Friday, February 27, 2009

Keeping people with mental-health problems out of prison

Every Primary Care Trust in England should set up a team of mental-health professionals to make sure criminals with mental-health problems are identified, and, if possible kept out of prison. That's the recommendation of a new report from the Sainsbury Centre for Mental Health which claims that services have developed in a piecemeal and haphazard way and calls for spending on this area to be tripled. The report says that diverting criminals with mental-health problems into community health services is good value for money and leads to more people getting better.

You can find out more about the report at

Thursday, February 26, 2009

Brainwriting or brainstorming

Many companies use brainstorming but studies have shown that it can be surprisingly ineffective. Louder people dominate, lazy people take it easy and say nothing and shy people are too scared to say anything. Another way for a group to come up with ideas is 'brainwriting.' Four group members write ideas on a piece of paper in silence. Each group member has a different colour ink so that it is possible to tell where an idea comes from. Once a piece of paper has four ideas on it it is thrown into the middle and another piece of paper is started. The second stage of the process involves group members going to the corners of the room and trying to remember as many of the ideas as possible. In the final stage of the process group members work alone for 15 minutes in an attempt to generate even more ideas. An early study found that brainwriting generated more ideas than brainstorming although more research is needed.

You can find out more about brainwriting at

If it's eight it must be turquoise

Synaesthesia is a mixing of senses and perception, so that, for instance, the number 9 is associated with the colour orange, or France with the taste of apples. Researchers from the University of Edinburgh tested 615 children, aged six-seven at 21 UK schools for a particular kind of synaesthesia where numbers are linked to colours. The researchers found that 1.3% of the children had this form of synaesthesia. The colour associated with each number remained constant over time and more links were added as the children grew up. The average child with synaesthesia had 10.5 number-colour links when aged six-seven and 16.9 links a year later.

You can find more information about this study at

To sleep, perchance to dream

Scientists are still unsure about why we dream and why we dream about certain things rather than others. A series of studies by researchers at Carnegie Mellon University looked into the significance people give to dreams and found that most people believed they contain important, hidden truths. One study of 149 students in the U.S., India and South Korea asked them to rate different theories about dreams. In all three countries an overwhelming majority of the students believed that dreams revealed hidden truths about themselves or the world. In another study 182 commuters at a Boston train station were given four different scenarios about things that had happened the night before a plane trip: that the nation's security threat had been raised to orange, that they had consciously thought about their plane crashing, that a real plane crash had occured on the route they were about to take or that they had dreamt about a plane crash. Dreaming about a plane crash was more likely to make people change their travel plans. A third study asked 270 people in the U.S. to remember a dream they had had about someone they knew. People gave more importance to pleasant dreams about people they liked than about people they didn't and gave more importance to unpleasant dreams about people they disliked. Finally, when people were asked about their religious dreams religious people were inclined to take seriously any dream involving God, whereas agnostic people only took the dream seriously if God had asked them to do something pleasant.

You can find out more about this research at

Negative emotions in schizophrenia

Negative facial emotions are more common in people with schizophrenia according to a review of psychologists' clinical interviews carried out by a research student at Stockholm University. The study found that negative feelings, such as disgust and contempt, were the most common ones in the patients' facial expressions. The expressions remained the same in a number of different interviews and regardless of who was carrying them out.

You can find out more about this research at

Familiarity and risk

We all have to take decisions about risk in our lives yet we don't always have the information to do so. Researchers at Michigan University presented students with made-up lists of food additives and roller-coaster rides and asked them to rate how dangerous the additives might be and how thrilling the rides were. The additives or roller-coaster rides with the most complicated or difficult-to-pronounce names were rated as the most dangerous or thrilling. The study fits in with previous research which suggests that people rate familiar things as less risky than unfamiliar ones, regardless of the real risks involved.

You can find out more about this research at

Text and the sexes

An analysis of text messages sent in to an Italian TV programme has shed light on the different ways men and women use new technology to communicate. The study, carried out by researchers at Indiana University, found that women used more characters than men, were more likely to use abbreviations such as gr8 and used more emoticons (smiling and frowning faces). This contrast with previous research on verbal conversation in which men were found to talk more while women were more polite.

You can find out more about this research at

Heroin clinics help users and neighbourhoods

Heroin is sometimes provided to drug addicts at medically-supervised clinics as this is thought to lessen the risk of overdose, and of picking up infections such as hepatitis C. One such initiative is the NAOMI project - the North American Opiate Medication Initiative. Researchers at the University of Montreal looked at the impact of the NAOMI project on the surrounding areas. They found no evidence of an increase in criminal acts or deviant behaviour and a decrease in the quantity of drug-injecting debris such as syringes, needle covers, spoons etc. Participants in the project reduced their consumption of illegal drugs by 70%, their criminal activity by 36% and improved their health (measured by the scores on a questionnaire) by 20%.

You can find out more about this research at

Wednesday, February 25, 2009

Postnatal depression and diabetes

Pregnant women and new mothers with diabetes could be at an increased risk of developing postnatal depression. A study of 11,000 pregnant women in New Jersey between July 2004 and September 2006 found that the women with diabetes had nearly twice the risk of suffering from postnatal depression. Previous research has linked diabetes with depression and the link held true for women with type 1, type 2 and gestational (linked to pregnancy) diabetes. The study was carried out by researchers at Harvard Medical School and looked at the six months before a woman gave birth and the year afterwards.

You can find out more about this research at

Tuesday, February 24, 2009

Peering into the virtual world

Worldwide nearly 45 million people play virtual reality games such as Everquest II and Second Life and the amount of (real) money involved would make this parallel world the seventh largest economy in the world. As relationships in these games leave a digital trace it is actually easier to track social networks in this world than in the 'real' one. A study by researchers at Northwestern University in the U.S. looked at which kind of people played Everquest II and how they related to each other using data from the game and questioning 7,000 participants. They found that players tended to underestimate how much time they spent playing the game and were more likely to say they were depressed than the rest of the population. Women preferred to play with men but were the most dedicated and satisfied users and players were substantially older than the teenage stereotype. Perhaps the most surprising finding was that players tended to play with people that they knew or who were from the same geographical area; people 10km from each other were more likely to be partners than those 100km away from each other.

You can find out more about this research at

Music, memories and MRI scans

People's memories can often be triggered by music and a study of 13 students by researchers at the University of California, Davis looked to see what happens in people's brains when this was going on. The students were played excerpts of 30 different tunes, chosen to have been in the charts when they were growing up, at the same time as they had magnetic resonance imaging (MRI) scans. After each excerpt the student responded to questions about the tune including whether it was familiar or not, how enjoyable it was and whether it was associated with any particular incident, episode or memory. How many memories a tune triggered corresponded to the amount of activity in the upper part of the medial pre-frontal cortex; part of the brain where memories of our past are supported and retrieved. This part of the brain is one of the last to be affected by Alzheimer's disease and it has often been observed that tunes can bring back memories in Alzheimer's sufferers when little else does.

You can find out more about this research at

Child abuse, suicide and genes

Our genes are not our destiny and what happens to us can affect them just as much as they affect us. A study of the brains of 36 people who died suddenly compared 12 suicide victims who had suffered from abuse (either physical, sexual or by neglect), 12 suicide victims who had not suffered abuse and 12 people who had died accidentally. Child abuse alters the body's response to stress and increases the risk of suicide and the researchers (from McGill University in Canada) looked for changes in genes involved in the hypothalamic-pituitary-adrenal function. They found genetic changes in a gene called the neuron-specific-glucocorticoid receptor in the abuse victims but not in the other suicide victims, or the accident victims, confirming findings from previous studies on rats.

You can find out more about this research at

Anger and heart problems

The idea that people can get so cross they give themselves a heart attack could be true - at least in people who already have a heart problem. Previous studies have linked wars, earthquakes and even the World Cup to temporary increases in heart attacks. Researchers at Yale University studied 62 people who had heart disease and who had been fitted with an implantable defibrillator which gives an electric shock to correct dangerously irregular heart rhythyms. They were asked to remember a recent incident which had made them angry and the electrical instability in their heart was measured. The researchers found that anger did increase this electrical instability. The participants were followed over the next three years and those who had shown the greatest electrical instability in response to anger were 10 times more likely to have an irregular heartbeat. It is unclear whether anger has similar damaging effects in people with healthy hearts.

