Thursday, July 31, 2008

Brain activity in OCD

Obsessive-compulsive disorder (OCD) is a debilitating condition that affects 2-3% of the population at some point in life. Patients suffer from recurrent intrusive thoughts (obsessions) that are distressing and hard to get rid of such as fears of contamination or that something horrible will happen to a loved one. Sufferers then engage in repetitive rituals designed to neutralise these thoughts (compulsions) including obsessive hand-washing and checking. Scientists at Cambridge University attempted to find out which parts of the brain are affected in OCD. They studied 40 people, 14 of them were healthy and had no family history of OCD, 14 had OCD and 12 were immediate relatives of OCD patients. They gave the participants a learning task and monitored their brains using functional magnetic resonance imaging (fMRI). The OCD participants and their family members all showed under-activation in an area of the brain called the lateral orbital frontal cortex which is involved in decision making and behaviour.

You can find out more about this research at

Topiramate for alcohol abuse

A 14-week trial by researchers at the Medical University of South Carolina on 371 male and female alcoholics looked into the effectiveness of the drug topiramate and found that as well as decreasing heavy drinking it also had a number of other health effects. Treatment with the drug was found to lower liver enzymes, cholesterol, body mass index and blood pressure all of which have been associated with heart disease. Topiramate also significantly contributed to a decline in obsessive thoughts and compulsions and led to an improvement in quality of life and a reduction in sleep disturbances. Topiramate is licenced to treat headaches and migraine by the U.S. Food and Drugs Administration but not yet for the treatment of alcoholism.

You can find out more about this research at

Injections for Alzheimer disease

Tumour necrosis factor-alpha (TNF-alpha) is a critical component of the brain's immune system and normally finely regulates the transmission of neural impulses in the brain. Elevated levels of TNF-alpha in the brains of people with Alzheimer disease could interfere with this regulation so researchers injected a drug called etanercept into Alzheimer sufferers. Family members, neurologists and other independent observers all noticed a rapid and significant improvement in people's language abilities after the injection.

You can find out more about this research at

Deep-brain stimulation and depression

Deep-brain stimulation is a new treatment that can be used when antidepressants, psychotherapy and even electro-convulsive therapy (ECT) have failed to work. It uses high-frequency electric stimulation targeted at specific areas of the brain. A study of 20 patients by scientists at the University of Toronto and Emory University School of Medicine implanted two, thin wire electrodes (one on each side of the brain) into the white matter of the patients' brains near to the subcallosal cingulate region which has been implicated in depression. The researchers regulated the intensity of the current according to the response of the patient. 12 of the 20 patients experienced a significant decrease in depressive symptoms after six months, with 7 of them being fully recovered. The benefits were still there after a year and no long-term side effects were reported.

You can find out more about this research at

Hearing and dementia

Central auditory processing dysfunction is the inability to pick out sounds among other noise - such as conversation at a party - even though one's hearing is normal in other circumstances. Researchers at the University of Washington, Seattle, studied 313 people, with an average age of 80, who had been participating in a dementia surveillance programme since 1994. 17 had dementia, 64 had mild memory impairment and 232 had no memory problems. Participants completed three tests designed to measure central auditory processing; one in which nonsense sentences were read out over the top of an interesting narrative and two involving different numbers and sentences being read into each ear simultaneously. The average scores were significantly lower in the people with dementia and mild memory impairment even when age and hearing status were allowed for.

You can find out more about this research at

PTSD, pain and depression

A study of 241 people by researchers at the University of Michigan looked into the links between post-traumatic stress disorder (PTSD), depression and chronic pain. The results showed that PTSD and depression were significantly correlated and that both disorders were associated with perceived disability attributed to chronic pain. The authors concluded that increased attention to treating PTSD in the rehabilitation of trauma victims is important when prior treatment for pain and depression has not been successful.

