Why you should keep going round to see Mum and Dad

The links between social support and mental health are now well-established but less is known about specific dimensions of social support and social networks. A Europe-wide study of 15,469 people over the age of 50 looked into how their children affected older people's mental health. The study found that childless men and women had more depressive symptoms and that fewer contacts with children was associated with an increased number of depressive symptoms. Older men and women living with a spouse or partner had the lowest levels of depression and the presence of a spouse or partner was more relevant for the mental health of older people than the presence of, or contact with, their children.

Buber, Isabella, Engelhardt, Henriette - Children's impact on the mental health of their older mothers and fathers: findings from the Survey of Health, Ageing and Retirement in Europe European Journal of Ageing, 2008, 5, 31-45

Social anxiety disorder in childhood

Social anxiety disorder (SAD) is characterized by a marked and persistent fear of one or more situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The feared situations are avoided or are endured with intense anxiety or distress. In children the most feared social situations usually include those where the child is expected to speak (e.g. talking to peers, reading aloud in class, joining in a conversation) but also other situations such as musical or athletic performances. However, it is unclear whether children with SAD have a distorted perception of their own abilities or whether they do actually have worse social skills than other children. A Norwegian study of 150 children compared those with social anxiety to those with ADHD and a healthy control group. The researchers found that those children with SAD did have a lower verbal IQ and worse motor skills than other children.

Kristensen, Hanne and Torgessen, Svenn - Is social anxiety disorder in childhood associated with developmental deficit/delay? European Child and Adolescent Psychiatry March 2008, 17(2), 63-72

Autism, ADHD and facial recognition

Theory of mind comprises thought processes that enable the behaviour and experiences of others to be recognized, understood, predicted and communicated. People with autism have great problems with theory of mind and can often find it hard to recognise people's emotions from their faces. Children with Attention Deficit Hyperactivity Disorder (ADHD) also find it hard to match facial expressions to emotions. Autism can be accompanied by increased inattention, hyperactivity and impulsivity and genetic, neuropsychological and brain-imaging studies suggest links between autism and ADHD. A German study of 99 children between the ages of 6 and 18 found that 52% of the autistic children also met the criteria for a diagnosis of ADHD. The children with ADHD were worse at recognising facial expressions than a healthy control group and both the children with pure ADHD and pure autism were worse than average at recognising emotions.

Sinzig, Judith, Morsch, Dagmar and Lehmkuhl, Gerd - Do hyperactivity, impulsivity and inattention have an impact on the ability of facial affect recognition in children with autism and ADHD? European Child and Adolescent Psychiatry 2008, 17, 63-72

Detection and untreated psychosis

People suffering from their first episode of psychosis often experience long periods of untreated psychosis before coming into contact with psychiatric services. The duration of untreated psychosis (DUP) averages 1-2 years but the longer DUP is the worse people's prognosis. An early detection programme and a comprehensive information campaign have been shown to be effective in reducing DUP. A Danish study of 552 people looked at what happened in Copenhagen where an early detection team was established in 1998 without an accompanying information campaign. The study found that the mean DUP was a year and that the early-detection team on its own had had no effect in reducing it. However, more people who had some symptoms of psychosis, without the full-blown disorder, had been referred for treatment.

Nordentoft, Merete ... [et al] - Does a detection team shorten duration of untreated psychosis? Early Intervention in Psychiatry 2008, 2, 22-26

Early intervention for psychosis - long-term effects

Psychotic disorders lead to an increased risk for suicide, particularly during the early course of the illness. Up to a third of first-episode psychosis patients attempt suicide prior to commencing treatment and as many as 15% do so in the first 1-2 years of treatment. Early intervention and treatment for psychosis is, therefore, seen as very important. An Australian study of 7,760 people with psychosis aged between 15 and 29 found that 8.5 years after treatment there was no difference in suicide rates between those who had and had not received early intervention. However, after adjusting for other socio-demographic, clinical and treatment factors suicide risk was lower by 50%, in the first three years after treatment, for the group who had received early intervention. A history of inpatient treatment, more days of treatment per annum and a shorter time to establish a psychiatric diagnosis were all associated with an increased risk of suicide. People who weren't working but who weren't looking for a job either were at less risk than those who were unemployed and looking for work.

