Antipsychotics for depression

Studies have found that a large percentage of depressed patients may have limited response and remission rates when treated with traditional antidepressants. There is increasing evidence in favour of the use of atypical antipsychotics in the treatment of depression and a review of the literature has found that olanzapine and risperidone have several controlled clinical trials indicating their effectiveness at doses lower than those used in treating psychoses. The review concluded that aripiprazole, olanzapine and risperidone are reasonable choices to add to anti-depressants in cases of treatment-resistant depression.

Philip, Noah S. ... [et al] - Augmentation of anti-depressants with atypical antipsychotics: a review of the current literature Journal of Psychiatric Practice January 2008, 14(1), 34-44

Childhood autism and mental-health problems

A long-term Danish study of 454 people compared the rates of mental-health problems in those who had been diagnosed with childhood autism to those free of the condition. The study found that 48.3% of the autistic group had been in contact with psychiatric hospitals over the course of the study compared to just 6% of those without the condition. 17% of the autistic group had been diagnosed with a mental illness compared to 2.7% of the control group. Those who had been diagnosed with autism in childhood were nearly four times as likely to be diagnosed with schizophrenia and nearly three times as likely to suffer from depression.

Mouridsen, Svend Erik ... [et al] - Psychiatric disorders in individuals diagnosed with infantile autism as children: a case control study Journal of Psychiatric Practice January 2008, 14(1), 5-12

Cognitive therapy for voice hearers

Most people with schizophrenia hear voices which can be insulting to them or give commands to harm themselves or other people and can contribute greatly to the distress experienced by people with mental illness. There is an emerging body of evidence that documents the efficacy of cognitive interventions for modifying appraisals linked with voice hearing. A U.S. study of 65 people with schizophrenia divided them up into two groups. One group received treatment as usual while the other group received 12, 90-minute sessions of cognitive interventions delivered by a mental-health nurse. Those who had received the cognitive intervention reported less severe hallucinations even a year after treatment and were over thirteen times as likely to maintain a reduction in their hallucinations.

England, Margaret - Significance of cognitive intervention for voice hearers Perspectives in Psychiatric Care January 2008, 44(1), 40-47

BPD and ADHD

Borderline personality disorder consists of pervasive affective (mood) instability, impulsivity, unstable relationships and self-image problems. It affects 1-2% of the population and is characterised by severe psychosocial impairment and a high suicide rate. According to some researchers 60% of adults with BPD meet the criteria for childhood Attention-Deficit Hyperactivity Disorder (ADHD) but no study has investigated the prevalence and impact of adult ADHD in people with BPD. A German study of 118 women seeking treatment for BPD found that 41.5% of them had suffered from ADHD in their childhood and 16.1% still suffered from it as adults. Childhood ADHD was associated with emotional abuse in childhood and greater severity of adult BPD symptoms while adult ADHD was associated with a greater risk for other mental-health problems.

Philipsen, Alexandra ... [et al] - Attention-deficit hyperactivity disorder as a potentially aggravating factor in borderline personality disorder British Journal of Psychiatry February 2008, 192(2), 118-123

Suicide and neighbourhood in Northern Ireland

Research shows that suicide risk is related both to individual characteristics such as age and gender and household ones such as marital status and socioeconomic circumstances but it is less clear whether place of residence constitutes an additional, independent risk over and above these factors. A five-year study of 1,116, 748 people in Northern Ireland found 566 suicides among the population over that time. Suicide risks were lowest for women and for those who were married or cohabiting. Indicators of individual and household disadvantage and economic and health status at the time of the census were also strongly related to the risk of suicide. There were higher rates of suicide in the more deprived and socially fragmented areas but these could be explained by individual and household factors rather than the geographical location per se. There was no significant relationship between population density and risk of suicide.

O'Reilly, Dermot ... [et al] - Area factors and suicide: 5-year follow-up of the Northern Ireland population British Journal of Psychiatry February 2008, 192(2), 106-111

Fat talk and eating disorders

'Fat talk' can be defined as conversations with family and friends pertaining to positive or negative comments about appearance, dieting techniques and the need to lose weight and is common, though not exclusive to, teenage girls an age group particularly at risk for eating disorders. In a 2003 experiment female undergraduates exposed to a 'stooge' who, despite being thin herself, talked about how fat she felt and how much she wanted to lose weight, had significantly increased body dissatisfaction compared to a group who talked to a 'stooge' about neutral topics. A study of 272 college students - male and female - in the U.S. explored this relationship further and found that the frequency of 'fat talk' was positively related to eating pathology and body dissatisfaction in students with and without an eating disorder diagnosis. The most frequently reported topic of 'fat talk' was about other people's appearance rather than the participants'.

