Friday, November 28, 2008

Giving up grass: why US teenagers *don't* take dope

There has been a lot of research into why people start using cannabis and the consequences of their doing so but much less research into why people stop using the drug, or never start using it in the first place. A study of 82,106 U.S. high-school seniors found that: 50% of those reporting cannabis use in the last year felt that they should either stop completely or cut down. Among those saying that they would not use cannabis in the coming year the most frequently reported reasons were concerns about psychological and physical damage and not wanting to get high. The least frequently reported reasons were expense, concerns about having a bad trip and availability. Girls were more likely to focus on moral and behavioural concerns about cannabis whereas boys were more likely to focus on practical concerns such as the risk of arrest, loss of energy and ambition, expense and availability. Black and Hispanic students were significantly less likely than whites to note concerns about expense, personal beliefs or getting in with the wrong crowd but were more concerned about addiction.

Terry-McElrath, Yvonne, O'Malley, Patrick M. and Johnston, Lloyd D. - Saying no to marijuana: why American youth report quitting or abstaining Journal of Studies on Alcohol and Drugs November 2008, 69(6), 796-805

Gateway holds good in New Zealand

The gateway hypothesis holds that drug users start off with alcohol and tobacco, move on to cannabis and then on to other illegal drugs. People who depart from this sequence of drug use are thought to be at an increased risk of long-term dependence. However, the 'market' for illegal drugs has changed considerably since the gateway hypothesis was developed and researchers in New Zealand looked at a sample of 12,992 people to see if it still held true. Only 2.6% of the sample departed from the sequence of drug use outlined in the gateway hypothesis. Use of other illicit drugs before cannabis was the most common departure found in 2.3% of alcohol users, 3% of cannabis users, 8.6% of cocaine users and 16.7% for those who had used other illicit drugs. Use of other illicit drugs before cannabis was more predominant in younger cohorts and those with more early-onset anxiety and depression. Once all the other factors had been taken into account people who departed from the gateway sequence were no more likely to develop drug dependence. Depression, anxiety and early-onset bipolar disorder were all more likely to increase the risk of drug dependence.

Well, J. Elisabeth and McGee, Magnus A. - Violations of the usual sequence of drug initiation: prevalence and associations with the development of dependence in the New Zealand Mental Health Survey Journal of Studies on Alcohol and Drugs November 2008, 69(6), 789-795

IQ and murder rates

People with better qualifications, higher-powered jobs and higher incomes are known to be at less risk of being murdered. However, there have been no studies into whether intelligence per se affects one's likelihood of being killed. A Swedish study looked at a group of 968,864 men who had served as military conscripts between the ages of 18 and 19. The men had taken IQ tests as part of their medical assessment when they were conscripted and were tracked over the next 20 years. 191 of them were murdered. A high IQ score was associated with a halving of the risk of being murdered and the higher people's IQ was the lower their risk.

Batty, G. David ... [et al] - IQ in early adulthood and later risk of death by homicide: cohort study of 1 million men British Journal of Psychiatry 193(6), 438-443

Suicide and bereavement

It is estimated that one person in the world kills themselves every 40 seconds. For every person who commits suicide it has been estimated that six people will feel intense grief - around 35,000 people in the U.K. each year. Although the effects of such a bereavement are not necessarily more severe than bereavement following other causes of death there are certain aspects, such as stigmatisation and a sense of rejection that may make coping particularly difficult. Researchers from the University of York looked into studies on the effectiveness of interventions for people bereaved by suicide. They found evidence of some benefit from: a cognitive-behavioural family intervention of four sessions with a psychiatric nurse; a psychologist-led 10-week bereavement group intervention for children; and an 8-week group therapy intervention for adults delivered by a mental-health professional and a volunteer. Studies which compared more than one different type of intervention had produced unclear results.

McDaid, Catriona ... [et al] - Interventions for people bereaved through suicide: systematic review British Journal of Psychiatry 193(6), 438-443

Monday, November 24, 2008

Head injuries and ADHD

Some studies have suggested that injury is more common in children with Attention Deficit Hyperactivity Disorder (ADHD) while others have suggested that moderate-to-severe traumatic brain injury in school-age children results in the development of ADHD. A UK study of 62,088 children compared those (2,782) who had suffered a head injury, those (1,116) who had suffered burns and the remainder who had suffered neither. Children who had had head injuries were 1.9 times as likely to develop ADHD while children who had suffered burns were 1.7 times more likely to develop the condition.

Keenan, Heather T., Hall, Gillian C. and Marshall, Stephen W. - Early head injury and attention-deficit/hyperactivity disorder: retrospective cohort study British Medical Journal November 22, 2008, 1208-1210

Alexithymia and depression

Alexithymia is a state of deficiency in understanding, processing or describing emotions and has been linked to major depression, eating disorders, panic disorder and substance abuse. However, alexithymia scores have been found to decrease as people's depression improves so it is unclear whether alexithymia is a cause or a symptom of depression. An Italian study of 149 women attending antenatal clinics in the Mantova region assessed them for alexithymia, major depression and anxious-depressive symptoms at monthly intervals throughout their pregnancy. The study found that the women who developed depression had similar alexithymia and depression/anxiety symptoms to other women before they developed depression, but raised alexithymia levels after they developed depression. When the women's depression remitted their alexithymia levels decreased suggesting that their alexithymia was a symptom, not a cause, of their depression.

