Plaques and prediction in Pittsburgh

A team of researchers at the University of Pittsburgh, U.S. have been looking into the beta-amyloid protein plaques found in the brains of people suffering from Alzheimer's disease. The team used a positron emission tomography (PET) scan and a radioactive substance that bound to the plaques to follow 56 people, between the ages of 65 and 80, at yearly intervals over four years. About 60% of the participants with mild cognitive impairment (MCI) had plaque levels similar to people with Alzheimer's while the rest had no detectable plaque. By the end of the study only those with plaques had developed a clinical diagnosis of Alzheimer's. About 25% of the 'healthy' control group - who had neither MCI nor Alzheimer's - had significant deposits of amyloid plaque. The team hope their new techniques of detecting plaques within the brain will lead to earlier diagnosis of, and treatment for, Alzheimer's.

You can find out more about this research at

http://psychcentral.com/news/2008/06/17/imaging-illuminates-early-alzheimers/2471.html

Insight and OCD

Insight - in mental health terms - is being aware that one's behaviour and/or feelings are not healthy or usual. In relation to obsessive-compulsive disorder (OCD) insight can be viewed as occuring on a continuum ranging from full awareness of the absurdity of obsessions and compulsions to a total lack of any such awareness. An Italian study of insight among 75 patients with OCD found that poor or absent insight was associated with higher perceived expressed emotion*, a higher severity of OCD symptoms, higher familial perceived criticism and more compulsions and depressive symptoms.

De Berardis, Domenico ... [et al] - Insight and perceived expressed emotion among adult outpatients with obsessive-compulsive disorder Journal of Psychiatric Practice May 2008, 14(3), 137-145

*http://en.wikipedia.org/wiki/Expressed_emotion for an explanation of expressed emotion

Adolescent OCD - intensive, inpatient treatment

Between 2-3% of people are thought to suffer from obsessive-compulsive disorder (OCD) at some point in their lifetimes and one-third of adults who suffer from OCD started to suffer in their childhood. Cognitive behaviour therapy is the first choice of treatment for paediatric OCD with serotonin reuptake inhibitors (SRIs) being recommended for more severe cases. However, one quarter of children do not recover after CBT. One alternative for these children is an intensive, inpatient programme with multidisciplinary support. A study of 23 patients being treated with such a programme in the U.S. found it led to a significant improvement and it is hoped that larger trials in the future will confirm these encouraging results.

Bjorgvinsson, Throstur ... [et al] - Treatment outcome for adolescent obsessive-compulsive disorder in a specialized hospital setting Journal of Psychiatric Practice May 2008, 14(3), 137-145

Conduct disorder and schizophrenia

Conduct disorder prior to the age of fifteen has been found to be much more common among men and women with schizophrenia than among those without, with one study finding that 40% of people who had developed schizophrenia by the age of 26 had fulfilled the diagnostic criteria for conduct disorder by the age of 15. A UK study of 205 men and women with severe mental illness found that conduct disorder before 15 was associated with an increased risk of being assaulted, aggressive behaviour in the six months prior to the study and convictions for violent crimes.

Hodgins, S. ... [et al] - From conduct disorder to severe mental illness: associations with aggressive behaviour, crime and victimization Psychological Medicine July 2008, 38(7), 975-987

Mental health and ME

A study of 3,035 people in the UK followed them for 43 years of their life and assessed them for chronic fatigue syndrome/ME (CFS/ME) at 53 years of age. 34 (1.1%) of the participants reported a diagnosis of CFS/ME at 53. CFS/ME was more common among women and those who had had mental-health problems between the ages of 15 and 36 were 2.65 times more likely to develop CFS/ME later. Increased levels of psychiatric illness - in particular depression and anxiety - were present prior to the occurence of fatigue symptoms. The more severe people's mental health problems were the more likely they were to develop CFS/ME.