Harris, Meredith G. ... [et al] - Impact of a specialized early psychosis treatment programme on suicide. Retrospective cohort study Early Intervention in Psychiatry 2008, 2, 11-21

Drug treatment drop-outs

Studies have shown that the drop-out rate from treatment for opiate addiction is around 30-40%. A study of people dropping out of opiate treatment in Stockholm found that only 20% of them had a detailed treatment plan and only 20% participated in their own treatment planning. None of the drop-outs were enrolled in a methadone or buprenorphine programme (aimed at weaning them off heroin) at admission. Having a treatment plan at intake improved the odds of not dropping out thirteen-fold but perceiving fewer positive aspects of drug use increased the risk of dropout by a factor of 12.6. Patients with sketchy or no treatment planning at intake, no maintenance treatment and a low score on positive aspects of drug use were 7.5 times more likely to drop out. Drop-outs lacked a close maternal relationship and had insecure attachment patterns which made contact difficult with social services and substance-abuse-treatment providers.

Berman, A. H. ... [et al] - Hopeless patients? A study of illicit opiate users who drop out from in-patient detoxification Journal of Substance Use April 2008, 13(2), 121-130

Dual diagnosis in South Africa

People with drug problems often have co-occuring mental-health problems as well. A study of 419 people at a private rehabilitation centre in Johannesburg found that 57.1% of them had a mental-health problem. 155 had a mood disorder, 40 had an anxiety disorder, 39 had ADHD, 35 had an eating disorder, 8 had a conduct disorder and 5 had schizophrenia. ADHD was linked to cannabis-related disorders and polysubstance (more than one drug) dependence. Anxiety-related disorders were linked to alcohol abuse and mood disorders were linked to cocaine.

Fabricius, V., Langa, M. and Wilson, K. - An exploratory investigation of co-occuring substance-related and psychiatric disorders Journal of Substance Use April 2008, 13(2), 99-114

Attributional style and depression

A person's attributional style is the way in which they ascribe causes to events in their lives. People who regard the causes of negative events as global, stable and internal (due to their own shortcomings) are more likely to develop depression. Some researchers believe that this negative attribution is itself a symptom of depression (mood-related) while others believe it is a permanent outlook (trait-related) that may be due to genetic factors. A study of 213 people in Cardiff compared depressed people and their siblings to a control group of unaffected people and their brothers and sisters. The researchers found that attributional style had more to do with current mood than trait-related factors. However, the tendency to blame oneself for negative events was related to having had a prior episode of depression suggesting that depression can have a 'scarring' effect predisposing people towards a negative view of events. People who had experienced minor difficulties were found to have a more positive attributional style suggesting that minor life events are protective against pessimistic attributions.

Ball, Harriet A., McGuffin, Peter and Farmer, Anne E. - Attributional style and depression British Journal of Psychiatry April 2008, 192(4), 275-278

Folate and depression in older people

Low levels of folate and vitamin B12 and high levels of a substance called homocysteine have been found to be associated with depression in a number of studies although not all studies have found this link. A Korean study of 521 people aged 65 and over measured participants' levels of these substances and followed them over 2-3 years to see who developed depression. The researchers found that lower levels of folate and vitamin B12 and higher homocysteine levels at baseline were associated with a higher risk of incident depression at follow up. Incident depression was associated with a decline in vitamin B12 and an increase in homocysteine levels over the follow-up period.

Kim, Jae-Min ... [et al] - Predictive value of folate, vitamin B12 and homocysteine levels in late-life depression British Journal of Psychiatry April 2008, 192(4), 268-274

Help-seeking behaviour and depression in adolescence

It is widely recognised that adolescence is a developmental period with fluctuating levels of psychological distress often in the form of depression and anxiety. Seeking appropriate help for these psychological problems before they become severe can reduce adolescents' risk for developing more severe psychological problems such as suicidal thoughts. However, only about a third of young people with mental-health problems receive professional mental-health care. One reason for this is a phenomenon called help negation in which people become more withdrawn and less likely to seek help from others as they become more depressed. A study of 1,766 children between the ages of 12 and 18 in Australia found that the more depressed children were the less likely they were to seek help from their parents. The researchers found a 'consistent trend for students to report being more likely to seek help from no one as depressive symptoms increased'.

