Anorexia or just a phase?

Eating-related problems are common in adolescence and tend to be temporary. But in about 10% of cases adolescents continue with their disordered eating patterns increasing the risk of a serious eating disorder. A two-stage study of 15-17 year olds in Finland asked them about their eating patterns at the start of the study and then again a year later. 11% reported symptoms of an eating disorder at the start of the study and 12% did so a year later. 5% reported eating problems at both time points and of these children 84% were girls. There were higher rates of psychological problems and more mental health complaints in those who reported symptoms at both time points and an increased level of anxiety about, and dissatisfaction with bodily appearance. Those who only reported symptoms at one time point also had higher rates of psychological problems and more health complaints than those with no symptoms.

Hautala, L. ... [et al] - Adolescents with fluctuating symptoms of eating disorders: a one-year prospective study Journal of Advanced Nursing 62(6), 674-680

Theory of mind in schizophrenia

Theory of mind is defined as 'the ability to attribute mental states (such as beliefs, intentions, desires, goals etc) to self and others and to appreciate that behaviours are guided by these mental states.' Theory of mind is known to be deficient in people with schizophrenia and a study of 31 people in the U.S. used brain scans to compare what went on in people's brains when they were using theory of mind. Two groups - one with schizophrenia and a healthy control group were asked to attribute mental states to characters in a story of their own creation. Compared to the control group the people with schizophrenia had a lower flow of blood in parts of the left hemisphere of the brain including the frontal and visual association cortices, the posterior hippocampus and the insula. However, they had a higher blood flow in the right hemisphere - including the multiple frontal and parietal regions, the insula, the visual association cortex and the pulvinar - suggesting that they were using this part of the brain to compensate.

Andreasen, Nancy C., Calage, Chadi A. and O'Leary, Daniel S. - Theory of mind and schizophrenia: a positron emission tomography study of medication-free patients Schizophrenia Bulletin July 2008, 34(4), 708-719

Imitation limitations in schizophrenia

People with schizophrenia often have problems relating to other people. One of the ways we learn how to do this is through imitation and a U.S. study of 36 people compared the ability of people with schizophrenia and healthy controls to imitate a variety of gestures and expressions. The participants with schizophrenia were significantly impaired on all imitation tasks. Errors in imitation were significantly correlated with reduced social competence and increased negative symptoms but not with deficits in working memory.

Park, Sohee, Matthews, Natasha and Gibson, Crystal - Imitation, simulation and schizophrenia Schizophrenia Bulletin July 2008, 34(4), 698-707

Psychiatrists fall down on basic medical care

Mental disorder and physical health are very closely linked. Physical illness can manifest itself as psychiatric disturbance while psychiatric patients have high rates of physical illness, much of which goes undetected. Psychiatric drugs can also have serious physical side effects which need careful monitoring. A survey of 50 outpatients and 50 inpatients in Solihull, West Midlands, found that while 80% of the inpatients had had routine blood tests only 6% of the outpatients group had. 62% of the inpatients group received a full physical examination whereas none of the outpatients had had one. The survey also found a poor level of record keeping in particular where physical examinations or investigations were omitted.

Dale, Jenny, Sorour, Eman and Milner, Gabrielle - Do psychiatrists perform appropriate physical investigations for their patients? A review of current practices in a general psychiatric inpatient and outpatient setting Journal of Mental Health June 2008, 17(3), 293-298

Advanced directives and coercive interventions

Psychiatric advanced directives (PADs) provide a legal means for competent people to refuse or consent to future mental health treatment during periods when they are incapable of making a decision. A major goal of the directives is to reduce coercive interventions during mental health crises but whether they can accomplish this in practice remains unclear. A study of 239 patients in the U.S. compared those who had filled out a PAD to those who had not and found out that those who had not filled out an advanced directive were twice as likely to have experienced a coercive intervention such as being picked up by the police, being committed, being placed in seclusion, being placed in restraints or receiving forced medication.

