Thursday, May 29, 2008

Heard the one about the schizophrenic ...

Humour is an important part of daily life. Not only does it bring pleasure and enjoyment in itself it is also considered a positive social trait that facilitates social interaction and bonding. There is substantial evidence that people with schizophrenia have deficits in social cognition, which includes recognizing other's mental states (theory of mind), social perception and attributional style. These skills are likely to play an important role in humour appreciation yet there have been relatively few studies examining this subject. A study of 60 people (30 with schizophrenia and a 30-strong control group) by researchers at the University of Sheffield asked participants to identify humorous moments in four slapstick-comedy films. The participants were asked to press a buzzer for every funny moment and asked about their reactions to the films afterwards. Compared to the control group the people with schizophrenia were less able to detect humour, although when they did detect it they appreciated it as much.

Tsoi, D. T.-Y. ... [et al] - Humour experience in schizophrenia: relationship with executive dysfunction and psychosocial impairment Psychological Medicine June 2008, 38(6), 801-810

Theory of mind and bipolar disorder

Theory of mind is the ability to infer what another individual is thinking or feeling based on their verbal and/or non-verbal behaviour. It is central to successful social interaction and develops throughout childhood and adolescence. Children with bipolar disorder often have significant impairments in their social and interpersonal functioning but there has been little research into Theory of Mind in this age group. A U.S. study of 46 children compared those with bipolar disorder to those without. In one task the participants were read stories with positive, negative and neutral emotional content and were assessed on their ability to recognize that a misleading series of events could lead one character to develop a false belief about another. In another task the participants were required to infer the real intentions behind subtle hints. The children with bipolar disorder performed significantly more poorly than the controls at picking up hints and on the positive- and negative-story tests. Among the children with bipolar disorder younger age, earlier illnes onset and manic symptoms were all associated with poorer theory-of-mind performance.

Schenkel, L.S. ... [et al] - Theory of mind and social inference in children and adolescents with bipolar disorder Psychological Medicine June 2008, 38(6), 791-800

Depression, abuse and hospital use

A small proportion of patients account for the majority of healthcare usage with 5-15% of patients responsible for 45-70% of costs. Heavy users often suffer from mental and physical illness, particularly an increased level of depression. Physical and sexual abuse, in either childhood or adulthood, is known to be linked to increased levels of depression and a U.S. study of 96 frequent users of health services examined the links between abuse, depression and frequent usage of health services. The researchers found that compared to people who had not been abused people who had suffered abuse over the past year were significantly more likely to be re-admitted to hospital. However, re-admissions were related to chronic disease management and were not the result of the physical effects of abuse. Major depression and abuse interacted with each other to increase rates of re-admission.

Levine, Jeffrey M. ... [et al] - Major depression and recent physical or sexual abuse increase readmissions among high-utilising primary care patients Mental Health in Family Medicine 2008, 5(1), 23-28

Debt and depression

At any one time between 2-5% of the population are suffering from depression and between 10-20% of people will suffer from it during the course of their life. Depression is more common among those with a poorer standard of living, independent of occupational social class, and unemployment is also a strong risk factor. Some researchers have suggested that perceived financial strain - the ability to meet one's commitments and one's level of indebtedness - is more important than unemployment and poverty per se. A study of 5,237 young women in Southampton, over two years, found that among those developing depression there was a higher proportion receiving benefits and a higher level of perceived financial strain. There were also modest rises in perceived stress and poorer levels of educational attainment. Women who were not depressed at the start of the study but who were receiving benefits had a 1.61x higher risk of developing depression. The risk associated with perceived financial strain did not remain statistically significant after adjustments were made for receipt of benefits, educational qualifications and perceived stress. In other words it was unemployment and/or poverty that was the most crucial factor in whether people developed depression not their perception of financial strain.

Dunn, Nick ... [et al] - Does perceived financial strain predict depression among young women? Longitudinal findings from the Southampton Women's Survey Mental Health in Family Medicine 2008, 5(1), 15-21

Wednesday, May 28, 2008

Maternal depression and childhood injuries

A study of 1,364 mothers in the U.S. examined the links between maternal depression and children's injuries. The mothers were periodically asked to list all their children's injuries that had required professional medical treatment, and, on four separate occasions during the study, asked to rate how often they experienced symptoms of depression. 2.5% of the mothers reported severe, clinical depression with 15.5% reporting being moderately depressed. The children between 0-3 whose mothers suffered from severe, chronic depression were three times more likely to suffer accidental injuries than infants and toddlers whose mothers were only moderately depressed. The link between severe, chronic depression and injuries remained consistent even when taking into account socio-economic status, parenting styles and the children's sex, temperament and behaviour. However, between three and starting school the levels of injuries were the same in the severely and moderately-depressed women. The researchers hypothesized that the severely depressed women were less able to provide a safe environment for their children but that this became less important as the children grew old and were more able to make their own decisions about safety and danger.

You can read more about this research at

Female sex offenders

Between 1988 and 2000 93 women were convicted of sexual offences in Sweden. Researchers at Karolinska University compared the incidence of mental illness and substance abuse in this group with 20,000 randomly selected women in the normal population and 13,000 women convicted of non-sexual crimes in the same period. 37% of the female sex offenders had undergone treatment in a psychiatric clinic and 8% had been diagnosed with psychosis but there was no difference in the incidences of mental illness and drug abuse between these women and women who had committed other kinds of violent crime. However, the figures differed widely from the control group of normal women with the rates of psychosis being 16 times higher and that of drug abuse being 23 times higher.

You can find out more about this research at

Separation and child development

A study of 1,619 children between the ages of 4 and 6 in Rochester, U.S. looked into the effects of separation from parents on children's development. 18% of the children had been separated from their parents at some point during their childhood with 7% of them being separated two or more times. Children who had been separated at any point scored significantly worse on their ability to learn new tasks and on their 'pre-literacy' skills.

