Wednesday, January 26, 2011

Greater involvement leads to greater workplace stress

Workers who feel themselves to be more central to, or involved in, their organisation are more likely to suffer from workplace stress. Researchers from the Centre for Addiction and Mental Health in Toronto surveyed 2,737 people, 18% of whom said that their job was highly stressful. The odds of having high stress were greater if workers were managers or professionals, if they thought their poor performance could have a detrimental effect on other people or if they worked long or variable hours. Workers who felt that poor job performance could result in physical injury, damage to their company's equipment or reputation or a fincancial loss were twice as likely to report high stress. Having a large commute or entertaining or travelling for work also increased the risk of stress. Those who were men, who were single and under 25 and who worked in a small business were more likely to be less stressed.

Migraines change brain but don't affect cognition

People who suffer from migraines and severe headaches do show changes to their brain over time but don't show symptoms of cognitive decline. Researchers from Inserm and the Universite Pierre et Marie Curie, Paris studied 780 people over 65. They studied them over 10 years using MRI (magnetic-resonance imaging) brain scans and performed cognitive tests of their 'orientation in time and space,' short-term memory and capacity and speed to correctly carry out specific tasks. The results showed that 21% of the sample suffered from severe headaches of whom 70% had migraine. The MRI scans showed that those who suffered with headaches were twice as likely to 'have a large quantity of microvascular brain lesions.' However, there was no difference in cognitive function between those with and without headaches.

Parents' divorce linked to increased risk of suicidal thoughts in men

Boys whose parents divorce could be more likely to think about killing themselves when they become adults. Researchers from the University of Toronto studied 6,647 adults of whom 695 had experienced their parents getting divorced while they were children. Once other factors such as parents being unemployed, being drug addicts or physically abusing their children were taken into account girls whose parents had divorced were no more likely to think about committing suicide; however, even after taking all these factors into account boys whose parents had split up were still twice as likely to think seriously about killing themselves.

NICE updates anxiety guidelines

The U.K.'s National Institute for Clinical Excellence (NICE) has updated its guidance on the treatment of generalised anxiety disorder (GAD). It says that patients should not be offered benzodiazepines or antipsychotics but should be educated about their condition and actively monitored. If this does not work patients should be offered low-intensity psychological interventions such as self-help groups or books and the chance to join psychoeducational groups. Patients who do not respond to this should be considered for cognitive behaviour therapy (CBT), applied relaxation or drug treatment while those most at risk of self-harm should be offered a specialist assessment of their needs and risks.

Tuesday, January 25, 2011

Brief intervention offers hope to insomnia sufferers

Researchers from the University of Pittsburgh School of Medicine have been looking into the effectiveness of a very brief therapy for adults with insomnia. They studied 79 older adults, with an average age of 72. Half received printed educational material aobut sleep and half received a brief behavioural treatment made up of one 45-60 minute face-to-face session, on 30-minute follow-up session and two 20-minute phone calls - a therapy much briefer than the usual six or eight-hour long appointments with a clinical psychologist. The behavioural instruction told the participants to stay in bed if they didn't feel sleepy and to have regular bed and waking-up times and also told them about the biology of sleep and body clocks. Two thirds of the people in the brief-treatment group improved after four weeks compared to only one in four in the other group. By the end of the trial 55% of the participants in the treatment group no longer had insomnia compared to only 13% in the other group, improvements which were sustained for at least six months.

Toddler tantrums, self-control and adult problems

Children who are badly behaved and impatient at three are already at risk of having problems as adults. Researchers from Duke University in North Carolina studied 1,000 people in New Zealand in a long-term study which followed them from early childhood to adulthood. Those children who were unable to tolerate frustration, lacked persistence, had difficulty sticking with a task, couldn't wait their turn and who acted before thinking when they were toddlers were more likely to have problems with their finances, be single parents, have a criminal record, smoke, drink too much and have a drug problem as young adults. The badly-behaved toddlers were also more likely to end up with breathing problems, gum disease, sexually-transmitted diseases, inflammation, overweight and high cholesterol and blood pressure. However, those people who were badly-behaved as toddlers but who later improved their self-control were at no greater risk of developing problems.

