Thursday, June 25, 2009

Mental Health Update Highland fling

I am going on holiday to Scotland next week where - depending on the weather - I will be either walking in the hills, or staring bitterly out of the window watching the rain lash down and contemplating the eighteenth game of Scrabble of the afternoon. I will be back at work on the 6th of July and will start blogging again shortly after that. So, if you follow the blog thank you very much for your interest and normal service will be resumed shortly!

Memory, sleep and genes

Some people seem able to function on very little sleep while others struggle after a sleepless night. Previous research has shown that a gene called PERIOD3 (PER3 for short) affects people's ability to cope with sleep deprivation. People with one variation of the gene are resilient to sleep loss and perform well on cognitive tasks after sleep deprivation, whereas people with the other variation perform more poorly. Researchers from the University of Liege in Belgium and the University of Surrey in the U.K. compared participants in their study with the resilient version of the gene to those with the other version, scanning their brains while they performed a memory task. Each participant was imaged four times: the night before and the morning after a good night's sleep and the night before and the morning after a bad night's sleep. The researchers found that the participants with the resilient gene were able to use other parts of their brains (as well as the ones normally expected to be used in the task) as they worked on the task whereas those with the less resilient version showed reduced activity in the brain structures normally activated by the task with no help from elsewhere in the brain. The people with the less resilient gene also performed worse even after a good night's sleep suggesting that people with this gene variation take a bit of time to get going in the morning.

You can find out more about this research at

Look into my brain, deep into my brain ...

Researchers from the University of Geneva have been looking into the neuroscience of hypnosis. The participants in their study were asked to make a hand movement in response to a cue, then, depending on what signal they heard either make the movement or keep still. Some of the participants were told they could not move their left hand while others were hypnotized into believing it was paralysed. The researchers found that hypnosis produced changes in the prefrontal and parietal areas involved in attention and in the connections between the motor cortex and other parts of the brain. Hypnosis was also associated with an enhanced activation of the precuneus, a brain region involved in memory and self-imagery. The researchers concluded that hypnosis worked by altering people's self-imagery so that they genuinely thought they were hypnotized rather than by affecting their motor circuits and their ability to move.

You can find out more about this research at

U.S. older adults stay sharper longer

Researchers from the Peninsula Medical School (in S.W. England), Cambridge University and the University of Michigan compared cognitive performance in older adults from the U.S. and England - and found that those from the U.S. were significantly sharper. The study compared 8,299 Americans with 5,276 English people with both groups taking the same test in the same year. The difference between the two countries was greatest among those over 85 but overall there was a 10-year difference between the two groups with an American 75-year-old performing as well as an English 65-year-old. The average score (out of 24) for English adults over 85 was 8.3 compared to 10.1 for the U.S. participants. For the younger section of the sample (65-74) the average English score was 12.5 compared to 13.8 for the U.S. participants. The study also measured other aspects of the participants' health. The American participants were less likely to be depressed than the English ones and it is known that depression is linked to lower cognitive function. They were also less likely to drink (50% vs 15.5% teetotal) and although they were more likely to have high blood pressure they were also more likely to be being treated for it; untreated high blood pressure can affect cognition. And the American adults tended to retire later which may have kept them sharper for longer.

You can read more about this research at

Alzheimer's, risk and race

Alzheimer's disease and milder forms of dementia are associated with an increased risk of death but the risks are the same for both black and white people. Some studies have found that African Americans live longer after being diagnosed with the condition than white people but a study of 1715 older adults by researchers at the Rush University Medical Center in Chicago found no differences between racial groups. At the start of the study 802 participants had no cognitive problems, 597 had mild impairment, 296 had Alzheimer's disease and 20 had other forms of dementia. Over the 10 years of the study 634 of the participants died. Compared to unaffected people the risk of death was around 50% higher in people with mild cognitive impairment and 200% higher in those with Alzheimer's.

Tuesday, June 23, 2009

Can an afternoon nap make you nicer?

Sadly, once we start full-time work not many of us get a chance for an afternoon nap. However, a study of 36 people by scientists at the University of California, Berkeley suggests that it can have an important effect on the way people perceive other people's emotions. In the study the participants were asked to rate four different categories of facial mood: fear, sadness, anger and happiness. They performed the task twice - once at midday and again at five in the afternoon. In between half the participants were allowed an afternoon nap of 60-90 minutes while the other half had to stay awake. Those people who had had a nap displayed an increased receptiveness to positive facial emotions while those who stayed awake were more receptive to faces depiciting anger and fear. The authors of the study pointed out that those people expected to make such judgements about these matters - for e.g. doctors, soldiers, new parents - are of often the ones who may be most at risk from sleep deprivation.

The neurology of truth and falsehood

Telling the difference between true and false sounds like a relatively straightforward process but a new neuroimaging study by researchers at the universities of Lisbon and Vita-Salute, Milan, has found that, on a neurological level at least, it is surprisingly complex. In the study participants were asked to read a simple sentence and decide whether it was true or false as the researchers gave them an MRI (magnetic resonance imaging) scan. The false statements led to activity in a part of the brain called the right fronto-polar cortex, an area associated with reasoning. The true statements activated regions called the left inferior parietal cortex and the caudate nucleus which deal with analysing language, memory and reward.

You can find out more about this research at

What did I come online to do ...?

Amber Johnson has compiled a list of 50 top tips to improve your memory ranging from diet and lifestyle tips to tricks and tools to help you remember things.

You can find Amber's tips at

New diagnosis tool for Alzheimer's

Early detection of Alzheimer's disease is crucial and researchers spend a lot of time trying to find tests that will help with diagnosis. Researchers at the Sahlgrenska Academy, part of the University of Gothenburg, studied the levels of substances in people's cerebrospinal fluid (CSF) and came up with a 'profile' of different indicators for people with Alzheimer's disease (CSF-AD). People with CSF-AD had a risk of deterioration 27 times greater than that of the control group and all the patients with mild cognitive impairment who went on to develop Alzheimer's had the CSF-AD profile. The profile also fitted in well with other factors related to the disease such as the presence of the APOE e4 gene and atrophy of the hippocampus.

You can find out more about this research at

Schizophrenia and cancer

People with schizophrenia are four times more likely to die of cancer than people in the rest of the population. Prof. Frederic Limosin of the University of Reims studied 3,470 people with schizophrenia, analysing the incidence of cancer between 1993 and 2004. He found that 476 of the participants died over the course of the study. The leading cause of death was suicide but the next highest was cancer which killed 74 people - a death rate four times greater than that of the rest of the population. In men the risk of lung cancer was much greater (people with schizophrenia are much more likely to smoke) although the risk of overall cancer death was not significantly higher. In women the overall risk was greater with death due to breast cancer being significantly higher. The higher death rate from breast cancer could be due to delays in diagnosis and failure to comply with treatment among people with schizophrenia.

