Magnetism and misery

The term vascular depression has been used to describe late-life depressive disorders in patients with evidence of cerebrovascular disease. Some studies have suggested that vascular depression is more long-lasting and more resistant to treatment than early-onset depression. Transcranial magnetic stimulation (TMS), in which powerful magnets are moved back and forth over the skull, has been proved to have an antidepressant effect in some studies but little research has been done on its effectiveness in treating older people or those with cerebrovascular problems. Researchers in Iowa studied 92 patients with vascular depression giving one group TMS and the other a sham treatment. In a second experiment the dose of TMS was increased without telling the patients. This was important as it is quite hard to produce a realistic 'sham' treatment for TMS. The researchers hoped that a higher dose of TMS would produce more positive results which were definitely down to the treatment rather than just positive thinking. In both experiments TMS proved far superior to a sham treatment and the higher dose turned out to be more effective than a lower one.

Jorge, Ricardo E. ... [et al] - Treatment of vascular depression using repetitive transcranial magnetic stimulation Archives of General Psychiatry March 2008, 65(3), 268-276

Tamoxifen and bipolar disorder

Protein Kinase C (PKC) is a family of enzymes that can affect neurotransmitters in the brain. Abnormalities in PKC activity have been linked to bipolar disorder. The breast cancer drug tamoxifen inhibits PKC and a team of researchers in Turkey studied its effect on patients suffering from mania. 50 people participated in the trial in which 29 of them received tamoxifen and 21 a placebo. Neither the patients nor their doctors knew whether they were taking the tamoxifen or the placebo. The study found that tamoxifen was effective in reducing mania and had very few side effects.

Yildiz, Aysegul ... [et al] - Protein Kinase C inhibition in the treatment of mania: a double-blind placebo-controlled trial of tamoxifen Archives of General Psychiatry March 2008, 65(3), 255-263

Teenage painkiller abuse

In the United States both prescribed and non-prescribed use of prescription pain relievers, as well as rates of opioid-related mortality and admissions to emergency departments have increased in the last few years. The rate of drug-overdose deaths associated with prescription opioid misuse has also increased and, in 2002, was greater than the rate associated with heroin or cocaine use. In 2005, an estimated 2.2 million Americans used pain relievers non-medically for the first time within the preceding year and more than a third of these first-time or new users were adolescents aged 12-17. A study of 18,678 adolescents in the U.S. found that approximately one in ten of them (9.3% of boys and 10.3% of girls) had abused prescription painkillers. The mean age of first non-prescribed use was 13.3, similar to the mean starting age for alcohol and marijuana but higher than that for solvent abuse. Approximately a quarter of painkiller abusers had never used another illicit substance. Male painkiller abusers were more likely than other children to have been cautioned or arrested by the police while female painkiller abusers were more likely than other girls to suffer from anxiety or depression.

Wu, Li-Tzy, Pilowsky, Daniel J. and Patkar, Ashwin A. - Non-prescribed use of pain relievers among adolescents in the United States Drug and Alchohol Dependence, 2008, 94(1-11)

Cyberbullying : what does the research say ?

Victimization over the Internet has attracted increasing attention from researchers and healthcare professionals. Defined as 'willful and repeated harm inflicted through the medium of electronic text' it can not only undermine children's freedom to use and explore resources on the Internet but can also result in severe functional and physical ramifications. Research into cyberbullying is still in its infancy but a team of researchers from the U.S. conducted an Internet survey of 1,378 adolescent Internet users. There were no associations between gender or race and cyberbullying but computer proficiency and time spent on-line were positively related to both cyberbullying, victimization and offending. Cyberbullying experiences were also linked to respondents who reported school problems (including conventional bullying), assaultive behaviour and substance use.

Hinduja, Sameer and Patchin, Justin W. - Cyberbullying: an exploratory analysis of factors related to offending and victimization Deviant Behavior February 2008, 29(2), 129-156

Computer use and teenage development

A study of 1,591 teenagers in Ontario, Canada looked at their Internet and computer game use over a 21-month period. Most girls (93.7%) and boys (94.7%) reported using the Internet at both time periods whereas more boys (80.3%) than girls (28.8%) reported gaming at both time periods. Girls reported a small decline in overall technology use over the course of the study mostly due to a decline in game playing. Those teenagers who used the Internet most had better quality friendships but less positive parental relationships. Moderate use of the Internet was associated with a more positive academic orientation than non-use or high levels of use.