Soft signs and schizophrenia

Neurological soft signs (NSS) are subtle motor and sensory deficits frequently found in people with schizophrenia. A German study of 64 people looked at the links between NSS and brain structure. They scanned 42 people with schizophrenia and 22 healthy controls and asked people to fill out a questionnaire designed to find out their NSS. The researchers found that NSS scores were significantly higher in patients than in the control group. NSS were significantly associated with reduced grey and white matter in the pre- and post-central gyrus, pre-motor area, middle and inferior frontal gyri, cerebellum, caudate nucleus and thalamus.

Thomann, P. A. ... [et al] - Neurological soft signs and brain morphology in first-episode schizophrenia Psychological Medicine March 2009, 39(3), 371-379

Monday, February 23, 2009

Childhood trauma and schizophrenia: nature and nurture?

The idea of gene-environment interaction is becoming increasingly influential. It can be defined as the genetic control of sensitivity to environmental factors or as the environmental control of the way genes work. One such interaction between nature and nurture is that between childhood trauma which has been associated with psychosis not only in schizophrenia but also in bipolar disorder. A study of 138 first-degree relatives (siblings or parents) of people with schizophrenia or bipolar disorder looked at the links between childhood trauma scores and schizotypy (unusual thought patterns that can be the precursor of either schizophrenia or bipolar disorder). They found that there was a link between childhood trauma and schizotypy in the relatives of the schizophrenia sufferers but not in the relatives of the bipolar sufferers suggesting that an interaction between a gene predisposing people to schizophrenia, and childhood trauma was behind the increase in schizotypy.

Schurhoff, F. ... [et al] Self -reported childhood trauma correlates with schizotypal measures in schizophrenia but not bipolar pedigrees Psychological Medicine 39(3) March 2009, 365-370

Puncturing the Penrose hypothesis

The Penrose hypothesis holds that there is an inverse relationship between the number of prison inmates and the number of psychiatric hospital beds in a population i.e. as one goes up, the other goes down. This was thought to be because there was a relatively-fixed proportion of people in a society in need of containment and if they were not in a psychiatric hospital they would be in a prison or vice versa. A number of studies have found that a fall in available hospital beds occured at the same time as a rise in prisoner numbers. Most of the authors of most of these studies concluded that the decline in psychiatric hospital populations was a cause of increased prison populations suggesting that the same people who may have been hospitalized at one time were later imprisoned. Other researchers observed the same relationship but argued that different factors affected the number of hospital beds and the number of prison places. However, despite the regular publication of national statistics for prisoners and psychiatric hospital patients there has been no study replicating Penrose's original one in 1939. An analysis of data from 179 countries by researchers in Australia found that in high-income countries there was no link betweeen prison population and the number of beds. In low- and middle-income countries there was a positive correlation i.e. as hospital beds went up so did prison places and vice versa . The researchers thought that this might be because countries built more of both as their economic circumstances improved.

Large, Matthew M and Nielssen, Olav - The Penrose hypothesis in 2004: patient and prisoner numbers are positively correlated in low- and middle-income countries but are unrelated in high-income countries Psychology and psychotherapy: theory, reserahc and practice March 2009, 82(1), 113-120

Who gets psychodynamic therapy?

Little is known about the kind of people who are referred for psychodynamic psychotherapy. A study by researchers in London and Coventry collected data from fourteen psychotherapy services about 1,136 service users. It found that most of them were in the moderate-to-severe range of psychiatric severity. 95% of them met the criteria for a psychiatric disorder (mostly anxiety and mood disorders) and/or a personality disorder. 82% of the service users were found to be suitable for treatment although there were relatively-high rates of treatment rejection by service users and treatment drop-out.

Chiesa, Marco ... [et al] - Psychiatric morbidity and treatment pathway outcomes of patients presenting to specialist NHS psychodynamic psychotherapy services: results from a multi-centre study Psychology and psychotherapy: theory, research and practice March 2009, 82(1), 83-98

Friday, February 20, 2009

Stigma and schizophrenia

A survey of 732 people with schizophrenia in 27 countries, carried out by researchers at the Institute of Psychiatry in London, has revealed the amount of discrimination they face in their everyday lives. The survey found that

  • 47% reported discrimination in making and keeping friends
  • 43% had experienced discrimination from family members
  • 27% had experienced discrimination in intimate or sexual relationships
  • 29% had suffered from prejudice while trying to find or keep a job
  • 64% hadn't bothered to apply for work, training or education because they expected to fail or face discrimination
  • 55% anticipated discrimination when seeking a close relationship
  • 72% said that they felt a need to conceal their diagnosis of schizophrenia

You can find out more about this research at

U.S. approves implant for OCD

The United States Government has approved a brain implant for people with obsessive-compulsive disorder (OCD) who have not benefited from medication or psychotherapy. The battery-powered device is implanted near the abdomen or collar bone and connected to electrodes implanted in the brain which block abnormal nerve signals.

You can read more about this story at

New NICE guidelines on antisocial personality disorder

Antisocial personality disorder (ASPD) is a condition that affects a person’s thoughts, emotions and behaviour in a way that harms other people. People with ASPD are impulsive, quick to anger and can behave in an irresponsible, reckless and deceitful way. They have often grown up in broken homes with lots of rows, where parenting is harsh and inconsistent. Many people with antisocial personality disorder have a criminal conviction and are imprisoned or die prematurely as a result of reckless behaviour.

The National Institute for Clinical Excellence (NICE) published guidance on the 28th of January whic outlines how healthcare professionals can treat, manage and prevent antisocial personality disorder (ASPD).

You can download a copy of the guidelines at

Alzheimer's and ApoE

There is thought to be a strong hereditary element to Alzheimer's disease with the ApoE gene playing a significant part. Researchers from the Boston University School of Medicine studied 715 people taking part in the long-running Framingham Heart Study. 282 of them had one or both parents suffering from dementia, while the rest had parents who were unaffected. All the participants were tested for the presence of the ApoE gene and on verbal and visual memory tasks. Among people who were carriers of the ApoE gene those who had parents with Alzheimer's, or another dementia, scored significantly worse on the memory tasks - equivalent to approximately 15 years of brain ageing. The effect was largely limited to those participants who were carriers of disease risk between the generations.

You can find out more about this research at

Poll reveals mental-health stigma

People would find it easier to admit to being bankrupt or having a drink problem than they would admitting to having a mental-health problem. That's according to a poll of 2,300 people carried out by the Time to Change campaign which aims to reduce the stigma of mental illness. The poll found that while one in five people would find it hard to come out as gay one in three would find it hard to admit to a mental-health problem. The poll also found that 30% of people thought that someone with a mental-health problem could not do a responsible job.

You can find out more about the Time to Change campaign at

Reading for teenage inpatients

A social worker has been honoured by the National Year of Reading for her work promoting reading at an adolescent psychiatric unit in Newcastle. Janice Hutton, who works at the Rycroft Clinic in Gosforth was given the status of 'reading hero,' by the National Year of Reading campaign. She improved access to books at the unit, set up reading groups for young people and hosted reading sessions with well-known authors. She also worked with the local library to promote access to reading for young people preparing to leave the unit.

You can find out more about the National Year of Reading campaign at

Inpatient care - what are service users' concerns?

User-led research into mental-health services is important because it reflects the perspective of the people for whom the services are intended but there has been very little research carried out specifically on psychiatric acute hospital services with inpatients as participants. A study carried out by service users in Northern Ireland looked at 13 psychiatric hospital sites throughout Northern Ireland and set up 10 focus groups to analyse the main areas of concern for service users. These were: information, communication, relationships, activities, self-help, patient involvement in care treatment plans and the physical environment.

Walsh, Jim and Boyle, Joan - Improving acute psychiatric hospital services according to inpatient experiences. A user-led piece of research as a means to empowerment Issues in Mental Health Nursing 2009, 30(1), 31-38

Anhedonia and drug addiction

Anhedonia - the inability or failure to experience pleasure - is a common characteristic in drug addiction. One theory is that the drugs raise the brain's threshold for feeling pleasure so that, for example, a cup of tea and a couple of chocolate biscuits no longer have the same effect, and that this threshold does not return to normal even after people have given up taking drugs. A study of 52 people by researchers at the University of Melbourne compared 33 people being treated for heroin addiction with 19 healthy controls. Participants were shown pictures of pleasant stimuli and drug-related stimuli and their reactions to them were measured using a range of physiological methods. The heroin users demonstrated a reduced responsiveness to the pleasant stimuli and an increased response to the drug-related stimuli. How the drug users reacted to the stimuli was a significant predictor of heroin use at a six-month follow-up.

