CD Roms and bingeing

Obese people who binge eat often become obese earlier than other people and start dieting earlier. Their weight goes up and down more and they have lower self esteem. They are also more likely to suffer from depression, anxiety and personality disorders. A comparison of a self-help CD-Rom - based on cognitive behaviour therapy (CBT) - with group CBT sessions found that more people dropped out of the group-therapy sessions than stopped using the CD-Rom. People on a waiting list for treatment were more likely to choose the CD-Rom than group therapy and people who used the CD-Rom carried on using it after the study had finished. Both treatments were found to reduce bingeing and there was little to choose between them in terms of effectiveness.

Shapiro, Jennifer R. ... [et al] - Feasibility and acceptability of CD-Rom-based cognitive-behavioural treatment for binge-eating disorder European Eating Disorders Review May-June 2007, 15(3), 175-184

Buprenorphine for heroin users

Long-term heroin use can often result in illness or death. Methadone is often used to wean addicts off heroin but it can be sold on to other users and it has been known to cause death by overdose. Recently a drug called buprenorphine has been used instead of methadone as it is less likely to cause death by overdose. A trial on 96 heroin addicts in Sweden compared the effectiveness of using methadone and buprenorphine and found that both were equally effective (about 80%) in weaning people off heroin. Given the safety benefits of buprenorphine the researchers called for it to become the first choice of drug for treating heroin addicts.

Kakko, Johan ... [et al] - A stepped care strategy using buprenorphine and methadone versus conventional methadone maintenance in heroin dependence : a randomized controlled trial American Journal of Psychiatry May 2007, 164 (5), 797-803

Interpersonal psychotherapy and depression

A trial on 124 people hospitalized for major depression in Germany compared the effects of five weeks of interpersonal psychotherapy and antidepressants with the usual treatment for depression, in this case medication plus intensive clinical management. After five weeks those patients who received interpersonal psychotherapy had a significantly greater reduction in symptoms compared to patients in the other group. Response rates were higher for the interpersonal psychotherapy group (70% vs 51%) and remission rates were also higher (49% vs 34%). After three months only 3% of the interpersonal therapy group had relapsed compared to 25% of the other group. However, after nine months there was no significant difference between the two groups.

Schramm, Elisabeth ... [et al] - An intensive treatment program of interpersonal psychotherapy plus pharmacotherapy for depressed patients : acute and long-term results American Journal of Psychiatry May 2007, 164 (5), 768-777

Nutrition and dementia

A Swedish study of people with Alzheimer's disease has found that improving their diet can also help to alleviate some of the symptoms of the condition. The researchers divided the study participants into two groups. One group were treated as normal and the other group were seated together for meals and allowed to help themselves. Over a three-month period the majority of patients who ate together put on weight and those people who gained weight showed a significant improvement in intellectual function with less confusion, anxiety and depression.

Journal of Clinical Nursing (2007) 16 : 987-996

Distal support and schizophrenia : putting the care back into community

Since the policy of closing down long-stay psychiatric hospitals and re-integrating people into the community was introduced there has been a lot of research into the best way of helping people settle into the community. This has concentrated on employment and support networks such as friends and families but much less research has been done in the field of casual, routine interactions with other members of the public such as might occur in shops, libraries, gyms, churches etc and which is known as 'distal support'. A study of 58 people with schizophrenia in the U.S. found that extroversion and openness were important in how much distal support a person received, regardless of how severe their symptoms were. Those who received the most distal support also reported a higher quality of life and a greater sense of belonging in their neighbourhood. However, those people who reported high levels of distal support were also more likely to be hospitalized. The researchers speculated that this could be because : i) the more contact people had with others in the community the more likely it was that someone would suggest that they get help when their symptoms worsened ii) that some of the interactions that the people with high distal support had with others in the community were negative and made their symptoms worse or iii) that the extroversion and openness that made people likely to have high levels of distal support also made them more likely to seek help when they felt that their condition was worsening.