You can read more about this research at

Antipsychotics for dementia : adverse effects

Antipsychotic drugs are commonly used to treat the behavioural and psychological symptoms of dementia, often being prescribed for short periods to treat agitation. About 17% of individuals admitted to nursing homes are started on antipsychotic medication within 100 days. A study of 41,241 older adults in the U.S. covered people with dementia living in nursing homes and in the community comparing those prescribed newer, atypical antipsychotics ; those prescribed older, typical antipsychotics and those not prescribed any antipsychotics at all. Among older adults living in the community those taking older drugs were four times more likely to experience an adverse event within 30 days of starting the drugs, while those taking the newer drugs were at three times the risk. Among the older adults living in nursing homes those taking older drugs had 2.4x the risk while those taking newer drugs had a 1.9x greater risk.

You can find out more about this research at

Social victimization at school

A study of more than 2,300 students between the ages of 12-18 carried out by researchers at the University of Alberta looked into the issue of social victimization - which can include receiving hurtful anonymous notes, being socially excluded or having rumours spread about oneself - in an attempt to see who was most at risk of it. The study found that girls who viewed themselves as attractive had a 35% increased chance of social victimization, whereas boys who thought they were good looking had a 25% reduction. Older teenagers who were sexually active had a 35% increased risk of being victimized.

You can find out more about this research at

ADHD in the workplace

Increasing numbers of children are being diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) but the condition can also be present in adults. Adults with ADHD may have difficulty in concentrating because they may be hyperactive, easily distracted, forgetful or impulsive. A survey by the World Health Organization looked into lost productivity due to ADHD surveying more than 7,000 employed or self-employed people between the ages of 18 and 44. On average 3.5% of workers had ADHD which was more prevalent in men and workers in developed, rather than developing, countries. People with ADHD were found to spend 22.1 more days not doing work than other workers, per year. This was made up of 8.4 days when they were unable to work or carry out their normal activities, plus 21.7 days of reduced work quantity and 13.6 days of reduced work quality.

You can find out more about this research at

Thursday, May 22, 2008

Vitamin D and depression

Depression is very common in older people and can affect up to 13% of this population. Some scientists have suggested that low levels of vitamin D can cause depression. Low levels of vitamin D can also cause an increase in parathyroid hormone levels which are in turn frequently accompanied by an increase in depressive symptoms. In fact people's mood usually returns to normal after treatment of hyperparathyroidism. A Dutch study of 1,282 elderly people between the ages of 65-95 found that levels of vitamin D were 14% lower in 169 people with minor depression and 14% lower in 26 people with major depression. Levels of parathyroid hormone were 5% and 33% higher respectively. Depression severity was significantly associated with decreased vitamin D and increased parathyroid hormone levels.

Hoogendijk, Witte J.G. ... [et al] - Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults Archives of General Psychiatry May 2008, 65(5), 508-512

Rheumatic diseases and mental-health problems

Rheumatoid arthritis, systemic lupus erythematosus and ankylosing spondylitis are caused by the body's immune system going wrong and causing inflammation in the joints and spine. Rheumatoid arthritis affects between 1-2% of the population, and ankylosing spondylitis between 0.5-4%. Lupus has a strong imbalance between the sexes affecting 4 per 100,000 men but over ten times (45 per 100,000) as many women. These diseases are also associated with an increased risk of mental-health problems either because of their biological effects or through the stress and anxiety they cause people. A Swedish study looked at the entire population in 1973 and again in 2004. It found that individuals with rheumatic diseases had a higher risk of psychiatric disorders than the general population with those with lupus and ankylosing spondylitis having the highest risk. Lupus carried an increased risk of dementia and delirium. Women with rheumatoid arthritis and lupus had an increased risk of psychotic disorders and severe depression.

Sundquist, Kristina ... [et al] - Subsequent risk of hospitalization for neuropsychiatric disorders in patients with rheumatic diseases Archives of General Psychiatry May 2008, 65(5), 501-507

Wednesday, May 21, 2008

CBT for very young children with OCD

As many as 1 in 200 children and adolescents suffer from Obsessive-Compulsive Disorder (OCD) which is characterized by recurrent and intense obsessions and/or compulsions - such as hand-washing, counting, checking and cleaning - that cause severe discomfort and interfere with daily functioning. Children as young as 5 can be diagnosed with the condition but few research programmes have looked into treatments for children this young despite the fact that if left untreated early childhood OCD can severely disrupt and impair a child's development and functioning and can extend into adulthood. A U.S. study of 42 young children looked into the effectiveness of family based cognitive behavioural therapy (CBT) which draws on successful approaches used with older children but also contains innovative elements that have been specifically tailored to children between the ages of 5 and 8. The study compared family CBT with relaxation techniques. The CBT programme was found to be significantly more effective in decreasing OCD symptoms and helping children achieve clinical remission. 69% of the children who completed all 14 weeks of the CBT programme achieved remission compared to only 20% of the relaxation group. Even among those children who started, but did not finish, the CBT programme 50% achieved clinical remission.

You can read more about this research at

Teenage troubles and school performance

A study of 589 high-school students in Los Angeles looked into the links between family and home stress and school performance. The teenagers reported their daily family and school experiences in a diary every day for a fortnight recording conflict with parents, family demands, learning difficulties, school attendance and other experiences. The study found that when the teenagers experienced stress at home they had problems with their school work over the next two days and when they had problems with their school work they had more problems at home over the next forty-eight hours. But there were also more long-term effects and adolescents who had higher levels of family stress and schoool problems at the start of high school saw declining achievement four years later.

You can find out more about this research at

Domestic violence against men

A new U.S. report on domestic violence against men has lifted the lid on the scale and nature of the phenomenon. In-depth interviews with over 400 men found that 5% had experienced domestic violence - including non-physical abuse - in the past year, 10% in the past five years and 29% over their lifetimes. Depressive symptoms were nearly three times as common in older men who had experienced abuse, with much more severe depression in the men who had been abused physically. Most men stayed in abusive relationships for years and domestic violence affected men from all walks of life.