Friday, January 21, 2011

Parent-training programmes for autism

Parents of children with autism often attend training programmes to help them cope and with the hope that they will improve their child's symptoms and behaviour. A programme called Early Bird is aimed at pre-school children and a programme called ASCEND  has been running for parents of older children in the Bradford area for the last five years. There has been little research into the effectiveness of these programmes so researchers from Bradford District Care Trust studied 79 parents (who had 58 children between them) attending the programme between 2004 and 2007. 88% found the course useful or very useful and parental knowledge and skills improved significantly across a range of learning outcomes. Scores on the Developmental Behaviour Checklist showed a significant reduction in problem behaviour which was associated with the parents learning improved skills in behaviour management.

Pillay, Mini - Autism Spectrum Conditions - Enhancing Nurture and Development (ASCEND): An evaluation of intervention support groups for parents Clinical Child Psychology and Psychiatry January 2011, 16(1), 5-20 

Family support and depression

High levels of support from one's family are associated with a more rapid recovery from depression while low levels are linked to people being ill for longer. However, there have been few long-term studies into this issue. Researchers from Stanford University studied 373 depressed people over a 23-year period. They found that higher family support was associated with less severe depression at the start of the study and a quicker recovery over the 23-year period. Women with supportive families reported the most rapid recovery from depression.

Kamen, Charles - Family Support and Depressive Symptoms: A 23-Year Follow-Up Journal of Clinical Psychology, Vol. 67(3), 215-223 (2011)

Which kids get hooked on tobacco?

Many children have a quick puff on a cigarette from time to time but not all of them go on to get hooked on tobacco. Researchers from Columbia University in New York studied 660 children, all of whom had smoked a cigarette when they were first interviewed in Year 6. The children were then followed up in Year 10 to see whether they had become hooked on tobacco. The researchers found that enjoying a first puff on a cigarette, having parents who smoked, being hooked in Year 6 and smoking more in Year 6 had the strongest effects on adolescent nicotine dependence in Year 10. Perceived peer smoking and teenage behaviour problems were less important factors.

Hu, Mei-Chen ... [et al] - Risk and protective factors for nicotine dependence in adolescence

Journal of Child Psychology and Psychiatry doi:10.1111/j.1469-7610.2010.02362.x

Wednesday, January 19, 2011

Escitalopram and hot flushes

The antidepressant escitalopram could reduce hot flushes in menopausal women. Researchers from the University of Pennsylvania School of Medicine studied 205 women over an 8-week period. Half were given escalitopram and half were given a placebo. After the eight-week trial the number of hot flushes experienced by the women declined by 47% in the group taking escitalopram and 33% in the group taking the placebo. Interestingly at a three-week follow-up those who had taken escitalopram had more hot flushes than those who had taken the placebo. The researchers' interpretation of this was that the flushes increased because the escitalopram had an effect on them but it could, of course, also mean that the placebo was more effective in the long term!

Video games and mental health - II

Following an earlier study of problematic gaming in young children in Singapore researchers from Yale School of Medicine have been looking into the effects of video games in older children. They surveyed 4,028 adolescents about their gaming and behaviour. 51.2% played video games, 76.3% of boys and 29.2% of girls. For most boys there were no negative consequences of playing the games and they were even linked to a decreased likelihood of smoking. However, among girls gaming was associated with getting into serious fights and carrying a weapon to school. A small percentage of the sample (4.9%) admitted to having problems cutting back on their gaming with boys being more likely to say this than girls. In this group problem gaming was linked to regular cigarette smoking, drug use, depression and getting into serious fights.

Child abuse and false confessions

Compliance involves people responding favourably to requests. In some cases this can be a good thing but in other instances it can lead to people making false confessions when pressure by the police, people being pressurised by their peers to commit crimes and people taking the blame for others' midemeanours. Some studies have shown a significant association between adverse events in people's childhoods, such as physical and sexual abuse, and the tendency to make false confessions and a team of researchers from King's College London and the University of Iceland looked into this further in a study of 113 people receiving outpatient treatment for substance misuse. They found that 64% of the sample reported more than one type of abuse and that compliance was significantly related to parental neglect and physical and sexual abuse. People who suffered from stress and low self-esteem were more likely to have suffered neglect as children while people who were more compliant were more likely to have been sexually abused. Suffering from more than one type of abuse had a multiplying effect on people's tendency to be compliant.

Gudjonssson, Gisli Hannes,  Sigurdsson, Jon Fridrik and Tryggvadottir, Hjordis Bjorg - The relationship of compliance with a background of childhood neglect and physical and sexual abuse The Journal of Forensic Psychiatry & Psychology DOI: 10.1080/14789949.2010.524707

Tuesday, January 18, 2011

Remind me who you are again ...

