scale six-eight week study into the effectiveness of the AMBR programme found that it reduced participants' desire to be thinner, concern with dieting, fear of gaining weight and body dissatisfaction.

Cook-Cottone, Catherine, Beck, Meredith and Kane, Linda - Manualized group treatment of eating disorders: Attunement in Mind, Body and Relationship (AMBR) Journal for Specialists in Group Work March 2008, 33(1), 61-83

Group work for fathers

Research and theories about child-rearing have tended to concentrate on the role and influence of mothers rather than fathers. However, in the last few years there has been much more research into fatherhood, pointing to its importance in exerting a positive influence on areas such as academic performance, ego and moral development, communication, individual well being and relationships. Involvement of fathers has been found to promote healthier adaptation in adolescents, prevent the development of stereotypical attitudes, problems with substance abuse and sexual activity and involvement with the police. This has led to the development of fathering programmes. The Re:Membering Fatherhood programme is designed to strengthen a father's capacity, self-awareness and confidence in performing the nurturing dimensions of fatherhood and to strengthen families as a whole by preparing them to play a more meaningful and active fathering role. A study of 29 fathers using the programme found that it led to significant improvements for fathers and their participation within the family including role performance, involvement, communication, task accomplishment within the family, self-esteem, a sense of increased competence and decreased stress in parenting.

Gearing, Robert Edward ... [et al] - Re:membering fatherhood: evaluating the impact of a group intervention on fathering Journal for Specialists in Group Work March 2008, 33(1), 22-42

Physical symptoms in disaster survivors

People who have survived disasters often suffer from psychosomatic symptoms such as fatigue, headaches and pains in their bones and muscles. However, little is known about the risk factors for these symptoms among disaster survivors. A study of 1,567 survivors of an explosion at a fireworks depot in Holland, which killed 23 people in May 2000, found that women, immigrants and people with pre-existing psychological problems were more likely to suffer from psychosomatic symptoms. Intrusive thoughts, avoidance, depression, anxiety and sleeping problems all played a part in perpetuating physical symptoms.

Berg, B. van den ... [et al] - Risk factors for physical symptoms after a disaster: a longitudinal study Psychological Medicine April 2008, 38(4), 499-510

Mental health after Chernobyl

The Chernobyl nuclear power plant accident in April 1986 was the world's worst nuclear disaster. 31 people died of radiation sickness in its immediate aftermath and another 19 people had died from the long-term effects of radiation poisoning by 2005. Around 600,000 people were sent in to help with the clean-up and although these people are regularly checked for cancer there has been little research into their psychological well-being. A study of 692 people in the Ukraine compared people who had taken part in the clean-up in 1986 with other people living in the area. They found that clean-up workers had slightly higher rates of depression (18% vs 13.1%), were more than twice as likely to have had suicidal thoughts, were over four times more likely to suffer from post-traumatic stress disorder and over five times more likely to suffer from headaches.

Loganovsky, K. ... [et al] - The mental health of clean-up workers 18 years after the Chernobyl accident Psychological Medicine April 2008, 38(4), 481-488

Friday, March 14, 2008

Magnetism and misery

The term vascular depression has been used to describe late-life depressive disorders in patients with evidence of cerebrovascular disease. Some studies have suggested that vascular depression is more long-lasting and more resistant to treatment than early-onset depression. Transcranial magnetic stimulation (TMS), in which powerful magnets are moved back and forth over the skull, has been proved to have an antidepressant effect in some studies but little research has been done on its effectiveness in treating older people or those with cerebrovascular problems. Researchers in Iowa studied 92 patients with vascular depression giving one group TMS and the other a sham treatment. In a second experiment the dose of TMS was increased without telling the patients. This was important as it is quite hard to produce a realistic 'sham' treatment for TMS. The researchers hoped that a higher dose of TMS would produce more positive results which were definitely down to the treatment rather than just positive thinking. In both experiments TMS proved far superior to a sham treatment and the higher dose turned out to be more effective than a lower one.