Wieland, Melissa E. ... [et al] - Distal support and community living among individuals diagnosed with schizophrenia Psychiatry Spring 2007, 70(1), 1-11

Hoarding up problems

In its most severe forms compulsive hoarding can lead to fires, rat and cockroach infestations, broken bones from tripping over clutter and other health and safety hazards. A review of studies into hoarding found that about a quarter of people with Obsessive-Compulsive Disorder (OCD) were hoarders. Those people with OCD who also hoarded were more impaired than non-hoarders and had ordering compulsions as well as contamination, sexual, religious, symmetry and somatic (to do with the body) obsessions. Hoarders were also more likely to suffer from social phobia, substance abuse and bipolar disorder. Male hoarders had higher levels of social phobia than non-hoarders whereas female hoarders had higher rates of bipolar disorder, substance abuse, alcohol abuse, panic disorder, social phobia and binge-eating. Paroxetine (an anti-depressant) has been shown to be effective in improving the mental health of people who hoard while Cognitive Behaviour Therapy (CBT) has also proved effective.

Kaplan, Aline - Hoarding : studies characterize phenotype, demonstrate treatment efficacy Psychiatric Times May 2007, 24(6), 1

Bullying - victims and perpetrators at increased risk

A study of 2,341 children, aged 13-19 in New York looked at bullying and its potential association with depression and suicidal behaviour among adolescents. About 20% of the sample reported that they were victims of bullying in school and another 10% said that they were bullied outside school. 25% of students said that they bullied other students in school and 15% said that they bullied people outside school. Children who were frequent victims of bullying in school were five times as likely to have suicidal thoughts and four times as likely to have attempted suicide than other children. However, those children who engaged in bullying behaviour were three times as likely to have suicidal thoughts and to have made suicide attempts than other children. Students who were both victims and perpetrators of bullying were at the highest risk for depression and suicidal behaviour.

Klomek, A.B. ... [et al] - Bullying, depression and suicidality in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 2007, 46, 40-49

Number sectioned remains steady

New figures from the Information Centre for Health and Social Care show that the number of people detained in mental health units has remained steady at 47, 400. Formal admissions under the Mental Health Act rose slightly from 26, 800 in 2004-5 to 27, 400 in 2005-6. At the 31st of March 2006 there were 14, 600 patients detained in hospital ; 12,100 in NHS facilities, 2,500 in the private sector. The rate of detentions was 87 per 100,000 population. The number of people detained under Place of Safety Orders - which allow police to remove a person who appears to have a mental disorder to a place of safety - rose from 5,100 in 2004-5 to 5,900 in 2005-6.

You can find more information about the survey at

www.ic.nhs.uk/pubs/mha0506

Learning disabled children suffer

A new report by the Foundation for People with Learning Disabilities and Lancaster University has found that children with learning disabilities are up to six times as likely to suffer from mental-health problems as other children. The study, The Mental Health of Children and Adolescents with Learning Disabilities, found that the increased risk of mental illness is not always due to the learning disability per se but arises because of exposure to greater poverty and social exclusion than experienced by other children. The report, based on a survey of 18,000 children aged 5-15, found that a third of children with learning disabilities had mothers with mental-health problems and nearly half (47%) were living in poverty. Children with learning disabilities had fewer friends than other children and were more likely to suffer abuse or be involved in serious accidents.

Children drink, smoke and take drugs less shock

Children are drinking, smoking and taking drugs less now than they were five years ago, according to a report from the Information Centre for Health and Social Care. The percentage of pupils between 15 and 11 who had drunk alcohol in the previous week fell from 26% to 21% and the proportion of pupils who had never drunk alcohol rose from 40% to 46%. The percentage taking drugs in the last year fell from 19% to 17% and the percentage taking drugs in the last month fell from 11% to 9%. The level of smoking remained unchanged at 9% although the proportion of pupils who had never smoked rose from 47% in 1982 to 61% in 2004.