For people like me, on the wrong side of 40 and hopeless at remembering faces, researchers at Harvard University and Dartmouth College in New Hampshire have got bad news - things aren't likely to get any better as we get older. The researchers tested 44,000 volunteers, aged between 10 and 70, on a variety of skills, including the ability to recognise computer-generated faces. They found that skills at other mental tasks, such as remembering names, peaked at around 23-24. However, on the face-recognition task skill rose sharply from age 10 to 20, continued increasing slowly through people's 20s and reached a peak of 83% correct responses in people aged between 30 and 34. Perhaps those of us who are a bit older should start practising our bluffing techniques!

Mum's iron puts kids on their mettle

Iron deficiency is the most common and widespread nutritional disorder in the world, affecting around 2 billion people. Iron is essential for the development of the central nervous system and early iron deficiency can interfere with nerve development, biochemistry and metabolism. Researchers from Johns Hopkins University Bloomberg School of Public Health studied 676 school-age children in Nepal. Their mothers had participated in a trial in which some of them received iron and folic acid supplements while they were pregnant while others didn't. The children whose mothers had received the supplements had better intellectual function, executive function and fine motor skills than those whose mothers had had no supplements.

Video games and mental health

Researchers from the University of Iowa have been studying the effects of video games on children in Singapore. The researchers surveyed 3,034 children between years 3 and 8 every year between 2007 and 2009. 83% of the children in the study played video games and the average time spent playing was between 20.5 and 22.5 hours a week. 9% of the children were classifiied as being addicted to video games. Playing games for more than 30 hours a week, lack of social competence, less-than-average empathy and greater impulsivity all contributed to the addiction. The children who were more addicted to the games were more likely to become anxious and depressed, to develop social phobias and to peform poorly at school.

Suicidal surgeons

A U.S. study by researchers from the Mayo Clinic in Rochester, Minnesota has found alarming levels of depression and suicidal thoughts among surgeons. Doctors are known to have a higher suicide rate than the rest of the population but this is thought to be because they have access to, and knowledge about, drugs. 7,905 surgeons - a response rate of 31.7% - answered a survey about depression and suicidal thoughts. 6.3% said they had thought about killing themselves in the last year. Older surgeons were more likely to report suicidal thoughts with surgeons who were 45 or over having one-and-a-half to three times the rate of suicidal thoughts as the rest of the population. Being married and having children were associated with lower levels of suicidal thoughts but being divorced raised the risk as did recently having made a surgical error or suffering from burnout. Only 26% of those who had had suicidal thoughts had sought help from a psychiatrist or psychologist.

Monday, January 17, 2011

Schizophrenia and shrinking brains

Brain scans could be used to help people at risk of developing schizophrenia so that they can be offered help before they become unwell. Schizophrenia is known to run in families and researchers from Edinburgh University compared 146 people with a family history of the illness, but who had suffered no symptoms themselves, with 36 healthy controls. All the participants were between 16 and 25 at the start of the study and were not taking anti-psychotic medication; they had brain scans every 18 months over a 10-year period. The study found that the participants who later went on to develop schizophrenia suffered from an acceleration of brain shrinkage before they became unwell. It is known that accelerated brain shrinkage occurs in people with bipolar disorder, or manic-depression, and schizophrenia, but until now it was not known whether these changes occurred before people became ill, as a result of their illness or as a side effect of their medication. The loss of brain tissue occurred in areas of the brain associated with personality, decision making and social behaviour.

Miserable materialists

People who want the latest type of toys and gadgets could be more depressed than people who are happy with what they have already got. Researchers from Murray State University in Kentucky asked 101 men and women how they felt about a range of gadgets including mobile phones, digital cameras, mp3 players, TVs, game consoles, laptops, cars, designer clothes and jewellery. The participants were asked whether they liked what they owned and, if not, how much they wanted a newer version. The people who were more materialistic and who longed for new gadgets had lower feelings of 'life satisfaction.

Colleges fail to pick up depressed students

Universities and colleges could be failing to pick up on, and offer help to, students who are depressed. Researchers from Northwestern University in Illinois studied 1,622 college students going to medical appointments for other health problems. They screeened them for depression with a seven-question survey and found that between a quarter and a fifth of them were depressed with about 2-3% having had suicidal thoughts. The research also found that students who took more exercise were less likely to be depressed.