Ousley, Louise, Cordero, Elizabeth D. and White, Sabina - Fat talk among college students: how undergraduates communicate regarding food and body weight, shape & appearance Eating Disorders January-February 2008, 16(1), 73-84

What makes bulimia last longer?

Some people can take a long time to recover from bulimia so it is important to know what factors make the disease last longer in some people than in others. Previous studies have found that co-occuring mental illnesses in bulimia sufferers can prolong people's bulimia and parental mental-health problems can also have an effect. A study of 94 women with bulimia in the U.S. looked at the mental-health problems and obesity of their parents to see how it affected the course of the women's illness. Substance abuse by fathers was the most common problem and this was associated with longer-lasting bulimia. Depression in mothers was also associated with a worse outcome in the long term as was mood disorder in the participants. However, obesity in mothers was associated with a better outcome at long-term follow-up.

Arikian, Aimee ... [et al] - Parental psychopathology as a predictor of long-term outcome in bulimia nervosa patients Eating Disorders January-February 2008, 16(1), 30-39

Older drinkers - when Irish eyes are seeing double

It is expected that there will be a rise in the number of older people over the course of the C21st and each successive group of older people is more likely to engage in hazardous, harmful and frequent heavy drinking. A survey of 60 older people in Southwark compared Irish pensioners with English ones as people of Irish origin drink most heavily of all the minority ethnic groups. Both groups of pensioners had reduced their drinking since their younger days but the Irish ones drank more overall, were more likely to drink at least once a week, had a higher mean alcohol intake, were more likely to binge drink and to drink above sensible limits. They were also more likely to have a family history of mental-health problems.

Rao, R., Wolff, K. and Marshall, E.J. - Alchohol use and misuse in older people: a local prevalence study comparing English and Irish inner-city residents living in the UK Journal of Substance Use February 2008, 13(1), 17-26

Drug use in Wales - there'll be a reefer in the Valleys

More young people are using drugs now than ever before and drug use among young people is widespread across Europe. After alcohol and tobacco cannabis is the most widely-used substance. A study of 3,088 children between 11 and 16 in Wales found that nearly half of the sample had used a drug in their lifetime and more than one in half had done so in the past month. Lifetime drug use was most likely to be reported by the oldest age group while recent drug use was more common among 12-13 year olds implying that the majority of young people who had used drugs in their lifetime had since given up. Inhalants were the most commonly used category of drugs while cannabis was the most commonly used individual drug. The least commonly used drugs were heroin, sedatives and ecstasy. The most important risk factors for taking drugs were antisocial behaviour and attitudes, lack of attachment to school, negative thinking, psychological problems and behavioural problems.

Case, Stephen and Haines, Kevin R. - Factors shaping substance use by young people in Wales Journal of Substance Use February 2008, 13(1), 1-15

Depression across the life cycle - middle age is a trough not a peak

A worldwide study of 2 million people from 80 different countries has found an extraordinarily consistent pattern in depression and happiness levels across the life cycle. The researchers found that happiness followed a U-shaped curve with happiness higher towards the start and end of people's lives and depression most common in the middle. The peak age for depression in the UK was 44. In the U.S. depression peaked at 40 for women and 50 for men and the same U-shaped curve held true for 72 other countries in the study irrespective of age, marital status, income and family status. The causes of the U-shaped curve are unclear although the researchers speculated that younger people had more hope while older people were better at counting their blessings.

You can read more about this research at

http://psychcentral.com/news/2008/01/29/middle-age-blahs-are-universal/1847.html

Back pain and antidepressants

Back pain affects eight out of ten adults over the course of their lifetime. For some people the pain becomes chronic and can be accompanied by depression. Doctors commonly prescribe antidepressants for patients with low back pain to provide pain relief, aid in sleep and treat co-existing depression but a review of studies into the effectiveness of antidepressants at relieving back pain has found that they are of little use. The review found no convincing evidence that antidepressants relieved back pain or depression more effectively than a placebo or that they were any more effective in improving patients' ability to function. Both tricyclic (older) antidepressants and newer SSRIs were no more effective than a placebo in reducing pain.