You can find out more about this research at

Maternal stress and babies' immune systems

Mothers' levels of stress during pregnancy may effect the immune system of their babies according to a study carried out by researchers at Harvard Medical School. The study of 387 mothers and their babies in Boston looked at levels of maternal stress, exposure to dust-mite allergens and levels of a substance called IgE in umbilical-cord blood. The researchers found increased levels of IgE expression - indicating immune-system problems - among infants whose mothers had experienced higher levels of stress. This link held true even when the women had been exposed to relatively low levels of dust-mite allergens during their pregnancy and regardless of the mother's race, class, education or smoking history.

You can read more about this research at

Who's in and out at school - the power of positive thinking

A study of 164 adolescents in the U.S. has found that how children perceive their social standing can be just as important as their actual levels of popularity. The researchers interviewed the children at 13 and 14 and also talked to their friends. Regardless of their actual levels of popularity teenagers who felt good about their social standing did well over time becoming increasingly less hostile and more frequently sought out by their peers. Conversely those children who were popular also did well, regardless of their own perceptions of their social standing. Adolescents who lacked both a strong sense of their own social acceptance and who were rated by their peers as unpopular fared the worst becoming more hostile, less sought after and more withdrawn over time.

You can find out more about this research at

Young people in PICUs and ethnicity

A U.S. study of 2,991 patients under the age of 22 admitted to an emergency paediatric psychiatry department has found strikingly different patterns of diagnosis among different ethnic groups. 4.5% of African-Americans and 4.9% of Hispanics received diagnoses of psychotic disorder compared to only 2.5% of white children. Diagnoses of behavioural problems were also more common in African-American and Hispanic children (50.3% and 46.4% respectively) compared to white children (34.9%). However, white children (37.8%) were more likely to receive diagnoses of depression than African American (28.5%) or Hispanic (30.1%) children. White children were also more likely to be diagnosed with bipolar disorder and alcohol and substance abuse.

You can find out more about this research at

Aging into happiness

A study of 1,450 people over the age of 60 in the U.S. has painted a rosy picture of older people's mental health. Previous research on emotions associated with aging has focused on negative emotions such as depression but this study found that older people felt more positive than negative emotions and more passive (contentment, calm, ease) than active ones. Women had more negative and passive emotions than men and participants with higher income and educational levels had significantly more positive emotions than less-well-educated and poorer ones.

You can read more about this research at

Birthday bingeing in the U.S.

A U.S. study of 2,518 current and former college students has revealed dangerously-high levels of drinking by people as they celebrate their 21st birthdays. (21 is the legal age for drinking in the U.S.). Over 80% of the participants reported that they had consumed some alcohol on their 21st. 34% of men and 24% of women had consumed 21 drinks or more. The maximum for men was about 50 drinks, the maximum for women about 30. The researchers estimated that 49% of men and 35% of women had blood alcohol contents of 0.26 or higher, a level that indicates severe alcohol intoxication which could lead to dangerous health problems such as disorientation, coma and even death.

You can find out more about this research at

Tuesday, May 20, 2008

Coping with stress

Individual differences in the levels of stress people experience can arise from many sources. Women and people with negative affectivity tend to report more stress than men and people with a more positive outlook on life but it is unclear whether this is because they actually experience more stress or because they cope less well with it. An Australian study of 216 undergraduates presented them with identical, hypothetical stressful scenarios. Women rated the scenarios as more stressful than the men did and people with higher negative affectivity rated them as more stressful than the people with lower negative affectivity did. Women were more likely to use emotion-focused coping strategies aimed at reducing unpleasant emotions by accepting responsibility, seeking support from others, venting their emotions and self-blame. People higher in negative affectivity were more likely to use avoidance-focused coping such as withdrawal, escape and denial.

Eaton, Rebecca J. and Bradley, Graham - The role of gender and negative affectivity in stressor appraisal and coping selection International Journal of Stress Management February 2008, 15(1), 94-115

ADHD drugs and drug abuse

Stimulants from the amphetamine family are the principal methods for treating Attention Deficit Hyperactivity Disorder (ADHD). However, there are some concerns that this may predispose people towards drug use later in life. Some studies have shown an increase in cocaine and nicotine use, others have shown no effect while others have concluded that ADHD medication can have a protective effect. A study of 112 children who had been treated for ADHD between the ages of 6 and 17 followed them up ten years later and found that although 22% of them were still taking stimulants 'there were no statistically significant associations between stimulant treatment and alcohol, drug or nicotine use disorders'. Those who had been treated for ADHD in childhood were neither more or less likely than other people to drink, smoke or take drugs.

Biederman, Joseph ... [et al] - Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: a naturalistic controlled 10-year follow-up study American Journal of Psychiatry May 2008, 165(5), 597-603

Cost-effectiveness of adolescent depression treatment

A study of 439 children in the U.S. looked into the cost-effectiveness of different treatments for adolescent depression. The study compared the effectiveness of fluoxetine alone, fluoxetine in conjunction with cognitive behaviour therapy (CBT) and CBT alone. The researchers found that CBT and fluoxetine produced the greatest improvement but that it was five times more expensive per quality-adjusted life year* than fluoxetine alone. After 12-weeks CBT 'was neither an effective nor cost-effective option'.

Domino, Marisa Elena ... [et al] - Cost-effectiveness of treatments for adolescent depression: results from TADS American Journal of Psychiatry May 2008, 165(5), 588-596

*for a definition of quality-adjusted life years see

Monday, May 19, 2008

Stigma, self-esteem and social support

A number of studies have demonstrated the existence of negative attitudes towards people with mental-health problems and these attitudes can have a detrimental effect on people suffering from a mental illness. There are a number of ways in which people can cope with this stigma but three of the most common ones - secrecy, education, and avoidance/withdrawal - have been shown to be ineffective. A study of 595 clients of rehabilitation centres in Belgium looked at whether social support could protect against the worst effects of stigma. The researchers found that stigma reduced self-esteem whereas peer support increased it. However, for those people who suffered from low self-esteem caused by stigmatization peer support did not have a beneficial effect.