Willoughby, Teena - A short-term longitudinal study of Internet and computer game use by adolescent boys and girls: prevalence, frequency of use, and psychosocial predictors Developmental Psychology January 2008, 44(1), 195-204

Gender identity disorder in girls over time

Research on child development has documented a number of areas in which children, on average, show significant sex differences: gender identity, self-labelling, sex of playmate preference, toy and activity interests, roles in fantasy play etc, etc. These have implications for other aspects of psychosocial development such as interpersonal relational styles, cognitive skills and vocational interests for which there are also significant sex differences. Boys are much more likely than girls to be referred to gender identity clinics and little is known about the longer-term psychosexual outcome of girls. A study of 25 girls between three and twelve attending a gender identity clinic in Toronto followed them up later to see how they were getting on; the girls had to be at least seventeen to participate in the follow-up study. The researchers found that at the follow-up 3 of the girls had Gender Identity Disorder (GID) or gender dysphoria. 8 of the girls were classified as bisexual/homosexual in fantasy and 6 were classified as bisexual/homosexual in behaviour. The remaining participants were classified as either heterosexual or asexual. The rates of GID and bisexual/homosexual orientation were substantially higher than base rates in the general female population. Girls who were more cross-sex typed in their childhood behaviour were more likely to be gender dysphoric at follow up and more likely to have been classified as bisexual/homosexual in behaviour.

Drummond, Kelly D. ... [et al] - A follow-up study of girls with gender identity disorder Developmental Psychology January 2008, 44(1), 34-45

Smoking during pregnancy - are there links to conduct problems

Smoking during pregnancy has been consistently linked with externalizing (behaviour) problems in children, particularly in males. It has been associated with parent-reported conduct problems, arrest history from national crime registries, contact with police, oppositional defiant disorder and attention-deficit/hyperactivity disorder. However, there are obvious ethical difficulties with controlled trials exposing fetuses to maternal smoking during pregnancy and it could be the case that the association between smoking during pregnancy and behaviour problems is due to other environmental factors that lead pregnant women to smoke and their children to become badly behaved. Previous studies have attempted to take these factors into account but a study of 4,886 women in the U.S. went further by comparing the behaviour of their children who had grown up in the same family but who had been exposed to different levels of nicotine in the womb. When these children were compared there was no significant difference in conduct problems or oppositional defiant problems between the children who had and had not been exposed to nicotine in utero. There was a small link between maternal smoking and ADHD but the researchers concluded that 'genetically informed analyses suggest that unmeasured environmental variables influencing both smoking during pregnancy and offspring externalizing behaviours account for the previously observed associations'.

D'Onofrio, Brian M. ... [et al] - Smoking during pregnancy and offspring externalizing problems: an exploration of genetic and environmental confounds Development and psychopathology (2008), 20: 121-137

ADHD children and parents

Parents often find the hyperactive and impulsive behaviour of children with Attention-Deficit Hyperactivity Disorder (ADHD) extremely challenging and stressful. Their behaviour towards their children is often characterized by high levels of coerciveness and negativity leading to a vicious circle of bad behaviour, leading to bad parenting which in turn leads to more bad behaviour. It is, therefore, important, to look into the factors affecting how parents respond to their children's ADHD. One such factor might be the presence of ADHD in parents as well as their children. Family studies of children with ADHD have found that 15-20% of mothers and 20-30% of fathers have ADHD which is now increasingly recognised as persisting into adulthood. Studies have suggested that parental ADHD is likely to reduce the quality of parenting and increase the risk of negative and chaotic parenting leading to a parenting style characterized by inconsistency, reactivity and a lack of self-reflectiveness. Two studies of mothers and children in Hampshire found that child ADHD symptoms were associated with negative maternal comments while maternal ADHD symptoms were associated with negative expressed emotions. However, in both studies maternal ADHD symptoms appeared to ameliorate the effects of child ADHD symptoms on negative parenting and parental response to children with high ADHD symptoms was more positive and affectionate when the mother also had high ADHD symptoms. The researchers thought this might be because there was a better 'fit' between the child's behaviour and the parents or, that having suffered with ADHD themselves the parents were more sympathetic to the children.