Harvey, S.B. ... [et al] - The relationship between prior psychiatric disorder and chronic fatigue: evidence from a national birth cohort study Psychological Medicine July 2008, 38(7), 933-940

Cannabis, brain damage and psychosis

There is conflicting evidence regarding the long-term effects of regular cannabis use. Although there is a growing literature suggesting that long-term cannabis use is associated with a wide variety of health problems many people in the community, as well as cannabis users themselves, believe it is relatively harmless and should be legally available. Animal studies have shown that long-term cannabis administration can affect the hippocampus but only a handful of brain-imaging studies have been undertaken in humans. An Australian study compared fifteen long-term cannabis users with a sixteen-strong control group and found that the hippocampi and amygdalas of the cannabis users were significantly smaller. The more people had smoked cannabis the smaller their hippocampi were and the more likely they were to have 'sub-threshold' psychosis symptoms. Positive symptom scores - delusions, hallucinations etc - were also associated with cumulative exposure to cannabis.

Yucel, Murat ... [et al] - Regional brain abnormalities associated with long-term heavy cannabis use Archives of General Psychiatry June 2008, 65(6), 694-701

Early intervention for untreated psychosis

The duration of untreated psychosis (DUP) - the time from the onset of psychotic symptoms to the start of adequate treatment - is one of the most important factors in the course of the condition and a shorter DUP has consistently been shown to correlate with a better course and outcome for all the symptoms of psychosis. Researchers in Scandinavia created a comprehensive, early-detection system for psychosis and launched a public information campaign in one area, and compared it to another area without early detection. The first-episode patients from the early-detection area had significantly lower DUP, better clinical status and milder negative symptoms at the start of the treatment. After a year there was still a difference in negative symptoms between the groups. After two years there were still differences in negative symptoms, depression and cognition between the two sets of patients.

Melle, Ingrid ... [et al] - Prevention of negative symptom psychopathology in first-episode schizophrenia: two-year effects of reducing the duration of untreated psychosis Archives of General Psychiatry June 2008, 65(6), 634-640

Sleep problems and depression and anxiety in children

Many children can suffer from difficulties in sleeping, however, for a small number of them this could be linked to depression and anxiety. An Italian study of 322 children between the ages of 7 and 11 compared those with depression, those with depression and anxiety, and a control group of unaffected children. 82% of the depressed children reported sleep problems, compared to only 5% of the controls. 42% of those with depression and anxiety and 29% of those with depression had problems getting to sleep. Depressed and depressed-and-anxious children had a significant tendency to a later bedtime and more fragmented sleep. 20% of the depressed-and-anxious children and 17% of the depressed children shared their parents' bed compared to only 5% of the control group.

You can read more about this research at

http://psychcentral.com/news/2008/06/09/child-sleep-problems-may-be-linked-to-depression-or-anxiety/2428.html

Happy marriage and sweet dreams

Sleep plays a vital role in promoting health and well-being. A study of 1,938 women by researchers at the University of Pittsburgh compared their marital happiness with their sleep quality. The study found that higher levels of marital happiness were associated with a lesser risk of having multiple sleep complaints, but only among White women.

You can read more about this research at

http://psychcentral.com/news/2008/06/09/marital-contentment-tied-to-sleep-quality/2429.html

Topiramate for alcohol problems

Topiramate is a drug currently used to treat seizures and migraines. However, a 14-week study of 371 alcoholics in Virginia, U.S. has found that it could also be useful in treating people with alcohol problems. Compared to a placebo topiramate decreased heavy drinking, lowered liver enzymes, cholesterol, body mass index and blood pressure. Topiramate also led to a decline in obsessive thoughts and compulsions about alcohol and a greater improvement in people's quality of life and a reduction in sleep disturbances.

You can find out more about this research at

http://psychcentral.com/news/2008/06/10/medication-reduces-alcohol-dependence/2432.html

Inflammation and depression

There are clinical parallels between depressive symptoms and the symptoms of certain inflammatory disorders. Now researchers from the University of Miami have found genetic differences in inflammation-related genes that are associated with susceptibility to major depression. The researchers found the differences in a study of 615 Mexican-Americans in Los Angeles by comparing those with and without depression. The genes involved are also linked to psoriasis and asthma both of which are known to co-exist with depression and be brought on by psychosocial stressors.