Lubman, Dan I. ... [et al] - Responsiveness to drug cues and natural rewards in opiate addiction Archives of General Psychiatry February 2009, 66(2), 205-213

DISC1 and schizophrenia

A number of different genes have been associated with an increased risk for schizophrenia. One such gene is DISC1. A study of 4,651 people in Finland looked into the links between variations in DISC1 and some of the symptoms of schizophrenia and found that it was linked to social anhedonia - the inability to enjoy social interaction - which is one of the main symptoms of the condition.

Tomppo, Liisa ... [et al] - Association of variants in DISC1 with psychosis-related traits in a large population cohort Archives of General Psychiatry February 2009, 66(2), 134-141

Thursday, February 19, 2009

Genetics, parenting and substance abuse

Every so often newspapers get excited about a 'gene for,' schizophrenia, Alzheimer's, depression or some other mental-health problem. Although genes can increase people's vulnerability to certain conditions the causes of mental-health problems are usually the result of a complex relationship between genetics and environmental factors. This turned out to be the case when researchers from the University of Georgia looked into the effects of a gene called 5HTT which is known to increase children's propensity to consume alcohol and drugs, and to raise levels of impulsivity and risk-taking. The study followed 253 African-American families in rural Georgia over a four-year period. Among children with the genetic risk factor those who received low levels of informed and supportive parenting were three times as likely to have substance-abuse problems as those with high levels of good parenting. However, for those children who received good parenting the difference between those with and without the genetic risk factor was negligible.

You can find out more about this research at

It's not how much time you've got it's how much time you think you have

Not having enough time is the perennial complaint of the overstretched worker, student and schoolchild but a recent study has found that this might be more a case of perception than reality. Researchers at Case Western Reserve University in the U.S. studied 163 people as they took the Iowa Gambling Task. In the task participants pick cards from four decks in order to win money. Some of the decks are positive, others negative so by working out which deck is which the participants can maximise their rewards. The participants were divided into two groups. One group was told they had enough time to finish the task while the other group was told they did not. The two groups were then further divided with one half of each group actually receiving less time to complete the task. Regardless of the actual amount of time they were given the group who were told they had enough time did better on the task.

You can find out more about this research at

Mixed blessings

People of mixed race are sometimes assumed to be at a disadvantage; perhaps because they may experience prejudice from more than one group. However, a study of 180 high-school students in the U.S. has found that this is not always the case. The study compared Black, Mexican and White students with mixed-race ones. On several indicators such as happiness, stress, citizenship and school alienation the mixed-race students were more engaged and felt better than other students.

You can find out more about this research at

Fluoxetine not effective for autism

Fluoxetine (Prozac) is often prescribed for people with depression, anxiety and obsessive-compulsive disorder but has also been used to treat repetitive behaviour in people with autism. Small-scale studies have shown promising results but trials of a new, low-dose form of the drug, aimed specifically at treating autism in children and adolescents, have proved a disappointment. The study of 158 children, aged between 5 and 17, carried out by researchers in 19 sites across the U.S. compared the fluoxetine to a sugar-pill placebo. Both reduced repetitive behaviours but there was no difference between the two.

You can find out more about this research at

New treatment shows promise for opioid addiction

Opioids include a wide range of drugs such as codeine, morphine and heroin. Some are completely illegal, while others are legitimate prescription drugs open to abuse. One of the main factors preventing people from seeking treatment for opioid addiction is the terrible withdrawal symptoms caused when people stop taking the drugs: agitation, insomnia, diaorrhea, nausea and vomiting. Of the current drugs used for treating withdrawal symptoms clonidine can have severe side effects and methadone and buprenorphine can themselves be addictive. The drug ondansetron, which is already used to treat nausea and vomiting, blocks the receptors that are involved in maintaining opioid addiction and trials on mice have proved promising. A very small-scale study on humans also showed encouraging results.

You can find out more about this research at

Unravelling the neuroscience of Alzheimer's

Researchers studying the development of human embryos may have shed light on the neurochemistry of Alzheimer's disease. When the brain and spinal cord are being formed excess nerve cells are generated that have to be removed to refine the pattern of nerve cell connections. Scientists from the U.S. biotechnology company Genentech found that the substance amyloid precursor protein (APP) is behind this process. APP is also found in the brain plaques characteristic of Alzheimer's disease and the scientists thought that it plays a part in killing healthy brain cells in people with the condition.

You can find out more about this research at

Ward atmosphere and outcome

The ward environment has, for a long time, been recognised as an important element in inpatient care and several studies have shown that it is related to patient satisfaction. Ordered environments with high levels of support seem to be associated with higher levels of patient satisfaction, especially for the most severely-impaired service users. However, little is known about how ward environment affects the outcome of people's treatment. A study of eighty service users at three different wards, carried out by researchers in Norway, found that differences in ward atmosphere were associated with differences in patient satisfaction but that there was only 'mixed' evidence that it was linked to patient outcomes (i.e. whether they got better or not). No links were found between ward atmosphere and self-efficacy (the feeling that one can deal with one's problems oneself) or life satisfaction.

Jorgensen, K. N., Romma, V. and Rundmo, T. - Associations between ward atmosphere, patient satisfaction and outcome Journal of Psychiatric and Mental Health Nursing March 2009, 16(2), 113-120

Wednesday, February 18, 2009

What drinkers say about binge drinking

Research into binge drinking has tended to focus on levels of alchohol consumption and its negative consequences but Professor Anna van Wersch of Teesside University decided to find out why people did it and what they got out of it. She carried out detailed interviews with 32 people, aged between 22 and 58, living in the north-east of England. Most of them saw weekend binge drinking as the norm and as a cultural pattern that people were socialised into. It was seen as easier and a better way to involve more people than, say, going to a restaurant or the cinema. People enjoyed the social aspect and sharing happy feelings with others. Positive aspects of binge drinking included increased confidence, a relaxed mood and a reduction in inhibitions. Hangovers and regret for one-night stands, things said and aggression were seen as the main downside.

You can find out more about this research at

Predicting adolescent depression

A study of 800 children by researchers from the University of Washington followed them from years one and two over the next seven years. The children filled out surveys that measured their levels of depression, anxiety and anti-social behaviour. Parents and teachers also filled out questionnaires about the children's anti-social behaviour, their ability to understand other people's feelings, to make new friends and to resolve conflicts. The parents filled out questionnaires about family and marital conflict, family stress and parental depression. Anti-social behaviour among girls and anxiety among both sexes in years one and two turned out to be the best predictors of adolescent depression but depression in years one and two was not predictive of depression later. The researchers thought that girls who were disturbed might show this through their behaviour at a younger age but then 'turn inwards' and become depressed as they got older.

You can find out more about this research at

Active hobbies lower dementia risk

Having mentally-active hobbies and interests, rather than just watching television, could help to delay or prevent memory loss, according to a study of 1,321 people by researchers at the Mayo Clinic in Rochester, New York. The study included 197 people with mild cognitive impairment. Participants - who were all between 70 and 89 - were asked about their daily activities within the past year and when they were between 50 and 65. People who, during their later years, read books, played games, used computers and did craft activities such as pottery or quilting had a 30-50% decrease in their risk of memory loss and people who watched television for less than 7 hours a day were 50% less likely to develop memory loss than people who watched for more than 7 hours a day. People who participated in social activities and read magazines during middle age were about 40% less likely to develop memory loss.

You can find out more about this research at

Unravelling the neuroscience of loneliness

Researchers are increasingly using magnetic resonance imaging (MRI) scans to see which areas of the brain are associated with certain activities, thought processes and characteristics. Researchers at the University of Chicago used MRI scans to look at the links between brain activity and 'perceived social isolation,' i.e. loneliness. They tested 23 female undergraduates to find out how lonely they were. They then put the participants through an MRI scanner while showing them pictures. The lonely participants showed much less activity in a part of the brain called the ventral striatum (which is associated with rewards) when they looked at pictures of people in pleasant settings and much less activity in a region called the tempoparietal junction (which is associated with empathy) when they saw pictures of people in unpleasant settings. But it is unclear whether it is loneliness that affects brain structure or brain structure that makes it more likely that some people will be lonelier than others.

You can find out more about this research at

PTSD among the medics

Working as a medical professional in a war zone is, without doubt, very stressful. Past research has found moderate-high levels of post-traumatic stress disorder (PTSD) in those directly exposed to trauma and low-to-moderate levels in those indirectly exposed. Researchers from the University of Haifa in Israel looked at the levels of psychological distress and levels of functioning of 412 medical and non-medical personnel working in a hospital that was under missile attack in the Second Lebanon War in Summer 2006. The average number of PTSD symptoms was 8.6. 10.2% of the participants met the criteria for a diagnosis of PTSD, however, only 13 of these 43 people reported an impaired level of function. There were no significant differences between people who had direct exposure to injured or traumatised casualties of the war and those who had not, in terms of symptom severity and frequency of probable PTSD.