Verhaeghe, Mieke, Bracke, Piet and Bruynooghe, Kevin - Stigmatization and self-esteem of persons in recovery from mental illness: the role of peer support International Journal of Social Psychiatry 2008, 54(3), 206-218

Asperger's at break-time

60% of children with autistic spectrum disorders in England are educated in mainstream school settings. Although children with Asperger's syndrome are able to cope with the academic demands of school work they do less well with the social demands of school such as interaction with peers, understanding rules and codes of conduct and what to do at break or lunch times when they are left to their own devices. Children typically spend a third of their time at school and a third of their school day outside the classroom yet so far there has been very little research on the social integration of pupils with Asperger's in mainstream schools. A study of 57 secondary-school children in Sheffield and Rotherham found that children with Asperger's engaged in fewer social interactions during the school day (both in and out of lessons), spent break and lunch times inside in quieter, more closely adult supervised areas of the school, reported having fewer friends, were less physically active and were more likely to be the targets of bullying although they did have as good an attendance record as the other children.

Wainscot, Jennifer J. ... [et al] - Relationships with peers and use of the school environment of mainstream secondary school pupils with Asperger syndrome (high-functioning autism): a case-control study International Journal of Psychology and Psychological Therapy 2008, 8(1), 25-38

Working with patients who deliberately self-harm

Deliberate self-harm can include a wide range of behaviours such as cutting, biting, picking, burning, insertion or ingestion of objects. It is common to a range of mental-health problems and its prevalence rate is estimated at between 2-6% of the population. Deliberate self-harm has the strongest correlation of all risk factors for suicide with up to 2% of people who self-harm dying within the following year, rising to 7% after nine years. A qualitative study involving eight community psychiatric nurses found that they struggled to conceptualize self-harm behaviour and found working with people who self-harm stressful, particularly in terms of managing the emotional impact upon themselves and the boundaries of their professional responsibilities in relation to managing risk. The therapeutic relationship was seen as crucial and a variety of coping methods to manage the impact of the work - which had largely developed through 'on-the-job' experience - were described in the study.

Thompson, Andrew R., Powis, Jane and Carradice, Angela - Community psychiatric nurses' experience of working with people who engage in deliberate self-harm International Journal of Mental Health Nursing June 2008, 17(3), 153-161

Exercise, eating behaviour and quality of life

A study of 177 women in the American mid-West looked into the links between attitudes to exercise, eating-disordered behaviour and quality of life. The researchers found that a high level of guilt when exercise was missed was associated with 'markedly elavated' levels of eating disorder psychopathology and a significantly reduced quality of life. The combination of exercising solely for weight and shape and intense guilt after missing exercise was associated with very high levels of eating disorder psychopathology, comparable to those of individuals seeking specialist treatment.

Mond, Jonathan ... [et al] - 'Excessive exercise' and eating-disordered behaviour in young adult women: further evidence from a primary care sample European Eating Disorders Review May-June 2008, 16(3), 215-221

Prevention programmes for eating disorders

The number of girls and women affected by full-blown eating disorders remains quite small. Conservative estimates are 0.2% and 0.8% for anorexia, 1% for bulimia and 1-3% for binge eating disorder. However, a far larger proportion of girls have symptoms of disordered eating which can lead on to the development of an eating disorder with some studies showing a third of older girls and a quarter of younger (11-13) ones having problematic eating behaviour. There have been attempts to develop primary prevention programmes aimed at reducing risk factors and building up protective ones. One such programme - developed in Germany - is the Prima programme which uses standardized posters and guidelines and is delivered by trained female teachers either within the normal class schedule or as a separate workshop. The girls who took part in the course reported significant improvements in body self-esteem, figure dissatisfaction, knowledge and eating attitudes. The teachers who conducted the programme felt well qualified and were evaluated significantly positive by their students.

Berger, Uwe ... [et al] - Primary prevention of eating disorders: characteristics of effective programmes and how to bring them to broader dissemination European Eating Disorders Review May-June 2008, 16(3), 173-183

Friday, May 16, 2008

Kidnappers and reoffending

Kidnapping is a rare crime compared with other crimes of violence and few studies of kidnapping have been published in the UK or the USA. A study of all 7,362 people convicted of kidnapping between 1979 and 2001 looked at the reconviction rates of kidnappers. It found that kidnappers were more likely to be convicted of another kidnapping offence than rape or murder. Within 20 years 5% of kidnappers were convicted of another kidnapping offence, 2% of rape and 1% of murder. The number of previous kidnappings was a significant risk factor as was the age at first kidnapping. Kidnappers are 30 times more likely than the rest of the population to murder someone and four times more likely than sex offenders to kill people.

Liu, Jiayi, Francis, Brian and Soothill, Keith - Kidnapping offenders: their risk of escalation to repeat offending and other serious crime Journal of Forensic Psychiatry and Psychology June 2008, 19(2), 139-147

Arsonists' mental health

Little is known about the patterns of mental illness in arsonists and how these compare to other offenders. A Swedish study of 214 arsonists (155 men and 59 women) compared them to 2,395 other violent offenders. The researchers found that the most common diagnoses among arsonists were psychoses and substance abuse. Compared to other violent offenders arsonists were more likely to have learning disabilities and Asperger's syndrome. The pattern of psychological problems did not differ greatly between male and female arsonists.