You can find out more about this research at

Values and motivation to change

Writing about important values can make people feel better and more receptive to advice according to researchers at the University of California, Santa Barbara. In one study the researchers asked participants to rank six values - social life, religion/morality, science, business, arts and government - in order of importance. One group later wrote for ten minutes about why their most important value was important to them and the other group wrote about why their least important value might be important to others. The second study followed the same procedure but some of the participants were smokers and all the participants later read an article about the health effects of smoking. In both studies those who wrote about an important value felt more loving and connected and in the second study those smokers who wrote about an important value were less defensive and more accepting of the content of the article. The researchers thought that writing about what they loved and cared for enabled people to transcend the self and could help foster learning under difficult circumstances; something that might prove useful in the treatment of addictive behaviours.

You can find out more about this research at

Diet and mental health

A review of previous studies has found that diet can have a major effect on our mental as well as our physical health. Omega-3 fatty acids, found in oily fish, walnuts and kiwi fruit, helped learning and memory and helped fight against mental-health problems such as depression and mood disorders, schizophrenia and dementia while deficiencies in omega-3 led to an increased risk of attention-deficit disorder, schizophrenia, dyslexia, dementia, depression, bipolar disorder and schizophrenia. Children who were given increased amounts of omega-3 performed better in school, in reading and in spelling and had fewer behavioural problems. Folate deficiency was also found to lead to neurological disorders such as depression and cognitive impairment.

You can find more about this research at

Drugs, genes and depression

Antidepressants are the most prescribed medicine in the U.S. with about 10% of adults taking prescription medication for depression. However, studies show that less than 50% of people treated for depression experience complete remission of their symptoms. Pharmacogenetics is the study of how people's genes interact with their medication and a U.S. study of 1,914 people looked into how people's genetic make-up affected the effectiveness of the antidepressant citalopram. The researchers found that White patients with a variation in the serotonin transporter gene SLC6A4 were more likely to see a remission of their symptoms after treatment with citalopram; but there was no difference for Black and Hispanic patients.

You can find out more about this research at

Tuesday, July 29, 2008

Good and bad cholesterol and memory loss

Researchers from the French National Institute for Health and Medical Research and from University College, London have found that low levels of high-density lipoproteins (HDL or 'good' cholesterol) in middle age can increase the risk of memory loss and lead to dementia in later life. At 55 years old participants with low HDL cholesterol had a 27% higher risk of memory loss compared to those with high HDL. To raise HDL and lower low-density lipoproteins (LDL or 'bad' cholesterol) the American Heart Association recommends exercising regularly, eliminating hydrogenated fats from the diet, reducing saturated fats and eating more polyunsaturates.

You can find out more about this research at

Teachers diagnosing ADHD

For children to be diagnosed with ADHD the symptoms of the condition need to have been diagnosed at home and at school so teachers have a crucial role to play in the whole process. However, a review of referrals to the Child and Adolescent Mental Health Service (CAMHS) team in Tower Hamlets suggests that teachers may be over-identifying the condition. Of the 52 children referred to the CAMHS team by teachers 14 of them were considered sufficiently serious to warrant a school observation but of these only 5% were diagnosed with ADHD.

You can read more about this research at

Double trouble for parents of twins

A Spanish study compared the mental health of parents who had had twins with those of parents who had had just one baby. The study looked at those parents who had had twins 'naturally' and those who had had twins as part of an assisted-conception process. After birth the fathers of twins had more depression, anxiety, social dysfunction and sleeping problems than fathers of one baby. However, the mothers of babies produced by assisted conception had fewer symptoms of depression before birth than the mothers of twins conceived spontaneously, perhaps because they had had more counselling preparing them for having twins.

You can find out more about this research at

Infant nutrition and intelligence

People who were better nourished in infancy can score higher on IQ tests years later, regardless of the number of years they attended school. Between 1969 and 1977 Guatemalan children in four villages took part in a study on the effectiveness of nutritional supplements. Some were given atole - a protein supplement - while others were given a sugar drink called fresco. Between 2002 and 2004 1,448 participants were interviewed and given IQ tests. Individuals exposed to atole between 0-2 scored higher on tests of reading comprehension and cognitive functioning than the other children and this association remained significant after allowing for years of schooling.