Jorge, Ricardo E. ... [et al] - Treatment of vascular depression using repetitive transcranial magnetic stimulation Archives of General Psychiatry March 2008, 65(3), 268-276

Tamoxifen and bipolar disorder

Protein Kinase C (PKC) is a family of enzymes that can affect neurotransmitters in the brain. Abnormalities in PKC activity have been linked to bipolar disorder. The breast cancer drug tamoxifen inhibits PKC and a team of researchers in Turkey studied its effect on patients suffering from mania. 50 people participated in the trial in which 29 of them received tamoxifen and 21 a placebo. Neither the patients nor their doctors knew whether they were taking the tamoxifen or the placebo. The study found that tamoxifen was effective in reducing mania and had very few side effects.

Yildiz, Aysegul ... [et al] - Protein Kinase C inhibition in the treatment of mania: a double-blind placebo-controlled trial of tamoxifen Archives of General Psychiatry March 2008, 65(3), 255-263

Wednesday, March 12, 2008

Teenage painkiller abuse

In the United States both prescribed and non-prescribed use of prescription pain relievers, as well as rates of opioid-related mortality and admissions to emergency departments have increased in the last few years. The rate of drug-overdose deaths associated with prescription opioid misuse has also increased and, in 2002, was greater than the rate associated with heroin or cocaine use. In 2005, an estimated 2.2 million Americans used pain relievers non-medically for the first time within the preceding year and more than a third of these first-time or new users were adolescents aged 12-17. A study of 18,678 adolescents in the U.S. found that approximately one in ten of them (9.3% of boys and 10.3% of girls) had abused prescription painkillers. The mean age of first non-prescribed use was 13.3, similar to the mean starting age for alcohol and marijuana but higher than that for solvent abuse. Approximately a quarter of painkiller abusers had never used another illicit substance. Male painkiller abusers were more likely than other children to have been cautioned or arrested by the police while female painkiller abusers were more likely than other girls to suffer from anxiety or depression.

Wu, Li-Tzy, Pilowsky, Daniel J. and Patkar, Ashwin A. - Non-prescribed use of pain relievers among adolescents in the United States Drug and Alchohol Dependence, 2008, 94(1-11)

Cyberbullying : what does the research say ?

Victimization over the Internet has attracted increasing attention from researchers and healthcare professionals. Defined as 'willful and repeated harm inflicted through the medium of electronic text' it can not only undermine children's freedom to use and explore resources on the Internet but can also result in severe functional and physical ramifications. Research into cyberbullying is still in its infancy but a team of researchers from the U.S. conducted an Internet survey of 1,378 adolescent Internet users. There were no associations between gender or race and cyberbullying but computer proficiency and time spent on-line were positively related to both cyberbullying, victimization and offending. Cyberbullying experiences were also linked to respondents who reported school problems (including conventional bullying), assaultive behaviour and substance use.

Hinduja, Sameer and Patchin, Justin W. - Cyberbullying: an exploratory analysis of factors related to offending and victimization Deviant Behavior February 2008, 29(2), 129-156

Computer use and teenage development

A study of 1,591 teenagers in Ontario, Canada looked at their Internet and computer game use over a 21-month period. Most girls (93.7%) and boys (94.7%) reported using the Internet at both time periods whereas more boys (80.3%) than girls (28.8%) reported gaming at both time periods. Girls reported a small decline in overall technology use over the course of the study mostly due to a decline in game playing. Those teenagers who used the Internet most had better quality friendships but less positive parental relationships. Moderate use of the Internet was associated with a more positive academic orientation than non-use or high levels of use.