You can find out more about this research at

http://psychcentral.com/news/2008/05/30/blood-test-may-identify-risk-for-depression/2380.html

Could stiff upper lips be back in fashion?

The conventional wisdom in popular culture and psychology is that it is better to talk about one's feelings than bottle them up. However, researchers at the University of Buffalo in the U.S. have called this into question. Using a large national sample the researchers tested people's responses to the terrorist attacks of 9/11 beginning immediately after the event and continuing for the following two years. In an online survey the respondents were given a chance to express their thoughts and feelings on the day of 9/11 and a few days afterwards. The researchers then compared people who chose to express their thoughts and feelings to those who didn't. The people who kept a stiff upper lip did better than those who talked about their feelings. Various alternative explanations were looked at to explain the difference but nothing else accounted for the difference between the two groups.

You can find out more about this research at

http://psychcentral.com/news/2008/06/02/not-talking-about-some-things-may-be-ok/2386.html

Job stress and depression

An Australian study into the links between workplace stress and depression has found that, in people of working age, almost one in six cases of depression are caused by stress at work. The study defined stressful work conditions as a combination of high job demands and low control over how the job gets done. The researchers found that more women than men experienced stress and that stress was more likely in lower-skilled occupations. Nearly one in five working women and one in eight working men with depression had problems due to job stress.

You can find out more about this research at

http://psychcentral.com/news/2008/06/02/work-related-depression-on-the-rise/2387.html

Genetics and schizophrenia

Schizophrenia affects approximately 1% of the world's population. About 40% of cases are thought to be inherited with the other 60% occuring spontaneously in people with no family history of the disease. A study of 1,077 people from the Afrikaner population in South Africa found that rare, spontaneous genetic mutations accounted for at least 10% of the non-familial cases of the disease. The researchers found mutations, either a gain or loss of genes, in 15 individuals diagnosed with schizophrenia that were not present in the chromosomes of either biological, unaffected parent. Chromosome 22 was found to be particularly significant.

You can find out more about this research at

http://psychcentral.com/news/2008/06/02/gene-mutations-spur-schizophrenia/2389.html

Bipolar disorder and substance abuse

There has long been thought to be a link between child and adolescent bipolar disorder and an increased risk of substance abuse but it is not clear whether this is due to bipolar disorder itself or co-existing conditions such as attention-deficit hyperactivity disorder (ADHD), conduct disorder or anxiety disorders. A U.S. study of 203 children compared those with bipolar disorder to an unaffected control group. The incidence of alchohol abuse, drug abuse and smoking was significantly higher in the children with bipolar disorder and overall the rate of substance abuse was much higher (34% vs 4%) among those with bipolar disorder. The onset of bipolar disorder preceded the onset of substance abuse and those who developed bipolar disorder in adolescence were more likely to develop drug problems than those who developed the condition in childhood. When adjusted to account for co-occuring behavioural and psychiatric conditions the results still indicated significantly higher risk in the bipolar group.

You can find out more about this research at

http://psychcentral.com/news/2008/06/03/study-confirms-bipolar-youth-at-risk-for-substance-abuse/2395.html

Exposure therapy and PTSD

People who develop acute stress disorder during or soon after a traumatic event are likely to go on to develop post-traumatic stress disorder (PTSD) which is associated with other mental and physical illnesses, a reduced quality of life and increased health-care costs. Exposure therapy, in which recent trauma survivors are instructed to relive the troubling event, and cognitive restructuring, which focuses on changing maladaptive thoughts and responses to a traumatic event, have been used as interventions to prevent people with acute stress disorder going on to develop full-blown PTSD. However, there is evidence that some clinicians do not use exposure therapy because it causes distress for recent trauma survivors. An Australian study with 63 participants compared those taking part in exposure therapy with those receiving cognitive restructuring. After the treatment fewer people in the exposure-therapy group (37% vs 63%) met the criteria for PTSD and more (47% vs 13%) met the criteria for full remission. Despite concerns that patients would not be able to manage the distress elicited by prolonged exposure there was no difference in drop-out rates between the two groups.