Enayati, Jasmin ... [et al] - Psychiatric morbidity in arsonists referred for forensic psychiatric assesment in Sweden Journal of Forensic Psychiatry and Psychology, June 2008, 19(2), 139-147

Thursday, May 15, 2008

DoH report shows extent of stigma

Research by the Department of Health has found that there is still a considerable amount of prejudice and discrimination against people with a mental-health problem. 1 in 8 people would not want to live next door to someone with a mental illness, while nearly six out of ten people described a person with mental illness as 'someone who has to be kept in a psychiatric or mental hospital'. One third of people thought that those with mental-health problems should not have the same right to a job as everyone else. Seperate research by the mental-health charity Rethink found that 9 out of 10 people with mental-health problems had been affected by stigma and discrimination with two-thirds saying that they had stopped doing things because of other people's prejudice.

You can find out more about this research at

Teenagers, dope and depression

Teenagers suffering from depression sometimes use alcohol, cigarettes and illegal drugs to alleviate their negative feelings. Depressed teenagers are more than twice as likely than non-depressed teenagers to use cannabis and other illegal drugs. However, by using cannabis to 'self-medicate' they could be making the situation worse. Teenagers who smoke cannabis at least once a month are three times more likely to have suicidal thoughts than non-users and cannabis use has also been linked to an increased risk of schizophrenia and psychosis.

Men and women, stress and alcohol

Women and men tend to respond to stress in different ways. Women are more likely than men to focus on the negative emotional aspects of stressful circumstances, thinking over and over again (ruminating) about their negative emotional state whereas men tend to try and distance themselves from negative emotions and not think about them. Researchers at Yale University exposed 54 healthy social drinkers (27 men and 27 women) to stressful imagery then assessed their emotions, physiological responses and alcohol cravings. They found that the women experienced greater sadness, anxiety and physiological arousal than the men. However, for the men an increase in physiological arousal was associated with an increase in alcohol craving. These findings are consistent with earlier research and raise the concern that if this response becomes a pattern in men it could lead on to alcohol problems.

You can find out more about this research at

Education and Alzheimer's

People who have spent longer in education may have a lower risk of developing neuro-degenerative disorders such as Alzheimer's, Parkinson's and dementia. A U.S. study which followed 7,000 people over 70 for seven years found that a 70-year-old with at least 12 years of education can expect to live 14.1 more years without cognitive impairment, two-and-a-half-more years more than someone who left school at 16. Better-educated people also spend less time at the end of their lives suffering from cognitive impairment - 1 year as opposed to 19 months - than less well-educated ones. However, better-educated people were more likely to suffer from severe cognitive impairment - memory loss, loss of language, disorientation etc - and were at a higher risk of dying after developing mental decline.

You can read more about this research at

Anti-inflammatories and Alzheimer's

Some scientists think that inflammatory processes may be involved in the development of Alzheimer's disease. This has raised hopes that anti-inflammatory drugs may help to prevent the development of the condition. A study of 2,117 people who were all over the age of 70 and who all had a family history of Alzheimer's disease divided them up into three groups. Two of the groups took anti-inflammatory drugs - celecoxib and naproxen - while the third group took a placebo. At the end of the 30-month trial the study found that the anti-inflammatories had no effect on cognitive function while naproxen may have had a detrimental effect.

You can read more about this research at

Adolescent depression in the U.S.

A U.S. study of 67,706 children between the ages of 12 and 17 has revealed alarmingly high levels of depression. Overall 8.5% of the sample had experienced a major depressive episode although there were 'striking differences' by sex with 12.7% of girls and 4.6% of boys being affected. Nearly half of the adolescents experiencing major depression said that it severely impaired their ability to function in at least one of the four areas of home life, school/work, family relationships and social life. Adolescents reporting the most serious impairment said that they were unable to carry out normal activities on an average of over 58 days in the past year. The survey was carried out using the criteria in the Diagnostic and Statistical Manual (DSM) but as it was carried out by survey takers not mental-health professionals it may have overestimated the extent of the problem.

You can find out more about this research at

Depression, anger and life changes in graduates

A seven-year study by researchers at the University of Alberta tracked 600 college graduates, aged between 20 and 29, measuring their levels of depression and anger and seeing how they were affected by changing life circumstances. The graduates showed a significant decrease in depression and anger over the course of the study. Younger participants were more depressed at times when they lived on their own while older participants were more depressed when they lived with their parents. While home was a haven for younger adults the longer people stayed at home, or if they returned home, the more likely they were to experience symptoms of depression. Women were more depressed and angry at the start of the study than men. Becoming a parent led to an increase in anger as people struggled to come to terms with the demands of parenthood.

You can find out more about this research at

Anxiety and insomnia

Insomnia and anxiety often go hand-in-hand. Studies have shown that around ten per cent of the population suffer from insomnia and of these people 80% have other mental or physical health problems. A U.S. study looked into the effectiveness of the anti-insomnia drug Lunesta in conjunction with the anti-depressant escitalopram at treating people with both insomnia and generalized anxiety disorder. The study found that patients who took both drugs showed improvements in measures of sleep and anxiety.

You can find out more about this research at

Wednesday, May 14, 2008

Internet gambling - worse than the traditional way?

Modern-day gambling is a very profitable business with many different and varied new ways to take part in gambling activities such as gambling via the Internet, mobile phone and interactive television. All over the world there has been a major shift by governments towards deregulation of the gambling industry which has taken gambling out of traditional gambling environments and has led to increases in access and opportunity to gamble remotely. A study of 473 students in the U.K. found that men were significantly more likely to be Internet gamblers than women, that Internet gamblers were significantly more likely to be problem gamblers than traditional gamblers and that men were more likely to be problem Internet gamblers. The researchers pointed out that Internet gambling was more likely to create problems because of its increased number of opportunities, its convenience, its 24-hour access and flexibility and the smaller intervals between gambles.