Willoughby, Teena - A short-term longitudinal study of Internet and computer game use by adolescent boys and girls: prevalence, frequency of use, and psychosocial predictors Developmental Psychology January 2008, 44(1), 195-204

Gender identity disorder in girls over time

Research on child development has documented a number of areas in which children, on average, show significant sex differences: gender identity, self-labelling, sex of playmate preference, toy and activity interests, roles in fantasy play etc, etc. These have implications for other aspects of psychosocial development such as interpersonal relational styles, cognitive skills and vocational interests for which there are also significant sex differences. Boys are much more likely than girls to be referred to gender identity clinics and little is known about the longer-term psychosexual outcome of girls. A study of 25 girls between three and twelve attending a gender identity clinic in Toronto followed them up later to see how they were getting on; the girls had to be at least seventeen to participate in the follow-up study. The researchers found that at the follow-up 3 of the girls had Gender Identity Disorder (GID) or gender dysphoria. 8 of the girls were classified as bisexual/homosexual in fantasy and 6 were classified as bisexual/homosexual in behaviour. The remaining participants were classified as either heterosexual or asexual. The rates of GID and bisexual/homosexual orientation were substantially higher than base rates in the general female population. Girls who were more cross-sex typed in their childhood behaviour were more likely to be gender dysphoric at follow up and more likely to have been classified as bisexual/homosexual in behaviour.

Drummond, Kelly D. ... [et al] - A follow-up study of girls with gender identity disorder Developmental Psychology January 2008, 44(1), 34-45

Tuesday, March 11, 2008

Smoking during pregnancy - are there links to conduct problems

Smoking during pregnancy has been consistently linked with externalizing (behaviour) problems in children, particularly in males. It has been associated with parent-reported conduct problems, arrest history from national crime registries, contact with police, oppositional defiant disorder and attention-deficit/hyperactivity disorder. However, there are obvious ethical difficulties with controlled trials exposing fetuses to maternal smoking during pregnancy and it could be the case that the association between smoking during pregnancy and behaviour problems is due to other environmental factors that lead pregnant women to smoke and their children to become badly behaved. Previous studies have attempted to take these factors into account but a study of 4,886 women in the U.S. went further by comparing the behaviour of their children who had grown up in the same family but who had been exposed to different levels of nicotine in the womb. When these children were compared there was no significant difference in conduct problems or oppositional defiant problems between the children who had and had not been exposed to nicotine in utero. There was a small link between maternal smoking and ADHD but the researchers concluded that 'genetically informed analyses suggest that unmeasured environmental variables influencing both smoking during pregnancy and offspring externalizing behaviours account for the previously observed associations'.

D'Onofrio, Brian M. ... [et al] - Smoking during pregnancy and offspring externalizing problems: an exploration of genetic and environmental confounds Development and psychopathology (2008), 20: 121-137

ADHD children and parents

Parents often find the hyperactive and impulsive behaviour of children with Attention-Deficit Hyperactivity Disorder (ADHD) extremely challenging and stressful. Their behaviour towards their children is often characterized by high levels of coerciveness and negativity leading to a vicious circle of bad behaviour, leading to bad parenting which in turn leads to more bad behaviour. It is, therefore, important, to look into the factors affecting how parents respond to their children's ADHD. One such factor might be the presence of ADHD in parents as well as their children. Family studies of children with ADHD have found that 15-20% of mothers and 20-30% of fathers have ADHD which is now increasingly recognised as persisting into adulthood. Studies have suggested that parental ADHD is likely to reduce the quality of parenting and increase the risk of negative and chaotic parenting leading to a parenting style characterized by inconsistency, reactivity and a lack of self-reflectiveness. Two studies of mothers and children in Hampshire found that child ADHD symptoms were associated with negative maternal comments while maternal ADHD symptoms were associated with negative expressed emotions. However, in both studies maternal ADHD symptoms appeared to ameliorate the effects of child ADHD symptoms on negative parenting and parental response to children with high ADHD symptoms was more positive and affectionate when the mother also had high ADHD symptoms. The researchers thought this might be because there was a better 'fit' between the child's behaviour and the parents or, that having suffered with ADHD themselves the parents were more sympathetic to the children.