Marchesi, C. ... [et al] - Is alexithymia a personality trait increasing the risk of depression? A prospective study evaluating alexithymia before, during and after a depressive episode Psychological Medicine December 2008, 38(12), 1717-1722

Disadvantage, isolation, ethnicity and psychosis

There have been a number of studies pointing to higher rates of schizophrenia and other psychoses in the Black Caribbean population in the U.K. The AESOP (aetiology and ethnicity in schizophrenia and other psychoses) study found rates of schizophrenia and manic psychosis in this group to be nine times greater than in the White British population. There has been a lot of speculation about the reasons for this disparity, most of them centring on the role of socio-economic disadvantage and racial discrimination. A study of 781 people in South-East London and Nottingham compared those experiencing a first episode of psychosis with those from a similar background unaffected by the condition. On all the indicators the people who had developed psychosis were more socially disadvantaged and isolated than healthy people. The more disadvantaged people were the more likely they were to develop psychosis, a pattern which held true for White British and Black Caribbean people. The indicators of social disadvantage and isolation were more common in Black Caribbean participants than White British ones.

Morgan, C. ... [et al] - Cumulative social disadvantage, ethnicity and first-episode psychosis: a case-control study Psychological Medicine December 2008, 38(12), 1701-1715

Friday, November 21, 2008

Antidepressants much of a muchness

A review of more than 200 studies into the effectiveness of second-generation antidepressants has concluded that they are all equally effective although they do have different side effects. The review was carried out by the American College of Physicians which recommended that physicians make treatment decisions based on side effects, cost and patient preferences and make changes if the patient's response is not sufficient after 6-8 weeks. The guidelines issued by the college also recommend continuing treatment for four to nine months after a satisfactory response to an antidepressant in patients with a first episode of major depression. Those people who have had two or more episodes of depression should have a longer course of treatment aimed at preventing a recurrence or relapse.

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Thursday, November 20, 2008

PTSD, self-esteem and locus of control

A survey of 200 Kuwaiti servicemen looked into the links between exposure to trauma during the first Gulf war, post-traumatic stress disorder (PTSD), self-esteem and locus of control (people's feelings that the causes of events are due to internal or external factors). The servicemen were made up of four equal groups: those who had retired before the invasion, those who had served but not in the front line, those who had served in battle and those who had been taken captive as a prisoner of war (PoW). 31.5% of the whole sample were found to be suffering from PTSD with the rate significantly higher (48%) among the PoWs. Avoidance symptoms were the most pronounced and self-esteem was significantly lower among the PoWs and participants with PTSD. An external locus of control was associated with PTSD, anxiety and depression. Self-esteem was linked to PTSD scores while locus of control was linked to anxiety; people with an external locus of control were more prone to be anxious.

Fawziyah, A. Al-Turkait and Ohaeri, Jude U. - Prevalence and correlates of post-traumatic stress disorder among Kuwaiti military men according to level of involvement in the first Gulf war Depression and Anxiety 25(11), 932-941

CBT for psychosis: what are the barriers?

According to National Institute for Health and Clinical Excellence (NICE) guidelines, cognitive behaviour therapy (CBT) for psychosis should be made available to service users, particularly those with persisting symptoms and treatment resistance. It has also been recommended that assertive outreach teams in the UK include CBT in their skills repertoire. However, recent evaluations in the UK have found that teams lack such provision and fail to deliver the NICE recommendations for CBT. A survey of people attending the National Forum for Assertive Outreach annual conference in 2006 asked them about the barriers to the implementation of psychosocial interventions in their area. Respondents identified a lack of organizational investment, the structured nature of CBT, caseload issues, medication issues, application to people with sensory impairment, staff apathy and staff burnout as some of the barriers against the implementation of CBT for psychosis.

Williams, C. H. J. - Cognitive behaviour therapy within assertive outreach teams: barriers to implementation: a qualitative peer audit Journal of Psychiatric and Mental Health Nursing December 2008, 15(10), 850-856

Exercise and schizophrenia

There has been a growing awareness in recent years of the links between exercise and mental health. Physical exercise has been found to improve depression and anxiety but there has been little research into its effects on schizophrenia. A Turkish study of 30 people with schizophrenia divided them into two groups. One group took part in an aerobic exercise programme over a 10-week period while the other group formed a control group. At the end of the 10-week study period the participants in the exercise programme showed a significant decrease in positive and negative symptoms and an improvement in their quality of life.

Acil, A., Dogan, S. and Dogan, O. - The effects of physical exercises [sic] to mental state and quality of life in patients with schizophrenia Journal of Psychiatric and Mental Health Nursing December 2008, 15(10), 808-815

Wednesday, November 19, 2008

Neuroscience of ADHD

A new technique for brain mapping has shed more light on the neuroscience of Attention Deficit Hyperactivity Disorder (ADHD). Large deformation diffeomorphic mapping (LDDMM) provides detailed analysis of the shape of specific brain regions, allowing for precise examination of brain structures well beyond what has been examined in previous MRI studies. Researchers from the Kennedy Krieger Institute in Baltimore scanned 113 children, aged between 8 and 13. 47 of them had ADHD while the rest were developing normally. The boys with ADHD had significantly smaller basal ganglia volumes and abnormalities in several regions of the basal ganglia which is important for basic motor response control, which may explain why children with ADHD have difficulty suppressing impulsive actions. However, the girls with ADHD had no significant brain differences compared to the unaffected children.

You can read more about this research at

Stress and breast cancer

There has long been known to be a link between stress and illness and a study of an intervention designed to reduce stress in breast-cancer sufferers has had dramatic results. The study - by researchers at Ohio State University - was made up of 227 participants who had been surgically treated for stage II or III breast cancer. Half were enrolled in the intervention programme while the other half were given check-ups at regular intervals. Those in the intervention group met up weekly, in groups of 8-12 over a four-month period. A clinical psychologist taught them progressive muscle relaxation for stress reduction, problem-solving for common difficulties, how to find support from family and friends, exercise and diet tips, how to deal with treatment side effects and how to keep up with medical treatment and follow-ups. The intervention group reduced their risk of dying of breast cancer by 56% after an average of 11 years and reduced the risk of recurrence by 45%. They lived for an average of 6.1 years, compared to 4.8 years for those in the control group. The participants in the intervention group were also less likely to die of causes such as heart disease or other cancers.

