Disappointing results for escitalopram in older depressed people

A study into the effectiveness of escitalopram in treating depression in people over 60 has yielded disappointing results. The 12-week trial divided 264 patients into two groups one receiving escitalopram and the other a placebo. Escitalopram was no more effective at treating depression than a placebo and 11% of the people taking the drug discontinued it due to side effects of headache, nausea, diaorrhea and a dry mouth.

Bose, Anjana, Dayong, Li and Gandhi, Chetan - Escitalopram in the acute treatment of depressed patients aged 60 years or older American Journal of Geriatric Psychiatry January 2008, 16(1), 14-20

Personality and leaving therapy

How people leave group psychotherapy is often as important as what goes on in the sessions. Drop-out is characterized by frequent absences from group sessions and avoidance of the therapist's solicitations. In evasion into health the member resists the group's successful penetration of his/her defences and denies the need for further help claiming that all his/her problems have been solved. In ending of a phase the group member feels that he/she has completed a successful piece of work and is unwilling to proceed further. In saying goodbye, the best possible outcome, the group member announces his/her departure in advance, works towards the definitive date, freely discusses his/her feelings and anticipates the after-therapy period. A Swiss study of 24 older people suffering from depression looked into the links between people's personalities and the quality of their termination from group therapy. The researchers found that neuroticism was not related to the quality of the termination but agreeableness and openness to experience were strongly associated with a successful ending to therapy.

Canuto, Alessandra ... [et al] - Impact of personality on termination of short-term group psychotherapy in depressed elderly outpatients International Journal of Geriatric Psychiatry January 2008, 23(1), 22-26

Life review programmes for older people

The Life Review Group Programme is a technique used to improve the psychological health and wellbeing of older people. It consists of a series of group discussions on topics such as childhood memories, adolescence, people's families, their jobs and friends, the greatest thing people have accomplished in life and a summary of the life review and the integration of life events. The sessions include group discussion, couple work and role-playing. A study of 75 elderly men in a nursing home in Taiwan found that the Life Review Group Programme led to significant improvements in self-esteem and life satisfaction which were maintained one month after the intervention.

Chiang, Kai-Jo ... [et al] - Evaluation of the effect of a life review group program on self-esteem and life satisfaction in the elderly International Journal of Geriatric Psychiatry January 2008, 23(1), 7-10

Anxiety and treatment-resistant depression

The STAR*D study is a ground-breaking, large-scale study of over 4,000 adults with treatment-resistant depression at 41 different locations in the U.S. As part of the study 2,876 people received the antidepressant citalopram. In the second phase of the study those people (1,292) who had failed to improve after taking citalopram for 14 weeks were then randomly assigned to take another antidepressant or a combination of citalopram and another drug. As part of the trial participants were asked about their anxiety levels. Approximately 53% of the sample had clinical anxiety problems and for those people remission was significantly less likely and took longer to occur. Ratings of drug side effects were also significantly greater in the anxious group. Changing medication or augmenting citalopram with another drug were also significantly less effective in anxious people.

You can find out more about this research at

http://psychcentral.com/news/2008/01/03/anxious-depression-predicts-poorer-treatment-results/1733.html

Depression and smell

There is a well-attested link between Alzheimer's disease and people losing their sense of smell and now researchers from Tel Aviv University have put forward the idea that depression might also be linked to a loss of the sense of smell. Research on autoimmune diseases (where the body attacks itself) such as arthritis, rheumatism and lupus shows that a particle known as an autoantibody which attacks the body's own immune system can weaken a person's sense of smell and induce feelings of depression. People who are depressed often respond well to aromatherapy and shops often use smells to improve customers' moods and get them to spend more.

You can find out more about this research at

http://psychcentral.com/news/2008/01/04/depression-may-affect-smell/1738.html

Light therapy for bipolar disorder

People with bipolar disorder are known to be sensitive to changes in outdoor ambient light and to seasonal changes and a small-scale U.S. study has shown encouraging results for light therapy. The light therapy was used to treat the depressive part of the disorder and the women who participated in the study were given light boxes and instructions on how to use them at home. Those who received morning light developed a mixed state with symptoms of depression and mania - racing thoughts, irritability, sleeplessness, anxiety and low mood - occuring all at once but those who used their light boxes at mid-day had a much more stable response and of the nine women treated six showed some sign of improvement. Optimal response was observed with mid-day light therapy for 45-60 minutes daily.