Brain structures and video-game performance

Researchers from the University of Illinois have been looking into the links between brain structures and learning. They studied 34 people looking at brain activity in structures called the caudate nucleus, the putamen and the nucleus accumbens. The caudate nucleus and the putamen are thought to be active when people learn new motor skills and in tasks that require people to come up with strategies and transfer their attention from one thing to another, while the nucleus accumbens processes emotions associated with reward and punishment. The participants spent time training and practising on a video game called Space Fortress. Activity in the caudate nucleus and the putamen - although not the nucleus accumbens - was found to be a good predictor of how well people picked up the game and could explain between 55 and 68% of the variation in the participants' performance.

Friday, January 14, 2011

Energy drinks make virtually no difference

Drinking so-called energy drinks alongside alcohol has no effect on people's driving ability or alertness. Researchers from Boston University School of Public Health and Brown University in Rhode Island studied 129 people, aged between 21 and 30. The participants were divided into four groups drinking caffeinated beer, ordinary beer, caffeinated non-alcoholic beer (and one can scarcely imagine the vileness of such a concoction) and ordinary non-alcoholic beer. The participants who drank alcohol ended up with blood alcohol levels half as much again as the U.S. drink-drive limit. Half an hour after drinking the participants were tested on a driving simulator and on an attention/reaction-time test. Alcohol affected the participants' performance on the driving test but there was no difference between the groups who had caffeinated beer and those who had non-caffeinated beer. Caffeine made a slight difference in people's reaction times but this was only of marginal significance.

Researchers find protein linking Down's syndrome with Alzheimer's

People with Down's syndrome develop Alzheimer's disease much earlier than other people - often in their 30s. Researchers from the University of British Columbia in Canada have been investigating the link between Down's syndrome and Alzheimer's and have found that people with Down's syndrome produce too much of a protein called RCAN1 which sets off a chain reaction which kills neurons in the hippocampus and cortex. People with Down's syndrome have an extra copy of the gene which produces RCAN1 but the researchers also found raised levels of the protein in people with Alzheimer's who did not have Down's syndrome. The researchers thought the raised level of protein in this group could be due to strokes or high blood pressure.

Children's mental health after the hurricane

In 2004 Hurricane Charley hit Charlotte County in Southwest Florida killing 35 people. Researchers from the University of Miami have been researching post-traumatic stress (PTS) in children caught up in the disaster and have found that the effects can be longer-lasting than previously thought. The researchers studied 384 children in Years 2-4 assessing them nine and 21 months after the hurricane struck. Their study found that 35% had moderate to severe levels of PTS nine months after the hurricane and 29% were still reporting these levels of stress 21 months after the event. Symptoms ranged from recurring dreams about the hurricane to being tense, more distracted, feeling like nobody understood them, problems sleeping and feeling sad and fearful. Other difficulties - such as parents separating or an illness in the family - intensified the children's post-traumatic stress whereas social support from their peers was found to be very helpful.

Survey shows mental-health problems in menopausal women

Compared to men women go through a number of hormonal changes throughout their life which can also affect their mental health. Menopause is associated with depression, sleep disturbances, anxiety and irritability and researchers from Selcuk University in Turkey studied mood and anxiety disorders in a sample of 269 post-menopausal women attending a gynaecology outpatient clinic. They found that 34.2% of them had at least one mood or anxiety disorder, the most common of which was generalised anxiety disorder which was suffered by 15.6% of the women. The less well-off the women were the more likely they were to suffer from mood and anxiety disorders.

Sahingoz, Mine,  Uguz, Faruk and Gezginc, Karim - Prevalence and Related Factors of Mood and Anxiety

Disorders in a Clinical Sample of Postmenopausal Women Perspectives in Psychiatric Care
doi: 10.1111/j.1744-6163.2010.00296.x

Wednesday, January 12, 2011

Gene linked to drunken impulsiveness

Some people who are relatively mild-mannered most of the time can become violent after a few drinks. Researchers from the National Institute on Alcohol Abuse and Alcoholism in Maryland compared the genes of people who had acted impulsively under the influence with those whose behaviour remained more or less the same. They found that those people who had a DNA variation which blocked the action of a gene known as HTR2B were more likely to behave impulsively after they had been drinking.