Wilson, Coralie Joy, Rickwood, Debra and Deane, Frank Patrick - Depressive symptoms and help-seeking intentions in young people Clinical Psychologist November 2007, 11(3), 98-107

Eating disorders, denial and deception

Denial of illness is a serious stumbling block for the detection, assessment and treatment of eating disorders. A survey by Belgian researchers of 401 ex-eating-disorder patients found that they had made a variety of attempts to conceal their eating disorder : making excuses to avoid eating together, methods to give the false impression of having eaten, avoidance of being weighed and falsifying weight. Often these methods were described as a deliberate strategy. Information about possible health risks had little or no impact on most respondents who were familiar with the notion of an eating disorder but did not apply it to themselves. Many believed that they would have recognised their eating disorder earlier if they had had a clinician who was familiar with this disorder.

Vandereycken, Walter and Humbeeck, Ina Van - Denial and concealment of eating disorders: a retrospective survey European Eating Disorders Review March-April 2008, 16(2), 109-114

Eating disorders and personality disorders

Previous research on the links between eating disorders and personality disorders has varied greatly in its findings although there is a general understanding that personality disorders are common among eating-disorder patients. A study of 545 eating-disorder patients in Denmark found that 29.5% of them had one or more personality disorders - less than the researchers were expecting to find. Personality disorders, in particular borderline personality disorder, were more common among people with bulimia.

Godt, Kristine - Personality disorders in 545 patients with eating disorders European Eating Disorders Review March-April 2008, 16(2), 94-99

Amphetamines in Volvo country

A zero-tolerance law for driving under the influence of drugs (DUID) was introduced in Sweden in 1999. This led to a huge increase in the number of blood samples sent off for toxicological analysis and a study of 26,556 cases of DUID found that 60% of the samples contained some form of amphetamine together with either legal or illegal drugs. In just under a quarter of the cases amphetamine was the only substance found in the blood sample. 85% of the amphetamine users were men who tended to be a few years older than the women. The mean age of ecstasy users was 26 - about ten years younger than the average age of the other amphetamine users.

Jones, Alan Wayne, Holmgren, Anita and Kugelberg, Fredrik C. - Driving under the influence of central stimulant amines: age and gender differences in concentrations of amphetamine, methamphetamine and ecstasty in blood Journal of Studies on alcohol and drugs March 2008, 69(2), 202-208

Drink, drugs and driving

A survey of 27,616 people in the U.S. looked into the links between the age at which people first started drinking, alcohol dependence, drug taking and driving under the influence of drink or drugs. All the sample were drinkers. 22% of the sample had used drugs, 10% had driven under the influence of drugs and 1% had been in a crash because of their drug use. Starting to drink at a young age and being alcohol-dependent were both associated with an increased risk of using drugs and becoming drug-dependent. Being drug and alcohol-dependent were both associated with an increased risk of driving under the influence of drugs and being involved in a drug-related accident.

Hingson, Ralph W., Heeren, Timothy and Edwards, Erika M. - Age at drinking onset, alcohol dependence, and their relation to drug use and dependence, driving under the influence of drugs, and motor-vehicle crash involvement because of drugs Journal of Studies on Alcohol and Drugs March 2008, 69(2), 192-201

Facial recognition in schizophrenia

For most people recognizing a face is a natural and effortless process. Because of the importance of facial recognition a distinct and highly efficient brain system has developed for processing and utilizing facial information. In schizophrenia impairments in recognizing faces has been reported and such impairments may play a crucial role in poor social interactions in patients. Facial recognition is known to be particularly sensitive to inversion (being upside down) and a study of 57 people in the U.S. looked at facial recognition and inversion effects in people with and without schizophrenia. The researchers found that people with schizophrenia were significantly worse at recognising primitive line drawings of people's faces, either upside down or the right way up. However, they were as good at recognizing trees both ways up suggesting there was something specific to facial recognition which they had trouble with.