Koren, Danny ... [et al] - Acute stress reactions among medical and non-medical personnel in a general hospital under missile attacks Depression and Anxiety February 2009, 26(2), 123-128

Depressed and stressed mums

Depression in mothers is a well-known risk factor for childhood mental-health problems and research has suggested that children of depressed mothers are at 2-3 times the risk of both depression and anxiety and behaviour problems. Impairments in how mothers relate to their children play an important part in this increased risk but it is not really clear how this works. One theory is that mothers with depression are more sensitive to stress caused by other people (including their children) and that this makes them less able to deal with conflict with their children; something that could be particularly pronounced when the child itself has a mental-health problem. A study of 44 women by researchers at the University of Pittsburgh looked into the effectiveness of an adapted form of interpersonal psychotherapy. 22 women with depression, and with a child with mental-health problems were divided into two groups. One group received the interpersonal psychotherapy while the other group carried on receiving therapy as normal. 22 women without depression, and with children with no mental-health problems were included in the study for control purposes. The mothers were asked to give a speech about a recent situation with their child that made them feel angry or stressed and their mood, blood pressure and heart rate were assessed. Those women who had received treatment as usual showed the greatest increase in blood pressure, heart rate and depressed mood in response to the task while the non-depressed mothers of healthy children showed the least increases. Those women who had received the interpersonal therapy fell between the two groups suggesting that it had made some difference to their ability to handle stress. Dealing badly with stress was also associated with maternal mental-health problems, levels of parental stress over time and a maternal history of childhood emotional abuse.

Cyranowski, Jill M. ... [et al] - Emotional and cardiovascular reactivity to a child-focused interpersonal stressor among depressed mothers of psychiatrically ill children Depression and Anxiety, February 2009, 26(2), 110-116

Tuesday, February 17, 2009

Spotlight on complaints

A review of complaints about the U.K.'s National Health Service has found that one in ten 'second-stage' complaints in the 2007/8 year were about mental-health trusts. The review -carried out by the Healthcare Commission - found that service users had received letters "full of jargon" that failed to address their concerns and that patients sometimes felt "powerless" and "controlled" by the professionals involved in their care.

You can download the Spotlight on Complaints report from

The true cost of mental illness in children and young people

New figures from the U.S. have revealed the cost of mental-health problems among children and young adults. A panel set up by the National Research Council and Institute of Medicine found that the cost of mental illness, substance abuse and behavioural problems in people under 24 was $247 billion a year. This was the cost of treatment for, and lost productivity caused by, depression, anxiety, schizophrenia, drug and alcohol abuse and behavioural problems. The figure excluded criminal justice and education, workplace disruption and social-welfare spending.

You can find out more about this research at

Predicting pregnant problem drinking

Researchers at Wayne State University in Detroit have developed a new questionnaire to assess problem drinking in pregnant women; something that can cause behavioural problems in children. They tried out the questionnaire on a sample of 75 African American women and their four-to-five-year old children. The mothers answered questions about how much, and how often, they had drunk alcohol around the time of their conception and pregnancy and the children took tests to assess their IQ, attention, memory, visual-motor function, motor skills and behaviour. The questionnaire identified 62% of the mothers as drinking at problem levels - 23% more than other measures of problem drinking. The test was also better at prediciting poor child cognition and behaviour problems than other methods of assessing maternal problem drinking.

You can find out more about this research at

Stress hormones on the battlefield

Some people cope with stress much better than others. There can be few situations more stressful than military conflict and researchers at Yale University looked at stress hormones among soldiers undergoing their survival training. They found that those soldiers who coped with their training best had lower levels of the stress hormone cortisol and produced more of a substance called neuropeptide Y, a chemical that dampened the body's stress response.

You can find out more about this research at

Learning disabilities and dementia

People with learning disabilities are at a greater risk of developing dementia than other people. People with Down's syndrome have a genetic predisposition for dementia, related to the APP gene on chromosome 21 but not all people with learning disabilities have Down's syndrome. The cognitive-reserve theory holds that everyone starts out with different levels of brain power. Dementia reduces this but only when the brain's capacity falls below a certain level do the symptoms of dementia appear. This would explain why people with higher IQs have a smaller risk of dementia; the same processes of decline are going on but they have enough spare capacity to cope without symptoms developing. According to this theory people with learning disabilities should develop dementia symptoms earlier as they have less capacity to begin with. 281 adults over 60, and with learning disabilities, took part in a study organised by researchers at University College Medical School. The study found that the rate of dementia was 2.77 times as high in this group as among the general population but that there was little difference in the rates of dementia between those with mild, moderate and severe learning disabilities. Younger people with learning disabilities were also at a higher risk of developing Alzheimer's disease than people of the same age without learning disabilities.

Strydom, A. ... [et al] - The relationship of dementia prevalence in older adults with intellectual disability (ID) to age and severity of ID Psychological Medicine January 2009, 39(1), 13-21

Exercise and neurodegenerative diseases: reviewing the evidence

Physical activity is known to prevent a number of different health problems including cardiovascular disease, high blood-pressure, type 2 diabetes and certain cancers. However, the links between physical exercise and neurodegenerative diseases - dementia, Alzheimer's and Parkinson's - are less well-established. Researchers from University College London reviewed 16 long-term studies into the links between exercise and neurodegenerative diseases. They found that, compared to people who did least exercise the people who did the most exercise had only seven-tenths the risk of developing dementia, just over half the risk of developing Alzheimer's and four-fifths the risk of Parkinson's.

Hamer, M. and Chida, Y. - Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence Psychological Medicine January 2009, 39(1), 3-11

Parenting and eating disorders

The causes of anorexia are varied and complex including biological, psychiatric, social and cultural factors. However, research suggests that 50% of the risk for anorexia may be due to inherited factors. Although parental mental-health problems are thought to play a part few studies have looked into this and it is hard to know whether it is the anorexia of their children that causes parental mental-health problems or vice versa. A study of 60 adolescent girls with eating disorders and their parents, carried out by researchers at Stanford University, California found that both fathers and mothers reported greater levels of obsessive-compulsive behaviour, hostility*, depression and anxiety. The longer the anorexia lasted the more hostile the fathers were and the worse the symptoms the more hostile the mothers were. However, there was no relationship between the severity of the parents' mental-health problems and the severity of the children's eating disorders suggesting that it was the eating disorders that caused the mental-health problems and not parents' mental-health problems that caused the eating disorders.

Ravi, Sheila ... [et al] - Is there a relationship between parental self-reported psychopathology and symptom severity in adolescents with anorexia nervosa? Eating Disorders January-February 2009, 17(1), 63-71

*For a definition of hostility see

Snacking, restraint and reinforcement

A study of 403 college students in Ontario, Canada looked into the links between dietary restraint, body-mass index and food reinforcement. The reinforcement value of something is defined as how hard someone is willing to work, or how much they would forego to get it. Generally speaking, for example, crack cocaine is more reinforcing, say, than Brussel sprouts. Dietary restraint is the conscious restriction of either calories or certain types of 'forbidden' foods and is believed to lie behind the beginning and perpetuation of eating disorders. The study found that for lighter women the more restrained their eating was the less reinforcing snack food was. However, for heavier women the more restrained their eating was then the more reinforcing snack food was.

Goldfield, Gary S. and Lumb, Andrew - Effects of dietary restraint and body-mass index on the relative reinforcing value of snack food. Eating Disorders January-February 2009, 17(1), 46-62

Video feedback for social anxiety

Social phobia is a common distressing condition that is thought to affect over 12% of the population. It often lasts for a long time and can have substantial negative consequences. Social phobia often starts in early adolescence and therapy for it often concentrates on boosting teenagers' social skills. However, recent research has suggested that people with social phobia may have social skills that are just as good as other people's and that the problem lies more with their perception of themselves. It is thought that people with social phobia pay more attention to their symptoms of anxiety and any negative feedback they receive from other people and miss out on more positive signs. A study of 36 adolescents with social phobia by researchers at the University of Manchester looked into the use of video feedback to help teenagers with social phobia. The children were asked to give two speeches to a camera and were asked to rate how anxious they were before making each speech, how well they thought they would perform and how well they had performed. Participants in the video feedback group were shown a video of themselves speaking after their first speech when it was pointed out to them that they did not look nearly as nervous, and had performed much better, than they thought they had. The other participants, in the control group, were simply asked to wait for ten minutes. Those participants who had received video feedback gave a much more positive appraisal of their first speech than the other group, predicted that they would do much better in the second speech and felt less anxiety. Independent observers, who did not know which of the youngsters had received video feedback, found no difference in performance between the two groups.