Griffiths, Mark and Barnes, Andrew - Internet gambling: an online empirical study among student gamblers International Journal of Mental Health and Addiction April 2008, 6(2), 194-204

Lifestyle and depression in older adults

A five-year study of 526 older men, between the ages of 70 and 89 in France, Italy and Holland looked into some of the links between diet and lifestyle factors and late-life depression. 11% of the men developed depression over the course of the study. The risk factors for depression at the five-year follow-up included already being depressed at the start of the study and a fall in cholesterol levels. Things that protected against later-life depression included physical activity and moderate alcohol intake

Bots, Sinnika ... [et al] - Lifestyle and diet-related factors in late-life depression: a five-year follow-up of elderly European men - the FINE study International Journal of Geriatric Psychiatry 2008, 23(5), 478-484

Depression and functional problems in older people

Depression is among the most common health problems in older people, particularly those in long-term care. Some studies have found up to 65% of people in old people's homes reporting symptoms of depression. Given the influence of depression on physical health and quality of life and the growing number of people in long-term care understanding the factors associated with depression in residential homes is important. Functional difficulties (the inability to do things) have often been associated with depression but it is unclear which particular difficulties have the greatest influence. A Czech study of 308 older adults in residential facilities measured people's cognitive function, general ability to perform basic activities of daily living, mobility and functional limitation by pain. The researchers found that cognitive function and functional limitation by pain were most strongly associated with depressive symptoms although the other functional difficulties also led to an increased risk for depression.

Vankova, Hana ... [et al] - Functional status and depressive symptoms among older adults from residential care facilities in the Czech republic International Journal of Geriatric Psychiatry 2008, 23(5), 466-471

What therapists and patients value in eating disorder treatment

A study by researchers in Holland looked into what factors therapists and patients considered to be important in the treatment of eating disorders. The study surveyed 73 therapists working with people with eating disorders, 156 current eating-disorder patients and 148 former eating-disorder patients. Both therapists and patients most often mentioned focus of treatment, therapeutic alliance and communication skills as important aspects of the quality of treatment. However, therapists valued the focus on eating-disorder symptoms and behavioural change more highly, whereas patients emphasised the importance of the therapeutic relationship and addressing underlying problems.

Rie, Simone de la ... [et al] - The quality of treatment of eating disorders: a comparison of the therapists' and the patients' perspective International Journal of Eating Disorders 2008, 41(4), 301-306

What is a healthy weight for adolescent anorexics?

Anorexia nervosa usually has its onset in adolescence, a time which is already characterized by marked changes in height and body weight. Weight restoration is an important early goal in the treatment of anorexia and is accompanied by a reversal of the medical complications of the disease and improved mood, and is felt by many to be necessary for psychotherapy to be effective. However, there is a lack of consensus as to how to determine treatment goal weight in the growing adolescent when both height and weight are changing as part of normal development. Some people use the reappearance of periods as an indicator of return to health and researchers in the U.S. followed 56 adolescent girls, between the ages of 12 and 19 over a three-month period to see at what body mass index (BMI) their periods returned. They concluded that this was at a BMI between the 14th and 39th percentiles (see the link to Wikipedia for an explanation of percentiles) and recommended that this be used as a treatment goal weight.

Golden, Neville H. ... [et al] - Treatment goal weight in adolescents with anorexia nervosa: use of BMI percentiles International Journal of Eating Disorders 2008; 41: 301-306

Personality disorders and problem gambling

The role played by personality disorders in other addictions has encouraged researchers to conduct studies into the links between personality disorders and pathological gambling. A Spanish study compared 50 pathological gamblers, 50 people being treated for other addictions and 50 other unaffected people. 32% of pathological gamblers showed a personality disorder, compared to 16% of the other addicts and 8% of the general population. The most common disorders were borderline personality (16%) followed by antisocial, narcissistic and non-specified personality disorders (8% each).

Echeburua, Enrique and Fernandez-Montalvo, Javier - Are there more personality disorders in treatment-seeking pathological gamblers than in other kinds of patients? A comparative study between the IPDE and the MCMI International Journal of Clinical and Health Psychology 2008, 8(1), 53-64

Agoraphobia and virtual reality

Agoraphobia has been described as the most complex phobia, the one most difficult to treat and the phobia that produces the highest level of incapacity. Phobias are often treated by a gradual exposure to the situation or thing that people are afraid of but this can sometimes be logistically, economically or psychologically impossible. There has been an increasing interest in virtual reality exposure, used in conjunction with cognitive behaviour therapy (CBT) but its results in agoraphobia are unclear or inconsistent. A team of Spanish researchers compared virtual reality exposure plus CBT with traditional CBT. Both groups showed a significant improvement which was maintained three months later. The virtual reality group showed a slight amelioration in symptoms relative to the CBT group.

Penate, Wenceslao ... [et al] - The effects of a treatment based on the use of virtual reality exposure and cognitive-behavioral therapy applied to patients with agoraphobia International Journal of Clinical and Health Psychology, 2008, 8(1), 5-22

Tuesday, May 13, 2008

Antidepressants and birth problems

Exposure to serotonin reuptake inhibitor (SRI) antidepressants late in pregnancy has been associated with an increased risk of lower birth weight, respiratory distress, seizures, jitteriness and irritability in up to 30% of exposed infants, compared with early prenatal exposure. A Canadian study of 3,500 women and their babies looked into the links between the timing of prescription of SRIs and problems with the babies. The study found that it was the length of time the women had been taking the drugs rather than the timing of the prescription that was linked to an increased risk of neonatal respiratory distress, low birth weight and reduced gestational age. The link remained the same, even allowing for maternal illness and medication dose.

Oberlander, Tim F. ... [et al] - Effects of timing and duration of gestational exposure to serotonin reuptake inhibitor antidepressants: population-based study British Journal of Psychiatry May 2008, 192(5), 338-343

Antipsychotics and unborn children

Little is known about the effects of exposure in the womb to antipsychotic drugs. The risks of antipsychotics in pregnancy are an important issue, since schizophrenia and bipolar disorder commonly have an onset in women during the reproductive years. A study of 108 mothers taking typical, atypical and no antipsychotics found that those taking atypical antipsychotics had larger babies. This can be a problem as excessively-large babies can cause vaginal lacerations, post-partum haemorrhages and a higher probability of emergency Caesareans in mothers and can themselves suffer from birth trauma, shoulder dystocia and foetal hypoxia and obesity and diabetes in later life. Those women taking older, typical antipsychotics had smaller than average babies which can also be a risk factor for problems in later life.