You can find out more about this research at

White matter and schizophrenia

White matter connects different regions of the brain together and it is known to be disrupted in people who have schizophrenia. Researchers at the University of California, Los Angeles used a new technique called diffusion tensor imaging to study 61 people between the ages of 21 and 26. The technique uses the movement of water molecules within white matter to chart connections in the brain. 36 of the participants were deemed to be at high risk of developing schizophrenia, based on genetic factors or because they showed early symptoms of it, while the other 25 participants formed a control group. The control group showed a normal increase in the 'integrity' of the white matter in their temporal lobes but the high-risk group did not show this normal developmental pattern. By looking at the integrity of people's white matter at the start of the study the researchers were able to predict how well they would be functioning at work, school and home over the course of the two-year study.

You can find out more about this research at

Binge drinking down in the U.S. - apart from students

In the U.S. the legal age for drinking alcohol was set at 21 in 1984. New research from Washington University School of Medicine in St Louis has found that this has led to a substantial reduction in binge drinking. The researchers analyzed data gathered between 1979 and 2006 by the National Survey on Drug Use and Health which surveyed more than 500,000 people. The survey found that binge drinking in young men had dropped substantially since 1979; down by 50% in males between 15 and 17, by 20% in men aged 18-20 and 10% in men aged 21 to 23. However, in women between 15 and 20 binge drinking was unchanged and for women between 21 and 23 it rose by about 40%. Binge drinking was unchanged among men in college but rose more than 40% among female students.

You can find out more about this research at

Monday, June 22, 2009

PET scans boost Alzheimer's diagnosis

PET (positron emission topography) scans could significantly improve diagnosis for people in the early stages of dementia. Early diagnosis of dementia is important for providing the best available treatments and therapies in the early course of the disease when they can be most effective. Researchers at the University of Michigan studied 66 people with either mild dementia or mild cognitive impairment who were evaluated by experts using standard neurological brain tests and anatomic brain imaging. The participants then had a PET test which looked for amyloid deposits in their brain (one of the main signs of Alzheimer's disease) and at the way their brains were dealing with the neurotransmitter dopamine. The participants' initial diagnosis changed more than 25% of the time after PET imaging and the PET scans provided images of important signs of disease that other scans missed, such as deposits of amyloid plaque and damage to dopamine nerves.

You can find out more about this research at

Wards face uphill struggle to stub out smoking

On the 1st July, 2008 smoking was banned in psychiatric hospitals in the U.K. However, many hospitals have failed to implement the ban fully - if at all - and there has been a rise in 'secret smoking' by service users. A study of services by the Mental Health Foundation found that 85% of units had not implemented the ban fully. Many units lacked a safe outdoor smoking area for service users and the need to escort patients off the ward was seen to be a considerable drain on resources. Staff felt uncomfortable enforcing the ban and often turned a blind eye to smoking. In wards where the ban had been implemented successfully there had been widespread consultation with staff and patients beforehand, there was support for service users to stop smoking and alternative activities were provided for them.

You can find out more about this study at

XBD173 and anxiety

Benzodiazepines have dominated the anti-anxiety treatment market since the 1960s but can cause side effects such as drowsiness, forgetfulness and clumsiness and, over the long-term, dependency. Serotonin-specific reuptake inhibitors (SSRIs) have also been used to treat anxiety but can take weeks to take effect. German scientists have been experimenting with a new drug called XBD173. In a week-long study involving 70 participants they compared it to a placebo and a benzodiazepine. They found that it produced a fast, anti-anxiety response with no withdrawal symptoms after use.

You can find out more about this research at

One for the road at college

'Prepartying' involves the consumption of alcohol before going out to the main event of the evening. It is linked to high levels of consumption of alcohol and negative consequences such as blacking out, throwing up and getting into trouble. Researchers from the University of Washington in Seattle studied prepartying in 444 college students. They found the most common reasons for it were arriving at a social event already 'buzzing,' saving money and making the night more interesting. Men were more likely to drink to boost their chances with the opposite sex than women. Underage and legal age drinkers (the legal age for drinking in the U.S. is 21) drank before going out to the same extent, and as often, as each other, but underage students had higher blood-alcohol levels.

Pedersen, Eric R., LaBrie, Joseph W. and Kilmer, Jason R. - Before you slip into the night, you'll want something to drink: exploring the reasons for prepartying behavior among college student drinkers Issues in Mental Health Nursing 2009, 30(6), 354-363

Friday, June 19, 2009

Attention, depression and brain structure

People with depression tend to pay more attention to negative things - something that can lead to a vicious circle that can make their condition worse. Researchers at the University of Hong Kong investigated this negative bias in women with and without depression and used magnetic resonance imaging (MRI) brain scans to look at the differences in brain structure associated with it. Their study of 17 women with and 17 women without depression found that the depressed women paid more attention to negative words and that this bias in their attention was linked to reduced grey-matter concentrations in their right superior frontal gyrus, their right anterior cingulate gyrus and their right fusiform gyrus.

Leung, K.-K. ... [et al] - Neural correlates of attention biases of people with major depressive disorder: a voxel-based morphometric study Psychological Medicine July 2009, 39(7), 1097-1106

Movement problems and psychosis - why it's not always the drugs

Movement problems are often found in people being treated with antipsychotic drugs. However, people with psychosis who have never taken antipsychotics - said to be antipsychotic naive - can also experience problems including dyskinesia (involuntary movements of the tongue, mouth or limbs) and parkinsonism (rigid muscles, slow movement and tremor). Researchers from the Institute of Psychiatry in London reviewed 13 studies into abnormal movement in antipsycotic-naive people with psychosis and found that 9% had dyskinesia and 17% parkinsonism.

Pappa, S. and Dazzan, P. - Spontaneous movement disorders in antipsychotic-naive patients with first-episode psychoses: a systematic review Psychological Medicine July 2009, 39(7), 1065-1076

Schizophrenia, infection and executive function

People with schizophrenia often suffer from cognitive deficits including executive dysfunction which shows itself in the form of impaired reasoning and problem-solving abilities and is associated with the more severe and disabling forms of the condition as well as poorer functional outcomes. There is increasing evidence that infections caught during pregnancy, in particular toxoplasmosis and influenza, can cause schizophrenia and researchers from Columbia University in New York studied 26 people with schizophrenia to see if there was a link between prenatal infection and poor executive functioning. People who had been exposed to infections in the womb made significantly more errors on the tests and took more time to finish them.