You can find out more about this research at

Pregnancy and mental health

Pregnant women and those who have recently given birth are said to be vulnerable to mental-health problems. Mental-health problems in these women have been linked to poor maternal health, inadequate prenatal care and adverse outcomes for their children including abnormal growth and development, poor behaviour during childhood and adolescence and health problems. A U.S. survey compared 14, 549 women, aged between 18 and 50, who had been pregnant in the past year, to 28,544 other women asking them about mental-health problems, substance use and whether they had sought treatment. The women had significantly lower levels of alcohol use and - apart from major depression - a lower risk of mood disorders than women who had not been pregnant. Age, marital status, health status, stressful life events and a history of traumatic experiences were all significantly associated with a higher risk of psychiatric disorders in pregnant and post-partum women. Women who had been pregnant in the past year were less likely to seek help for psychiatric problems. Groups of women with a particularly high prevalence of psychiatric disorders were identified and these groups included women aged 18-25 living without a partner, widowed, separated, divorced or never married women and women who experienced pregnancy complications and stressful life events.

You can find out more about this research at

Monday, July 28, 2008

Dimebon for Alzheimer disease

Dimebon is an antihistamine that used to be popular in Russia before better alternatives became available. It is also a weak cholesterinase inhibitor, similar to certain drugs used to combat Alzheimer disease. A trial of Dimebon for mild-to-moderate Alzheimer disease found that patients treated for six months did significantly better on four separate measures of cognition, behaviour, and functioning than those given a matching placebo. Doctors' impressions of patients' progress were also significantly more favourable for those patients treated with Dimebon. Dry mouth and depression were the main side effects.

Lancet 2008: 372: 207-215

Friday, July 25, 2008

Low-secure units: outcomes and risk factors

A study of 86 patients admitted to a low-secure unit in S.E. London aimed to measure the effectiveness of treatment and to identify predictors of change. Significant improvements were found on the Health of the Nation Outcome Scales (HoNOS), the Staff Observed Aggression Scale (SOAS) and the Global Assessment Scale (GAS) and improvements on the GAS and HoNOS were associated with moves to a lower level of security. Patients with a history of conviction for property damage, cannabis use and who were admitted on a forensics section or who had a diagnosis of personality disorder were more likely to move to a higher level of security. Increased length of stay was related to the presence of physical assault, physical health problems and anxiety symptoms.

Beer, M. Dominic ... [et al] - Predicting outcome in low secure environments: a case series from one low secure unit Journal of Psychiatric Intensive Care December 2007, 3(2), 85-92

Thursday, July 24, 2008

IQ and vascular dementia

Vascular dementia occurs when the blood flow to the brain is impaired and is the most common type of dementia after Alzheimer's disease. A study of people in Scotland, who took an IQ test in 1932 when they were 11, has found that the people who went on to develop vascular dementia were 40% more likely to have low test scores when they were children than the people who did not develop dementia. However, there was not the same link between IQ and Alzheimer's disease. Risk factors for vascular dementia include high blood pressure, high cholesterol and smoking. The findings support the hypothesis that low childhood IQ acts as a risk factor for dementia through vascular risks rather than the "cognitive reserve" theory which says that greater IQ and education create a buffer against the effects of dementia in the brain allowing people with greater cognitive reserve to stay free of signs of dementia longer, even though the disease has started affecting their brains.

You can find out more about this research at

New tool helps to diagnose cognitive problems in older people

A new questionnaire developed by researchers in the U.S. could help with the early diagnosis of mild cognitive impairment and Alzheimer's disease. The Everyday Cognition questionnaire or ECog is made up of 39 questions and is filled out by someone who knows the affected person well. The questionnaire measures the same things as established tests and its results were found to agree with medical diagnoses. It was able to differentiate between people with no cognitive problems, those with mild cognitive impairment and those with Alzheimer's and its results did not appear to be strongly influenced by education as is the case with some other tests.