You can read more about this research at

http://psychcentral.com/news/2008/06/03/exposure-therapy-may-reduce-ptsd/2396.html

Better foster care yields better prospects

People who have been in foster care can often suffer from higher rates of mental and physical health problems. A study of 659 fostered children by researches from Harvard Medical School compared those going through a private system - staffed by highly-trained social workers with low caseloads and good access to quality services - to those going through the normal public system (because of a lack of spaces on the private one). Those children going through the private programme had significantly more stable placements (32.7 vs 13.3 months); were at consistently lower risk of foster parent neglect, physical abuse and sexual abuse; were far less likely to suffer from depression (11.3% vs 24.3%), anxiety disorders (28.8% vs 43%) and substance-use disorders (5.1% vs 11.1%) and a lower prevalence of ulcers (7.4% vs 13%) and cardio-metabolic conditions (14.9% vs 22.6%).

You can find out more about this research at

http://psychcentral.com/news/2008/06/03/good-foster-care-improves-mental-health-in-adulthood/2397.html

Middle-aged anorexics

The number of middle-aged people being treated for eating disorders has increased during the last decade. Body image issues and body dissatisfaction increase as the human body undergoes natural changes such as greying hair, wrinkles and weight gain and it has been theorized that mid-life eating disorders could be caused by mid-life transitions such as the loss of parents, siblings or children; traumatic illness and empty-nest syndrome. In some cases this may be a recurrence of an eating disorder which first appeared in childhood but little is known about women developing an eating disorder for the first time at this age. A study of 50 women with a first eating-disorder onset at age 40 or above found that compared to younger patients middle-aged anorexics had less severe and less-common symptoms; a predominance of 'pure' restricting behaviours and a rarity of bulimia; similar rates of depression and anxiety but of less severity; fewer substance-use disorders and substantially greater histories of sexual abuse.

Cumella, Edward J. and Kally, Zina - Profile of 50 women with midlife-onset eating disorders Eating Disorders May-June 2008, 16(3), 193-203

CBT for psychosis

Psychosis can recur throughout people's lives leading to long-term disability. Reviews of studies have shown that combining drugs with psychological interventions - specifically cognitive behavioural therapy (CBT) and family intervention - improves clinical outcome. Family interventions have been shown to produce a reduction of around 20% in relapses but the evidence for CBT is less clear. A study of 301 patients and 84 carers found that both CBT and family intervention had no effect on rates of remission and relapse or on days in hospital at 12 or 24 months. CBT showed a beneficial effect on depression after two years whereas there were no effects for family intervention. In people with carers CBT significantly improved delusional distress and social functioning.

Garety, Philippa A. ... [et al] - Cognitive-behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised and controlled trial British Journal of Psychiatry June 2008, 192(6), 412-423

Antipsychotics and diabetes

Diabetes is one of the most common chronic diseases affecting 3-4% of the population. This proportion is predicted to double by 2030, largely as a result of an ageing population and an increased incidence of obesity. Type 1 diabetes, which begins in childhood, accounts for 10-15% of cases with type 2 diabetes, which begins in adulthood, making up the remainder. The prevalence of diabetes has been reported to be two to three times higher among people with schizophrenia than in the rest of the population and there has been increasing concern that antipsychotics - particularly newer, second-generation ones - are associated with an increased risk. A review of 14 studies compared the relative risk of first- and second-generation antipsychotics and concluded that the second generation ones led to a 32% increase in the risk of developing diabetes.

Smith, M. ... [et al] - First- v. second-generation antipsychotics and risk for diabetes in schizophrenia: systematic review and meta-analysis British Journal of Psychiatry June 2008, 192(6), 406-411