Brown, Alan S. ... [et al] - Prenatal exposure to maternal infection and executive dysfunction in adult schizophrenia American Journal of Psychiatry June 2009, 166(6), 683-690

Cognitive impairment in schizophrenia

People with schizophrenia often suffer from mild-moderate cognitive impairment which often appears before the onset of psychosis, persists throughout people's lives even after their psychosis has gone away and can cause a number of negative effects on people's lives. Researchers from all over Europe, working as part of the European First Episode Trial (EUFEST), studied 498 people with schizophrenia to compare the effectiveness in treating cognitive impairment of the older, first-generation drug haloperidol with the newer second-generation ones amisulpride, olanzapine, quetiapine and ziprasidone. They found that all groups improved but that there was little difference between them and only a weak correlation between improvements in people's cognition and their other schizophrenia symptoms.

Davidson, Michael - Cognitive effects of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: a randomized, open-label clinical trial (EUFEST) American Journal of Psychiatry June 2009, 166(6), 675-682

Self-regulation and sex offenders

The self-regulation model is a theory used to explain why sex-offenders reoffend. It talks about two factors. The first one is avoidance or approach - whether the sex offenders want to avoid committing more crimes or to commit them again. The second part deals with how the offenders regulate their behaviour to achieve their goals - either passively with no clearly-thought-out strategy or actively taking more concrete steps to achieve their goals. This gives a total of four categories into which offenders can be placed: avoidant-active, avoidant-passive, approach-passive and approach-active. Avoidant-active offenders are the least dangerous (although this is relative and they can re-offend if their active strategies are of poor quality) and approach-active ones are the most dangerous. It is not known whether this framework can be applied to sex offenders with learning disabilities so researchers from Birmingham University and two local NHS trusts studied 28 sex offenders with a learning disability. They found that the offenders could be fitted into the four categories and that there were similar numbers of offenders in each category compared to offenders without learning disabilities. The offenders who used a passive self-regulatory style had a lower level of intellectual functioning than those with a more active style.

Ford, Hannah J., Rose, John and Thrift, Sue - An evaluation of the applicability of the self-regulation model to sexual offenders with intellectual disabilities Journal of Forensic Psychiatry and Psychology June 2009, 20(3), 440-457

Prison staff and self harm

Self-harm is now a major public-health concern. It is estimated to result in 200,000 hospital visits a year and the risk of suicide increases up to 100 times within the first year following self-harm. Self-harm among prisoners has increased by 37% in the last five years and, in women, rose by 48% between 2003 and 2007. Rates are higher among women than men and in 2005 56% of self-harm incidents occured in women's prisons. Researchers from the University of Manchester looked into the attitudes of prison staff towards female prisoners who self-harm. They interviewed eight prison officers and five healthcare staff from a women's prison in the North of England. They found that the staff made a distinction between what they saw as 'genuine' and 'non-genuine' self-harm with those who engaged in the latter being seen as 'rational manipulators' harming themselves to play the system. The staff felt resentful towards these women. The prison staff also found it hard to balance their roles contributing to the welfare of the prisoners and maintaining security and found the security part of the job easier. They felt untrained and unsupported in the welfare part of their role and pressurised due to a lack of time and staff. This combination of factors led to most of the prison staff feeling a lack of confidence in dealing with women who self-harm.

Short, Vicky ... [et al] - Custody vs care: attitudes of prison staff to self-harm in women prisoners - a qualitative study Journal of Forensic Psychiatry and Psychology June 2009, 20(3), 408-426

Thursday, June 18, 2009

Moving house and suicide

People move around a lot these days and about 50% of children have moved house at least once before their 10th birthday. It can be very difficult to change schools and move away from friends and some children may even be at risk of suicide. There have been few studies into this link so researchers at the University of Aarhus in Denmark studied 128,960 children to look into this issue. They found that the more frequently the children moved the higher their risk of suicide was. This held true even after allowing for other factors such as birth order, birthplace, links to a father and paternal age at birth.

Qin, Ping, Mortensen, Prehen Bo and Pedersen, Carsten Becker - Frequent change of residence and risk of attempted and completed suicide among children and adolescents Archives of General Psychiatry June 2009, 66(6), 628-632

Citalopram and autism

Although no drugs have been approved by the U.S. Food and Drugs Administration (FDA) for the treatment of autism medication use in this group has become increasingly common with the global market estimated to be worth $2.2-$3.5bn. Selective serotonin reuptak inhibitors (SSRIs) account for 59% of this market but there is a dearth of evidence for their effectiveness. A team of researchers in the U.S., led by Bryan H. King from the University of Washington in Seattle studied the effectiveness of the SSRI citalopram in preventing the repetitive behaviour associated with autism and Asperger's syndrome. They studied 149 children between the ages of 5 and 17. 73 received citalopram and 76 a placebo. After 12 weeks there was no significant difference between the two groups and citalopram was more likely to cause side effects such as impulsiveness, decreased concentration, hyperactivity, diaorrhea, insomnia and dry or flaky skin.

King, Bryan H. ... [et al] - Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behaviour Archives of General Psychiatry June 2009, 66(6), 583-590
Mindfulness has been defined as "paying attention in a particular way: on purpose, in the present moment, and non-judgmentally." There has been a growing interest in mindfulness over the last few years and it has been shown to be effective in pain management, improving the function of the immune system, preventing relapses in depression, reducing anxiety and decreasing stress. Researchers from the American University in Washington, D.C. looked into the effectiveness of transcendental meditation (TM) on people's mindfulness. They studied 287 students, some of whom were enrolled on a transcendental meditation course while others were placed on a waiting list. The results showed that those students who had taken the TM course showed a greater increase in mindfulness than those on the waiting list. The study also found a 'self-selection' effect whereby those students who were most interested in taking up meditation were already more mindful than their peers.

Tanner, Melissa A. ... [et al] - The effects of the transcendental meditation program on mindfulness Journal of Clinical Psychology June 2009, 65(6), 574-589

Unravelling the marvels of mindfulness

Mindfulness has been defined as "paying attention in a particular way: on purpose, in the present moment, and non-judgmentally." There has been a growing interest in mindfulness over the last few years and it has been shown to be effective in pain management, improving the function of the immune system, preventing relapses in depression, reducing anxiety and decreasing stress. However, less is known about how mindfulness works and under what circumstances. Researches at Fort Lewis College in Colorado studied 57 students. They were divided into four groups. One group did nothing (the control group), another group did a course of brief meditation focusing on breathing, sound and bodily sensations focusing on accepting whatever arises, a third group concentrated on extending compassion, friendliness, joy and peace to themselves and others and a fourth group did both meditation courses. The longer combined meditation group significantly reduced anxiety and negative affect and increased hope. The whole effect of the mindfulness intervention could be explained by its impact on cognitive distortions*, negative thoughts such as "it would be awful if...", "I couldn't cope with...," "People will think I'm a failure if..." etc.