Parr, Clare J. and Cartwright-Hatton, Sam - Social anxiety in adolescents: the effect of video feedback on anxiety and the self-evaluation of performance Clinical Psychology and Psychotherapy January-February 2009, 16(1), 46-54

Attachment and personality disorders

Attachment styles are patterns of expectations, needs, ways of regulating one's moods and social behaviour. They are believed to stem from our relationship with our primary caregiver - usually our mother - during our first few years of life. A sensitive and consistent response to a child leads to positive models of oneself and others developing but inadequate responsiveness leads to either a negative model of oneself as undeserving of support, or others as fundamentally unreliable. People with negative models of themselves are said to suffer from attachment anxiety. They are hypersensitive to things going wrong in relationships, constantly monitor the situation for signs of abandonment and can be 'clingy.' People with negative models of others downplay the importance of relationships and try not to think about them too much - something psychologists term attachment avoidance. Researchers from New York looked at the links between attachment style and interpersonal problems in a sample of 41 people receiving outpatient treatment for a mental-health problem. They found that people with secure attachment were less likely to be dominant, vindictive, cold, socially-inhibited and non-assertive. People with attachment anxiety were more likely to be cold, vindictive, socially-inhibited and dominant, although they were also more likely to be self-sacrificing. People with attachment avoidance were more likely to be dominant.

Haggerty, Greg, Hilsenroth, Mark J. and Vala-Stewart, Rosemarie - Attachment and interpersonal distress: examining the relationship between attachment styles and interpersonal problems in a clinical population Clinical Psychology and Psychotherapy January-February 2009, 16(1), 1-9

Friday, February 13, 2009

Predicting postnatal psychosis

It can be common for mothers to experience mental-health problems in the months following childbirth. These can include 'baby blues' in the days after birth and mild-moderate postnatal depression in the weeks and months afterwards. However, around 1 in a 1000 women go on to develop postnatal psychosis which is serious in itself and also causes a risk of self-harm and suicide. Researchers in Sweden looked at nearly three-quarters of a million women who gave birth for the first time between 1983 and 2000. 892 of them had been admitted to a hospital for psychosis within 90 days of giving birth. About half of these women had no previous record of being hospitalised for mental illness. The incidence of psychosis was highest in the first month after birth and dropped to a tenth of this rate after 90 days. Women over 35 were at twice the risk of developing psychosis compared to women aged 19 and under. Maternal diabetes and a higher infant birth weight were associated with a lower risk of psychosis but other factors including smoking and not living with the baby's father were not found to make much difference.

You can find out more about this research at

Recovering from teenage depression: a long haul but most get there in the end

A study of 439 teenagers by researchers at the University of Texas has found that a majority of them did show lasting improvement after treatment. Only a quarter had improved after the first 12 weeks but by 9 months 60% were feeling better. Of those who did respond to early treatment two-thirds maintained their improvement over 9 months. Of those who had not improved early on in their treatment 71% were doing well after 9 months. The study found that cognitive behaviour therapy (CBT) and antidepressants were similarly effective after 9 months. However, those who received both were more likely to show a quick improvement than those on either treatment alone. A substantial number of the teenagers were still clinically depressed after 9 months of treatment.

You can find out more about this research at

Passive smoking and dementia

Passive smoking has been linked to an increased risk of a number of different health problems and now a study is suggesting that it could be linked to dementia. The study looked at 5,000 adults over the age of 50. Saliva samples were taken to measure the levels of a substance called cotinine, a product of nicotine found in saliva for around a day after exposure to second-hand smoke. The participants were also given tests aimed at measuring their brain performance, such as verbal memory and keeping track of time. The study found a 44% increased risk of dementia and other forms of cognitive problems for people exposed to high levels of second-hand smoke. One possible explanation is that passive smoking increase the risk of heart disease and stroke, conditions known to increase the risk of dementia and other cognitive problems.

Thursday, February 12, 2009

Brain scans help early Alzheimer's diagnosis

There is currently no cure for Alzheimer's disease but an early diagnosis can allow drug treatment to improve, or at least stabilise, the symptoms. In Alzheimer's disease the death of brain cells and tissue loss can cause parts of the brain to shrink. Researchers at the University of California San Diego School of Medicine used magnetic resonance imaging (MRI) scans to look at the brains of people with Alzheimer's, those with mild cognitive impairment and a healthy control group. The researchers were looking for a pattern of brain shrinkage in the participants with mild cognitive impairment that would be a good indicator of people going on to develop Alzheimer's. They found that people with mild cognitive impairment who had brain shrinkage in the medial and lateral temporal lobes and in their frontal lobes showed a significant decline a year later and were more likely to progress to a diagnosis of Alzheimer's disease. The authors of the study hope that their findings could be a useful tool in the early diagnosis of Alzheimer's.

You can find out more about this research at

Heroin addict's children: counting the cost

A study of the children of heroin addicts by researchers at the University of Washington in the U.S. has revealed just how tough they have it in childhood and how this can affect them well into adulthood. The study looked at families between 1991 and 1993 and then re-interviewed the children in 2005/6 when they were, on average, 23 years old. The survey looked at adverse events in childhood (on top of having a heroin addict for a parent) including: family mental illness, having a parent jailed, family violence, being a victim of abuse and having a parent die. They found that 70% of children were exposed to two or more of these events, 62% to three or more, and 22% to four or more. Of the 125 young adults who took part in the study only 30 had demonstrated 'resilience' defined as being either working or in school, not using drugs and having a clear criminal record for the last five years. Girls were four times more likely to achieve this than boys, primarily because they were much less likely to get into trouble with the law.

You can find out more about this research at

Alcohol relapse and genetics

Some people are more at risk of relapsing after alcohol treatment than others. The causes of alcoholism are cultural, psychological and social and, as it runs in families there is likely to be a genetic element to it as well. Researchers at the University of Warsaw studied 123 people with drink problems who were followed for a year to see how they got on after treatment. They found that a particular variation in a gene governing a substance called brain derived neurotrophic factor (BDNF) was associated with an increased risk of relapse. BDNF is a protein found in the brain that helps nerve cells survive and connect with one another.

You can find out more about this research at

The neuroscience of risk-taking

Risk-taking can manifest itself in a socially-acceptable fashion such as sky-diving or rock-climbing or in less acceptable ways such as antisocial behaviour or substance abuse. Researchers from the University of Kentucky recruited two sets of volunteers using psychological tests and questionnaires. One set were high-sensation seekers (risk-takers) and the other were low-sensation seekers who were more risk-averse. The researchers gave the participants a brain scan while showing them images some of which were neutral and some of which were arousing (either erotic or violent). When the high-sensation seekers viewed the arousing pictures there was increased activity in a part of the brain called the insula which is associated with addictive behaviour. However, when the low-sensation seekers looked at the same photographs they had more activity in their frontal cortex, an area of the brain involved in emotional regulation. The researchers concluded that the high-sensation seekers were more easily aroused and less able to regulate their emotions than the low-sensation seekers.

You can find out more about this research at

Severe personality disorder: in, out, what's it all about?

Until relatively recently the treatment of choice for people with severe personality disorders was admission for long-term treatment in psychotherapy hospitals or therapeutic communities. However, most of these institutions have closed down and the gap has been filled by partial hospitalization and outpatient, community-based approaches. It is uncertain how these two models compare though so researchers in London contrasted a community-based programme provided by the Cassel Hospital in London with inpatient treatment at the same facility. Their study found that people in the community-based programme improved to a significantly greater degree and had a lower dropout rate than people being treated on an inpatient basis.

Chiesa, Marco, Fonagy, Peter and Gordon, John - Community-based psychodynamic treatment program for severe personality disorders: clinical description and naturalistic evaluation Journal of Psychiatric Practice January 2009, 15(1), 12-24

Differentiating dementias

Although Alzheimer's disease and dementia are often used as synonyms there are a number of different types of dementia. A French study followed the progress of 970 people attending a memory clinic between 1995 and 2001, monitoring them for an average of 4.7 years. 663 had Alzheimer's, 166 had Alzheimer's and cerebrovascular disease and 141 had vascular dementia. The participants with Alzheimer's and cerebrovascular disease tended to be older. Those patients with vascular dementia had the best cognitive function at the start of the study. Decline in cognitive function was greatest for patients with Alzheimer's alone, then for people with Alzheimer's and cerebrovascular disease followed by people with vascular dementia. The shorter the time between the onset of symptoms and the first visit to the memory clinic the longer the patients survived highlighting the importance of early diagnosis for this group.