New figures show more people sectioned and hospitalized in England

The number of people in England detained under the Mental Health Act rose by a third last year. The number of people detained rose from 32,649 in 2008-9 to 42,499 in 2009-10. The overall number of mental-health inpatients rose by 5% to 107,765. Nearly 40% of inpatients were detained under the Act, a rise of 7.6% on 2008-9.

You can find out more about this story here.

Tuesday, January 11, 2011

Allergies, cytokines and suicide risk

People who have severe nasal or skin allergies could have a higher risk of suicide. Researchers from Aarhus University in Denmark analyzed the medical records of 27,000 people who had killed themselves. They found that just over 1% had been hospitalized for severe nasal allergies or eczema compared to 0.8% of the general population. Although the risk of suicide was small for both groups those with severe allergies had a 33% greater risk of committing suicide. Apart from the misery caused by the allergies themselves the researchers also thought that substances called cytokines, produced during allergic reactions, could be responsible. Cytokines can have depression-promoting effects and the study found that the people with allergies who had been treated for depression and anxiety actually had a lower suicide risk. This could be because the antidepressants used to treat these conditions also have the effect of damping down cytokines.

Brain structure and social networks

The amygdala is an almond-shaped structure deep within the temporal lobe of the brain. Research on apes and monkeys has shown that the more sociable they are the larger their amygdalas and a new study by researchers at Massachusetts General Hospital suggests that the same may be true of humans. The researchers asked 58 people, between 19 and 83 about the size and complexity of their social networks and gave them an MRI (magnetic-resonance imaging) brain scan. The study found that, on average, the larger people's amygdala was the larger and more complex their social networks were.

New survey shows recession's toll on youngsters' mental health

Nearly a million 16-24 year-olds in the U.K. are unemployed and a new survey by the Prince's Trust charity shows the toll that this is taking on youngsters' mental health. The survey of 2,170 people aged between 16 and 25 found that young people were twice as likely to self-harm or suffer from panic attacks if they had been jobless for more than a year. Almost half of the sample had problems such as self-harm or insomnia. About one in six respondents to the survey said being out of work was as stressful as a family breakdown, and one in eight said unemployment gave them nightmares. Half of young people seeking work said visits to a job centre made them feel ashamed, and more than half said that job-searching had left them feeling disillusioned or desperate.

Overweight mums not linked to children's intellectual and behaviour problems

Previous studies have shown that women who are overweight before becoming pregnant are more likely to have children with behavioural and learning problems. However, a new study by researchers at the University of Bristol suggests that there is not a direct link between mothers being too fat and their children being badly behaved or doing poorly at school. The researchers studied 7,500 British and Dutch children. The British children were born between 1991 and 1992 and the Dutch children were born between 2002 and 2006. Overall there was no connection between the mothers' pre-pregnancy weights and their children's performance on tests of language and other skills. Children born to overweight women did do less well on language tests but once the fact that fatter mothers tended to be less well-educated and have lower incomes was taken into account the link disappeared.

Monday, January 10, 2011

Mediterranean diet may lead to fewer senior moments

Researchers from Rush University Medical Centre in Chicago have been adding to the evidence which suggests that a Mediterranean diet can prevent cognitive decline in older people. The researchers studied 4,000 people aged 65 and over and gave their diets scores based on how closely they matched a traditional Mediterranean diet - high in wine, fruit, vegetables, legumes, olive oil and fish and low in saturated fat and red meat. The study found that those participants who adhered most closely to a Mediterranean diet had a slower cognitive decline even after taking into account the influence of other factors such as education.

Steps to respect shuts up malicious gossip

Despite proverbs about sticks and stones malicious gossip can be hurtful to children and adults alike, and, in the playground at least, can often lead on to physical bullying. Researchers from the University of Washington in Seattle studied the effectiveness of a programme called Steps to Respect at reducing spiteful gossip. The programme encourages empathy, teaches assertiveness, emphasises that bullying is not a social norm and teaches children not to retaliate as this can make matters worse. Researchers used Palm Pilots to electronically record 610  Year 3 to Year 6 students' behaviour for five minutes, once a week, while they were in the playground. After the programme the children who had taken part in the Steps to Respect programme showed a 72% decrease in malicious gossip.