Sears, Sharon and Kraus, Sue - I think therefore I om: cognitive distortions and coping style as mediators for the effects of mindfulness meditation on anxiety, positive and negative affect, and hope Journal of Clinical Psychology June 2009, 65(6), 561-573

*see for an explanation of cognitive distortions

Wednesday, June 17, 2009

CBT for insomnia

Most people with insomnia can be treated effectively with cognitive behaviour therapy (CBT). Researchers from Kentucky studied the effectiveness of CBT on 64 participants who all completed five or more treatment sessions. The CBT teaches strategies to 'reset' the bodily systems that regulate sleep. Specific strategies included education on sleep-regulating systems, sleep-scheduling recommendations, sleep-hygiene education, relaxation training, cognitive therapy and mindfulness training. The results of the study showed that 50-60% of the participants experienced remission of their main sleep problem. The participants also showed improvements in sleep efficiency, average nightly awakenings, total sleep time and average nights of sleep medication use per week.

You can find out more about this research at

Finding the strengths of people with autism

In recent years there has been a move away from focusing on autistic people's weaknesses towards appreciating their differences and respecting their strengths. Researchers at the universities of Montreal and Harvard studied 33 people between the ages of 14 and 36, fifteen of whom had autism. They were asked to complete patterns in Raven's Standard Progressive Matrices - a test that measures hypothesis-testing, problem-solving and learning skills. The autistic and non-autistic groups were matched for IQ and the people with autism performed 40% quicker. The participants in the study underwent magnetic resonance imaging (MRI) scans as they took the test. The group with autism showed more activity in the perceptual regions of the brain - areas in which people with autism have particular strengths.

You can find out more about this research at

Better to buy than to receive - at least in Montreal

It's often said that it is better to give than to receive but research from the Canadian academic Jean-Sebastien Marcoux suggests that it might also be better to buy than receive as well. Marcoux carried out a ten-year (1997-2007) study of people moving house in Montreal. Many people move house at times of stress such as divorce, job loss, separation or bereavement yet the study found that the guilt and obligation connected with asking for help from friends and family often drove people to use the less emotionally-charged services of professional moving companies.

You can find out more about this research at

New blood test for Alzheimer's

Scientists at McGill University and the Lady Davis Institute for Medical Research in Canada have come up with a blood test that can detect the early stages of Alzheimer's disease. There is currently no accepted blood test for Alzheimer's and diagnosis is based on a series of neurological and psychological tests. The Canadian scientists used a technique called near-infrared biospectroscopy to identify changes in blood plasma. They analysed samples from people with Alzheimer's disease, mild cognitive impairment and from healthy control subjects. They were able to identify people with Alzheimer's with 80% accuracy and also identify people with mild-cognitive impairment, which is often a precursor of Alzheimer's.

You can find out more about this research at

Tuesday, June 16, 2009

New theory on neuroscience of Alzheimer's

Neurons are the actors in the brain, transmitting and receiving electrical signals via synapses but they rely on a large supporting cast of cells called glia which help to maintain and nourish them. One group of glial cells called microglia has been implicated in causing Alzheimer's disease. The theory was that microglia reacted to the formation of plaques of a protein called amyloid-beta in the brain by mounting an immune response which in turn led to a toxic release of chemicals worsening the disease. The idea that the inflammation caused by this response by the microglia was behind Alzheimer's has led to a number of trials of anti-inflammatory drugs for the condition none of which proved successful. Researchers at the universities of Florida and Frankfurt looked at the brains of 19 dead people. Some had severe Alzheimer's disease when they died, others a more moderate version and others no disease at all. The researchers found no evidence of any inflammation in the brains of the people with Alzheimer's. However, they did find that microglia were aging and degenerating - just like other cells - something that may lead to the damage to neurons thought to have been caused by inflammation.

You can find out more about this research at

Campus drinking on the rise

Alcohol is taking more of a toll on college campuses in the U.S. The National Institute on Alcohol Abuse and Alcoholism found that drinking-related accidental deaths among 18-24-year-old students rose from 1,440 in 1998 to 1,825 in 2005. Over the same period the proportion of students who reported recent binge drinking rose from 42% to 45% and those who admitted drink driving rose from 26.5% to 29%. The increases occured among 21-24-year-olds rather than 18-20-year-olds.

You can find out more about this research at

Afternoon naps and happy tots

Sadly for most adults afternoon naps are just a dim-and-distant memory but for toddlers they are often part of a daily routine. Researchers from Pennsylvania State University in the U.S. studied 62 children, between the ages of four and five, of whom 23% no longer took daytime naps. Despite the fact that there was no difference in total sleep between the groups those children who did not take afternoon naps showed significantly more symptoms of hyperactivity, anxiety and depression. But it was unclear whether the lack of naps caused these symptoms or whether these problems made it more difficult for children to get to sleep.

You can find out more about this research at

Long-term effects of methadone use

Methadone has been used to treat people addicted to heroin since the 1960s. People who use it are aging and can be subject to the same diseases of old age and unhealthy lifestyles as the rest of the population. Researchers from Emory University in the U.S. studied 91 people who had been enrolled on the methadone-maintenance programme at the Atlanta Veterans Affairs Medical Center. They found that people who had been using methadone for a long time were more likely to die of diabetes and liver and gastrointestinal cancer (although there was no indication that this was due to the methadone). However methadone had reduced drug use and psychiatric, medial and legal problems among long-term users. Those who had dropped out of methadone treatment showed no improvement in their addictive behaviour.

Fareed, Ayman ... [et al] - Benefits of retention in methadone maintenance and chronic medical conditions as risk factors for premature death among older heroin addicts Journal of Psychiatric Practice May 2009, 15(3), 227-234

Dialectical Behaviour Therapy and Borderline Personality Disorder

Borderline personality disorder (BPD) usually involves unstable moods, "black and white" thinking (or splitting), unstable personal relationships and a disturbance in an individual's sense of self. One of the main ways of treating BPD is with dialectical behaviour therapy (DBT). This was first developed by Marsha Linehan from the University of Washington and draws its principles from cognitive behaviour therapy (CBT), dialectical philosophy and Zen Buddhism. The treatment aims to balance acceptance of things that cannot be changed with changing things that can and aims to help people not just survive but to build a worthwhile life. There are four stages of treatment with self-harm and other life-threatening behaviours being given priority. In the second stage patients are encouraged to experience the painful emotions they have been avoiding. Stage three addresses job and relationship problems while stage four focuses on helping people to feel complete and on reducing feelings of emptiness and boredom. Researchers from Brown University in the U.S. studied 47 women who had had a five-day, partial-hospitalization programme of DBT. They found that after three months the women's levels of depression, helplessness, anger, dissociation and mental-health problems had significantly decreased. Those who had felt emptiness, been impulsive and suffered from disturbed relationships showed improvement on a number of outcomes. However, those who had disturbed identities and a fear of abandonment showed less improvement.