You can find out more about this research at

Wednesday, February 11, 2009

Diabetes and dementia

It is well known that diabetes is a risk factor for mild cognitive impairment, vascular dementia and Alzheimer's disease and previous studies have shown that people with diabetes are 1.5 times more likely to experience cognitive decline and develop dementia than those without the condition. Researchers at Wake Forest University Baptist Medical Centre studied nearly 3,000 people aged 55 and over. They measured their blood sugar levels and gave them a 30-minute series of tests to measure their cognitive performance. The study found that a 1% increase in average blood glucose levels corresponded to slightly lower scores for psychomotor speed, cognitive function, memory and multi-tasking ability.

You can find out more about this research at

Money can buy you happiness - if you spend it on the right things

It is often said that money can't buy you happiness but a recent study by researchers at San Francisco State University suggests that it can - as long as you spend it on the right things. Participants in the study were asked to write reflections on and answer questions about, their recent purchases. The study found that although spending money on things didn't provide lasting happiness spending money on experiences - such as holidays, restaurants and trips to the theatre - did. The experiences produced more happiness than material possessions regardless of how much they cost or the income of the consumer.

You can find out more about this research at

Genes, serotonin and alcohol

Researchers at the University of Virginia have been investigating the links between a variation of the gene SLC6A4, which is linked to the neurotransmitter serotonin, and how heavily people with alcohol problems drink. The study, of 275 people seeking treatment for drink problems, found that one variation of the gene had a significant association with drinking intensity. Heavy drinking increases serotonin in the brain for a time but over the years chronic drinking reduces serotonin levels leading to a vicious circle in which people drink more to make up the deficit.

Thinking can change the brain

Most neuroscience research has concentrated on the way the brain's physical make up effects the way we think. However, new research from the Karolinska Institutet in Sweden has shown that the process can also work in the other direction. The researchers have previously shown that working memory can be improved with a few weeks' training. After giving people training they also carried out a Positron Emission Tomography (PET) scan on their brains. The researchers found that the training changed the number of dopamine D1 receptors in the cortex. Dopamine plays an important part in many of the brain's functions and disruption to it can cause problems with working memory.

You can find out more about this research at

Smoking and child behaviour

Children whose mothers smoked during their pregnancy are more likely to be badly-behaved but it is very difficult to tell whether it is the smoking itself that causes this or other genetic or environmental factors. Researchers from Cardiff University got around this by studying 779 children born via in-vitro-fertilisation (IVF) some of whom were genetically related to their mothers and some of whom were not. The study found that there was a link between smoking and bad behaviour but only if the mother and child shared the same genes. There was no link if they did not suggesting that antisocial behaviour is more dependent on inherited factors passed on from mother to child.

You can find out more about this research at

Study finds little evidence for brain-training

'Brain-training' is becoming a big industry as people look to boost their cognition and stave off mental decline. However, a review of the research by academics at Brown University in the U.S. has found that there is little evidence to back up the claims for cognitive training. The review found only a very small number of trials that met its quality criteria and even these were limited in their methodologies and follow-up. The authors of the study said that brain-training gadgets could actually have a negative effect by costing people money, diverting their time from exercise which is proven to prevent Alzheimer's and by worrying otherwise well people who are unable to master the devices.

You can find out more about this research at

Not-so-terrible teens

Teenagers have a reputation for being stroppy and obstreperous but a study of 120 teenagers and their parents by researchers in the U.S. has found that they do not always live up - or down - to their image. The study presented the children and their parents with a number of different scenarios in which either parents of children asked for help. It found that teenagers didn't always act out of personal desire or selfishness but felt relatively obligated to help their parents, even when the request was small. In fact the parents thought the teenagers had more right to refuse to help than the children themselves did. The parents thought that older teenagers should behave less selfishly than the younger ones but the older children felt it was more within their rights to refuse leading to conflict as parents' and children's views moved apart as they got older.

You can find out more about this research at

Genes and risk-taking

People's genetic make-up may influence how much risk they take with their money according to a study by researchers at Northwestern University in Chicago. The study looked at the influence of two genes governing the neurotransmitters dopamine and serotonin. Variations in the dopamine gene are thought to be linked to risk taking while variations in the serotonin gene are linked to anxiety levels. The 60 participants in the study took a DNA test and were given money to invest in a mixture of high- and low-risk investments. Those with the 'anxious' version of the serotonin transporter gene 5-HTTLPR invested 28% less money in the high-risk investment than those without. People with the high risk-taking version of the dopamine gene DRD4 invested about 25% more in risky investments than the other participants. The authors of the study pointed out that a number of other non-genetic factors also influenced people's risk-taking.

You can find out more about this research at

Tuesday, February 10, 2009

Good Childhood report calls for more therapists

The Government should make sure that 1,000 psychological therapists are trained over the next five years to cope with the increasing number of children with mental-health problems according to the Children's Society's Good Childhood Inquiry. According to the inquiry only a quarter of children who need it are receiving any specialist help and one in 10 5-16-year-olds had clinically-significant mental-health problems. It said the extra therapists would pay for themselves by cutting crime, social care and remedial costs in the future. The report also criticised the "aggressive pursuit of personal success by adults," income inequality, high rates of family break-up and commercial pressures towards premature sexualization of children.

You can find out more about the Good Childhood report at

Sleep and mental health

A study of 18,631 twins in Finland, carried out between 1975 and 1981 looked at the relationship between people's quality of sleep and their satisfaction with life. In 1975 about 9% of the participants said they were dissatisfied with life and the same people were likely to be just as unhappy in 1981. However, the quality of these people's sleep did not get any worse between the two years. On the other hand, people who said they slept badly at the start of the study were 2.4 times more likely to be dissatisfied after six years and this relationship held true even after a number of other factors were taken into account. So, while unhappiness did not cause bad sleep, bad sleep did lead to an increase in unhappiness.

You can find out more about this research at

New test for Alzheimer's drivers

Whether, and for how long, to allow someone with Alzheimer's disease to continue driving is a difficult balance between society's safety and an individual's rights. Researchers at the University of Iowa College of Public Health may have made the task slightly easier by developing a series of tests which could help predict which people with dementia are riskier drivers. In a study of 155 people the participants took a series of tests of memory, visual processing and motor skills and then took a standard road test driving along a 35-mile route. The Alzheimer's group made more errors, although most of them were minor. Those people who performed better on the lab tests also made fewer errors on the road raising hopes that the tests could be used as part of assessing people's fitness to drive.

You can find out more about this research at

Mediterranean diet prevents cognitive impairment

The Mediterranean diet is one high in vegetables, fruits and nuts, legumes, fish and cereals and low in dairy products, meat and fat, with moderate alcohol consumption. It has been proven to be good for the heart and new research suggests that it could also prevent cognitive impairment. Researchers from Columbia University Medical Centre, New York, studied 1,875 people; 1,393 of them had no cognitive difficulties at the start of the study and 482 of them had mild cognitive impairment. The participants were followed up four years after the start of the study. Those who ate the most Mediterranean diet had a 28% lower risk of developing mild cognitive impairment. Of the participants who had mild cognitive impairment at the start of the study those with the most Mediterranean diet had a 48% smaller risk of developing Alzheimer's disease.

You can find out more about this study at

Government launches National Dementia Strategy

The U.K. Government has published the National Dementia Strategy, a five-year plan which will cost £150m in its first two years. The plan aims to create a memory clinic in every town and city in England. It also recommends better training for GPs in recognising the early symptoms of dementia. The memory clinics will be run by geriatricians, old-age psychiatrists, neurologists, or GPs with a special interest in dementia.

You can download a copy of the National Dementia Strategy at

Headaches and mental health

Headache has consistently been shown to be associated with depression and anxiety disorders and recent studies have found that adverse childhood events may play a part in this. A study of 18,303 people in 10 different countries found that the number of childhood adversities - for example child abuse, divorce, poverty etc - was associated with adult-onset headaches. Early and current-onset of depression/anxiety disorders were also associated with an increased risk of headaches.

Lee, Sing ... [et al] - Association of headache with childhood adversity and mental disorder: cross-national study British Journal of Psychiatry February 2009, 194(2), 111-116

Self-harm: what do service users say?

Self-harm is increasingly common in many countries, is often repeated and is associated with a range of other problems including an increased risk of suicide. A review of the international literature on service users' satisfaction with clinical services looked at 31 studies. Service users' experiences had a lot in common all over the world. Poor communication between patients and staff and a perceived lack of knowledge of staff were common themes and many participants suggested that psychosocial assessments and access to after-care needed to be improved.