Psychogiou, Lamprini ... [et al] - Do maternal attention-deficit/hyperactivity disorder symptoms exacerbate or ameliorate the negative effect of child attention-deficit/hyperactivity disorder symptoms on parenting? Development and psychopathology 2008, 20, 121-137

Study questions NICE Alzheimer's guidance

Despite enthusiasm from clinicians, patients and carers' groups doubts continue to be expressed on the impact and cost/benefits of cholinesterase inhibitors in treating Alzheimer's disease. The National Institute for Clinical Excellence (NICE) has issued guidance that these medicines should be prescribed only to moderate cases of Alzheimer's disease producing an angry reaction from clinicians and the Alzheimer's society and a referral to the Court of Appeal. A study of 88 patients in Wolverhampton taking the drug donepezil for their Alzheimer's found that 64.7% remained on treatment beyond six months, 57.9% beyond a year and 12.5% beyond 4 years. 56% remained alive after 4 years almost twice the number predicted. The mean score on the Mini Mental State Examination - a cognitive test used to assess people with dementia - did not deteriorate over four years in those taking donepezil. The researchers concluded that the benefits of donepezil for individuals were confirmed, especially for those with mild impairment and that 'expenditure on medication was modest in a population context' and said that their findings 'question recent guidance' from NICE.

Lyle, Sarah ... [et al] - Treatment of a whole population sample of Alzheimer's disease with donepezil over a 4-year period: lessons learned Dementia and geriatric cognitive disorders 2008, 25: 226-231

Frontotemporal dementia and psychosis

Frontotemporal dementia (FTD) usually begins in middle age with neuropsychiatric symptoms. The development of disinhibition, socially inappropriate behaviour, emotional disengagement, repetitive behaviour and poor insight can lead to FTD being misdiagnosed as psychosis but the true prevalence of psychosis in people with FTD is unclear. A U.S. study of 109 people compared those with FTD to those with Alzheimer's. Among the FTD patients only 2.3% had delusions, only half of whom had paranoid ideas and no FTD patients had hallucinations. By contrast 17.4% of the Alzheimer's patients experienced delusions and paranoia. A review of other studies also failed to establish a significant association between FTD and psychosis.

Mendez, Mario F. ... [et al] - Psychotic symptoms in frontotemporal dementia: prevalence and review Dementia and geriatric cognitive disorders 2008, 25: 206-211

Children of depressed parents - 23 years later

Many children of depressed parents are at risk of poor functioning but few studies have followed them into adulthood to see how they are doing then. A study of 476 people in the U.S. compared the children of depressed parents with a control group. Children with depressed parents were more likely to be depressed themselves and to suffer from disability and obtained more help for mental-health problems. They also reported more severe recent stressors but were more likely to use positive thinking and seek alternative rewards in order to cope. There was no difference in the levels of other mental-health problems, physical functioning and pain, social functioning and hospitalizations and medication use for depression. Adult children of parents who had still not recovered from their depression were the most likely to show impaired functioning compared to the control group.

Timko, C. ... [et al] - Functioning status of adult children of depressed parents: a 23-year follow up Psychological Medicine March 2008, 38(3), 343-352

Single parents' mental health

A quarter of families with dependent children are now headed by lone parents, usually a mother. Lone mothers have worse mental and physical health than mothers in a relationship and than the rest of the population. However, it is unclear whether this is due to the financial hardships and lack of social support experienced by single mothers or whether there is something inherent in single parenthood that causes mental-health problems. A study of 8,580 people in Fife found that lone mothers were twice as likely to have a mental-health problem as other women but that once financial problems and social support were taken into account the difference disappeared. However, lone fathers were nearly four times more likely to have a mental-health problem than other men and this risk remained undiminished by controlling for age, income, debt and levels of social support.

Cooper, C. ... [et al] - Depression and common mental disorders in lone parents: results of the 2000 National Psychiatric Morbidity Survey Psychological Medicine March 2008, 38(3), 335-342

Friday, March 07, 2008

Montessori activities for people with dementia

Care homes often provide inappropriate environments and inadequate activity programmes for adults with dementia. One study found that nearly 40% of nursing home residents with severe cognitive impairment did not participate in any activity in the course of a week. Inactivity or inappropriate activities involving infantilization and developmentally inappropriate or meaningless tasks can lead to boredom, lower quality of life and problem behaviours including agitation and aggression. A study of 10 older adults with dementia at an adult day programme looked into the effectiveness of a Montessori-based approach. The Montessori programme is based on the use of everyday materials, a progressive complexity of tasks, the idea that it is the process not the end result that is important and teaching by demonstration rather than instruction. Teaching is tailored to the individual and varies in complexity according to their needs. The study found that the participants showed more constructive engagement and less non-engagement when doing Montessori activities, compared to the normal activities of the day centre. However, there was no difference in people's mood between the Montessori group and the control group.