Yen, Shirley ... [et al] - A 5-day dialectical behavior therapy partial hospital program for women with borderline personality disorder: predictors of outcome from a 3-month follow-up study Journal of Psychiatric Practice May 2009, 15(3), 173-182

Foster care and risk-taking

Adolescence is generally a time of good health. More than 50% of illness and death during adolescence is due to risky behaviour such as drug taking and under-age sex. Children in foster care tend to have poorer health than other children with more acute health problems, chronic illnesses and poor nutrition but little research has been done into risk-taking behaviour among this group. Researchers from the University of California, San Francisco studied 56 children in foster care. They found that they were more likely to engage in risky behaviour although younger children and those who were fostered by relatives were not quite as likely to behave riskily. Risk behaviour was increased for children who were in care homes, who had experienced a parental death, or who had a history of physical or emotional abuse or attempted suicide.

Gramkowski, Bridget ... [et al] - Health risk behavior of youth in foster care Journal of Child and Adolescent Psychiatric Nursing May 2009, 22(2), 77-85

Thursday, June 11, 2009

Caffeine, risk-taking and sleep deprivation

Researchers from Harvard Medical School have been looking into the links between sleep deprivation and risk-taking. They measured people's risk taking by showing them a series of expanding balloons on a computer screen. The more the balloons expanded the more money they got but if the balloons popped they got nothing. The participants in the study were deprived of sleep for 75 hours. Half of the 25 volunteers (who were all aged between 20 and 35) were given caffeine gum and the other half were given a placebo. Both groups were unchanged in their risk-taking behaviour after 51 hours but after 75 hours without sleep the group who were given the placebo showed a significant increase in risk-taking. The study showed that there may be a 'breaking point' of sleep deprivation after which people are much more inclined to take risks and that caffeine can help to protect against this effect.

You can find out more about this research at

Night owls not so wise after all

Students who think of themselves as 'night owls' - feeling more alert and doing their better work at night - could end up with worse grades than their early-bird counterparts. Researchers from Hendrix College in Arkansas studied 123 students and found that night owls had poorer sleep hygiene than other students. Sleep hygiene is defined as a set of good practices helpful for getting a decent night's sleep such as a regular bedtime routine, going to bed and waking up at the same time and sleeping in a comfortable bed. The night owls had lower grades than other students and slept, on average, 41 minutes less each night.

You can find out more about this research at

Sedatives, sleeping pills and suicide

Sedatives and sleeping pills are often prescribed to people with anxiety, depression and sleeping problems. However, a study by researchers from Gothenburg University has found that they could quadruple the risk of suicide among older people. The study compared the medical records of 85 men and women older than 65 who had killed themselves and compared them with a similar group from the general population who had not committed suicide. After adjusting for mental-health problems those people taking sleeping medication were four times more likely to kill themselves. The researchers thought that the drugs themselves could make people more aggressive and impulsive and therefore more likely to kill themselves; that the drugs provided a means with which to commit suicide and that the sleep problems that led people to take the drugs in the first place could make them more suicidal.

Ritalin and movement in ADHD

Hyperkinetic disorder is a form of attention-deficit hyperactivity disorder (ADHD) in which children not only have attention problems but also act impulsively and have difficulty sitting still and controlling their movements. They commonly have increased muscle tension which can hinder normal movement and manifest itself as stiffness, restlessness (as they repeatedly move around to get comfortable) and even poor handwriting. Researchers at the University of Stavanger in Norway studied 24 8-12-year-old boys with hyperkinetic disorder on two separate days. On one day they were given a placebo and on another day they were given methylphenidate (Ritalin). On the day the children were given the methylphenidate they showed temporary improvements on tests of coordination such as throwing a ball or holding a leg in the air, as well as improvements in thumb movement which could lead to better handwriting.

Paxil, cognition and people with cancer

People with cancer often have problems with their memory and attention. The 'circuits' in the brain responsible for the cognitive problems in cancer patients are also linked to depression and researchers from the University of Rochester in New York looked into the effectiveness of the antidepressant Paxil in helping with these cognitive problems. They studied 800 people with cancer aged between 22 and 87. The study showed that even taking into account its effects on depression Paxil still had a 'significant effect' on cognitive functioning.

You can find out more about this research at

U.K. cocaine use shoots up

Cocaine use shot up in the U.K. between 2003 and 2008 with women and Londoners at the forefront of the increase. The study by the North West Public Health Observatory at Liverpool John Moores University found that the proportion of people aged between 16 and 59 who had used cocaine at least once in their lifetime rose from 55.7 per 1,000 in 2002/3 to 72.5 per 1,000 in 2007/8. The price of cocaine fell from $100 per gram in the 1980s to $40-60 per gram now. London was described as the epicentre of cocaine use wih 47,000 users. In 2003 8.2% of men had used cocaine compared to only 4.6% of women but by 2006 the gap had narrowed with 7.2% of men having tried the drug compared to 6.6% of women.

You can find out more about this research at

Antipsychotics approved by FDA panel

A panel advising the U.S. Food and Drug Administration has backed the use of antipsychotic medication for children and teenagers with schizophrenia and bipolar disorder. The panel backed the wider use of the pills but had worries about the long-term effects the drugs could have on youngsters. The drugs already have combined sales of $10 billion a year but there has been little research into their long-term effects and there were also concerns that they could be used to treat other conditions such as attention deficit hyperactivity disorder (ADHD). The drugs have the side effect of weight gain and sleepiness but these symptoms need to be weighed against the damage caused by the hallucinations and delusions of schizophrenia and the extreme mood swings of bipolar disorder.

The Mental Costs of Not Getting Enough Sleep - guest post by Meredith Walker

Most of us are aware of the physical ramifications that lack of sleep causes. Extended periods of sleeplessness can even contribute to making you sick, increasing your risk of illness, causing you to put on weight and making you a generally miserable person. There is a hefty mental toll to be paid for not getting enough sleep as well, however.

Depression: While depression can actually cause sleeplessness, sleeplessness can be a contributor to depression as well. After all, even those who are not depressed are well aware of the effects of a sleepless night on their mood in the morning.
Memory Loss: Harvard researchers found that getting a good night’s rest helps protect memories from interference, allowing you to recall them more easily the next day. The sooner you go to bed and rest well after learning something new, the better off you’ll be. Additionally, lack of sleep has been shown to take an especially big toll on spatial memory, making it hard for you to learn new tasks.
Cognitive Impairment: Not getting enough sleep can take a big toll on your IQ. Researchers at the University of Virginia found that a lack of sleep impaired both cognitive development and IQ in children.
Difficulty Concentrating: Most people are aware of how hard it is to study or focus at work when all they really want to do is head back to bed. Sleeping even a few hours fewer than you need can impact your mental abilities as studies have shown that in school age children this lack causes them to perform significantly worse on tests of memory and attention.
Slowed Reaction Times: Slowed reaction times not only make it more difficult to do your job or do well in school but also make you a potential danger to yourself and those around you if you operate machinery or engage in potentially hazardous activities. With over 100,00 sleep-related accidents every year this is a very significant risk and can at times be akin to driving while intoxicated.