Risk from forensic units is very low

Secure forensic psychiatric units aim to assess, treat and rehabilitate mentally disordered offenders. Most of the people inside them suffer from severe psychotic disorders, personality disorders and substance abuse and have usually commited offences involving severe violence against the person. Between 1995 and 2001 the number of beds in NHS medium-secure units rose from 1225 to 2225 and there are proposals to increase capacity by another 29% with a similar expansion in private-sector facilities. This can often lead to concern in local communities over the offences that patients might commit when they are on supervised or unsupervised leave from their units. However a study of four medium-secure units in south-east England has found that between 1998 and 2002 only one burglary was commited by a patient on leave with no violent incidents whatsoever.

Gradillas, Vicente ... [et al] - Do forensic psychiatric inpatient units pose a risk to local communities? The Journal of Forensic Psychiatry and Psychology June 2007, 18(2), 261-265

'Just say no' helps dual diagnosis forensic patients

'Dual diagnosis' is when people have a mental-health problem and a substance-abuse problem and is common in forensic units which deal with mentally-ill offenders. Surveys of patients in such units have shown that a third are alcohol abusers and half drug abusers. Substance abuse is of particular concern in forensic mental health services as it increases the risk of crime, particularly theft and violence. As patients are often in forensic units for a considerable period of time they represent a good chance of getting patients off drink and drugs. A study of dual-diagnosis offenders at the Denis Hill unit at the Bethlem Hospital looked at a programme of two stages of 12-week treatment groups supporting people in becoming and remaining drug and alcohol free through motivational interviewing, psycho-education and relapse prevention. After their release the offenders took part in the 'Just Say No' participant-led social group to support their continued abstinence for the six months after their discharge. The study found that the 'Just Say No' group had a significant effect on whether people remained drug-free. By the end of the treatment people reported more insight into their problems, felt more confident that they could stay off drugs and felt less cravings for cannabis.

Miles, Helen ... [et al] - 'Just say no' : a preliminary evaluation of a three-stage model of integrated treatment for substance use problems in conditions of medium security The Journal of Forensic Psychiatry and Psychology June 2007, 18(2), 141-159

Getting by with a little help from their friends

A survey of 270 mental health service users has found mixed attitudes about the relationship between service users and their friends. 62% of service users said that it helped to have their friends around at times of mental distress but 44% didn't want their friends to know they had a mental health problem and nearly half (48%) felt unable to talk to their friends about their mental health problems. Nearly a third said that they had lost friends after they had confessed to a mental health problem although 60% said their friends had reacted sympathetically and 47% said that they had offered support. Two-fifths of people said that they had received more help from their friends than doctors, counsellors, families or partners. The best forms of help were just being around, emotional support and keeping in touch.

You can read the whole survey at the Mental Health Foundation's web site at

www.mhf.org.uk

Job satisfaction high for mental health staff

The annual survey of NHS staff by the Healthcare Commission has found that, despite having a high chance of being beaten up on the job, mental health staff have one of the highest levels of job satisfaction (73%) in the NHS, second only to primary care staff (75%). 22% had experienced physical and verbal violence from service users - the same level as last year - and 34% had experienced bullying and verbal abuse. However only 10% had suffered from work-related stress or injuries - 4% down on last year. You can read more about the Healthcare Commission's survey at

http://www.healthcarecommission.org.uk/newsandevents/pressreleases.cfm/cit_id/5334/FAArea1/customWidgets.content_view_1/usecache/false

GPs still neglecting depression

A survey by the mental health charities SANE and the Depression Alliance has found that, of the 450 patients surveyed 40% had not discussed treatment options with their GP while 58% wanted more ongoing support. More than half of those surveyed had stopped taking their antidepressants before the course of medication was completed - 46% because of their side effects, 22% because they wanted to come off treatment and 30% because they felt better.