Psychogiou, Lamprini ... [et al] - Do maternal attention-deficit/hyperactivity disorder symptoms exacerbate or ameliorate the negative effect of child attention-deficit/hyperactivity disorder symptoms on parenting? Development and psychopathology 2008, 20, 121-137

Study questions NICE Alzheimer's guidance

Despite enthusiasm from clinicians, patients and carers' groups doubts continue to be expressed on the impact and cost/benefits of cholinesterase inhibitors in treating Alzheimer's disease. The National Institute for Clinical Excellence (NICE) has issued guidance that these medicines should be prescribed only to moderate cases of Alzheimer's disease producing an angry reaction from clinicians and the Alzheimer's society and a referral to the Court of Appeal. A study of 88 patients in Wolverhampton taking the drug donepezil for their Alzheimer's found that 64.7% remained on treatment beyond six months, 57.9% beyond a year and 12.5% beyond 4 years. 56% remained alive after 4 years almost twice the number predicted. The mean score on the Mini Mental State Examination - a cognitive test used to assess people with dementia - did not deteriorate over four years in those taking donepezil. The researchers concluded that the benefits of donepezil for individuals were confirmed, especially for those with mild impairment and that 'expenditure on medication was modest in a population context' and said that their findings 'question recent guidance' from NICE.

Lyle, Sarah ... [et al] - Treatment of a whole population sample of Alzheimer's disease with donepezil over a 4-year period: lessons learned Dementia and geriatric cognitive disorders 2008, 25: 226-231

Frontotemporal dementia and psychosis

Frontotemporal dementia (FTD) usually begins in middle age with neuropsychiatric symptoms. The development of disinhibition, socially inappropriate behaviour, emotional disengagement, repetitive behaviour and poor insight can lead to FTD being misdiagnosed as psychosis but the true prevalence of psychosis in people with FTD is unclear. A U.S. study of 109 people compared those with FTD to those with Alzheimer's. Among the FTD patients only 2.3% had delusions, only half of whom had paranoid ideas and no FTD patients had hallucinations. By contrast 17.4% of the Alzheimer's patients experienced delusions and paranoia. A review of other studies also failed to establish a significant association between FTD and psychosis.

Mendez, Mario F. ... [et al] - Psychotic symptoms in frontotemporal dementia: prevalence and review Dementia and geriatric cognitive disorders 2008, 25: 206-211

Children of depressed parents - 23 years later

Many children of depressed parents are at risk of poor functioning but few studies have followed them into adulthood to see how they are doing then. A study of 476 people in the U.S. compared the children of depressed parents with a control group. Children with depressed parents were more likely to be depressed themselves and to suffer from disability and obtained more help for mental-health problems. They also reported more severe recent stressors but were more likely to use positive thinking and seek alternative rewards in order to cope. There was no difference in the levels of other mental-health problems, physical functioning and pain, social functioning and hospitalizations and medication use for depression. Adult children of parents who had still not recovered from their depression were the most likely to show impaired functioning compared to the control group.

Timko, C. ... [et al] - Functioning status of adult children of depressed parents: a 23-year follow up Psychological Medicine March 2008, 38(3), 343-352

Single parents' mental health

A quarter of families with dependent children are now headed by lone parents, usually a mother. Lone mothers have worse mental and physical health than mothers in a relationship and than the rest of the population. However, it is unclear whether this is due to the financial hardships and lack of social support experienced by single mothers or whether there is something inherent in single parenthood that causes mental-health problems. A study of 8,580 people in Fife found that lone mothers were twice as likely to have a mental-health problem as other women but that once financial problems and social support were taken into account the difference disappeared. However, lone fathers were nearly four times more likely to have a mental-health problem than other men and this risk remained undiminished by controlling for age, income, debt and levels of social support.