While few are deprived of sleep completely for a significant length of time, the effects can be startling as after even a few days individuals can develop mania and hallucinations. Even if you’re just slightly tired, consider this as an indictor of how much your brain truly needs sleep, even if you think you’re doing fine without it.

When thinking about sleep it’s important to remember that both quantity and quality count, so work on keeping your sleep space quiet, dark and cool so you can get a solid, uninterrupted block of sleep every night.

This post was contributed by Meredith Walker, who writes about the online masters in healthcare. She welcomes your feedback at MeredithWalker1983 at

There is a link to Meredith's website in the Links section on the right-hand side of the blog.

Wednesday, June 10, 2009

How many children have Tourette's

Nearly 150,000 children in the U.S. could have Tourette's syndrome. Researchers from the Centers for Disease Control and Prevention looked at data from the 2007 National Survey of Children's Health which covered 64,034 people between 6 and 17. They found that 3 in 1,000 children had Tourette's which is characterized by sometimes debilitating tics such as repetitive, stereotypical movement and inappropriate vocalizations. The syndrome is linked to higher rates of attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) and can cause learning disabilities and problems getting on with other children.

You can find out more about this research at

Early drinking increases accident risk

People who start drinking earlier may be at a greater risk of having alcohol-related injuries. Researchers from the U.S.'s National Institute on Alcohol Abuse and Alcoholism studied 34,600 adults. In 2001-2002 they were asked about the age when they began drinking alcohol and in 2004-2005 they were asked about their subsequent behaviour and whether they had engage in risky activities such as driving, swimming and operating machinery under the influence of alcohol since the last survey. Starting drinking at 16 or younger (the legal age for drinking alcohol in the U.S. is 21) doubled the likelihood of alcohol-related driving or unintentional injuries and the risk for alcohol dependence or abuse. One-third of unintentional injuries while under the influence of alcohol occurred among 25-year-old respondents even though they made up only a small proportion of the sample.

You can find out more about this research at

Diabetes and depression

People with type 1 diabetes, the kind which people have from childhood, are much more likely to be depressed than people without the condition. Researchers from the University of Colorado Health Sciences Center studied 1,004 adults, 458 of whom had type 1 diabetes. The results showed that people with diabetes were almost three times as likely to have a clinically-significant score for depression and were nearly twice as likely to be on antidepressant medication. Overall 32.1% of people with diabetes had some symptoms of depression compared to 16% of the rest of the sample. Those people experiencing complications of their diabetes - such as eye problems, amputation and kidney problems - had (hardly surprisingly) much higher depression scores. The study recommended that people with type 1 diabetes be regularly screened for depression.

You can find out more about this research at

Tuesday, June 09, 2009

Over a third of nurses could be depressed

Nursing in a hospital is a challenging job that requires physical stamina, emotional intelligence and intelligence. With many nurses also having to look after elderly parents and/or children it's not surprising that a lot of nurses suffer from stress and burnout. Darlene Welsh from the University of Kentucky studied 150 nurses. She found that over a third (35%) of them had mild-moderate depressive symptoms. Fatigue/low energy (43%), joint pain (30%), trouble sleeping (29%), back pain (28%) and headaches (18%) were the main physical complaints. Depressive symptoms were made worse by physical health problems, major life events (such as bereavement and divorce) and occupational stress. The longer people had worked in hospitals and the higher their income the lower their risk of depression was.

Welsh, Darlene - Predictors of depressive symptoms in female medical-surgical hospital nurses Issues in Mental Health Nursing 30(5), 320-326

Life review for older women

Life review has been defined as "a retrospective survey of existence, a critical study of a life, or a second look at one's life." It involves recalling one's entire lifespan, both positive and negative events, evaluating things in the presence of a sympathetic listener. The hope is that by reflecting on their lives people find meaning and integrate their experiences into a satisfactory whole. Researchers from Texas Woman's University spoke to 13 older women who had taken part in a Therapeutic Life Review intervention programme delivered in six, forty-minute sessions by home-care workers. They analysed the women's responses and found five main themes:
  • Someone was there to listen to my story
  • It was a special time
  • A valued interaction with the home-care worker developed
  • Remembering was meaningful and pleasurable
  • Integration with one's lived experiences was healing

Binder, Brenda K. ... [et al] - Community-dwelling, older women's perspectives on therapeutic life review: a qualitative analysis Issues in Mental Health Nursing 30(5), 288-294

Friday, June 05, 2009

Anxiety, insomnia and sleeping tablets

People who suffer with anxiety can often have sleep problems as well and the prevalence of insomnia in people with generalized anxiety disorder has been estimated at 43.6%. People who have insomnia are also likely to suffer from anxiety and one study estimated that 32.5% of people with insomnia also suffered from anxiety. Despite this there has been little attempt to investigate the effectiveness of using insomnia drugs alongside ones for anxiety. Researchers in the U.S. studied 383 people with insomnia and anxiety in 41 centres across the U.S. Half were given the anti-anxiety drug escitalopram and a placebo and half were given escitalopram and the insomnia drug zolpidem. Those participants who took zolpidem slept longer and were less drowsy in the day than those taking the placebo but no less anxious. The trial was financed by a drugs company but - according to the journal in which it was published - "the authors of [the] article were fully responsible for the content and editorial decisions and received no financial support."

Fava, Maurizio ... [et al] - Zolpidem extended-release improves sleep and next-day symptoms in comorbid insomnia and generalized anxiety disorder Journal of Clinical Psychopharmacology June 2009, 29(3), 222-230

PTSD raises risk for diabetes and heart disease

Metabolic syndrome includes being overweight, having a pot belly and having high blood pressure and cholesterol and is a significant risk factor for developing diabetes and heart disease. There is some evidence that people suffering from post-traumatic stress disorder (PTSD) may be more at risk for developing metabolic syndrome and taking antipsychotic drugs is also known to raise the risk. Researchers from the University of California, San Diego studied 203 people. They were all over 40 and had psychotic symptoms for which they were taking antipsychotic medication. 65 had a diagnosis of schizophrenia, 56 had dementia, 49 had a mood disorder and 33 had PTSD. The study found that 72% of people with PTSD had metabolic syndrome, compared to 60% of those with schizophrenia, 58% of those with a mood disorder and 56% of those with dementia. Those people with PTSD, schizophrenia and a mood disorder had significantly higher body-mass indices than those with dementia and the PTSD group had significantly higher blood pressure compared to the dementia and mood-disorder group.