You can find out more about this research at

Still no miracle cure for Alzheimer's

Growth hormone is naturally produced in the body and in turn stimulates the release of another hormone called insulin-like growth factor-1 (IGF-1). Studies on mice have suggested that IGF-1 might reduce beta-amyloid plaques (which are one of the main symptoms of Alzheimer's disease) and scientists have been wondering whether boosting the levels of IGF-1 in the human body might help to combat Alzheimer's. Researchers at Merck Research Laboratories in the U.S. looked into a compound called MK-677 which stimulates the release of natural growth hormone from the pituitary gland, which in turn stimulates the release of IGF-1 in other parts of the body. The researchers divided 416 people with mild-to-moderate Alzheimer's disease into two groups, one taking MK-677 and the other taking a placebo. They found that although MK-677 did boost people's levels of IGF-1 it did nothing to slow the development of the amyloid plaques.

You can find out more about this research at

Pregnant women's memory problems

There are anecdotal reports of women experiencing memory problems during pregnancy and these reports have been confirmed by studies of retrospective memory, such as word-learning tasks. Researchers at Australian Catholic University looked at prospective memory in pregnant women i.e. the ability to remember to do things such as attend appointments or take medication. They compared the performances of 20 pregnant and non-pregnant women on a board game called Virtual Week, which involved remembering to carry out daily tasks, and on a task in which they were required to 'check in' with a portable device at the same time four times each day. The pregnant women were no worse at the board game but were significantly worse at the second task. This impairment remained even 13 months after giving birth although by this point the women with young children were more likely to remember later that they had forgotten to 'check in.'

You can find out more about this research at

Can't remember what I forgot

A new book on memory loss - 'Can't remember what I forgot' by Sue Halpern - has highlighted the importance of exercise in helping to stave off memory loss. The book surveys the scientific progress - or lack thereof - in the hunt for a cure for Alzheimer's and concludes the 'one incontrovertible means of neurogenesis' is aerobic exercise. Exercise promotes new cell growth in old brains by increasing their blood volume and in turn cell growth improves memory. Exercise also increased the amount of brain-derived neurotrophic growth factor in the brain, again stimulating cell growth. Exercise was unable to prevent the growth of amyloid plaques, one of the main hallmarks of Alzheimer's disease, but it did allow the brain to cope with them better.

You can read the New York Review of Books review of Can't Remember What I Forgot at,+2008+issue&utm_term=Just+Remember+This

ADHD drugs - latest news

There remains considerable controversy over the effectiveness and ethics of prescribing medication to children with Attention Deficit Hyperactivity Disorder (ADHD). The U.S. Food and Drug Administration has approved a 30-minute onset of action for a drug called Focalin XR which will allow the manufacturers, Novartis, to claim that the drug takes effect within this time. The move is based on clinical data, including a study of 86 children aged between 6 and 12.

You can find out more about this story at

Predicting adolescent depression

Predicting who is likely to develop an illness allows doctors and other healthcare professionals to intervene and, with any luck, prevent the condition worsening. A team of researchers at the University of Chicago have developed a way of predicting which children will go on to develop depression after a year. They looked at risk factors at the start of the study (social and cognitive vulnerability and mood) using data from the 1995 National Longitudinal Study of Adolescent Health then aimed to develop a risk prediction index using statistical techniques. The best model was made up of 20 items.

You can find out more about this research at

Tuesday, November 18, 2008

Child psychology dropouts

People dropping out of treatment is a significant issue in all mental-health services but particularly so in child and adolescent mental-health services, with previous studies reporting dropout rates of between 28-75%. Dropping out can affect the effectiveness of treatment and lead to considerable costs for mental-health services. Researchers in Australia reviewed the files of 520 cases over a 12-month period and looked at the relationship between diagnosis and drop-out rate. Clients experiencing family problems, conduct disorder and ADHD were more likely to drop out of treatment whereas children experiencing negative life events, anxiety disorders and with no diagnosis were least likely to drop out.

Johnson, Emily, Mellor, David and Brann, Peter - Differences in dropout between diagnoses in child and adolescent mental health services Clinical Child Psychology and Psychiatry October 2008, 13(4), 515-530

Deliberate self-harm: the parents' story

Parents of children who deliberately harm themselves report finding incidents of self-harm extremely traumatic. They can experience feelings of helplessness and concerns about their ability to cope after their children are discharged from hospital and they also report a lack of information and support from healthcare professionals. There is an association between adolescent deliberate self-harm and family dysfunction and impaired adolescent-parent communication. Higher incidences of family disengagement, conflict, parental dissatisfaction and marital discord have been reported within these families as well as higher-than-average rates of affective disorder and substance abuse. A qualitative study of 25 parents involved in setting up a parents' support group in Ireland found that participants expressed the need for: support, information about suicidal behaviour in young people, skills for parenting an adolescent and advice on managing further incidents. Parents described significant difficulties in family communication, parent-child relationships and in the area of discipline following self-harm.

Byrne, Sinead ... [et al] - Deliberate self-harm in children and adolescents: a qualitative study exploring the needs of parents and carers Clinical Child Psychology and Psychiatry October 2008, 13(4), 493-504

Exercise and mental health

Physical activity referral schemes (PARS) involve the referral of patients by health professionals (usually their GP) to a leisure provider so that they can undertake a programme of physical activity under the supervision of a qualified exercise professional. PARS have proliferated rapidly in the UK since their conception in the early nineties and are thought to be the most prevalent type of community-based physical activity programme. At the same time there has been an increasing interest in the role of physical activity in the prevention and treatment of mental-health problems and in the use of physical activity as a non-pharmacological treatment alternative. A study of 2,901 people participating in a PARS scheme between 2000 and 2003 compared the rates of referral, uptake and completion of people suffering from physical and mental illness. A similar percentage of people met up with a PARS coordinator (94% of people with a physical illness compared to 90% of people with a mental illness) but fewer people with mental-health problems (60% vs 69%) got as far as attending their first exercise sessions and fewer (22% vs 34%) completed their exercise programme.