You can read more about this research at

Health benefits of relaxation

The relaxation response, which can be produced by practices such as meditation, deep breathing and prayer can not only alleviate the symptoms of psychological disorders, such as anxiety, but has also been found to affect heart rate, blood pressure, oxygen consumption and brain activity. Now researchers from the U.S. have found that it can also affect the way in which genes work. The study compared trained practitioners of relaxation techniques with inexperienced controls who then underwent training in relaxation. The study showed that the relaxation response altered the expression of genes involved with processes such as inflammation, programmed cell death and free radicals. The changes in gene expression were the opposite to those produced, to harmful effect, in conditions such as post-traumatic stress disorder.

You can find out more about this research at:

Anorexia or just a phase?

Eating-related problems are common in adolescence and tend to be temporary. But in about 10% of cases adolescents continue with their disordered eating patterns increasing the risk of a serious eating disorder. A two-stage study of 15-17 year olds in Finland asked them about their eating patterns at the start of the study and then again a year later. 11% reported symptoms of an eating disorder at the start of the study and 12% did so a year later. 5% reported eating problems at both time points and of these children 84% were girls. There were higher rates of psychological problems and more mental health complaints in those who reported symptoms at both time points and an increased level of anxiety about, and dissatisfaction with bodily appearance. Those who only reported symptoms at one time point also had higher rates of psychological problems and more health complaints than those with no symptoms.

Hautala, L. ... [et al] - Adolescents with fluctuating symptoms of eating disorders: a one-year prospective study Journal of Advanced Nursing 62(6), 674-680

Wednesday, July 23, 2008

Theory of mind in schizophrenia

Theory of mind is defined as 'the ability to attribute mental states (such as beliefs, intentions, desires, goals etc) to self and others and to appreciate that behaviours are guided by these mental states.' Theory of mind is known to be deficient in people with schizophrenia and a study of 31 people in the U.S. used brain scans to compare what went on in people's brains when they were using theory of mind. Two groups - one with schizophrenia and a healthy control group were asked to attribute mental states to characters in a story of their own creation. Compared to the control group the people with schizophrenia had a lower flow of blood in parts of the left hemisphere of the brain including the frontal and visual association cortices, the posterior hippocampus and the insula. However, they had a higher blood flow in the right hemisphere - including the multiple frontal and parietal regions, the insula, the visual association cortex and the pulvinar - suggesting that they were using this part of the brain to compensate.

Andreasen, Nancy C., Calage, Chadi A. and O'Leary, Daniel S. - Theory of mind and schizophrenia: a positron emission tomography study of medication-free patients Schizophrenia Bulletin July 2008, 34(4), 708-719

Imitation limitations in schizophrenia

People with schizophrenia often have problems relating to other people. One of the ways we learn how to do this is through imitation and a U.S. study of 36 people compared the ability of people with schizophrenia and healthy controls to imitate a variety of gestures and expressions. The participants with schizophrenia were significantly impaired on all imitation tasks. Errors in imitation were significantly correlated with reduced social competence and increased negative symptoms but not with deficits in working memory.

Park, Sohee, Matthews, Natasha and Gibson, Crystal - Imitation, simulation and schizophrenia Schizophrenia Bulletin July 2008, 34(4), 698-707

Psychiatrists fall down on basic medical care

Mental disorder and physical health are very closely linked. Physical illness can manifest itself as psychiatric disturbance while psychiatric patients have high rates of physical illness, much of which goes undetected. Psychiatric drugs can also have serious physical side effects which need careful monitoring. A survey of 50 outpatients and 50 inpatients in Solihull, West Midlands, found that while 80% of the inpatients had had routine blood tests only 6% of the outpatients group had. 62% of the inpatients group received a full physical examination whereas none of the outpatients had had one. The survey also found a poor level of record keeping in particular where physical examinations or investigations were omitted.