Taylor, Tatiana L. ... [et al] - Attitudes towards clinical services among people who self-harm: systematic review British Journal of Psychiatry February 2009, 194(2), 104-110

Adverse drug reactions go unnoticed

Adverse drug reactions (ADRs) are fairly common and need to be recorded so that the same patient is not exposed again to a drug which may have caused a problem earlier. However, very little has been written about the recording of ADRs in psychiatric settings. A survey of 150 patients on acute adult and elderly wards in Oxleas NHS Trust, S.E. London found that almost two-thirds of them had experienced an ADR. For 64 patients documentation of ADRs was either inaccurate or incomplete and allergy documentation was either innacurate or absent for 81 of the patients. The severity of an allergic reaction did not seem to predict whether it would be recorded or not. The researchers concluded that the documentation of ADRs for these patients was 'below acceptable standards.'

Sohel, Jagjit, Clark, Ben S. and Paton, Carol - Allergies and adverse drug reactions: clinical records versus patients' perceptions Journal of Mental Health February 2009, 18(1), 51-56

Compliance and motivational interviewing

Non-compliance, or non-adherence (people not taking their medication) is a big worry for health professionals. This problem is particularly bad among people with schizophrenia where the rates of non-compliance are estimated at between 40-53% depending on the definition used. Motivational interviewing is sometimes used to improve compliance. It attempts to get over people's mixed feelings about changing their behaviour by bringing out their inner motivation to change. It has been used to get people with diabetes and asthma to take their medication, to treat drink and drugs problems and to get people to eat more healthily and take more exercise. Researchers from Marquette University in Wisconsin, U.S. carried out a review of studies into the effectiveness of motivational interviewing at improving compliance among people with schizophrenia. They found only five studies between 1965 and 2006. Two of them showed that motivational interviewing was effective but the other three found that it made no difference. The researchers concluded that the small sample of studies and their methodological limitations made it difficult to draw any meaningful conclusions.

Drymalski, Walter M. and Campbell, Todd C. - A review of motivational interviewing to enhance adherence to antipsychotic medication in patients with schizophrenia: evidence and recommendations Journal of Mental Health February 2009, 18(1), 6-15

Friday, February 06, 2009

TV, teenagers and depression

Watching a lot of television as a teenager could lead to an increased risk of depression in young adulthood according to a study of 4,100 adolescents by researchers from the University of Pittsburgh School of Medicine. At the start of the study the teenagers were asked how many hours they had spent during the last week watching TV or videos, playing computer games or listening to the radio. Seven years later they were screened for symptoms of depression. For each hour of TV viewed per day the youngsters had a statistically-significant higher risk of developing depression in young adulthood. Given the same amount of media exposure young women were less likely to develop symptoms of depression than young men. The researchers thought that the harmful effects of TV could be due to it taking the place of other more beneficial activities, it reducing the youngster's levels of sleep and the content of the programmes themselves.

You can find out more about this research at

Diet and cognitive impairment

A U.K. study of 1,766 older adults has found that low levels of vitamin D are associated with cognitive impairment. The researchers took blood samples to measure people's vitamin D levels and gave them the Abbreviated Mental Test to assess attention, orientation in time and space and memory. Even taking into account co-existing illness older adults with the lowest levels of vitamin D were more than twice as likely to be impaired as those with the highest levels.

You can find out more about this research at

Power lines and Alzheimer's disease

Most mental-health problems have a number of different causes both environmental and genetic and Alzheimer's disease is no exception. A Swiss study of 4.7 million people using census data from 1990 and 2000 and mortality data from 2000-2005 has added another environmental factor to the list in the form of high-voltage power cables. Those people who lived within 50m of a power line were 24% more likely to die of Alzheimer's and the longer they lived there the greater the risk. After 5 years the risk rose by 51%, after a decade 78% and after 15 years the risk doubled. However, in Switzerland at least, it is estimated that only 0.3% of the population live so close to a power line at any one time.

You can find out more about this research at

Thursday, February 05, 2009

Are you sitting comfortably ...

A reading charity has won funding from primary-care and mental-health trusts to hold group-reading sessions for service users. The Reader Organisation runs more than eight weekly read-aloud groups for people in GP practices and hospitals throughout Merseyside. Reading aloud raises self-esteem and confidence and improves people's concentration and vocabulary. There is no set list of books although novels, poetry and biographies have proved more popular than non-fiction.

You can find out more about this project at

Internet therapy for anxiety

There is good evidence that cognitive behaviour therapy (CBT) can improve the symptoms of anxiety. However, many people avoid or delay seeking treatment either because of stigma, because their condition limits how far they can travel or because of a shortage of qualified clinicians. Internet and computer-based treatments have been used in an attempt to overcome some of these barriers and researchers from Tacoma, Washington in the U.S. reviewed 19 trials into the effectiveness of Internet therapy for anxiety. They found that Internet therapy was more effective than being on a waiting list and as effective as traditional therapy. However, the trials had small sample sizes and some methodological problems so the review gave a qualified thumbs up rather than a whole-hearted endorsement.

Reger, Mark A. and Gahm, Gregory A. - A meta-analysis of the effects of Internet- and computer-based cognitive-behavioural treatments for anxiety Journal of Clinical Psychology January 2009, 65(1), 53-75

Psychotherapies and drugs for depression - which is cheapest?

Experiments and reviews have suggested that evidence-based psychotherapies are at least as effective as drugs in treating depression yet drugs are often used in the belief that they are more cost-effective than psychotherapy. A Romanian study of 170 people suffering from depression divided them up into three groups. One group received rational-emotive behaviour therapy (REBT), another group cognitive therapy (CT) and a third group received fluoxetine (Prozac). Six months after treatment the three treatments had all proved equally effective. The researchers based their calculations of cost-effectiveness on the price per depression-free day and the price per 'quality-adjusted life year.' On the first measure the costs were CT $26.44, REBT $23.77 and fluoxetine $34.93. The costs per QALY were: CBT $1.64, REBT $1.73 and fluoxetine $2.29.

Sava, Florin A. ... [et al] - Cost-effectiveness and cost utility of cognitive therapy, rational-emotive behaviour therapy, and fluoxetine (Prozac) in treating depression: a randomized clinical trial Journal of Clinical Psychology January 2009, 65(1), 36-52

Antidepressants and gastrointestinal bleeding

Antidepressants are widely used to treat not just depression but also obsessive-compulsive disorder, panic attacks, post-traumatic stress disorder and social anxiety. For the most part they are effective and safe but a number of case reports have linked them to bleeding abnormalities. An Italian study of 35,869 people compared different categories of antidepressants to see whether they increased the risk of bleeding problems. None of the depressants had an effect on the overall incidence of bleeding problems and the older antidepressants did not cause an increased risk of gastrointestinal bleeding. But selective-serotonin-reuptake-inhibitor (SSRI) antidepressants caused a minor increase in the incidence of gastrointestinal bleeding and mianserin, mirtazapine, reboxetine, trazodone and venlafaxine led to a statistically-significant increase in the risk of gastrointestinal bleeding.

Barbui, Corrado ... [et al] - Antidepressant drug prescription and risk of abnormal bleeding: a case-control study Journal of Clinical Psychopharmacology February 2009, 29(1), 33-38

Tardive dyskinesia and mortality

Tardive dyskinesia is one of the main side effects of antipsychotic drugs and is characterized by repetitive, involuntary and purposeless movements such as grimacing, tongue protrusion, lip smacking, rapid eye blinking and involuntary movements of the hands and feet. A study of 608 Asian people with schizophrenia compared the mortality rate in those with and without tardive dyskinesia. It found that people with tardive dyskinesia were nearly twice as likely to die over the six years of the study although the condition was not linked to any specific cause of death.

Chong, Siow-Ann ... [et al] - Mortality rates among patients with schizophrenia and tardive dyskinesia Journal of Clinical Psychopharmacology February 2009, 29(1), 5-8

Wednesday, February 04, 2009

Substance abuse and TB

A survey of 153,268 people with tuberculosis in the U.S. has found that around a fifth of them also have alcohol and drugs problems. The survey tracked people from 1997 to 2006 accounting for nearly everyone aged 15 and over with the disease during that period. Overall 19% of the participants reported that they abused drugs and/or alcohol but among people born in the U.S. that figure rose to 29%. The most commonly reported risk factor for TB was substance abuse which was more frequent than other factors such as HIV infection or homelessness among the sample.