You can read the full text of the Now we're talking report at

http://www.depressionalliance.org/documents/Now-Were-Talking-Report.pdf

CBT and bereavement by suicide

Bereavement can often lead to psychological problems over and above the normal grieving process - something referred to as 'complicated grief'. This can be characterized by symptoms such as avoidance of reminders of the dead person, purposelessness, detachment, disbelief and bitterness. These symptoms can be particularly acute when the person being mourned has commited suicide. A Dutch trial on 122 relatives who had been bereaved by suicide looked at the effectiveness of a family-based counselling programme of four sessions with a trained psychiatric nurse counsellor between three to six months after the suicide. Unfortunately the trial found that the cognitive-behaviour therapy based treatment was not associated with a reduction in grief although it did help people to blame themselves less for their relative's suicide.

de Groot, Marieke ... [et al] - Cognitive behaviour therapy to prevent complicated grief among relatives and spouses bereaved by suicide : cluster randomised controlled trial British Medical Journal May 12, 2007, 994-996

Aspirin might save your life but it won't make you cleverer

In recent years aspirin has been hailed as something of a wonder drug in terms of reducing people's risk of heart disease and stroke. However a recent trial on 6,377 women in the U.S. has found that aspirin does not improve cognitive function. The women were divided into two groups, one group taking aspirin and the other a placebo, and given tests at periodic intervals. The women who were taking the aspirin performed no better than the placebo group.

Kang, Jae Hee ... [et al] - Low dose aspirin and cognitive function in the women's health study cognitive cohort British Medical Journal 12 May, 2007, 987-990

Child abuse and PTSD

Many studies have shown that child abuse is responsible for long-term psychiatric disabilities, medical problems, substance abuse, learning problems, interpersonal violence and other serious social and health problems. However, there is also growing evidence that early comprehensive intervention may effectively reverse some of this damage and lessen the risks to children. Victims of child abuse are often diagnosed with Post-Traumatic Stress Disorder (PTSD) and the recommended treatment for this is Trauma-Focused Cognitive Behaviour Therapy (TF-CBT). A trial of a 16-session course of TF-CBT for abused 9-14 year-old children in New Zealand made up of psychosocial strengthening, coping-skills training and gradual exposure to perceived threats together with special issues relevant to trauma and abuse has been found to show 'a good deal of promise' in a pilot study on 4 children.

Feather, Jacqueline and Ronan, Kevin R. - Trauma-focused cognitive and behavioural therapy for abused children with post-traumatic stress disorder : a pilot study New Zealand Journal of Psychology November 2006, 35(3), 132-145

Meditation, relaxation and mental powers

There is a good body of evidence to suggest that meditation can provide considerable emotional and physical benefits to those people who practise it and, in the long-term, it can improve people's intellectual capacity too. A study of 54 people in Australia aimed to see whether meditation could also confer immediate benefits on people's thought processes. People were enrolled in either a short session of meditation or of relaxation then given tests to assess their cognitive functioning. Meditation was not found to be any more effective than relaxation on any of the measures used.

King, Gillian and Coney, Jeffrey - Short term effects of meditation versus relaxation on cognitive functioning The Journal of Transpersonal Psychology 2006, 38(2), 200-215

Mental health and physical illness in Cambodia

Mental distress often manifests itself as an undiagnosed physical illness, something that psychologists call somatic symptoms. A study of 268 people in Cambodia compared people who exhibited unexplained physical symptoms with healthy controls. The researchers found an increased incidence of traumatic events, depression, anxiety and panic in those who had somatic symptoms. Those who had suffered under Pol Pot's regime and the subsequent civil war showed more somatic symptoms and panic while those who had endured domestic violence suffered from increased levels of depression, anxiety and panic.

Perry, Christopher T., Oum, Phalyka and Gray, Sheila Hafter - The body remembers : somatic symptoms in traumatized Khmer Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry Spring 2007, 35(1), 77-84