Jin, Hua ... [et al] - Association of posttraumatic stress disorder with increased prevalence of metabolic syndrome Journal of Clinical Psychopharmacology June 2009, 29(3), 210-215

Bradley Report calls for major overhaul

The Bradley Report - into services for mentally-ill offenders - has been published in the U.K. and calls for major changes in: custodial and prison care, identifying people with mental-health problems and learning difficulties and giving them the appropriate support, and in rehabilitating ex-offenders with mental-health problems. The report says that there is no national vision of what the Government intends to achieve for offenders with a mental illness or learning disability; a problem made worse by the lack of adequate data, different assessment tools being used by different agencies and the fact that there is no common training for different groups within the criminal-justice system. The report makes 82 recommendations including: setting up a Criminal Justice Mental Health Team to be responsible for people's mental health while they are in prison, finding out a person's mental-health needs before they are given an antisocial behaviour order (ASBO) and transferring responsibility for providing healthcare services in police custody to the NHS.

You can download a copy of the Bradley Report at

Thursday, June 04, 2009

Therapists' therapy and the therapetic alliance

The idea that therapists should themselves have therapy goes right back to Freud and a number of studies since then have backed the idea that therapists who have had therapy are more effective than those who haven't. The therapeutic alliance is the relationship between the therapist and the patient and includes agreement on goals, assignment of tasks and the development of bonds. It is known to have a big impact on the effectiveness of therapy yet there has been little research into the effects of therapists' therapy on the therapeutic alliance. Researchers from Adelphi University in New York compared therapists who had and had not received therapy as they assessed 60 outpatients. They found that there was no difference between the two groups in the quality of the therapeutic alliance as rated by the patients. However, the therapists who had received therapy were more confident, felt they had more agreement about goals and were happier overall with the therapeutic alliance. Those therapists who had had therapy themselves also treated their patients for twice as long as the other group.

Gold, Stephanie H. and Hilsenroth, Mark J. - Effects of graduate clinicians' personal therapy on therapeutic alliance Clinical Psychology and Psychotherapy May-June 2009, 16(3), 159-171

Social anxiety in students

Social anxiety is the third most common mental-health problem after depression and alcohol abuse. Studies have shown that adults with social anxiety do less well than their peers on measures of education and subsequent career attainment and these changes might be made worse by changes in the higher-education system. There is much more emphasis now on group-based learning, peer review and assessed presentations - all things which are more likely to be stressful for students with social anxiety. Researchers at Plymouth University surveyed 1,007 students and found that approximately 10% of them reported marked-to-severe social anxiety.

Russell, Graham and Shaw, Steve - A study to investigate the prevalence of social anxiety in a sample of higher education students in the United Kingdom Journal of Mental Health June 2009, 18(3), 198-206

Boys, girls and comfort eating

Emotional eating is eating more than you need in response to a negative mood. Despite evidence that emotional eating is quite common and contributes to obesity there has not been much research into this issue. Latino adolescents are more likely to be overweight than Caucasian ones and researchers from the University of Southern California surveyed 666 students from predominantly Latino schools in Los Angeles to investigate this issue. They found that boys and girls were as likely to engage in emotional overeating as each other. However girls overate in response to stress, worries and tension/anxiety while boys overate in response to 'confused mood.'

Nguyen-Rodriguez, Selena T., Unger, Jennifer B. and Spruijt-Metz, Donna - Psychological determinants of emotional eating in adolescence Eating Disorders May-June 2009, 17(3), 211-224

Bodybuilders, body dissatisfaction and bulimia

Body dissatisfaction and unhealthy eating practices are common in sports and activities that require low body fat or a low weight for improved performance. Competitive bodybuilding requires its participants to be exceptionally lean and bodybuilders often have unhealthy eating patterns and use anabolic steroids. A Canadian study of 45 women compared competitive bodybuilders with recreational weight trainers. The study found high rates of weight and shape preoccupation, body dissatisfaction, bulimic practices and anabolic steroid use among the bodybuilders and similar problems (albeit to a lesser degree) in the weight trainers. The competitive bodybuilders shared many of the eating patterns of the women with bulimia but few psychological traits.

Goldfield, Gary S. - Body image, disordered eating and anabolic steroid use in female bodybuilders Eating Disorders May-June 2009, 17(3), 200-210

Wednesday, June 03, 2009

Captivity, torture and PTSD

Cruel, inhuman and degrading treatment (CIDT) stops short of actual physical torture but can still be deeply distressing for those exposed to it and, according to new research, may actually cause more pyschological damage. CIDT includes: being held captive in a hostile and life-threatening environment, the deprivation of basic needs, sexual torture, psychological manipulation, humiliation, exposure to extreme temperatures, isolation and forced-stress positions. Dr Metin Basoglu from King's College London studied 432 people from former Yugoslavia and Turkey who had been held captive and tortured. The participants were asked about how distressing they had found various forms of torture, how distressing their overall experience of captivity had been and were assessed for post-traumatic stress disorder (PTSD). The survivors who rated CIDT as more distressing were also likely to report their overall torture experience as more stressful whereas the perceived severity of physical torture was not associated with the perceived severity of the overall torture experience. PTSD was associated with CIDT and sexual abuse but not with physical torture. Those who had been detained in a war setting were 2.8 times more likely to have PTSD than those detained by state authorities in their own country. Being held captive by an enemy was a stronger risk factor for PTSD than the actual experience of torture itself.

You can find out more about this research at

Computerized CBT helps with insomnia

Computerized cognitive behaviour therapy (CBT) is effective in treating sleep problems. Researchers from the University of Manitoba in Canada studied 118 adults with chronic insomnia. Half of them used a computerized CBT programme and half were placed on a waiting list for treatment. The programme was made up of information about insomnia and sleep hygiene, stimulus control instruction, relaxation training, sleep restriction and cognitive therapy. The cognitive therapy part of the programme was designed to help individuals develop realistic expectations about sleep and the impact of sleep on their functioning the next day while teaching them a variety of strategies for coping with worries and an over-active mind. The results showed that 81% of the people using the programme showed at least mild improvement in their sleep and 35% rated themselves as much, or very much, improved. 30% of people who finished the programme managed to get an extra hour's worth of sleep. They also developed healthier attitudes about sleep and were less likely to have an over-active mind at bedtime. However, there was a 33% drop-out rate for the programme, compared to only 22% for 'in person' psychotherapy.

You can find out more about this research at

Alcohol, glucose and violent crime

There is a strong link between alcohol intoxication and violent crime but not everyone who drinks becomes aggressive or violent. A Finnish study of 89 people compared impulsive, violent, antisocial male offenders to a non-offending control group. The participants' glycogen levels (which are connected to glucose metabolism) were measured at the start of the study and the participants were followed for eight years to see whether they committed any violent crime. 17 of the offenders re-offended over the course of the study and the average glycogen levels of these people were much lower than in those participants who stayed out of trouble.