Crone, Diane ... [et al] - Uptake and participation in physical activity referral schemes in the UK: an investigation of patients referred with mental-health problems Issues in Mental Health Nursing 2008, 29(10), 1088-1097

Friday, November 14, 2008

Antipsychotics for young people

Atypical, or second-generation antipsychotics are considered to be the standard treatment for children and adolescents with early-onset schizophrenia and schizoaffective disorder. However, the superiority of atypical antipsychotics over older, first-generation antipsychotics has not been demonstrated. Researchers from a number of different U.S. universities randomly assigned 116 children to receive either the second-generation antipsychotics olanzapine or risperidone or a first-generation drug molindone. Molindone had a better response rate (50%) than olanzapine (34%) or risperidone (46%) although this difference was not statistically significant, and there was no difference between the drugs in terms of symptom reduction. Olanzapine and risperidone showed the greatest risk of weight gain and other metabolic side effects while molindone led to more of the participants saying they suffered from akathisia, an unpleasant feeling of fidgetiness and an inability to sit still.

Sikich, Linmarie ... [et al] - Double-blind comparison of first- and second-generation antipsychotics in early-onset schizophrenia and schizoaffective disorder: findings from the Treatment of Early-Onset Schizophrenia Spectrum Disorders (TEOSS) Study American Journal of Psychiatry November 2008, 165(11), 1420-1431

Psychotherapy for bipolar disorder

Despite advances in drug treatment most people with bipolar disorder cannot be treated with medication alone. Up to 50% of bipolar patients do not recover from acute manic episodes within a year and only 25% achieve full recovery of function. Rates of recurrence average 40-60% in 1-2 years even when patients undergo pharmacotherapy. Patients spend as much as 47% of their lives in symptomatic states, especially depressive states and only about 40% of patients are fully adherent with medication regimes in the year following an episode. So psychotherapy still has a crucial role to play in this condition. A review of 18 trials into the effectiveness of psychological interventions by David J. Miklowitz from the University of Colorado found that family therapy, interpersonal therapy and systemic care were the most effective at preventing recurrences when initiated after an acute episode, whereas cognitive behavioural therapy and group psychoeducation were most effective when initiated during a period of recovery. Individual psychoeducational and systematic care programmes were more effective for manic than for depressive symptoms whereas family therapy and cognitive behavioural therapy were more effective for depressive than for manic symptoms.

Miklowitz, David J. - Adjunctive psychotherapy for bipolar disorder: state of the evidence American Journal of Psychiatry November 2008, 165(11), 1408-1419

Childhood mental-health problems

Mental-health problems are estimated to affect up to 20% of children in modern Western societies. They are divided into externalising problems such as aggression and 'oppositional defiance' and internalising ones such as depression and anxiety. Early mental-health problems often continue through childhood and adolescence into adulthood and can cause problems socialising, learning difficulties, school dropout, substance abuse, poor vocational outcomes, family violence and suicide. A three-year study of 589 children in Australia found that 'the consistent and cumulative predictors of externalising behaviours were parent stress and harsh discipline. Predictors of internalising behaviours included small family size, parent distress and parenting.'

Bayer, Jordana K. ... [et al] - Early childhood aetiology of mental-health problems: a longitudinal population-based study Journal of Child Psychology and Psychiatry November 2008, 49(11), 1166-1174

Thursday, November 13, 2008

Youth suicide - latest figures

A report into youth suicides between 1997 and 2003 has found that suicide rates for 10-19 year-olds fell by 28% between the two years. More boys than girls killed themselves and 15-19 year-olds were more likely to commit suicide than 10-14-year-olds. However, only 14% of the youths who killed themselves had been in contact with mental-health services, and only 12% of boys. Those youths who had been in contact with mental-health services and subsequently killed themselves were characterised by a diagnosis of affective disorder, a history of mental illness, 'residential instability', self-harm and substance abuse. Over half of the suicides lived with their parents but only a fifth were in full-time education.

Windfuhr, Kirsten ... [et al] - Suicide in juveniles and adolescents in the United Kingdom Journal of Child Psychology and Psychiatry November 2008, 49(11), 1155-1165

OCD, OCPD, OCPT and EDs - perfectionism and eating disorders

Obsessive-compulsive personality disorder (OCPD) is different from obsessive-compulsive disorder (OCD) and is defined as 'a pervasive pattern of preoccupation with orderliness, perfection, mental and interpersonal control'. OCPD is associated with eating disorders (EDs) before, during and after they develop but it can be difficult to retrospectively measure people's OCPD in childhood before they developed an ED. A team of researchers at the Institute of Psychiatry in London developed the Childhood Retrospective Perfectionism questionnaire (CHIRP) and surveyed 246 people with an eating disorder, 93 informants (close friends or family members of the people with EDs), and 89 healthy controls. The CHIRP questionnaire was found to be reliable compared to the informants' memories of the ED group as children and interviews with the ED group themselves. The participants with EDs showed more experience of childhood OCPD than the control group and the more symptoms of OCPD people had had in childhood the worse their eating disorder symptoms were.

Southgate, Laura ... [et al] - The development of the Childhood Retrospective Perfectionism questionnaire (CHIRP) in an eating disorder sample European Eating Disorders Review November-December 2008, 16(6), 451-462

Separation, surgery and eating disorders

Mental-health problems are often triggered by adverse events and eating disorders are no exception. The effects of sexual and physical abuse in causing eating disorders have been studied but a team of researchers in Israel looked into the effects of surgery and parental separation on people's eating patterns. They followed 2,206 children through secondary school for four years and found that parental separation, oral surgery and cosmetic surgery were all significantly correlated with eating disorder symptomology. The researchers speculated that oral surgery could make the mouth associated with trauma while the cosmetic surgery could increase the youngsters' awareness of their bodily appearance thus leading on to eating problems.