Swanson, Jeffrey W. ... [et al] - Psychiatric advance directives and reduction of coercive crisis interventions Journal of Mental Health June 2008, 17(3), 255-267

CBT4CBT

Cognitive behaviour therapy (CBT) has a comparatively strong level of empirical support as a treatment for a range of psychiatric disorders, including substance abuse. However, due to a lack of staff and resources CBT remains rarely implemented in the range of settings where individuals with substance use disorders are treated. Computer-assisted therapy could provide a comparatively low-cost method of teaching CBT skills to more substance users and a U.S. trial of 77 patients compared those using computer-based training for cognitive behaviour therapy (CBT4CBT) with those receiving standard treatment. Participants using CBT4CBT submitted significantly more negative urine samples and tended to have longer continuous periods of abstinence during treatment. The programme was positively evaluated by participants and completion of CBT4CBT homework asssingments was significantly correlated with outcome.

Carroll, Kathleen M. ... [et al] - Computer-assisted delivery of cognitive-behavioral therapy for addiction: a randomized trial of CBT4CBT American Journal of Psychiatry July 2008, 165(7), 881-888

Brain structure and depression

There have been many studies into the links between brain structure and depression. Particular emphasis has been placed on the limbic system, specifically the hippocampus and amygdala, which controls emotion and mood regulation. A U.S. study of 64 people compared people with depression, psychotic depression and healthy controls using brain scans to measure the size of their hippocampi and amygdalas. The researchers found that the participants with psychotic depression had smaller amygdalas than those with depression and the control group whose amygdalas were of similar size. The smaller people's amygdala the earlier was the age of onset of their psychotic depression.

Keller, Jennifer ... [et al] - Hippocampi and amygdalar volumes in psychotic and nonpsychotic unipolar depression American Journal of Psychiatry July 2008, 165(7), 872-880

Hallucinations, ethnicity and social adversity

In Europe people from ethnic minorities are more likely to suffer from psychosis. This is thought to be due to social rather than biological factors as the rates of schizophrenia are increased in migrants from a wide variety of countries of origin, there is no increased incidence of schizophrenia in the countries people come from and it is unlikely that people predisposed towards psychosis would be more likely to emigrate from their country of origin. A Dutch study looked into the links between ethnicity, social adversity and people's experience of auditory and visual hallucinations as recent research suggests many people may experience these without developing full-blown psychosis. The study found that Turkish women, Moroccan men, Surinamese/Antilleans, Indonesians and other non-Western immigrants were all more likely to report hallucinations whereas Western immigrants, Turkish men and Moroccan women did not differ from their Dutch counterparts. Once social adversity was taken into account some, but not all of the increased incidence of hallucinations disappeared.

Vanheusen, K. ... [et al] - Associations between ethnicity and self-reported hallucinations in a population sample of young adults in the Netherlands Psychological Medicine August 2008, 38(8), 1095-1102

Schizophrenia and social capital

The more urban an environment people live in the greater their risk for schizophrenia and the link remains even when age, sex, ethnicity, family history of psychosis and cannabis use are taken into account. One factor which is thought to be important is social capital; the levels of civic participation, social networks and trust in an area. A survey of 16,459 people in South London looked into the links between schizophrenia and social capital. It found that areas with low and high socil capital both had increased levels of schizophrenia. The researchers thought that this might be because the low-social-capital areas had less support available to compensate for the stresses of urban living. The higher incidence of schizophrenia in the higher-social-capital areas could be either because even though there are lots of social networks and a healthy civic society certain people are excluded from them or that, because there are better social networks and a higher level of social support people are more likely to be steered towards medical services when they become ill.