You can find out more about this research at

http://psychcentral.com/news/2008/01/31/antidepressants-do-not-improve-back-pain/1862.html

Massive suicide study reports

The largest, most representative study of suicidal behaviour ever conducted has found that risk factors for suicidal thoughts, plans and attempts appear to be similar across the globe. Risk factors include having a mental disorder, being female, younger, less educated and unmarried. The study, by the World Health Organization, interviewed 84,850 adults in 17 countries. Among those interviewed 9.2% reported that they had seriously thought about suicide and 2.7% reported making a suicide attempt at some point in their lives. Rates of suicidal thoughts ranged from 3.1% of people in China to 15.9% in New Zealand. The risk of sucidal thoughts increased sharply during adolescence and young adulthood and impulse control disorders, substance use disorders and anxiety disorders were all associated with a significantly higher risk of suicidal thoughts and attempts.

You can find out more about this research at

http://psychcentral.com/news/2008/02/01/suicidal-risks-similar-worldwide/1865.html

Depression in older people

Major depression affects approximately 1-2% of older adults living in the community but as many as 20% experience symptoms. Researchers from Yale University School of Medicine studied 754 people over 70, starting in 1998. At the beginning of the study, and at follow-up assessments conducted every 18 months participants were asked to provide demographic information, take cognitive tests and report any medical conditions. They were also screened for symptoms of depression during the previous week. Over the course of the study 35.7% were depressed at some point, 17.8% were depressed during two consecutive time periods, 11.2% at three time points, 6.3% at four points and 4.5% at all five. More women than men were depressed at each 18-month follow-up and women were more likely than men to experience depression at consecutive time points.

You can find out more about this research at

http://psychcentral.com/news/2008/02/05/as-women-age-depression-increases/1875.html

Schizophrenia and stress in pregnancy

There is an increasing amount of evidence of a link between schizophrenia and early brain development with environmental factors, including those occuring during pregnancy, and susceptibility genes interacting to influence risk. A study of 1.38 million Danish births between 1973 and 1995 looked at women whose relatives had died or received a diagnosis of cancer, heart attack or stroke during the women's pregnancy then looked to see whether their children developed schizophrenia. The researchers found that the risk of schizophrenia and related disorders was approximately 67% greater among the children of women who were exposed to the death of a relative during the first trimester of their pregnancies. However, death of a relative up to six months before or at any other time during pregnancy was not related to an increased risk of schizophrenia and nor was exposure to serious illness in a relative. The association between a family death and risk of schizophrenia appeared to be significant only for individuals without a family history of mental illness. Chemicals released by the mother's brain in response to stress could have an effect on the fetus' developing brain and these effects may be strongest in early pregnancy when protective barriers between the mother and fetus are not fully constructed.

You can find out more about this research at

http://psychcentral.com/news/2008/02/05/early-term-stress-may-up-risk-of-offspring-psychosis/1877.html

Antipsychotics, ghrelin and weight gain

Atypical antipsychotics have become widely used since the introduction of clozapine in the U.S. in 1990. It is generally accepted that atypical antipsychotics have less side effects than older drugs but they can cause weight gain, insulin resistance and lipid abnormalities, all of which can have serious effects on health. One theory is that the atypical antipsychotics stimulate the production of a hormone called ghrelin which stimulates food intake and fat accumulation. A 2-week trial on healthy participants in the U.S. divided them up into three groups taking olanzapine, risperidone and a placebo respectively. The olanzapine group put on the most weight, followed by the risperidone group while the group taking the placebo stayed more or less the same. However, there was no significant difference in ghrelin levels between the groups and the participants' ghrelin levels did not change over the course of the study suggesting that increased levels of the hormone were not to blame for the weight gain.

Roerig, James L. ... [et al] - A comparison of the effects of olanzapine and risperidone versus placebo on ghrelin plasma levels Journal of Clinical Psychopharmacology February 2008, 28(1), 21-26

Aripiprazole and alcoholism

Dopamine is a neurotransmitter that sends messages in the brain and it is known that people with alcohol and substance abuse problems have abnormalities in the way they produce and process it. Aripiprazole is an atypical antipsychotic drug used in the treatment of schizophrenia which affects dopamine levels and a team of researchers in the U.S. conducted a trial to see whether it would be useful in treating alcoholism. The study of 295 people divided them into one group who received the aripiprazole and another who received a placebo. More people dropped out of the aripiprazole group than the placebo group and the aripiprazole group also suffered more side effects. The mean percentage of days abstinent was higher in the placebo group. The percentage of subjects without a heavy drinking day and the length of time to the first drinking day were about the same between the two groups.