You can find out more about this research at

Vitamin D and cognition

Lower levels of vitamin D in the bloodstream could be associated with cognitive impairments in older men. Researchers from the University of Manchester tested cognitive performance and vitamin D levels in 3133 men between the ages of 40 and 79. Those with low levels of vitamin D scored worse on a standard test of cognitive ability than people with normal levels. The average level of vitamin D of the participants was 63 nanomoles per litre; levels of 90 to 140 nanomoles are considered healthy.

You can find out more about this research at

Too much coffee and texting leaves teenagers needing forty winks

Teenagers are stoking themselves up with caffeine, staying up all night playing with gadgets and falling asleep during the day. Researchers from Drexel University in Philadelphia surveyed 100 12- to 18-year-olds about their use of technology at night, their caffeine consumption and their sleepiness during the day. They found that on average the children spent 5.3 hours between nine at night and six in the morning using electronic gadgets. Only one in five said they got between eight and ten hours sleep a night. A third of the children said they fell asleep in school and some said they fell asleep as many as eight times a day. The more time children spent playing with gadgetry the likelier they were to fall asleep. The average caffeine consumption was 215mg per day; the equivalent of a couple of espressos. Nearly three-quarters of the participants drank more than 100mg a day and 11% drank over 400mg.

You can find more about this research at

Tuesday, June 02, 2009

Stigma still a barrier for depressed teenagers

Researchers in the U.S. looked into the barriers teenagers face in getting treatment for depression. They interviewed 368 teenagers with and without depression and found that social stigma and worry over how their parents would react were among the biggest barriers. Those teenagers who felt the most social stigma about their condition and worry about their parents' reaction were less likely than other youngsters to have started counselling and drug therapy six months later. Parents tended to focus on more practical issues such as paying for treatment and physically getting their children to see a healthcare professional.

You can find out more about this research at

SSRI warnings affect depression care in U.S.

In 2003 the U.S. and European authorities sent out a series of public health warnings about the use of antidepressants in young people after clinical trials showed that they increased the risk of suicidal thoughts and behaviour in children and teenagers. In February 2005 the warnings were strengthened and in May 2007 they were extended to young adults between the ages of 18 and 24. Anne Libby and her colleagues from the University of Colorado analyzed health-insurance claims from the U.S. from July 1997 to June 2007 to see how the treatment and diagnosis of depression had changed over this period. They found steady increases in the rate of depression diagnoses between 1999 and 2004 but a sharp fall after that. Doctors diagnosed fewer cases of depression with a 44% lower rate among children and adolescents, a 37% lower rate among young adults and a 29% lower rate among other adults. There was an 8% rise in suicides among youth and teens in 2004. Doctors prescribed fewer SSRIs but did not turn to older drugs to treat depression and anxiety or offer psychotherapy as an alternative.

You can find out more about this research at

Long-acting naltrexone shows promising results for heroin addicts

There is a lot of research suggesting that the drug naltrexone blocks the action of heroin in the body yet its clinical usefulness has proved limited. This could be because many people are reluctant to take the drug or start taking it and then stop. Longer-lasting injections of naltrexone could get around some of these difficulties. Preliminary studies have been encouraging and a study of 56 heroin addicts by researchers in Norway has also proved promising. The group was divided into two with half receiving the long-lasting naltrexone and half receiving the usual treatment for heroin addicts. Those participants who received naltrexone had, on average, 45 days less heroin use than the other participants. The naltrexone stayed in the participants' bloodstreams throughout the study. Unfortunately two patients in the control group (but none among those taking naltrexone) died during the course of the study.

Kunoe, Nikolaj ... [et al] - Naltrexone implants after in-patient treatment for opioid dependence: randomised controlled trial British Journal of Psychiatry June 2009, 194(6), 541-546

Antidepressants and the amygdala: effects take hours not weeks

Selective Serotonin Reuptake Inhibitors (SSRIs) are used to treat depression. It is thought that it takes several weeks for them to take effect but some studies have suggested that they work much quicker than that. Both depression and anxiety have been associated with over-activity in a part of the brain called the amygdala and one way it is thought that SSRIs may be effective is in damping down this over-activity. One of the ways in which the amygdala becomes over-active is when responding to threatening faces or situations. Researchers from Warneford Hospital in Oxford and Oxford University used brain scans to study the effect of the SSRI antidepressant citalopram on 26 healthy volunteers. They gave half of them citalopram and half a placebo then, after three hours, they showed them a series of facial expressions while giving them an MRI scan. They found that the participants who took citalopram showed much lower amygdala activity in response to the fearful faces than those who took the placebo.

Murphy, Susannah E. ... [et al] - Effect of a single dose of citalopram on amygdala response to emotional faces British Journal of Psychiatry June 2009, 194(6), 535-540

Unwanted pregnancy and mental illness

Previous studies have found that women who reported their pregnancies were 'unwanted' (rather than 'wanted' or 'mistimed') had children who were approximately 2.4 times as likely to develop schizophrenia by the age of 28 and another study has found that unwanted pregnancy leads to a 1.75 times greater risk of the child developing schizophrenia. Researchers in Sweden looked further into this link by studying 166 people, 91 of whom were deemed to be at normal risk i.e. their mothers had not suffered from psychosis and 75 of whom were deemed to be high-risk i.e. their mothers had suffered from psychosis. Unwanted pregnancy was found to be related to an increase in the risk of schizophrenia but only in the high-risk group where it interacted with the genetic risk for the condition. Unwanted pregnancy was also found to be related to an increased risk of affective (mood) disorders. Other stresses in pregnancy, compiclations in and around birth, birth defects and stresses in early childhood were all examined in the study but could not explain the link between unwanted pregnancy and mental illness.

McNeil, T.F. ... [et al] - Unwanted pregnancy as a risk factor for offspring schizophrenia-spectrum and affective disorders in adulthood: a prospective high-risk study Psychological Medicine June 2009, 39(6), 957-965

Cannabis and psychosis

Cannabis is the most widely used illegal drug in the world and there is increasing evidence that it can cause psychosis in people with no previous history of mental illness. The use of cannabis is particularly common in the age group most at risk for the onset of psychosis, 15-30. But not all heavy users of cannabis go on to develop psychosis and not all people who develop psychosis have used cannabis. One factor behind these differences is thought to be people's underlying proneness to psychosis, or schizotypy. Researchers from University College London compared 140 cannabis users with 144 non-users. The cannabis users were asked about their psychosis symptoms while they were intoxicated and when they were free of the drug with the non-users being asked about their psychosis symptoms at the same time. Both groups were given a questionnaire to assess their proneness to psychosis. Smoking cannabis was found to lead to a marked increase in psychosis symptoms and the more prone to psychosis someone was the worse their symptoms were when they took cannabis.

Mason, O. ... [et al] - Acute cannabis use causes increased psychotomimetic experiences in individuals prone to psychosis Psychological Medicine June 2009, 39(6), 951-956