Jarrott, Shannon E., Gozali, Tsofit and Gigliotti, Christine M. - Montessori programming for people with dementia in the group setting: an analysis of engagement and affect Dementia March 2008, 7(1), 95-108

Interventions for agitation in dementia

Agitation and disruptive behaviour in people with dementia living in nursing homes is a widespread problem affecting the care of patients, staff satisfaction and the ability of staff to cope with providing care to these individuals. Agitation can be defined as 'inappropriate verbal, vocal or motor activity that is not explained by needs or confusion per se. It includes behaviour such as aimless wandering, pacing, cursing, screaming, biting and fighting'. There is a growing body of knowledge supporting relaxation techniques, diversion activities, music and massage to decrease agitation in people with dementia. A Canadian study of 41 people with mild to moderate dementia looked into the effectiveness of playing people their favourite music and hand massage in reducing agitated behaviours. Both treatments, individually and together, were effective at immediately reducing agitation and worked up to an hour after their use.

Hicks-Moore, Sandee L. and Robinson, Bryn A. - Favorite music and hand massage: two interventions to decrease agitation in residents with dementia Dementia March 2008, 7(1), 95-108

Tardive dyskinesia and antipsychotics

Tardive dyskinesia (TD) is one of the worst side effects of antipsychotic drugs. It is characterized by repetitive, involuntary and purposeless movements including grimacing, tongue protrusion, lipsmacking, puckering and pursing of the lips and rapid eye blinking. Rapid movements of the arms, leg and trunk may also occur. A review of 12 studies looking into the links between TD and antipsychotic drugs compared the rates of the problem in those taking first and second generation antipsychotics. In children the incidence of TD was 0.35% for those taking second-generation drugs. In adults 7.7% of those taking first-generation drugs developed TD compared to only 2.98% of those taking second-generation drugs. In elderly patients the rates of TD were about the same for those taking first and second-generation drugs. In four adult studies the rates of TD in those taking second-generation drugs, no drugs at all and first-generation drugs were 13.1%, 15.6% and 32.4% respectively.

Correll, Christoph U. and Schenk, Eva M. - Tardive dyskinesia and new antipsychotics Current Opinion in Psychiatry March 2008, 21(2), 151-156

Treatment compliance - second generation antipsychotics fail to live up to their promise

Long-term maintenance anti-psychotic treatment remains the most reliable means of preventing relapses, minimizing mortality and illness and ensuring independent living in people being treated for schizophrenia. However, treatment non-adherence remains a significant concern with the reported rates of non-adherence varying between 24-90% depending on the kind of patients being treated. One of the causes of non-adherence to treatment is the side effects of drugs. Second generation anti-psychotics were thought to have at least partially overcome this problem as they have fewer side effects than earlier drugs. However, a review of studies into compliance with treatment for schizophrenia has found that 'the data have failed to substantiate the notion that novel antipsychotic drug use leads to improved medication compliance and favourable clinical outcomes'.

Voruganti, Lakshmi P., Baker, Laura K. and Awad, George A. - New generation antipsychotic drugs and compliance behaviour Current Opinion in Psychiatry March 2008, 21(2), 133-139

Wednesday, March 05, 2008

Peer relationships, violence and ethnicity

Peer relationships are one of the most significant risk factors for an adolescent to engage in violent and/or delinquent behaviour. Youths exposed to groups of people, such as peers, whose norms, values and practices are more permissive of criminal behaviour are more likely to participate in delinquent and violent activities themselves. Specific aspects of peer relationships related to violence and delinquency include attachment to peers, perceived delinquency of peers, perceived peer attitudes toward delinquency, peer pressure and time spent with delinquent peers. A U.S. study of 128 female juvenile (13-18) offenders looked into the effects of peer relationships on violence among four different racial groups (White, African American, Hispanic and mixed race). The results showed that high levels of peer association and extrinsic rewards from peer relationships best predicted violence among all groups. Among Hispanics positive peer attitudes towards delinquency significantly contributed to violence. Among Whites greater time spent with peers was associated with higher levels of violence. For African Americans tangible rewards from peer relationships significantly contributed to violence. There were no significant differences between the mixed-race girls and the other groups.