Dale, Jenny, Sorour, Eman and Milner, Gabrielle - Do psychiatrists perform appropriate physical investigations for their patients? A review of current practices in a general psychiatric inpatient and outpatient setting Journal of Mental Health June 2008, 17(3), 293-298

Advanced directives and coercive interventions

Psychiatric advanced directives (PADs) provide a legal means for competent people to refuse or consent to future mental health treatment during periods when they are incapable of making a decision. A major goal of the directives is to reduce coercive interventions during mental health crises but whether they can accomplish this in practice remains unclear. A study of 239 patients in the U.S. compared those who had filled out a PAD to those who had not and found out that those who had not filled out an advanced directive were twice as likely to have experienced a coercive intervention such as being picked up by the police, being committed, being placed in seclusion, being placed in restraints or receiving forced medication.

Swanson, Jeffrey W. ... [et al] - Psychiatric advance directives and reduction of coercive crisis interventions Journal of Mental Health June 2008, 17(3), 255-267

Monday, July 21, 2008


Cognitive behaviour therapy (CBT) has a comparatively strong level of empirical support as a treatment for a range of psychiatric disorders, including substance abuse. However, due to a lack of staff and resources CBT remains rarely implemented in the range of settings where individuals with substance use disorders are treated. Computer-assisted therapy could provide a comparatively low-cost method of teaching CBT skills to more substance users and a U.S. trial of 77 patients compared those using computer-based training for cognitive behaviour therapy (CBT4CBT) with those receiving standard treatment. Participants using CBT4CBT submitted significantly more negative urine samples and tended to have longer continuous periods of abstinence during treatment. The programme was positively evaluated by participants and completion of CBT4CBT homework asssingments was significantly correlated with outcome.

Carroll, Kathleen M. ... [et al] - Computer-assisted delivery of cognitive-behavioral therapy for addiction: a randomized trial of CBT4CBT American Journal of Psychiatry July 2008, 165(7), 881-888

Brain structure and depression

There have been many studies into the links between brain structure and depression. Particular emphasis has been placed on the limbic system, specifically the hippocampus and amygdala, which controls emotion and mood regulation. A U.S. study of 64 people compared people with depression, psychotic depression and healthy controls using brain scans to measure the size of their hippocampi and amygdalas. The researchers found that the participants with psychotic depression had smaller amygdalas than those with depression and the control group whose amygdalas were of similar size. The smaller people's amygdala the earlier was the age of onset of their psychotic depression.

Keller, Jennifer ... [et al] - Hippocampi and amygdalar volumes in psychotic and nonpsychotic unipolar depression American Journal of Psychiatry July 2008, 165(7), 872-880

Hallucinations, ethnicity and social adversity

In Europe people from ethnic minorities are more likely to suffer from psychosis. This is thought to be due to social rather than biological factors as the rates of schizophrenia are increased in migrants from a wide variety of countries of origin, there is no increased incidence of schizophrenia in the countries people come from and it is unlikely that people predisposed towards psychosis would be more likely to emigrate from their country of origin. A Dutch study looked into the links between ethnicity, social adversity and people's experience of auditory and visual hallucinations as recent research suggests many people may experience these without developing full-blown psychosis. The study found that Turkish women, Moroccan men, Surinamese/Antilleans, Indonesians and other non-Western immigrants were all more likely to report hallucinations whereas Western immigrants, Turkish men and Moroccan women did not differ from their Dutch counterparts. Once social adversity was taken into account some, but not all of the increased incidence of hallucinations disappeared.