You can find out more about this research at

Calories and memories

Eating fewer calories may improve older people's memories, according to research carried out by the University of Munster in Germany. The study had 50 participants who were either normal weight or overweight. They were divided into three groups: one cut their calories by 30%, another group increased their consumption of unsaturated fatty acids by up to 20% and a third group made no changes. After three months the group who restricted their calories showed, on average, a 20% increase in their verbal memory scores whereas the other group showed no significant changes in their memory performance. The memory improvements in the calorie-restricted groups were correlated with a decrease in their insulin levels and in substances associated with inflammation in the body.

You can find out more about this research at

Study compares newer antidepressants

A review of newer antidepressants published in the Lancet looked at data from 117 studies. It found that sertraline (brand name Zoloft) and escitalopram (Lexapro) were the most effective and well-tolerated. The studies were carried out from 1991 to 2007 and involved more than 25,000 participants; 12 drugs were compared. Mirtazapine (Remeron) and venlafaxine (Effexor) were also more effective than the other drugs. Far more people remained on sertraline and escitalopram than on the other drugs.

You can find out more about this research at

Premature birth and autism

A study of 988 children by researchers at Boston University School of Medicine has found that they were two to three times more likely to show signs of autism by the age of two as other children. The children were all born at least three months prematurely and were screened at the age of two. Under 6% of the children born full-term showed symptoms of autism compared to 21% of those born prematurely. Whether it is prematurity itself or a factor common to prematurity and autism that causes premature babies to develop the condition is unclear but premature birth is also associated with a number of other health problems including learning disabilities, cerebral palsy, lung problems and vision and hearing loss.

You can find out more about this research at

Hormones and postnatal depression

Postnatal depression affects as many as 1 in 5 women four-six weeks after giving birth and 7% of new mothers suffer from major depression. A study of 100 women by researchers at the University of California, Irvine found that there was a link between high levels of a hormone called corticotropin-releasing hormone (CRH) and postnatal depression. CRH is normally produced in tiny amounts by the hypothalamus in response to stress but pregnant women's placentas produce 100 times as much. The hormone is thought to prepare pregnant women for childbirth but the levels drop immediately afterwards and the 'withdrawal' symptoms can affect the endocrine system. 12 of the 16 women who had high levels of the hormone 25 weeks into their pregnancy went on to develop postnatal depression. The researchers hoped that a blood test for the hormone could be used to pick up women at risk of developing postnatal depression.

You can find out more about this research at

SSRIs and suicide risk

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They include paroxetine (brand name Paxil) and fluoxetine (Prozac). After 2003 authorities in the U.S. and Europe sent out warnings about their use following clinical trials which showed the drugs increased the risk of suicide in teenagers and children. A review of eight large studies involving more than 200,000 participants by researchers at the University of Verona has confirmed that the drugs do seriously raise the suicide risk for children. However, the study also found that SSRIs reduced the suicided risk for adults by 40% and for older adults by 50%.

You can find out more about this research at

Coffee and dementia

A 20-year study of 1,400 Finnish people has found that those who drank three to five cups of coffee a day in middle age were two-thirds less likely than non-coffee drinkers to develop dementia. It was not clear from the study whether it was the coffee itself that lowered dementia risk or another factor common to coffee drinkers. Coffee drinking is believed to lower the risk of developing type 2 diabetes which is in turn linked to Alzheimer's. Coffee also contains antioxidants such as chlorogenic acid that may prevent cell damage over time and caffeine blocks receptors for a chemical called adenosine which has depressant effects in the central nervous system.

You can find out more about this research at

Mental health and violence

A survey of 34,653 people by researchers at the University of North Carolina looked into the links between mental health and violence and also at some of the other factors linked to violence. Participants in the study filled out questionnaires between 2001 and 2003 and three years later they were asked whether they had commited any acts of violence. Those people with severe mental illness but who did not take drugs were no more likely than anyone else to be violent. However, those people with alcohol and/or drugs problems and severe mental illness were three times more likely to have been violent. Even so the combination of severe mental illness and substance abuse was only ninth out of the top ten predictors of violence behind factors such as youth, a history of juvenile detention, violence and physical abuse, criminal parents and unemployment. People with a prior history of violence, substance abuse and severe mental illness were nearly ten times as violent as those with mental illness only.

You can find out more about this research at

Tuesday, February 03, 2009

Prostitution and drug abuse

The link between prostitution and drugs is well-documented. However, not much is known about how prostitutes fare when they receive drug treatment and whether such treatment stops them being involved in the sex trade. Researchers from Stanford University, California, studied 1,287 women undergoing treatment for drug problems of whom 533 were prostitutes. The study found that those women involved in prostitution at the start of the study were more frequent users of drugs and alcohol, had reduced abstinence rates and had more mental-health symptoms than other women a year after they had finished their treatment although the rate of prostitution had declined by then. Receiving more mental-health and psychosocial services during treatment was associated with a lower rate of prostitution at follow-up. Giving up prostitution was associated with lower substance use, higher rates of abstinence and fewer mental-health problems at follow-up.

Burnette, Mandi L. ... [et al] - Impact of substance-use disorder treatment on women involved in prostitution: substance use, mental health, and prostitution one year after treatment Journal of Studies on Alcohol and Drugs January 2009, 70(1), 32-40

Truancy and marijuana use

Playing truant from school is linked to a number of problems including poor school performance, dropping out of school, commiting crimes and teenage pregnancy. Truancy is also associated with poor adult outcomes including violence, marital instability, job instability, lower status jobs, criminality and ending up in jail. A study of 969 youngsters in Rochester, New York, followed them from 1988 (when they had an average age of 14) to 1992 and looked into the links between truancy and cannabis use. It found that truancy was a significant predictor of cannabis use and that this link was particularly strong in early adolescence. The link remained even after commitment to school, school grades, prior involvement in delinquency and parenting were taken into account. The authors of the study thought that this might be because truancy took the children away from the social control exercised by the school and gave them unsupervised and unmonitored time.

Henry, Kimberley L., Thornberry, Terence P. and Huizinga, David H. - A discrete-time survival analysis of the relationship between truancy and marijuana use Journal of Studies on Alcohol and Drugs January 2009, 70(1), 5-15

UK charities launch new self-harm web site

A number of UK charities have joined forces to launch a web site about self-harm. The site has been set up by 42nd Street (a mental-health charity), DePaul UK (a homelessness charity) and YouthNet and includes information about self-harm, professional advice, real-life stories and moderated discussion forums.

You can find the site at

Exploring the evidence

The U.K.'s National Treatment Agency for Substance Abuse has published its research into substance abuse among young people Exploring the Evidence. The research found that the number of young people receiving treatment for substance misuse rose from 17,000 in 2006-7 to 24,000 in 2007-8.

You can download the full text of the report at

Duloxetine and venlafaxine for anxiety

A study of 581 participants in a number of countries by researchers from Mexico, Canada and the U.S. looked into the effectiveness of the drugs duloxetine and venlafaxine in treating generalized anxiety disorder. The study compared the drugs to a placebo. Both drugs produced significant improvements on the Hamilton Anxiety Rating Scale and were also found to be effective in alleviating some of the physical (somatic) symptoms of anxiety.

Nicolini, H. ... [et al] - Improvement of psychic and somatic symptoms in adult patients with generalized anxiety disorder: examination from a duloxetine, venlafaxine extended-release and placebo-controlled trial Psychological Medicine February 2009, 39(2), 267-276

Rumination, distraction and depression

The Response Styles Theory deals with two ways in which people cope with negative thoughts. The first way is called rumination and involves passively focusing one's attention on one's bad mood and repetitively thinking about possible causes and consequences of it. Distraction is defined as actively turning one's attention away from one's symptoms on to pleasant or neutral thoughts and actions. The Response Styles Theory is that rumination worsens and prolongs depressed mood by increasing the likelihood of recalling negative memories and by impairing problem solving. A study of 60 university students by researchers in Germany induced a negative mood by playing them sad music and asking them to think of negative events or feelings in the past. They were then divided into three groups. One group was asked to think about their feelings and what they might mean - this was the 'rumination' group. Another group was distracted by being asked to think about external things and a third group (the mindfulness group) was asked to accept their feelings in a non-judgmental way, concentrate on moment-to-moment awareness and perform breathing exercises. The participants in the 'distraction' group showed a marked improvement in mood compared to the other two groups. The students in the rumination group showed a significant increase in dysfunctional attitudes. Those students who already showed symptoms of depression and who had been asked to ruminate showed a smaller decrease in the levels of the stress hormone cortisol than those who had a lower score for depression.

Kuehner, C., Huffziger, S. and Liebsch, K. - Rumination, distraction and mindful self-focus: effects on mood, dysfunctional attitudes and cortisol stress response Psychological Medicine February 2009, 39(2), 219-228