Bachar, Eyten ... [et al] - Surgery and parental separation as potential risk factors for abnormal eating attitudes - longitudinal study European Eating Disorders Review November-December 2008, 16(6), 442-450

Homocysteine and depression

Depression is one of the main causes of disability worldwide and estimates of its prevalence in people over 60 range from 8.8% to 18.3%. High levels of a substance called homocysteine have been linked not only with an increased risk of depression but also with physical health problems. A study of 3,752 men aged 70 and over by researchers in Australia found that the odds of depression rose by 4% with every unit increase of homocysteine (micromoles per litre). Homocysteine was higher in people with a certain variation in the MTHFR C677T gene. Older adults with higher levels of homocysteine were 1.7 times more likely to suffer from depression. Those who had the variation in the gene were 22% more likely to have current depression or a history of depression.

Almeida, Osvaldo P. ... [et al] - Homocysteine and depression in later life Archives of General Psychiatry November 2008, 65(11), 1286-1294

Neuroscience, genetics and schizophrenia

Structural brain abnormalities have consistently been found in people with schizophrenia and can get worse as the disease progresses. More pronounced changes in brain volume are linked to worse outcomes but cause and effect in this relationship are unclear and there is the added complication of medication use which may also affect brain volume. Studies of twins, both identical and non-identical can shed light on the role played by genetics in schizophrenia. A Dutch study with 92 participants looked at 9 pairs of identical twins and 10 pairs of non-identical twins where one twin had schizophrenia and the other didn't. The results were compared with 14 pairs of identical and 13 pairs of non-identical twins none of whom had schizophrenia. In the pairs of twins where one twin had schizophrenia even the unaffected twin (the co-twin) showed a significant decrease over time in whole brain and frontal and temporal lobe volumes. At least 51% of the correlation between brain-volume loss and schizophrenia could be explained by genetic factors that are also directly implicated in the disease. None of the co-twins were taking anti-psychotic medication so this could not have been to blame for the loss of brain volume.

Brans, Rachel G. H. ... [et al] - Heritability of changes in brain volume over time in twin pairs discordant for schizophrenia Archives of General Psychiatry November 2008, 65(11), 1259-1268

Vitamin D deficiency in inpatients

Vitamin D deficiency has been linked to a number of different medical conditions and is known to cause bone problems such as rickets. Its main source is sunlight but it can also be found in fish, eggs, dairy products and fortified margarines and cereals. Researchers at St Bernard's Hospital, Middlesex looked at vitamin D levels in 17 male psychiatric inpatients. They found that 15 of them had vitamin D deficiency while the other two had borderline deficiency. The vitamin levels of the inpatients could be restored with the use of calcium and ergocalciferol tablets but the authors of the study recommended that all psychiatric inpatients should have adequate exposure to sunlight and healthy diets to ensure that they receive their recommended daily amounts of vitamins and minerals.

Tiangga, Eleanor, Gowda, Asha and Dent, John A. - Vitamin D deficiency in psychiatric in-patients and treatment with daily supplements of calcium and ergocalciferol Psychiatric Bulletin 2008, 32: 390-393

New mental-health web site

The national anti-stigma campaign, Shift, and the Sainsbury Centre for Mental Health have teamed up to launch a mental-health web site. The Shift web site provides employers with advice and resources on managing mental health and promoting mental wellbeing in the workplace and can be found at

Emotionally focused therapy

People who have suffered abuse in the past still look for, yearn for, and form relationships with other people. However, the trauma literature has suggested that trauma survivors should mainly concentrate on their own treatment with couple therapy being offered afterwards. This can leave trauma survivors and their partners with nowhere to turn to when their relationships are in distress. Researchers from the University of Ottawa looked at ten couples where one of the partners had experienced child sexual abuse and studied the effectiveness of emotionally focused therapy, a short term approach to couples therapy based on attachment theory. They found that half the couples reported clinically significant increases in trauma symptoms. However, symptoms such as affect dysregulation (inability to manage one's moods) and hypervigilance hampered people from fully engaging with the therapy.

Macintosh, Heather B. and Johnson, Susan - Emotionally focused therapy for couples and childhood sexual survivors Journal of Marital and Family Therapy July 2008, 34(3), 298-315

Monday, November 10, 2008

Genetics, neuroscience and alcohol problems

Researchers at the University of Pittsburgh School of Medicine used brain scans to look at the links between genetics, brain structure, alcohol problems and impulsivity. They gave brain scans to 107 teenagers and young adults. 63 of them were in a high-risk group with several relatives with alcohol problems while the remainder had no close relatives with alcohol or drug problems. Those youngsters in the high-risk group were more likely to have variations in the genes 5-HTT and BDNF that in turn led to a reduction in the size of an area of the brain called the right orbito-frontal cortex - which is involved in regulating emotional processing and impulsive behaviour -leading them to become more impulsive. These differences were observed even if the youngsters in the high-risk group were not drinking excessively suggesting that they were risk factors for alcohol problems, not the consequences of them.

You can find out more about this research at

Late entrants to the criminal classes

A long-term study of 400 men by researchers from the universities of Turin and Cambridge compared those who had had blameless childhoods but who had later turned to crime, those who had begun their criminal career early in life and those who had been law-abiding all their life. Compared with early-onset offenders late-onset criminals were more nervous, had fewer friends from the ages of 8-10 and were less likely to have had sex before the age of 18. Compared to non-offenders those who turned to crime later in life were more anxious at school between the ages of 12 and 14 and very neurotic by 16.