Newham, James J. ... [et al] - Birth weight of infants after maternal exposure to typical and atypical antipsychotics: prospective comparison study British Journal of Psychiatry May 2008, 192(5), 333-337

Thursday, May 08, 2008

What works for childhood OCD

Obsessive-Compulsive Disorder (OCD) affects approximately one in a hundred children. It can substantially disable children's functioning at home, at school and with peers and can increase the risk of psychological problems in adulthood including continuing OCD, clinical anxiety and depression, personality disorders and social maladjustment. A review into treatments for childhood OCD has found that cognitive-behaviour therapy (CBT) and pharmacotherapy were the only effective treatments for the condition with CBT being more effective than pharmacotherapy.

Watson, Hunna J. and Rees, Clare S. - Meta-analysis of randomized controlled treatment trials for pediatric obsessive-compulsive disorder Journal of Child Psychology and Psychiatry May 2008, 49(5), 489-498

Interventions to improve school readiness

School readiness includes the concepts of emotional self-regulation, social competence and family-school involvement as well as the absence of behaviour problems. It plays an important role in young children's future social adjustment and academic success. Coming from a deprived background can lead to children becoming lacking in school readiness; not being able to control their emotions, having fewer social skills, a lack of parent-school involvement and behaviour problems. A number of interventions have been developed to address these problems and one of them is the Incredible Years programme. This has two elements; Teacher Classroom Management and the Child Social and Emotional Curriculum (Dinosaur School). A study of 153 teachers and 1,768 pupils divided them up into two groups with one taking part in the programme and the other being a control group. The study found that those schools which had taken part in the programme used more positive classroom management strategies, their students showed more social competence and emotional self-regulation and they had fewer conduct problems. The teachers who took part in the programme were more involved with the children's parents and satisfaction with the programme was very high.

Webster-Stratton, Carolyn, Reid, M. Jamila and Stoolmiller, Mike - Preventing conduct problems and improving school readiness: evaluation of the Incredible Years Teacher and Child Training Programs in high-risk schools Journal of Child Psychology and Psychiatry May 2008, 49(5), 471-488

Traditional dress and mental health

A study of White British and Bangladeshi schoolgirls aged between 11 and 14 has found that Bangladeshi girls who wear traditional clothing have a lower risk of developing mental health problems. The researchers speculated that a traditional upbringing might include greater religious adherence and less exposure to unfamiliar, culturally-challenging life events.

Bhui, K. ... [et al] - Cultural identity, clothing and common mental disorder: a prospective school-based study of White British and Bangladeshi adolescents Journal of Epidemiology and Community Health 62, 435-441

Weighted blankets

Weighted blankets are used in acute mental health care settings for crisis intervention. They give the feeling of a firm hug, holding, swaddling or massage and facilitate the ability to feel safe, comforted and grounded in the world. A study of 32 people by researchers in the U.S. measured their blood pressure, pulse rate and electrodermal activity (which is used by lie detectors to measure stress) while they were using a weighted blanket. The study showed that the weighted blankets were safe and produced a reduction in electrodermal activity. 63% of the sample reported lower anxiety after use and 78% said it had made them feel more relaxed.

Mullen, Brian ... [et al] - Exploring the safety and therapeutic effects of deep pressure stimulation using a weighted blanket Occupational Therapy in Mental Health 24(1), 65-89

Fitness to drive and mental-health problems

Mental health problems are characterized by alterations in thinking, attention, concentration, decision-making abilities, mood and behaviour and can have far-reaching effects on a person's ability to function. One such effect is on people's ability to drive and a review of the literature looked into fourteen studies on this to weigh up the evidence. In eight of the studies mental illness was linked to higher traffic accident rates. Some psychotropic drugs had the potential to affect fitness to drive, especially in the starting phase of treatment or when adjusting medications. SSRIs (Serotonin Specific Reuptake Inhibitors) improved some of the skills needed for driving. Newer antipsychotic drugs improved cognitive skills but these improvements did not translate into driving-related skills.

Menard, Ingrid and Korner-Bitensky, Nicol - Fitness to drive in persons with psychiatric disorders and those using psychotropic medications: a systematic review Occupational Therapy in Mental Health 24(1), 2008, 47-64

Wednesday, May 07, 2008

Computerised CBT for drug users

Cognitive behavioural therapy (CBT) concentrates on teaching skills and strategies to help people change behaviour patterns and has proven to be effective in treating a wide variety of psychiatric disorders. However, there is often a shortage of trained CBT practitioners so attention has shifted to new ways of delivering CBT, including by computer. A U.S. study of 77 drug users compared the effectiveness of traditional counselling to that of psychotherapy, supplemented by computer-assisted CBT. The computer-assisted therapy programme consisted of text, audio and videotaped examples designed to help the user learn new ways of avoiding the use of drugs and changing other problem behaviours. The participants who received computer-assisted training had significantly fewer positive drug tests at the conclusion of the study.

You can read more about this research at

Risk factors for Alzheimer's in men and women

A French study of 7,000 people over the age of 65 looked into the risk factors for Mild Cognitive Impairment (MCI) which can develop into Alzheimer's disease. Men with MCI were more likely to be overweight, diabetic and to have had a stroke and men who had had a stroke were almost three times as likely to progress from MCI to Alzheimer's. Women with MCI were more likely to be in poorer general health, disabled, suffering from insomnia and to have a poorer support network. Women unable to perform routine daily tasks, which would allow them to live without assistance, were 3.5 times as likely to progress to Alzheimer's and those who were depressed were twice as likely to do so. Stroke was not a risk factor for women, despite a similar rate of occurence in both sexes.