You can find out more about this research at

http://psychcentral.com/news/2008/01/04/bright-light-therapy-for-bipolar/1740.html

Anxiety and heart attack risk

A study of 735 men by researchers at the University of Southern California has found that anxiety can increase people's risk of a heart attack by 30-40%. Each of the 735 participants in the study completed psychological tests in 1986 and was in good cardiovascular health at the time. The men completed tests for psychaesthenia (excessive doubts, obsessive thoughts and irrational compulsions), social anxiety, phobias and their tendency to experience tension and physical arousal in stressful situations. They also completed psychological tests about their hostility, anger, type A behaviour, depression and negative emotions and their smoking, alcohol consumption, daily diets and general physical health was also assessed. Regardless of all other factors those men who came in the top 15% of any of the anxiety scales faced an increase in their heart attack risk of 30-40%.

You can find out more about this research at

http://psychcentral.com/news/2008/01/08/long-term-anxiety-ups-heart-attack-risk/1754.html

Regular meals and eating disorders

As children go through adolescence disordered eating behaviours, including binge eating and self-induced vomiting, become more common. Disordered eating behaviours are associated with a number of harmful behavioural, physical and psychological consequences including poor quality diets, weight gain, obesity, depressive symptoms and the onset of eating disorders. A study of 2,516 adolescents in Minnesota looked at how often children ate with their families, their weight, their feelings of family connectedness and their eating behaviour. Girls who ate five or more meals with their families a week in 1999 were significantly less likely to use self-induced vomiting or laxatives to control their weight in 2004 regardless of their sociodemographic status, body mass index or family connectedness although this did not hold true for teenage boys.

You can read more about this research at

http://psychcentral.com/news/2008/01/08/regular-family-meals-lower-risk-of-disordered-eating/1755.html

Predicting psychosis in high-risk youth

A study of 325 youngsters in the U.S. has found that those who have a combination of different risk factors for the condition have a 65-80% chance of going on to develop full-blown psychosis. The researchers who conducted the study claim that an understanding of these combinations could help scientists predict who is likely to develop the illness within two to three years with the same accuracy that other kinds of risk factors can predict major medical diseases, such as diabetes. 35% of people with the accepted criteria for being at risk of psychosis go on to develop the illness but the figure rises to 65-80% with the following combination of risk factors :

• deteriorating social functioning (e.g. spending increasing amounts of time alone in one's room)
• a family history of psychosis combined with a recent decline in functioning e.g. a drop in school marks or a withdrawal from extracurricular activities)
• an increase in unusual thoughts (e.g. thinking strangers' conversations are about one's self)
• an increase in suspicion/paranoia
• past or current drug abuse

The researchers also found that those who progressed to a psychotic disorder tended to do so relatively quickly. 22% developed psychosis within the first year, 11% by the end of the second year and the remaining 3% by the end of 2 1/2 years.

You can find out more about this research at

http://psychcentral.com/news/2008/01/08/predict-psychotic-illness-in-high-risk-youth/1757.html

Alcohol, cognition and domestic violence

Recent studies suggest a strong relationship between alcohol use, physical violence and cognitive functioning. Alcohol use is involved in 40-60% of incidents of domestic violence and between 50-60% of men who seek treatment for alcoholism have assaulted their wives and partners in the year prior to starting treatment. Alcohol use has been linked to deficits in impulse control that are in turn linked with violent behaviour. However, there have been few studies into the differences in cognition between alcoholics who do, or do not, beat their wives and partners. A study of 25 alcoholics in the U.S. found that those who assaulted their partners had more severe deficits in attention, concentration and cognitive flexibility. Both groups were more impulsive and had poorer decision-making skills than a control group of smokers without a drink problem.


Easton, Caroline J. ... [et al] - Neurocognitive Performance Among Alcohol Dependent Men With and Without Physical Violence Toward Their Partners: A Preliminary Report The American Journal of Drug and Alcohol Abuse 34(1), 29 - 37

Middle schools and mental health

There is considerable evidence that middle schools (corresponding to late primary/early secondary) in the U.S. play an important role in children's adjustment, not just in terms of their school work but in other areas of life as well. Most studies into how middle school affects children have focused on their academic performance rather than on psychological or behavioural problems but the emergence of depressive symptoms, low self-esteem and behavioural difficulties often coincides with the middle-school years. A New York study of 1,451 children from 11-14 asked them to rate their school's 'climate' (teacher support, children's friendliness, students' autonomy in the classroom and clarity and consistency of school rules) and assessed their psychological and behavioural adjustment. The researchers found that all four measures of school climate declined over time and that these declines were associated with poorer psychological and behavioural adjustment. Girls experienced a sharper decline in friendliness among their peers although they still felt they got on better with their teachers and their peers than boys. The influence of teacher support, peer support and clarity of rules affected the children's psychological and behavioural adjustment but the children's psychological and behavioural adjustment did not affect how they perceived their school's climate i.e. the relationship only worked in one direction.