Vanheusen, K. ... [et al] - Associations between ethnicity and self-reported hallucinations in a population sample of young adults in the Netherlands Psychological Medicine August 2008, 38(8), 1095-1102

Schizophrenia and social capital

The more urban an environment people live in the greater their risk for schizophrenia and the link remains even when age, sex, ethnicity, family history of psychosis and cannabis use are taken into account. One factor which is thought to be important is social capital; the levels of civic participation, social networks and trust in an area. A survey of 16,459 people in South London looked into the links between schizophrenia and social capital. It found that areas with low and high socil capital both had increased levels of schizophrenia. The researchers thought that this might be because the low-social-capital areas had less support available to compensate for the stresses of urban living. The higher incidence of schizophrenia in the higher-social-capital areas could be either because even though there are lots of social networks and a healthy civic society certain people are excluded from them or that, because there are better social networks and a higher level of social support people are more likely to be steered towards medical services when they become ill.

Kirkbride, J. ... [et al] - Testing the association between the incidence of schizophrenia and social capital in an urban area Psychological Medicine August 2008, 38(8), 1083-1094

Thursday, July 17, 2008

Eating disorders in Australia and Singapore

It was once thought that eating disorders were more common in Western societies. However, recent research has found that eating disorders have long existed in other societies and their prevalence in non-Western countries is not significantly lower. A study of 154 women with and without an eating disorder compared levels of body dissatisfaction among North European Australians, East Asian Australians, Singaporean Chinese and North European expatriates in Singapore. Irrespective of cultural group the women with an eating disorder had similar levels of body dissatisfaction. Among those women without an eating disorder Singaporean Chinese had greater levels of body dissatisfaction than the other groups. Within each cultural group women with eating disorders had higher levels of body dissatisfaction than other women apart from the Singaporean Chinese women where there was no difference between those with and without eating disorders.

Soh, Nerissa Li-Wey ... [et al] - Body image disturbance in young North European and East Asian women with and without eating disorders in Australia and in Singapore European Eating Disorders Review July-August 2008, 16(4), 287-296

Eating disorders, personality and self-harm

Certain personality traits are though to predispose people towards eating disorders. Introversion, conformity, perfection and obsessive-compulsive behaviour have been associated with anorexia nervosa while impulsivity, low self esteem and antisocial personality traits have been associatd with bulima. Self-injurious behaviour is more common among people with eating disorders and a Swedish study of 115 people looked into the links between personality disorders, self-injurious behaviour and eating disorders comparing 38 people with eating disorders to 67 controls. Both the anorexic and bulimic patients had higher anxiety- and detachment-related traits than the control group and people with bulimia showed higher hostility. Anorexics scored lower than bulimics on scales measuring impulsivity, guilt and self-injurious behaviour was more frequent among bulimic patients.

Ahren-Moonja, Jennie ... [et al] - Personality traits and self-injurious behaviour in patients with eating disorders European Eating Disorders Review July-August 2008, 16(4), 268-275

Insomnia and inpatients

Sleep problems are common among psychiatric patients. A survey of 560 patients in the Netherlands found that 36% of them perceived themselves as having a sleep problem. The patients filled in the Pittsburgh Sleep Quality Index which found that 66% of them could be classified as bad sleepers. 49% of the sample used sleep medication one or more times a week.

de Niet, G.J. ... [et al] - Perceived sleep quality of psychiatric patients Journal of Psychiatric and Mental Health Nursing August 2008, 15(6), 465-470

Wednesday, July 16, 2008

Blood differences in people with schizophrenia

Schizophrenia is a severe and complex mental illness that affects about 1% of the population. Diagnosis currently relies on subjective clinical interviews and the assessment of ambiguous symptoms which frequently lead to delays in diagnosis and treatment. A physical method of diagnosing the condition would, therefore, be very useful. Researchers at Cambridge University looked to find a 'protein fingerprint' in the blood by comparing samples from those with and without schizophrenia. They found that those people with schizophrenia had raised levels of substances called alpha defensins which kill microbes and viruses as part of the immune system. The higher levels of alpha defensins were found in people who had recently been diagnosed with schizophrenia suggesting that this was not due to the drugs used to treat the condition or the disease itself. Unaffected twins of people with schizophrenia also had higher alpha defensin levels leading the researchers to speculate that this might point to a genetic link to the condition.