Alcoholism and obesity

People with a family history of alcoholism may be more likely to become obese. Researchers from Washington University in St Louis studied 80,000 people taking part in a national survey in 2001 and 2002. They found that women with a family history of alcoholism were 49% more likely to be obese than those without. Men who had a family history of alcoholism were also at a greater risk of becoming too fat but to a lesser extent. The researchers think that the link might be due to the fact that the high levels of fat and sugar in junk food affect the same 'reward' centres in the brain that alcohol does.

Sibling age differences and autism

Children who are born closer in age to their older siblings may have an increased risk of being diagnosed with autism. Researchers from Columbia University in New York studied more than 600,000 pairs of siblings born in California between 1992 and 2002. In 3,000 of these pairs the older child had not been diagnosed with autism while the younger one had. In sibling pairs where the mother became pregnant with her second child less than a year after giving birth to her first 7.5 out of 1,000 younger children were diagnosed with autism but where the gap was three years or more only 2.5 out of every 1,000 were. The shorter the age gap between children the greater the risk of developing autism. The researchers thought that this could either be because women's nutrition and stress levels had not recovered properly after giving birth to their first child by the time they became pregnant again or because, having seen normal childhood development relatively recently, the parents were quicker to spot abnormal development in their younger child.

Friday, January 07, 2011

Light boxes might help with non-seasonal depression too

Light boxes are often used to help people suffering from seasonal affective disorder (SAD). However, a new study by researchers from the VU University Medical Centre in Amsterdam suggests that it may also be helpful for people suffering from non-seasonal depression too. In the study 89 men and women aged 60 and over were assigned to two groups. One group got genuine light therapy while the other group sat in front of a dimmer light which has no known effects on the body. After three weeks of treatment the group receiving the genuine light therapy showed an improvement in their depression symptoms - an improvement which was still maintained three weeks later. The people in the light-therapy group showed increases of the hormone melatonin - which promotes sleep - in the evening and decreases in their levels of the stress hormone cortisol, and the lamps were effective for people already taking anti-depressants. However, this was quite a small trial and there is a need for evidence that the lamps produce an improvement in symptoms over a period longer than three weeks.

Even second-hand TV can increase the risk of eating disorders

The mixed blessings of broadcast television only arrived in Fiji in 1995 which makes it an ideal place to research its effects. Researchers from Harvard Medical School have been looking into the effects of media consumption on eating disorders in adolescent girls there and found that the girls participating in the study did not even need to have a TV at home themselves in order to see a raised risk of eating-disorder symptoms. In fact, by far the biggest factor for eating disorders was how many of a subject's friends and schoolmates had access to TV. By contrast, researchers found that direct forms of exposure, like personal or parental viewing, did not have an independent impact, when factors like urban location, body shape and other influences were taken into account. Higher exposure to TV among a girl's peer group was linked to a 60% increase in the odds of having a high level of eating-disorder symptoms. The study is particularly interesting as Fijian culture traditionally prizes a fuller-figure among women.

New blood test for Alzheimer's could be new breakthrough

Researchers from the Florida campus of the Scripps Research Institute have developed a new blood test for Alzheimer's disease which could detect the condition much earlier than current methods. The test is based on the body's immune system which produces antibodies in response to proteins on viruses and bacteria and those produced in Alzheimer's disease. The team used 15,000 synthetic proteins as 'bait' to 'fish' for antibodies in blood samples taken from six patients with Alzheimer's disease, six with Parkinson's and six healthy individuals. The test proved successful in this small sample but lots more research is needed before it can be fully established.

More evidence on overuse of antipsychotics

So-called 'second-generation,' antipsychotic drugs were originally developed to tackle psychoses and schizophrenia but are increasingly being used to tackle unrelated conditions where cheaper and more effective alternatives exist. Researchers from the University of Chicago and IMS Health used data from a survey of U.S. physicians. They found that 16.7 million prescriptions for antipsychotic drugs were written in 2008, accounting for $10 bn, or nearly 5% of U.S. spending on prescription drugs. 9 million of the prescriptions - about $6bn across the U.S. - were for conditions where the use of the drug does not have approval from the U.S.'s Food and Drug Administration. There were particular concerns about the use of antipsychotic drugs to treat bipolar disorder and depression where cheaper and more evidence-based alternatives exist. The drugs can have a number of different side effects including weight gain, diabetes and heart disease.