You can find out more about this research at

Stillbirth and mental illness

Researchers from the Centre for Women's Health at the University of Manchester have been looking at the medical records for 1.5 million births that took place in Denmark between 1973 and 1998. Scandinavian countries tend to keep very extensive medical records on their citizens which make such research easier to carry out there. The aim was to investigate the links between mental health problems and stillbirth. There were 7,021 stillbirths over the course of the study and the risk was twice as high for mothers admitted with a serious psychiatric illness. Schizophrenia, psychosis, mood-affective disorders, manic depression and drug and alcohol problems all increased the risk of a stillbirth. Women with drug and alcohol problems had more than twice the risk of stillbirth due to complications during delivery while women with affective disorders were more than twice as likely to give birth to babies with congenital abnormalities leading to stillbirth. Because different mental-health problems led to different kinds of stillbirth the researchers thought that it was the poor lifestyle of mentally-ill women (smoking, a poor diet, less antenatal care and poverty) rather than their mental illness per se that caused the stillbirths.

You can find out more about this research at

Counselling and mentoring cut youth injuries

A study of 113 children aged between 10 and 15 treated for assault injuries (including gunshot, knife and fist-fight wounds) at either the Johns Hopkins Children's Center [sic] in Baltimore or the Children's National Medical Centre, Washington D.C. looked into the effectiveness of counselling and mentoring at keeping them out of trouble in the future. Half of the victims received at least six sessions of one-on-one counselling and three parent-home visits while the other half were referred to community resources and received two follow-up phone calls. The counselling sessions included advice on how to avoid triggers for anger, conflict resolution and getting out of dangerous situations in appropriate ways. Those in the counselling/mentoring group reported 27% fewer fights and 42% fewer fight injuries six monts later compared to those in the control group.

You can find out more about this research at

Genetic link for SAD

Past research has shown that seasonal affective disorder (SAD) tends to run in families. Researchers at the Uniformed Services University in Bethesda, Maryland, looked into the links between SAD and variations in genes responsible for the production of a hormone called melanopsin, which is produced in response to light and affects the body clock. The researchers found that people with SAD were more than five times as likely to have a particular variation of a gene called P10L responsible for the production of melanopsin.

You can find out more about this research at

Stigma and schizophrenia

People with schizophrenia are often devalued and discriminated against because of their mental illness. This stigma can take the form of public stigma - negative stereotypes in the community - and self-stigma, applying stereotypes to oneself and internalizing them. Stigma has been shown to interfere with help-seeking and recovery from schizophrenia. People with mental illness expect to be rejected leading them to become secretive about their condition, or limit, or withdraw entirely from, social interaction. A study of 127 outpatients, diagnosed with schizophrenia asked them about perceived stigma, their use of secrecy and withdrawal as methods of coping, their symptoms, their feelings of confidence in coping with their condition (self-efficacy), their depression and their levels of insight. The study found that perceived stigma led to a significant increase in secrecy and withdrawal and to a loss of self-efficacy.

Kleim, Birgit ... [et al] - Perceived stigma predicts low self-efficacy and poor coping in schizophrenia Journal of Mental Health October 2008, 17(5), 482-491

New research backs assertive outreach

Assertive outreach teams target people with severe mental illness who are difficult to engage, have high levels of need and regularly get admitted to hospital. While there is growing evidence that assertive outreach reduces demands on in-patient care in the U.S. to date this has been unsubstantiated in the U.K. The research data on symptom reduction is equivocal and there appears to be little to indicate a beneficial impact on social and vocational outcomes. So the evidence for assertive outreach teams exerting a positive influence on quality of life remains weak. A study of 250 service users in Birmingham has, however, painted a more positive picture of the effects of assertive outreach. Objective and subjective quality of life was assessed when the participants started working with five assertive outreach teams and again two years later. There were significant gains in service users' objective quality of life; notably an increase in income. Overall subjective quality of life - apart from family relations - also improved significantly over the course of the study.

Commander, Martin ... [et al] - North Birmingham assertive outreach evaluation of service users' quality of life Journal of Mental Health October 2008, 17(5), 462-470

Lost in translation? Let the Geordies come to the rescue

Northumberland Tyne and Wear NHS Trust have compiled a list of leaflets and resources available in other languages. The database contains 1,700 records in 50 different languages and contains a separate section for mental-health resources.

You can find this very useful service at

Friday, November 07, 2008

A strange case of confabulation

People who have suffered damage to their frontal cortex can sometimes literally be unable to tell the truth. This symptom is known as confabulation and differs from ordinary lying in being inherently implausible and in not being done either to secure an advantage or prevent harm. Confabulation has traditionally been thought of as a problem with memory retrieval - a mixing up of real memories with imagined facts. Researchers from the Fondazione Santa Lucia in Italy studied a 55-year-old woman who frequently confabulates following an aneurysm in the front of her brain. The women gave bizarre, innacurate answers when asked about her past experience but also made up strange answers to factual questions, invented new features when asked to copy simple line drawings and gave the origins of words when asked about their definition suggesting that her problems with confabulation were more complex than just being a memory problem.

Zannino, Gian Daniele ... [et al] - Do confabulators really try to confabulate? A case report Cognitive Neuropsychology 2008, 25(6), 831-852

It really could be the little things that make you happy

Past research into happiness has shown that even after major life events such as accidents and lottery wins people's levels of happiness tend to return to their 'default settings' over the long term. However, studies by researchers at the Massachusetts Institute of Technology have found that repeated 'doses' of less dramatic events can have an effect on people's happiness levels. People questioned after a religious service, a yoga class or a gym session were found to be happier than they had been before but it was also the case that the more services or gym classes a person attended the happier they were suggesting that these short-term boosts had a longer-term effect when repeated over time.