You can read more about this research at

Ground down down under

A huge Australian study of more than 60,500 people looked into the incidence and risk factors for workplace stress. The study found that nearly 5% of employees had high levels of psychological distress associated with a high likelihood of a mental disorder. With another 9.6% of people suffering from moderate psychological distress. Only 22% of the highly-stressed workers were currently receiving treatment, 29% admitted to having a problem but had not sought treatment while 31% denied having a problem. People who worked in sales and/or who were expected to work for more than 60 hours a week had the highest levels of stress. Working in non-traditional gender roles (i.e. women working as labourers and men working as secretaries) was also associated with more workplace stress as were marital separation and low levels of education.

You can read more about this research at

Diagnosing dementia

The most commonly used screening test for cognitive problems in older adults is the Mini Mental-State Examination (MMSE). The maximum score is 30 and a score of 24 or less is typically used to detect people with cognitive dysfunction. A study of 1,141 people carried out by researchers at Texas Tech University looked at the accuracy of the MMSE's diagnosis in people with dementia, people with mild cognitive impairment and healthy older adults. It found that for older adults who were better educated a cut-off point of 27 on the MMSE would provide a more accurate diagnosis of cognitive problems. Better-educated people tend to decline and die more quickly after being diagnosed with Alzheimer's so it is particularly important to pick up problems in this group.

You can find out more about this research at

Eye problems and suicide

Eye conditions that lead to physical impairment can have a number of psychological, social and health consequences including impaired activities of daily living, social isolation, mental impairment, increased dependency on others, increased car crashes, falls and fractures, depression and poor health. A study of 137, 479 people in the U.S. found that even after allowing for age, sex, race, marital status and other health problems visual impairment was still associated with a 50% increase in death by suicide (although this was not considered statistically significant by the researchers). When eye problems were combined with poor self-rated health and other medical conditions they were found to significantly raise the risk of suicide.

You can read more about this research at

Exercise and Alzheimer's

Keeping fit could help slow the progress of Alzheimer's disease according to researchers at the University of Kansas. 121 people aged 60 and over took fitness tests on a treadmill and had brain scans to measure their white matter, grey matter and total brain volume. 57 of the group were in the early stage of Alzheimer's disease while the rest were unaffected. Physical fitness had no effect on the brain in the healthy group but in those with early Alzheimer's people who were unfit had four times more brain shrinkage than fitter people.

You can read more about this research at

Stress and the immune system

It has long been known that stress can affect the immune system and now researchers at UCLA in the US have found out one of the ways in which this might happen. Every cell contains a tiny clock called a telomere, which shortens each time the cell divides. Short telomeres are linked to a range of diseases including HIV, osteoporosis and heart disease. When people experience stress the body boosts production of cortisol which helps with the 'fight or flight' response. Cortisol suppresses telomerase an enzyme which immune cells produce that maintains the length of their telomeres.

You can find out more about this research at

Tuesday, July 15, 2008

SSRIs and gastrointestinal bleeding

There is evidence that selective serotonin reuptake inhibitors (SSRIs) which are used as antidepressants can increase the risk of bleeding in the upper gastrointestinal tract. However, more research is needed and a UK study of 11,321 patients has found that SSRIs did increase the risk of gastrointestinal bleeding particularly when people were also using nonsteroidal anti-inflammatory drugs. However, using other acid-suppressing drugs reduced the risk of bleeding.

de Abajo, Franciso J. and Garcia-Rodriguez, Luis A. - Risk of upper gastrointestinal tract bleeding associated with serotonin reuptake inhibitors and venlafaxine therapy: interaction with nonsteroidal anti-inflammatory drugs and effect of acid-suppressing agents Archives of General Psychiatry July 2008, 65(7), 795-803