Cooper, C. ... [et al] - Depression and common mental disorders in lone parents: results of the 2000 National Psychiatric Morbidity Survey Psychological Medicine March 2008, 38(3), 335-342

Montessori activities for people with dementia

Care homes often provide inappropriate environments and inadequate activity programmes for adults with dementia. One study found that nearly 40% of nursing home residents with severe cognitive impairment did not participate in any activity in the course of a week. Inactivity or inappropriate activities involving infantilization and developmentally inappropriate or meaningless tasks can lead to boredom, lower quality of life and problem behaviours including agitation and aggression. A study of 10 older adults with dementia at an adult day programme looked into the effectiveness of a Montessori-based approach. The Montessori programme is based on the use of everyday materials, a progressive complexity of tasks, the idea that it is the process not the end result that is important and teaching by demonstration rather than instruction. Teaching is tailored to the individual and varies in complexity according to their needs. The study found that the participants showed more constructive engagement and less non-engagement when doing Montessori activities, compared to the normal activities of the day centre. However, there was no difference in people's mood between the Montessori group and the control group.

Jarrott, Shannon E., Gozali, Tsofit and Gigliotti, Christine M. - Montessori programming for people with dementia in the group setting: an analysis of engagement and affect Dementia March 2008, 7(1), 95-108

Interventions for agitation in dementia

Agitation and disruptive behaviour in people with dementia living in nursing homes is a widespread problem affecting the care of patients, staff satisfaction and the ability of staff to cope with providing care to these individuals. Agitation can be defined as 'inappropriate verbal, vocal or motor activity that is not explained by needs or confusion per se. It includes behaviour such as aimless wandering, pacing, cursing, screaming, biting and fighting'. There is a growing body of knowledge supporting relaxation techniques, diversion activities, music and massage to decrease agitation in people with dementia. A Canadian study of 41 people with mild to moderate dementia looked into the effectiveness of playing people their favourite music and hand massage in reducing agitated behaviours. Both treatments, individually and together, were effective at immediately reducing agitation and worked up to an hour after their use.

Hicks-Moore, Sandee L. and Robinson, Bryn A. - Favorite music and hand massage: two interventions to decrease agitation in residents with dementia Dementia March 2008, 7(1), 95-108

Tardive dyskinesia and antipsychotics

Tardive dyskinesia (TD) is one of the worst side effects of antipsychotic drugs. It is characterized by repetitive, involuntary and purposeless movements including grimacing, tongue protrusion, lipsmacking, puckering and pursing of the lips and rapid eye blinking. Rapid movements of the arms, leg and trunk may also occur. A review of 12 studies looking into the links between TD and antipsychotic drugs compared the rates of the problem in those taking first and second generation antipsychotics. In children the incidence of TD was 0.35% for those taking second-generation drugs. In adults 7.7% of those taking first-generation drugs developed TD compared to only 2.98% of those taking second-generation drugs. In elderly patients the rates of TD were about the same for those taking first and second-generation drugs. In four adult studies the rates of TD in those taking second-generation drugs, no drugs at all and first-generation drugs were 13.1%, 15.6% and 32.4% respectively.

Correll, Christoph U. and Schenk, Eva M. - Tardive dyskinesia and new antipsychotics Current Opinion in Psychiatry March 2008, 21(2), 151-156

Treatment compliance - second generation antipsychotics fail to live up to their promise

Long-term maintenance anti-psychotic treatment remains the most reliable means of preventing relapses, minimizing mortality and illness and ensuring independent living in people being treated for schizophrenia. However, treatment non-adherence remains a significant concern with the reported rates of non-adherence varying between 24-90% depending on the kind of patients being treated. One of the causes of non-adherence to treatment is the side effects of drugs. Second generation anti-psychotics were thought to have at least partially overcome this problem as they have fewer side effects than earlier drugs. However, a review of studies into compliance with treatment for schizophrenia has found that 'the data have failed to substantiate the notion that novel antipsychotic drug use leads to improved medication compliance and favourable clinical outcomes'.