Silverman, Jenna R. and Caldwell, Roslyn M. - Peer relationships and violence among female juvenile offenders: an exploration of differences among four racial/ethnic populations Criminal Justice and Behavior March 2008, 35(3), 333-343

Violent video games and aggression - new research

Concerns that video games promote violent behaviour in players began shortly after they became available in the 1970s. The first major controversy was over the game Death Race in which the player was a car driver running over pedestrians and more recently games such as Mortal Kombat and Street Fighter have provoked concern. Some researchers have suggested that because of their participatory nature violent video games have a greater effect than violent TV while others have blamed different factors such as children's innate aggression and family environment. A study of 101 undergraduates in Texas and Wisconsin randomly allocated some of them to play either a violent or non-violent video game with the remainder of the participants being allowed to choose. After playing the game the participants were tested for their levels of aggression using the Taylor Competitive Reaction Time Test in which participants believe that they are punishing an opponent for losing in a reaction time test by subjecting them to noise blasts or electric shocks. The level of punishment meted out by the participants are used as a proxy (substitute) measure for aggression. The researchers found that although males were more aggressive than females neither exposure to the violent video games or previous experience of playing them led to any differences in aggression. A second study of 428 undergraduates by the same researchers looked into the links between innate aggression, violent criminal acts, exposure to violent video games and family violence. The results indicated that innate aggression, family violence and being male were predictors of violent crime but exposure to violent video games was not.

Ferguson, Christopher J. ... [et al] - Violent video games and aggression: causal relationship or byproduct of family violence and intrinsic violence motivation? Criminal Justice and Behavior March 2008, 35(3), 311-332

Tuesday, March 04, 2008

Suicide and early psychosis - what are the risk factors?

Suicide is the main cause of premature death among people with schizophrenia. There is some evidence that the risk factors for self-harm may be different for those with schizophrenia compared with other groups and there is some emerging evidence that risk factors for self-harm may alter during the course of a psychotic illness. Suicidal behaviour is more common during the early stages of psychosis and the period of time between the onset of psychotic symptoms and and individual's first contact with mental-health services can be particularly risky. A study of 496 people in South-East London and Nottingham presenting (turning up for treatment) for psychosis over a two-year period found that 11.3% of them had engaged in self-harm since the onset of their psychosis. Being male, being in a higher socio-economic group, depression, a prolonged period of psychosis before seeking treatment and increased insight (consciousness of being unwell) were all associated with an increased risk of self-harm.

Harvey, S.B. ... [et al] - Self-harm in first-episode psychosis British Journal of Psychiatry March 2008, 192(3), 178-184

Childhood sexual abuse and self-harm - is there a link?

Self-injurious behaviour can be defined as the causing of intentional, direct damage to one's body without suicidal intent. Common examples include cutting oneself and burning one's skin. Because such behaviour is associated with suicide and psychiatric disorders and because its treatment can be challenging it has attracted substantial attention in both the clinical and research literature. Little is known about its causes but some people have suggested that childhood sexual abuse is one of them. A number of studies have shown a link between childhood sexual abuse and later self-harm but other studies have found little or no association. Researchers have now got powerful and sophisticated tools which allow them to combine the results from a number of different studies - a process called meta-analysis. A meta-analysis of 45 different studies into the link between childhood sexual abuse and self-harm found that the significance of the relationship was very small and that in studies that take into account other psychiatric risk factors childhood sexual abuse explained little or no unique variance in self-injurious behaviour.

Klonsky, E. David and Moyer, Anne - Childhood sexual abuse and non-suicidal self-injury: meta-analysis British Journal of Psychiatry March 2008, 192(3), 166-170