Thursday, January 06, 2011

ADHD and the daydreaming brain

The default mode network (DMN) connects various parts of the brain; it is active when we are daydreaming or staring into space and gives rise to spontaneous thought but is suppressed when we are concentrating on a particular task. New research from the University of Nottingham suggests that children with attention-deficit hyperactivity disorder (ADHD) could have difficulty in switching their DMNs off which could explain why they have problems concentrating. The researchers compared 18 children between nine and 15 who had been diagnosed with ADHD against a similar number of unaffected controls scanning their brains as they played a video game. The researchers found that the control group were better at switching off their DMNs when they needed to than the children with ADHD.

Deaf people, seclusion and restraint

It is widely believed that people who are deaf or who have hearing problems are more often subject to restraint and seclusion in mental-health services than other people but there is little hard evidence to back this up. Researchers from Oregon State Hospital and Pacific University in Oregon compared 22 deaf or hard of hearing people committed to a large state hospital with 22 similar people who had also been committed but who did not have hearing problems. They found that the people with hearing problems were more likely to be subject to seclusion and restraint although the people with good hearing were, on average, secluded for longer.

Hartman, Brian and Blalock, Ann - Comparison of Seclusion and Restraint Prevalence between Hearing Patients and Deaf or Hard of Hearing Patients in a State Hospital Setting Issues in Mental Health Nursing, 32: 42–45, 2011

Wednesday, January 05, 2011

Iraq - the long-term toll of PTSD

Nearly 2 million U.S. troops have served in Iraq since 2001. Researchers from the University of Minnesota Medical School studied 953 National Guard soldiers who answered questions in Iraq a month before returning home and then again a year later. In the first survey 7.6% of the soldiers were thought to have post-traumatic stress disorder (PTSD) whereas in the second survey 18.2% were. The troops who had had PTSD in the first survey were more likely to suffer from memory and balance problems, concentration difficulties and irritability a year later than those who had suffered concussion without PTSD.

Schizophrenia and impulsivity

Being over-impulsive is one of the hallmarks of schizophrenia and can lead to violence, drug abuse and suicide. However, it is not really known what happens in the brains of people suffering from schizophrenia that makes them more impulsive. Researchers from the Universite de la Mediterranee in Marseilles studied this issue by comparing 26 people with schizophrenia with 30 healthy controls. The participants filled out a questionnaire about their impulsiveness, took a 'Go/No go' test - in which not reacting to things is as important as reacting to them - and had MRI brain scans. The patients with schizophrenia were more impulsive than the controls and a region of their brains called the right ventrolateral prefrontal cortex was less efficient at processing 'inhibitory control.'

Kaladjian, A. ... [et al] - Impulsivity and neural correlates of response inhibition in schizophrenia Psychological Medicine (2011), 41, 291–299

What to do with people who fall through the gaps?

Unless people present a danger to themselves or others mental health services don't treat them until they voluntarily seek help. Psychologists now think that people might be at risk of developing psychosis for a while before they become severely ill. Developing psychosis can have a massive impact on people's lives but so can being labelled as mentally ill and the side effects of antipsychotic drugs so that intervening in the lives of people who are 'at risk' for psychosis is a vexed issue, both medically and ethically. Researchers from the Institute of Psychiatry, King's College London attempted to shed a little more light on this debate in a study of people who had been referred to mental-health services by their GP. The study found that 21.2% of people had not turned up for their appointment with mental-health services. Around half this group subsequently received a diagnosis of mental illness and over a fifth of the 'no-shows' were later given a diagnosis of psychosis with nearly 70% of them seeking help from other mental-health services. People who did go on to their appointments with mental-health services were more likely to be employed. The authors of the study argue that there is a case for mental-health services chasing up people who have been referred to them by GPs but who have not turned up for their appointments.

Green, C. E. L. ... [et al] - Outreach and Support in South London (OASIS). Outcomes of non-attenders to a service for people at high risk of psychosis: the case for a more assertive approach to assessment Psychological Medicine (2011), 41, 243–250

Seclusion and restraint in Canada

Patients in psychiatric hospitals are often put on their own - in seclusion - for a while until they calm down and stop being a danger to either themselves or others. However, researchers don't know that much about how often it happens or which people are most likely to be placed in seclusion. Researchers from Montreal University studied 2,721 psychiatric patients. They found that 23.2% of them had been placed in seclusion and that 17.5% of them had been secluded with (physical) restraint. Being young; suffering from schizophrenia or psychosis; suffering from bipolar or personality disorder and having to stay in hospital for a longer time were all associated with seclusion while being young, having bipolar or personality disorder and staying for a longer time in hospital were all associated with having to be physically restrained.