Way, Niobe, Reddy, Ranjini and Rhodes, Jean - Students’ Perceptions of School Climate During the Middle School Years: Associations with Trajectories of Psychological and Behavioral Adjustment American Journal of Community Psychology (2007) 40:194–213

Drinking, depression and naltrexone

People with drink problems often suffer from depression as well. People who suffer from depression are more likely to drink heavily and people who drink heavily are more likely to suffer from depression. Those people with drink problems and depression have increased treatment dropout rates, higher rates of relapse, greater levels of alcohol consumption and more use of medical services. Naltrexone is used to treat people with alcohol problems but there has not been much research into its effectiveness in drinkers with depression or how its effectiveness is affected by interactions with antidepressants. A U.S. study of 627 people being treated for alcohol problems found that there was no difference in the effectiveness of naltrexone in people taking antidepressants and that it helped to reduce the number of days' drinking in people taking depression medication.

Krystal, John H. ... [et al] - Naltrexone is associated with reduced drinking by alcohol dependent patients receiving antidepressants for mood and anxiety symptoms : results from VA cooperative study no. 425 "Naltrexone in the treatment of alcoholism" Alcoholism : clinical and experimental research January 2008, 32(1), 85-91

Social anxiety and alcoholism

There is a well-documented relationship between social anxiety and alcohol use. People with social anxiety often use alchohol to relieve their symptoms and untreated social anxiety can lead to the development, maintenance and relapse of alcohol problems. A U.S. study of people being treated for social anxiety, who were also problem drinkers, looked into whether people's drinking would decrease if their social anxiety was relieved. They divided the 42 participants into two groups one receiving paroxetine for their social anxiety and the other receiving a placebo. Neither group received any treatment for their problem drinking. Paroxetine reduced people's social anxiety and the amount they drank to relieve anxiety but did not reduce the overall frequency or quantity of people's drinking. Those people whose social anxiety improved carried on drinking as much but for different reasons.

Thomas, Suzanne E. ... [et al] - A complex relationship between co-occuring social anxietyand alcohol use disorders : what effect does treating social anxiety have on drinking ? Alcoholism : clinical and experimental research January 2008, 32(1), 77-84

Ageing and social participation

Concepts of successful ageing and active ageing both emphasize independence and participation in productive activities as being good for elderly people's health. A six-year study of 4,049 older people in Taiwan looked at their levels of participation in paid and unpaid work and compared them with levels of mortality over the course of the study. The researchers found that those people who had continuous paid work were also more likely to participate in social groups. Having paid or unpaid work at the start of the study lowered the risk of mortality six years later, especially for men. However, having unpaid work was associated with a higher risk of impaired cognitive function compared to that of non-workers. Participating in a religious group reduced the risk of mortality for women and participating in political groups reduced the risk of impaired cognitive function for men.

Hsu, H. C. - Does social participation by the elderly reduce mortality and cognitive impairment Ageing and Mental Health November 2007, 11(6), 699-707

Depression in older adults - what are the best psychosocial interventions

Depression in older adults is a frequent problem that can lead to an increased risk of illness, death and reduced quality of life. A review of 57 studies into the effectiveness of psychotherapy and other behavioural interventions on depressive symptoms in clinically-depressed older adults found that cognitive-behaviour therapy and reminiscence were the best supported by the evidence from trials. Interventions with 7-12 sessions had the best balance between optimizing effectiveness and minimizing drop-out rates. For physically and cognitively-impaired patients modifications in treatment format and/or content might be effective e.g. combining psychotherapy with social work interventions and pharmacotherapy.