Chen, Yue ... [et al] - Inefficient face detection in schizophrenia Schizophrenia Bulletin 34(2), 367-374

Schizophrenia rates in different countries

It has long been thought that schizophrenia has a better prognosis in countries in the developing world than in developed countries. Evidence has come from three World Health Organization (WHO) studies: the International Pilot Study of Schizophrenia, the Determinants of Outcome of Severe Mental Disorder study and the International Study of Schizophrenia. A review of research conducted outside the auspices of WHO looked at 23 studies of schizophrenia outcomes in 11 low- and middle- income countries. The study looked at clinical, disability and social outcomes and found little difference compared to more-developed countries. The researchers concluded that 'it is time to re-examine presumed wisdom about schizophrenia outcomes in low- and middle-income countries'

Cohen, Alex ... [et al] - Questioning an axiom: better prognosis for schizophrenia in the developing world? Schizophrenia Bulletin 34(2), 229-244

Abdominal obesity and Alzheimer's

A study of 6,583 people in northern California measured their abdominal fat between the ages of 40 and 45 then followed them up an average of 36 years later. By that time 16% of the participants had been diagnosed with dementia. A pot belly increased the risk of dementia regardless of whether the participants were of normal weight, overweight or obese and regardless of existing health conditions including diabetes, stroke and cardiovascular disease. Those who were overweight with a large belly were at 2.3 times greater risk while those who were obese with a large belly were at 3.6 times greater risk. Women were more likely than men to have abdominal obesity, along with non-whites, smokers, people with high blood pressure, high cholesterol or diabetes and those who were less well educated.

You can read more about this research at

http://psychcentral.com/news/2008/03/28/big-belly-could-up-risk-of-dementia/2092.html

Genetics and schizophrenia

Emerging evidence suggests that many people with schizophrenia have small genetic abnormalities that affected their brain in childhood and adolescence. In a series of new studies on adult-onset schizophrenia scientists from the National Institute for Health in the U.S. found that people with the condition possessed high rates of rare genetic deletions and duplications that apparently disrupted their brain during youth. The genes affected in patients were involved in creating the infrastructure by which neurons communicate, neuronal growth, migration, proliferation, differentiation and cell death. The genetic abnormalities were found in 15% of the adult-onset patients and 20% of the childhood- or adolescent-onset schizophrenia sufferers compared to only 5% of a healthy control group. The mutations occured across the whole of the genome and were often specific to single cases or families ; virtually every mutation in a sample of 150 adults with schizophrenia was different.

You can find out more about this research at

http://psychcentral.com/news/2008/03/31/genetic-disturbance-linked-to-schizophrenia/2097.html

Young families and happiness

It is often thought that those people who start a family early miss out on career opportunities, make poor choices of partners and can experience other problems. A study of 8,000 young adults in the U.S. compared those who set up a family over the course of a five-year period to those who remained single or who had not had children. Those who had set up a family early in their lives were more likely to come from low-income families, have less well-educated parents and to have lived in a household with one or no biological parents. However, despite these disadvantages there were very few differences in overall happiness between the two groups. Those who had broken up with a live-in partner had higher levels of depression but this group only made up 14% of the people in the 'early families' group. The researchers speculated that leaving to live together, marry or have children may provide an opportunity to escape from an unloving home and create a more positive family.

You can read more about this research at

http://psychcentral.com/news/2008/03/31/delayed-marriage-and-parenting-not-always-best/2098.html

Paranoia on the Piccadilly Line

A virtual-reality Tube ride used by researchers at the Institute of Psychiatry in London has found that suspicious and paranoid thoughts are far more common in the general population than was previously thought and are almost as common as anxiety and depression. Wearing virtual-reality headsets 200 participants walked around a virtual Tube-train carriage in a four-minute journey between station stops. The carriage contained computer-generated people who breathed, looked around and sometimes met the gaze of the participants. The participants interpreted the same computer characters very differently. The most common reaction was to find them friendly or neutral but almost 40% of the participants experienced at least one paranoid thought. Those who were anxious, worried, focused on the worst-case scenario and had low self-esteem were the most likely to have paranoid thoughts.

You can find out more about this research at

http://psychcentral.com/news/2008/04/01/paranoid-thoughts-are-relatively-common/2104.html