Dumais, A. ... [et al] - Prevalence and correlates of seclusion with or without restraint in a Canadian psychiatric hospital: a 2-year retrospective audit Journal of Psychiatric and Mental Health Nursing doi: 10.1111/j.1365-2850.2010.01679.x

Tuesday, January 04, 2011

Hospital art - is it really a waste of money?

In times of budget cutbacks hospital art is often the first thing to go, however, a new piece of research suggests that this might be a false economy. Upali Nanda from American Art Resources in Houston led a study based in a lounge for psychiatric patients in a hospital in East Alabama. On different days either a picture of nature or a landscape; a piece of abstract art or no art at all was hung up in the lounge. The researchers then noted how much medication was prescribed on a pro re nata (PRN) (over and above patients' normal prescriptions) basis to deal with patients who had become agitated or anxious. The study found that there was a significant reduction in PRN medication on the days when natural and landscape art was hung in the lounge although some abstract art was found to make patients more agitated. The reduction in PRN medication was found to be around $30,000 per annum - more than enough to buy a few halfway-decent prints for the lounge.

Nanda, U. ... [et al] - Effect of visual art on patient anxiety and agitation in a mental health facility and implications for the business case Journal of Psychiatric and Mental Health Nursing
doi: 10.1111/j.1365-2850.2010.01682.x

Mindfulness and stress. Who does it help?

Mindfulness - being aware in the present moment in an open and non-judgemental fashion - is used to help with a number of different psychological problems. Mindfulness-based stress reduction (MBSR) has been shown to be helpful to people but there has been little research into whether it is more effective in certain people or not. Researchers from Santa Clara University in California studied 30 people. 15 of them formed a control group while 15 of them received MBSR. MBSR was found to increase mindfulness, wellbeing and empathy in assessments carried out two and 12 months later. However, those participants who already had the highest levels of mindfulness before the MBSR treatment started showed the greatest levels of improvement.

Shapiro, Shauna L. - The Moderation of Mindfulness-Based Stress Reduction Effects by Trait Mindfulness: Results From a Randomized Controlled Trial Journal of Clinical Psychology doi: 10.1002/jclp.20761

Executive dysfunction, problem-solving and depression

People with executive dysfunction have problems setting goals, planning, initiating and sequencing behaviour. Executive dysfunction is often a symptom of depression and a team of researchers from Weill Cornell Medical College in New York studied the effectiveness of two different kinds of therapy in combating it in a study of 221 older adults with depression. Problem-solving therapy (PST) helps patients identify the most important problems in their lives, select solutions and make concrete plans for dealing with them while supportive therapy (ST) is more like counselling being based on 'active listening' and offering support in a non-judgemental environment. The participants were divided into two groups, each having either PST or ST, and received 12 weekly sessions of therapy. After six weeks both groups had shown comparable levels of improvement, however, the group receiving PST showed greater improvements after nine and 12 weeks and this difference was still there 24 weeks after the end of treatment. PST was particularly helpful for people who had cognitive problems and who had had more previous episodes of depression.

Alexopoulos, George S. ... [et al] - Problem-Solving Therapy and Supportive Therapy in Older Adults With Major Depression and Executive Dysfunction: effect on disability Archives of General Psychiatry January 2011, 68(1): 33-41

Bupropion and tobacco cravings

Bupropion hydrochloride was originally marketed as an antidepressant but it has also been found to be effective in helping people to give up smoking. It reduces people's cravings for cigarettes but noone knows quite how it works. A team of researchers from the University of California Los Angeles studied 30 people all of whom were hooked on cigarettes. Over an eight-week study half of them were given bupropion and half were given a placebo. The participants who had been given bupropion reported fewer cravings and less activation in the left ventral striatum, the right medial orbitofrontal cortex and the bilateral anterior cingulate cortex than those who were taking a placebo. All the participants showed reduced brain activity in the bilateral medial orbitofrontal cortex and the left anterior cingulate cortex when they were trying to resist tobacco cravings suggesting that bupropion works by dampening down these areas of the brain.

Culbertson, Christopher S. ... [et al] - Effect of Bupropion Treatment on Brain Activation Induced by Cigarette-Related Cues in Smokers Archives of General Psychiatry doi:10.1001/archgenpsychiatry.2010.193