Voruganti, Lakshmi P., Baker, Laura K. and Awad, George A. - New generation antipsychotic drugs and compliance behaviour Current Opinion in Psychiatry March 2008, 21(2), 133-139

Peer relationships, violence and ethnicity

Peer relationships are one of the most significant risk factors for an adolescent to engage in violent and/or delinquent behaviour. Youths exposed to groups of people, such as peers, whose norms, values and practices are more permissive of criminal behaviour are more likely to participate in delinquent and violent activities themselves. Specific aspects of peer relationships related to violence and delinquency include attachment to peers, perceived delinquency of peers, perceived peer attitudes toward delinquency, peer pressure and time spent with delinquent peers. A U.S. study of 128 female juvenile (13-18) offenders looked into the effects of peer relationships on violence among four different racial groups (White, African American, Hispanic and mixed race). The results showed that high levels of peer association and extrinsic rewards from peer relationships best predicted violence among all groups. Among Hispanics positive peer attitudes towards delinquency significantly contributed to violence. Among Whites greater time spent with peers was associated with higher levels of violence. For African Americans tangible rewards from peer relationships significantly contributed to violence. There were no significant differences between the mixed-race girls and the other groups.

Silverman, Jenna R. and Caldwell, Roslyn M. - Peer relationships and violence among female juvenile offenders: an exploration of differences among four racial/ethnic populations Criminal Justice and Behavior March 2008, 35(3), 333-343

Violent video games and aggression - new research

Concerns that video games promote violent behaviour in players began shortly after they became available in the 1970s. The first major controversy was over the game Death Race in which the player was a car driver running over pedestrians and more recently games such as Mortal Kombat and Street Fighter have provoked concern. Some researchers have suggested that because of their participatory nature violent video games have a greater effect than violent TV while others have blamed different factors such as children's innate aggression and family environment. A study of 101 undergraduates in Texas and Wisconsin randomly allocated some of them to play either a violent or non-violent video game with the remainder of the participants being allowed to choose. After playing the game the participants were tested for their levels of aggression using the Taylor Competitive Reaction Time Test in which participants believe that they are punishing an opponent for losing in a reaction time test by subjecting them to noise blasts or electric shocks. The level of punishment meted out by the participants are used as a proxy (substitute) measure for aggression. The researchers found that although males were more aggressive than females neither exposure to the violent video games or previous experience of playing them led to any differences in aggression. A second study of 428 undergraduates by the same researchers looked into the links between innate aggression, violent criminal acts, exposure to violent video games and family violence. The results indicated that innate aggression, family violence and being male were predictors of violent crime but exposure to violent video games was not.

Ferguson, Christopher J. ... [et al] - Violent video games and aggression: causal relationship or byproduct of family violence and intrinsic violence motivation? Criminal Justice and Behavior March 2008, 35(3), 311-332

Suicide and early psychosis - what are the risk factors?

Suicide is the main cause of premature death among people with schizophrenia. There is some evidence that the risk factors for self-harm may be different for those with schizophrenia compared with other groups and there is some emerging evidence that risk factors for self-harm may alter during the course of a psychotic illness. Suicidal behaviour is more common during the early stages of psychosis and the period of time between the onset of psychotic symptoms and and individual's first contact with mental-health services can be particularly risky. A study of 496 people in South-East London and Nottingham presenting (turning up for treatment) for psychosis over a two-year period found that 11.3% of them had engaged in self-harm since the onset of their psychosis. Being male, being in a higher socio-economic group, depression, a prolonged period of psychosis before seeking treatment and increased insight (consciousness of being unwell) were all associated with an increased risk of self-harm.

Harvey, S.B. ... [et al] - Self-harm in first-episode psychosis British Journal of Psychiatry March 2008, 192(3), 178-184

Childhood sexual abuse and self-harm - is there a link?

Self-injurious behaviour can be defined as the causing of intentional, direct damage to one's body without suicidal intent. Common examples include cutting oneself and burning one's skin. Because such behaviour is associated with suicide and psychiatric disorders and because its treatment can be challenging it has attracted substantial attention in both the clinical and research literature. Little is known about its causes but some people have suggested that childhood sexual abuse is one of them. A number of studies have shown a link between childhood sexual abuse and later self-harm but other studies have found little or no association. Researchers have now got powerful and sophisticated tools which allow them to combine the results from a number of different studies - a process called meta-analysis. A meta-analysis of 45 different studies into the link between childhood sexual abuse and self-harm found that the significance of the relationship was very small and that in studies that take into account other psychiatric risk factors childhood sexual abuse explained little or no unique variance in self-injurious behaviour.

Klonsky, E. David and Moyer, Anne - Childhood sexual abuse and non-suicidal self-injury: meta-analysis British Journal of Psychiatry March 2008, 192(3), 166-170