Early interventions for psychosis

Some people think that there is a critical period - just after people become ill with psychosis - in which the potential exists to intervene and improve the long-term course of the illness. However, there is no evidence that indicates how long early interventions need to be active to prevent a relapse or how long the effects last. A Danish study of 547 patients with first-episode psychosis compared a two-year, intensive, early-intervention treatment made up of assertive community treatment, family involvement and social-skills training to standard treatment. There was an improvement in the early-intervention group after two years but after five years there was no difference between the two group as far as symptoms were concerned. But fewer of the early-intervention group were living in sheltered housing and they had had fewer days in hospital over the 5-year period.

Bertelsen, Mette ... [et al] - Five-year follow-up of a randomized multicenter trial of intensive early intervention vs. standard treatment for patients with a first episode of psychotic illness Archives of General Psychiatry July 2008, 65(7), 762-771

Thursday, July 03, 2008

Suicide and occupation

There has been much research into the links between unemployment and suicide but much less into the proportional risk of different jobs. A UK study used mortality data from death certificates between 2001-2005. The highest risks, as a proportion of those employed in those jobs, were among health professionals and agricultural workers. Among women those working in administration or as secretaries had the highest numbers of suicides but the highest proportional risk was among health professionals and those working in sport and fitness.

Meltzer, Howard ... [et al] - Patterns of suicide by occupation in England and Wales British Journal of Psychiatry July 2008, 193, 73-76

Psychosis and ethnicity in East London

Raised rates of psychoses have been reported in immigrant groups since the 1930s and a recent analysis of over 40 studies found that the incidence of schizophrenia was, on average, nearly three times as high among immigrants than in the rest of the population. In the UK Black Caribbean and Black African groups have consistently been observed to have a higher rate of psychoses than other groups with conservative estimates suggesting a rate four to six times greater than the rest of the population. A study of 484 people suffering from psychosis in East London found that, even after socioeconomic status was taken into account, certain ethnic groups remained at more risk of developing psychoses. Black Caribbean were 3.1x more likely to develop psychosis, Black African 2.6x, Pakistani women 3.1x and Bangladeshi women 2.3x.

Kirkbride, J.B. ... [et al] - Psychoses, ethnicity and socio-economic status British Journal of Psychiatry July 2008, 193, 18-24

Self-esteem in the sandtray

Adolescence is a troublesome time for many people and adolescent girls tend to be more vulnerable than boys. In particular adolescent girls tend to have a lower self-esteem than boys; this is important as a high self-esteem is considered to be a protective factor for mental-health problems. Many girls between 11-14 are still in the concrete operational stage of development and often have difficulty in expressing their feelings adequately in words so group activity therapy may be more appropriate in this group. Group sandtray therapy is an intervention in which "group members build small worlds with miniature figures in individual trays of sand and share about their worlds as they are willing." Sessions are facilitated by a trained therapist who explores some of the psychological and interpersonal issues raised by participants. A U.S. study of 37 girls found that after nine sessions of sandtray therapy self-esteem was improved in the areas of: scholastic competence, social acceptance, physical appearance, behavioural conduct and global self-worth.

Shen, Yu-Pei and Armstrong, Stephen A. - Impact of group sandtray therapy on the self-esteem of young adolescent girls Journal for Specialists in Group Work June 2008, 33(2), 118-137

The cost of serious mental illness in the U.S.

Mental illness can often lead to a reduction in people's income. A U.S. survey of 4,982 people found that a serious mental illness in the previous 12 months significantly predicted reduced earnings. People with serious mental illness had 12-month earnings on average $16,306 less than other people. If replicated across the whole country this would cost $193.2 billion.

Kessler, Ronald C. ... [et al] - Individual and societal effects of mental disorders on earnings in the United States: results from the National Comorbidity Survey Replication American Journal of Psychiatry June 2008, 165(6), 703-711