Pinquart, M., Duberstein, P.R. and Lyness, J.M. - Effects of psychotherapy and other behavioral interventions on clinically depressed older adults : a meta-analysis Ageing and Mental Health November 2007, 11(6), 645-657

Social skills training and schizophrenia

People with chronic schizophrenia can lack social skills. They find it hard to hold conversations with people, make friends or solve problems. Poor social skills are closely related to repetitive recurrences of schizophrenia and rehospitalizations and have been reported as important factors affecting prognosis. Patients with chronic mental illness can also suffer from low self-esteem which impedes effective interpersonal relationships and negatively affects their abilities to cope with stress and problems. Raising self-esteem is one of the most important ways of preventing recurrence and ensuring long-term success in rehabilitation among patients with chronic schizophrenia. Social skills training has been proven to be effective when delivered by psychiatrists and psychologists but little research has been done into the effectiveness of nurse-led social-skills training. A Korean study divided 66 patients into two groups comparing a nurse-led social-skills training programme with a control group. After 16 sessions those people who had received social-skills training showed a significant improvement in their conversational, interpersonal and assertiveness skills and had higher self-esteem although their problem-solving ability had not improved.

Seo, Ji-Min ... [et al] - Social skills training as nursing intervention to improve the social skills and self-esteem of inpatients with chronic schizophrenia Archives of Psychiatric Nursing December 21(6), 317-326

Psychiatrists and religion

Historically there has often been tension between psychiatry and religion. Freud equated religion with neurosis and even called it an enemy while DSM-III was also criticized as portraying religion negatively. Several studies of psychiatrists' religious characteristics have indicated that psychiatrists are measurably less religious than the general population, their patients and other physicians. However, studies of the health effects of religion and spirituality have linked it to reduced depression and anxiety, increased longevity and other physical and psychological health benefits. A survey of 1,144 psychiatrists and physicians in the U.S. found that although psychiatrists were less religious than other doctors they generally endorsed the positive influences of religion on health. They were more likely to be aware of the negative impact of religion but they were also more likely to encounter religious issues in clinical settings and were more open to addressing religious issues with patients.

Curlin, Farr A. ... [et al] - Religion, spirituality, and medicine : psychiatrists' and other physicians' differing observations, interpretations, and clinical approaches American Journal of Psychiatry December 2007, 164(12), 1825-1831

Cognitive remediation and schizophrenia

Cognitive impairment is a core feature of schizophrenia and is strongly related to functioning in areas such as work, social relationships and independent living. The worse people's cognitive functioning the worse their response is to psychiatric rehabilitation. There has been a lot of research devoted to how to improve cognitive functioning in people with schizophrenia but pharmacological treatments have limited effects. Cognitive remediation programmes employ a variety of methods, such as drill and practice exercises, teaching strategies and compensatory strategies to reduce the effects of persistent cognitive impairments and a review of 26 studies on cognitive remediation including a total of 1,151 patients found that it was associated with significant improvements to cognitive performance, psychosocial functioning and schizophrenia symptoms. The effects of cognitive remediation were significantly stronger in studies where it was used alongside psychiatric rehabilitation.

McGurk, Susan R. ... [et al] - A meta-analysis of cognitive remediation in schizophrenia American Journal of Psychiatry December 2007, 164(12), 1791-1802

Lithium and mood disorders in older adults

Mood disorders are a major cause of illness and disability among older people. Although lithium has been shown to be effective in preventing and treating bipolar disorder in younger people its effectiveness has not been thoroughly investigated in older adults with depression and bipolar disorder. An Israeli study of 60 people over 60 compared participants' mental health before and after beginning treatment with lithium. The researchers found that lithium brought about significant reductions in the frequency, duration and severity of depressive and manic relapses, the rate and duration of hospitalizations, and suicidal behaviour.

Lepkifker, Elie ... [et al] - Lithium therapy for unipolar and bipolar depression among the middle-aged and older adult subpopulation Depression and Anxiety 24(8), 571-576

Combination therapy, social functioning and depression

People with depression often have problems at work, in their social life and in their family life and these problems get worse the more severe their depression is. Social functioning can improve after treatment with antidepressants but seldom gets back to a 'normal' level. A Dutch study of 167 people looked into whether combination therapy (psychotherapy plus antidepressants) could improve patients' social functioning. The participants were split into two groups. One group received pharmacotherapy while the other group received pharmacotherapy plus 16 sessions of short, psychodynamic supportive psychotherapy. Severity of depression decreased significantly more in the psychotherapy group and the number of dimensions of social functioning that had improved significantly was also higher in the psychotherapy group who had a larger improvement in their overall social functioning than those taking antidepressants alone.

Molenaar, Pieter J. ... [et al] - Does adding psychotherapy to pharmacotherapy improve social functioning in the treatment of depression ? Depression and Anxiety 24(8), 553-562