Mochon, D., Norton, M. and Ariely, D. - Getting off the hedonic treadmill, one step at a time: the impact of regular religious practice and exercise on well-being Journal of Economic Psychology 29(5), 632-642

Thursday, November 06, 2008

Physical health of Alzheimer's sufferers

People diagnosed with Alzheimer's disease can live for anything between three and nine years afterwards. A survey of 323 people who had no memory problems at the start of the study but who later went on to develop dementia found that people with diabetes were twice as likely to die sooner rather than later and people with high blood pressure were two-and-a-half times more likely to die earlier.

You can find out more about this research at

Children of deployed parents

More than 2 million children in the U.S. have had parents deployed to Iraq or Afghanistan during the wars there and about 40% of them are under five. Researchers from the Boston University School of Medicine studied 169 families with children aged between one-and-a-half and five who were enrolled in the military childcare centres at a large Marine base in 2007. Children aged 3 and older who had a deployed parent had significantly higher scores on measures of externalizing and overall behaviour than children of the same age without a deployed parent. The reported symptoms remained the same after controlling for parental stress and depression and were the same whether parents or childcare providers were reporting them.

You can find out more about this research at

Drug treatment for teenage substance-abusers

In 2007 it is estimated that between 200,000 and 400,000 adolescents abused prescription opioids and it is thought that a number of these youngsters could become dependent on, or addicted to them. Buprenorphine and naloxone have been shown to be effective in treating opioid addiction but only limited use of these drugs has been recommended for younger people. A study by researchers at the University of Pennsylvania looked at 152 young people between the ages of 15 and 21. 55% were using heroin, 35% prescription opioids and 10% both. One group were given 12 weeks of treatment with buprenorphine and naloxone, the other group only 2 weeks. After eight weeks of treatment only 23% of those on the long-term treatment tested positive for opioids compared to 54% on the short-term therapy. However, after 12 weeks the gap had narrowed; 43% of those on the extended drug therapy tested positive compared to 51% in the short-term group. However, participants in the long-term group were much more likely to stay in treatment (70% vs 20.5%) and reported less use of opioids, cocaine and marijuana, less injecting and less need for additional addiction treatment.

You can find out more about this research at

Wednesday, November 05, 2008

Nostalgia, realism and rose-coloured spectacles

Older people are often thought to be nostalgic and to look back at their past through rose-coloured spectacles. However, a survey of 3,000 adults in the U.S. by researchers at Pennsylvania State University has painted a more subtle picture of how people view their past and their future. The survey found that younger and middle-aged people tended to underestimate their past happiness and over-estimate their future happiness whereas older people were more accurate in recalling their prior and future life satisfaction. The study found that most people's life satisfaction changed very little over the years. The results of the survey also showed that it was better to have a more realistic view of the past and the future than either an overly-optimistic or pessimistic one. Those participants who more accurately perceived their past and future happiness tended to suffer less depression and enjoy better health.

Lachman, Margie E. ... [et al] - Realism and illusion in Americans' temporal views of their life satisfaction: age differences in reconstructing the past and anticipating the future Psychological Science 19(9), 889-897

GABA and insomnia

Chronic insomnia affects about 10% of adults in developed countries and is the most common sleep disorder. Most cases are secondary insomnia resulting from a physical or mental health problem or from the effects of medication or substance abuse. However, about a quarter of people with insomnia have primary insomnia which has no other cause. A small-scale study by researchers at Harvard Medical School found that people with primary insomnia have lower levels - by about 30% - of a substance called gamma-aminobutyric acid (GABA) in their brains. GABA decreases overall brain activity in many areas helping the brain to shut down. Significant correlations were found between GABA levels and both subjective and objective sleep measures. Reductions in GABA levels have also been found in people suffering from anxiety and depression. Primary insomnia shares many features with anxiety and depression and is considered to be an important risk factor for both.

You can find out more about this research at

Psychosocial intervention for dementia caregivers

As well as affecting those who actually have the condition Alzheimer's disease also takes a terrible toll on caregivers, leading to anxiety and depression among this group. A U.S. study of 158 spouse-caregivers looked into the effectiveness of counselling and social support in helping to prevent or ameliorate depression. Half the participants were given a comprehensive psychosocial intervention, including two individual and three family counselling sessions, as well as telephone counselling on demand for two years; the other participants were merely given information on request. Symptoms of depression in the caregivers were measured at the start of the study, and at regular follow-up assessments over two years. Over the course of the study the group receiving the psychosocial intervention showed reduced levels of depression whereas levels of depression increased in the control group.

You can find out more about this research at

Immigration and psychosis

There has long been known to be a link between immigration and psychosis. Researchers from St Bartholomew's Hospital, London studied 484 people in three inner-city East London boroughs who first developed psychoses between 1996 and 2000. The participants, aged 18-64 were asked about their ethnicity, their place of birth and the place where their parents were born and were then divided into six ethnic groups: white British, white other, black Caribbean, black African, Asian (Indian, Pakistani and Bangladeshi) and 'other'. All the groups, apart from the white British one, had a raised incidence of psychosis but there were differences in how first- and second-generation immigrants fared between different ethnic groups. Black Caribbean second-generation immigrants were at higher risk than first-generation immigrants. Asian women of both generations were at a higher risk compared to white British people but Asian men did not suffer from an increased risk. The discrimination, isolation and alienation experienced by immigrants are all thought to be risk factors for psychosis.

You can find out more about this research at

Tuesday, November 04, 2008

Depression, helplessness and pain

Depression and pain often go hand-in-hand. More than three-quarters of patients with depression experience recurring or chronic pain and between 30-60% of patients with chronic pain report symptoms of depression. A brain-scanning study of 30 people by researchers at the University of California, San Diego looked into the links between pain, depression and helplessness. Participants were evaluated for their feelings of depression and helplessness and then shown either a green shape or a red one. A green shape indicated that they would receive a non-painful warmth via an electric pad while a red shape indicated that they would receive a dose of painful warmth. In comparison with depression-free participants participants with depression reported increased activity in the right amygdala and decreased activity in areas of the brain responsible for the amelioration of pain. In effect they were more startled by the prospect of pain and less able to control it. Those participants with higher scores for helplessness had higher levels of activation in their right amygdalas after they had been shown the red shape and were anticipating pain.