The research was published, ahead of print, in the Journal of Neurology, Neurosurgery and Psychiatry

Parent's mental health and autistic children

A Swedish study of 32,162 children born between 1977 and 2003 has found that parents with autistic children were roughly twice as likely to have been hospitalized for a mental disorder as those whose children were not autistic. The link between autism and a parent's hospitalization for a mental disorder, such as depression or schizophrenia, was present regardless of the timing of the parent's diagnosis relative to the child's. Mothers and fathers diagnosed with schizophrenia were about twice as likely to have a child diagnosed with autism. The mothers of autistic children had higher rates of depression and personality disorders.

You can read more about this research at

Illness, disability and treatment : WHO has the answers

A major study by the World Health Organization (WHO) into illness, disability and treatment has found that mental illnesses are under-treated compared to physical illnesses even though respondents more often attributed their disability to a mental disorder. The study took place in 15 countries and surveyed 73,441 people. The researchers measured treatment sought and received for both physical and mental disorders and assessed the level and type of disability attributed to them by respondents. They measured the impact of illness and disability on home management, ability to work, social life and close personal relationships. Participants generally attributed more of their disability to a mental, rather than a physical, disorder and the higher levels of disability associated with mental disorders was much more pronounced in social and personal relationships than in productive roles, such as work and housework. The study also found that the proportion of people receiving treatment was much lower for mental than for physical disorders. This was apparent in the high-income countries which took part in the survey (Belgium, France, Holland, Germany, Italy, Spain, Japan, the U.S. and New Zealand) and was even worse in the low-income countries (Colombia, Lebanon, China, South Africa and the Ukraine).

You can read more about this research at

Bipolar disorder: under-diagnosis or over-prescribing

Much attention has been given to the problem of under-diagnosis of mental health problems leading to people not being given the treatment they need. However, a U.S. study of 700 people has suggested that over-diagnosis may be just as big a problem. The study, of 700 psychiatric outpatients, found that 145 of them had previously been diagnosed with bipolar disorder. However, when the researchers assessed them with the Structured Clinical Interview for DSM-IV (SCID), considered to be the most reliable diagnostic tool, fewer than half of them met the criteria for bipolar disorder. The researchers pointed out that over-diagnosis could lead to patients being unecessarily exposed to the side effects of mood-stabilizing drugs on the renal, endocrine, hepatic, immune and metabolic systems.

You can find out more about this research at

Antipsychotic use soars in children

Research comparing the prescription rates for antipsychotic drugs for children in the U.K. and the U.S. has found rates soaring in both countries. The drugs were prescribed at a rate of 4 per 10,000 children in 1992 but this had increased to 7 per 10,000 by 2005. In the U.S. the rate of prescription increased from 23 per 10,000 in 1996 to 45 per 10,000 in 2001. Most of the drugs were not officially approved for children but they were used to treat autism and attention deficit disorder. Side effects of the drugs can include weight gain and heart problems and there is little long-term evidence that the drugs are safe.

You can find out more about this research at

Adoption and mental-health problems in adolescence

In addition to 'domestic' adoption worldwide approximately 40,000 children per year are moved between 100 countries through adoption. Despite the popularity of adoption there is a persistent concern that adopted children may be at heightened risk of mental health or adjustment problems. Researchers at the University of Minnesota in the U.S. studied 1,232 adolescents (11-21) comparing those who had not been adopted, those who had been 'internationally' adopted and those who had been adopted from within the U.S. Being adopted approximately doubled the risk of attention deficit disorder and oppositional defiant disorder. Compared to international adoptees domestic adoptees had higher odds of having a disruptive disorder. However, international adoptees were at higher risk of major depressive disorder and separation anxiety disorder.

You can find out more about this research at

Tuesday, May 06, 2008

Engaging young offenders with services

Mental-health problems are at least three times more prevalent among young offenders than in the rest of the population. Studies have found high levels of depression, behavioural problems, hyperactivity and substance abuse among young offenders and almost a third of young offenders in the UK have a mental-health problem. The ART (Adolescent Resource and Therapy) service in Lewisham is an assertive outreach service that provides therapeutic help for young offenders and young people at risk of offending. Its clients are aged between 10 and 18 and have typically been exposed to multiple risk factors for both offending and mental ill health. A study of clients and ex-clients of the service found that the majority of them believed it had helped them to some extent. The five factors which had helped to overcome clients' initial reluctance to use the service were: (i) a manner which demonstrated respect and commitment (ii) being able to operate flexibly and offer outreach appointments (iii) clinical effectiveness (iv) making therapeutic sessions seem personally relevant and (v) explaining clearly the role of the service.

Naylor, Chris, Lincoln, John and Goddard, Nick - Young people at risk of offending: their views on a specialist mental health service in South East London Clinical Child Psychology and Psychiatry April 2008, 13(2), 277-286

Autonomy, adolescence and AIDS : what is the impact on adolescent caregivers?

Autonomy has been defined in a number of ways: the process of becoming a self-governing person; development of a sense of individuation; the ability to give direction to one's own life by defining goals, feeling competent and being able to regulate one's own actions; and freedom to carry out actions on one's own behalf while maintaining appropriate connections to significant others. The development of autonomy is seen as a crucial part of adolescence but it can be affected by a number of different factors, among which is parentification. Parentification is the term given to what happens when a child ends up looking after a parent, assuming adult roles that the parent can no longer perform and taking on some of the caregiving of an ill parent. Research into the effects of parentification has been inconclusive and researchers in the U.S. studied 108 children whose mothers had HIV. The researchers found that children with greater attachment to their mothers had higher autonomy, whilst children who drank or used drugs had lower autonomy. Attachment to peers was associated with higher autonomy. Those children who had taken on more responsibility for caretaking roles because of their mother's illness showed better autonomy development in early and middle adolescence.

Murphy, Debra A. ... [et al] - Early and middle adolescents' autonomy development: impact of maternal HIV/AIDS Clinical Child Psychology and Psychiatry April 2008, 13(2), 253-276