Anton, Raymond F. ... [et al] - A randomized, multicenter, double-blind, placebo-controlled study of the efficacy and safety of aripiprazole for the treatment of alcohol dependence Journal of Clinical Psychopharmacology February 2008, 28(1), 5-12

Minor physical anomalies and schizophrenia

Minor physical anomalies are a range of subtle alterations of the head, hands, hair and feet which serve as indicators of altered morphogenesis during the first or early second trimester and act as timed, biological markers of developmental disturbance. An increased prevalence of these anomalies has been extensively documented in people with schizophrenia compared to healthy controls but the precise pattern of physical anomalies and their specificity for schizophrenia remains unclear. A study of 400 people in the UK compared those with first-episode psychosis to an unaffected control group. People with psychosis had more of the following anomalies: facial assymetry, assymetry of the orbital landmarks, a 'V-shaped' palate, reduced palatal ridges and ear abnormalities. There was no difference between those with affective psychoses and those with schizophrenia. The pattern of anomalies were "suggestive of an insult occuring during organogenesis in the first trimester of pregnancy".

Lloyd, T. ... [et al] - Minor physical anomalies in patients with first-episode psychosis: their frequency and diagnostic specificity Psychological Medicine January 2008, 38(1), 71-77

Psychological interventions for social phobia

Social phobia is characterized by a marked and persistent fear of social or performance situations in which the person may be scrutinized by others and fears coming across in a way that would be embarrassing or humiliating. It is a chronic disorder that usually begins in early adolescence and results in considerable impairment that increases over an individual's lifespan. A lifetime prevalence ranging from 3-13% has been reported by epidemiological and community studies. A review of 30 studies into psychological interventions for social phobia has found that cognitive behaviour therapy (CBT) involving cognitive restructuring and exposure to feared or avoided social situations or behavioural experiments is an "efficacious and specific treatment for social phobia". Exposure therapy was also found to be effective. There were mixed findings regarding the relative efficacy of CBT and in vivo exposure with some studies reporting that the interventions were equivalent while others found that CBT produced better outcomes. There was little evidence to support the use of social-skills training.

Ponniah, K. and Hollon, S. D. - Empirically supported psychological interventions for social phobia in adults: a qualitative review of randomized controlled trials Psychological Medicine January 2008, 38(1), 3-14

Temperament, child rearing and bad behaviour

The role of temperament in the development of children's personalities and behaviour has been the subject of enquiry for decades. Difficult temperament includes features such as negative emotionality and mood, high reactivity, and fearfulness. Ratings of difficult temperament tend to be quite stable during infancy and early childhood and studies have shown links between difficult temperament, measured early in life, and later behaviour problems especially when other risk factors are present. A U.S. study of 985 children examined the links between difficult temperament, parenting styles and bad behaviour in the first year of school life. Three aspects of parenting style were assessed: harshness, sensitivity, and the opportunities the children were given for productive behaviour. The researchers found stronger relations between maternal sensitivity and bad behaviour and opportunities for productivity and bad behaviour in the children with difficult temperaments. Harsher parenting was associated with a fall in problem behaviour in the first grade but this was not found to be statistically significant. Those children with difficult temperaments whose mothers were sensitive to them and who gave them more opportunities to engage in productive activity were better behaved in the first grade.

Bradley, Robert H. and Corwyn, Robert F. - Infant temperament, parenting, and externalizing behavior in first grade: a test of the differential susceptibility hypothesis Journal of Child Psychology and Psychiatry February 2008, 49(2), 124-131

Cleft lips and later problems

Cleft lip and palate affects one in every 650 children. In the school years affected children are at raised risk for both socio-emotional and cognitive difficulties. An important question is the extent to which the problems of children with clefts may be explained by difficulties in parent-child interactions since these often predict poor child functioning. Giving birth to an infant with a cleft is often followed by shock and distress and this may affect parent-child interactions. A U.K. study of 190 very young children looked at the child's relationship with their mothers at two, six, twelve and eighteen months and measured their behaviour problems and mental development at eighteen months. Some of the children had clefts which were repaired early (before 3-4 months), others had clefts which were repaired later and others were unaffected by the condition. The study found that early interaction difficulties between mothers and the children who had 'late' repair for their cleft lips and palates were associated with poor cognitive functioning at 18 months.

Murray, Lynne ... [et al] - The effect of cleft lip and palate, and the timing of lip repair on mother-infant interactions and infant development Journal of Child Psychology and Psychiatry February 2008, 49(2), 115-123