You can find out more about this research at

Heart attacks and PTSD

Surviving a heart attack can leave people with feelings of intense fear, painful intrusive memories and hyperarousal that may qualify an individual for a diagnosis of post-traumatic stress disorder (PTSD). Between 8-20% of patients with acute coronary syndromes and 27-38% of those who survive a cardiac arrest develop PTSD. A German study looked at 211 patients who had received implantable cardiac defibrillators in 1998, assessed them 27 months afterwards to see which of them had developed PTSD and followed them up in March 2005 to see how they were getting on. Those patients with PTSD were 2.4 times more likely to die than the other patients once the effects of age and gender had been taken into account.

You can find out more about this research at

ADHD and coordination

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common psychological problems in children and its symptoms include impulsiveness, hyperactivity, inattention and constant daydreaming. It has also been associated with problems with coordination and a study of 268 children by researchers at the Johns Hopkins University School of Medicine in Baltimore, U.S. compared motor skills in children with and without the condition. The children who were between the ages of seven and fifteen, were tested on how fast and how well they could tap their toes, walk on their heels, maintain balance and keep a steady rhythym during a task. The girls with ADHD and the group without the condition had much better scores than the boys with ADHD. This may be because girls' brains mature more quickly than boys'.

You can find out more about this research at

New NICE guidelines on antenatal and postnatal mental health

The National Institute for Clinical Excellence (NICE) has issued new guidelines on the treatment of antenatal and postnatal mental-health problems.

You can download the guidance from

New guidance for psychologists

The British Psychological Society has issued new guidance on good practice for psychologists.

You can download a copy of the guidance at

New guidance on treatment for young people with substance-abuse problems

The Government has issued new guidelines on assessing the needs of young people with substance-abuse problems.

You can download the guidance at

Medication use rises in the U.S.

A survey of the drugs being prescribed to children in the U.S. has found increases in the number of prescriptions being written for ADHD drugs and antidepressants. The survey covered the years between 2002 and 2005 and used a database of prescription claims from children with private health insurance, almost four million children altogether. Prescriptions for ADHD drugs rose by 40.4% (63% among girls and 33% among boys) and prescriptions for antidepressants rose by 7% among girls and 4% among boys.

You can find out more about this research at

Monday, November 03, 2008

New research sheds light on genetics of Alzheimer's

A study by researchers at the Institute for Neurological Disease, Massachusetts General Hospital, Boston has found four new genes that they think are implicated in the development of Alzheimer's disease. The researchers tested samples from more than 400 families in which at least three members had Alzheimer's disease. The analysis revealed five genetic markers linked to Alzheimer's. One was a gene called APOE which was already known about but the researchers also found other markers on chromosome 14; in a gene known to cause a movement disorder called spinocerebellar ataxia, in a gene involved in the immune system and in a gene that produces proteins in synapses.

You can find out more about this research at

Combination therapy and childhood anxiety disorders

A study of 488 children between the ages of 7 and 17 by researchers at Columbia University in New York City looked into the effectiveness of cognitive behaviour therapy (CBT), the antidepressant sertraline (brand name Zoloft) and a combination of the two in treating childhood anxiety. One group of children was given a combination of sertraline and CBT, one group was given sertraline on its own, one group was given CBT on its own and a fourth group was given a placebo. Over the course of the 12-week study 81% of the children receiving CBT and sertraline improved, compared with 60% who received CBT alone and 55% who received sertraline alone. Among patients receiving the placebo only 24% showed an improvement.

You can find out more about this research at

Learning disabilities and mental-health problems

The term learning disability covers a variety of clinical presentations, syndromes and underlying pathologies. About 1% of the population have a learning disability and most studies have found that the risk of mental-health problems is higher in people with a learning disability. However, identifying mental health problems in people with a learning disability is difficult. An Australian study used a register of people with learning disabilities and a register of people with mental-health problems to look at people with a 'dual diagnosis' of learning disability and mental illness. The study showed that 31.7% of people with an intellectual disability had a psychiatric disorder, while 1.1% of people with a psychiatric illness had an intellectual disability. Schizophrenia was most closely linked to learning disabilities and 3.7-5.2% of those with intellectual disabilities had co-occuring schizophrenia. Pervasive developmental disorder was much more common among people with 'dual diagnosis' while Down Syndrome was much less common. Individuals with a learning disability and mental health problems were more disabled than those with psychiatric illness alone.

Morgan, Vera A. ... [et al] - Intellectual disability co-occuring with schizophrenia and other psychiatric illness: population-based study British Journal of Psychiatry November 2008, 193(5), 364-372

Cannabis and psychosis

There has been much interest in, and debate about, the links between cannabis use and psychosis. Cannabis intoxication can produce transient psychotic and affective experiences and can have detrimental effects on motivation and memory. Yet people with psychosis also report that it can reduce their anxiety and make them more sociable. A review of 13 studies into the links between cannabis and psychosis carried out by researchers at Bristol University found that cannabis use was consistently associated with relapse and non-adherence to medication. However, the researchers also found that few of the studies took into account how ill people were to begin with and the influence of alcohol or other factors on people's psychosis. Taking these other factors into account resulted in a substantial weakening of the link between cannabis and psychosis.

Zammit, Stanley ... [et al] - Effects of cannabis use on outcomes of psychotic disorders: systematic review British Journal of Psychiatry November 2008, 193(5), 357-363