Kirkbride, J. ... [et al] - Testing the association between the incidence of schizophrenia and social capital in an urban area Psychological Medicine August 2008, 38(8), 1083-1094

Eating disorders in Australia and Singapore

It was once thought that eating disorders were more common in Western societies. However, recent research has found that eating disorders have long existed in other societies and their prevalence in non-Western countries is not significantly lower. A study of 154 women with and without an eating disorder compared levels of body dissatisfaction among North European Australians, East Asian Australians, Singaporean Chinese and North European expatriates in Singapore. Irrespective of cultural group the women with an eating disorder had similar levels of body dissatisfaction. Among those women without an eating disorder Singaporean Chinese had greater levels of body dissatisfaction than the other groups. Within each cultural group women with eating disorders had higher levels of body dissatisfaction than other women apart from the Singaporean Chinese women where there was no difference between those with and without eating disorders.

Soh, Nerissa Li-Wey ... [et al] - Body image disturbance in young North European and East Asian women with and without eating disorders in Australia and in Singapore European Eating Disorders Review July-August 2008, 16(4), 287-296

Eating disorders, personality and self-harm

Certain personality traits are though to predispose people towards eating disorders. Introversion, conformity, perfection and obsessive-compulsive behaviour have been associated with anorexia nervosa while impulsivity, low self esteem and antisocial personality traits have been associatd with bulima. Self-injurious behaviour is more common among people with eating disorders and a Swedish study of 115 people looked into the links between personality disorders, self-injurious behaviour and eating disorders comparing 38 people with eating disorders to 67 controls. Both the anorexic and bulimic patients had higher anxiety- and detachment-related traits than the control group and people with bulimia showed higher hostility. Anorexics scored lower than bulimics on scales measuring impulsivity, guilt and self-injurious behaviour was more frequent among bulimic patients.

Ahren-Moonja, Jennie ... [et al] - Personality traits and self-injurious behaviour in patients with eating disorders European Eating Disorders Review July-August 2008, 16(4), 268-275

Insomnia and inpatients

Sleep problems are common among psychiatric patients. A survey of 560 patients in the Netherlands found that 36% of them perceived themselves as having a sleep problem. The patients filled in the Pittsburgh Sleep Quality Index which found that 66% of them could be classified as bad sleepers. 49% of the sample used sleep medication one or more times a week.

de Niet, G.J. ... [et al] - Perceived sleep quality of psychiatric patients Journal of Psychiatric and Mental Health Nursing August 2008, 15(6), 465-470

Blood differences in people with schizophrenia

Schizophrenia is a severe and complex mental illness that affects about 1% of the population. Diagnosis currently relies on subjective clinical interviews and the assessment of ambiguous symptoms which frequently lead to delays in diagnosis and treatment. A physical method of diagnosing the condition would, therefore, be very useful. Researchers at Cambridge University looked to find a 'protein fingerprint' in the blood by comparing samples from those with and without schizophrenia. They found that those people with schizophrenia had raised levels of substances called alpha defensins which kill microbes and viruses as part of the immune system. The higher levels of alpha defensins were found in people who had recently been diagnosed with schizophrenia suggesting that this was not due to the drugs used to treat the condition or the disease itself. Unaffected twins of people with schizophrenia also had higher alpha defensin levels leading the researchers to speculate that this might point to a genetic link to the condition.

You can read more about this research at

http://psychcentral.com/news/2008/07/11/new-method-evaluates-risk-for-schizophrenia/2594.html

Ground down down under

A huge Australian study of more than 60,500 people looked into the incidence and risk factors for workplace stress. The study found that nearly 5% of employees had high levels of psychological distress associated with a high likelihood of a mental disorder. With another 9.6% of people suffering from moderate psychological distress. Only 22% of the highly-stressed workers were currently receiving treatment, 29% admitted to having a problem but had not sought treatment while 31% denied having a problem. People who worked in sales and/or who were expected to work for more than 60 hours a week had the highest levels of stress. Working in non-traditional gender roles (i.e. women working as labourers and men working as secretaries) was also associated with more workplace stress as were marital separation and low levels of education.

You can read more about this research at

http://psychcentral.com/news/2008/07/14/worksite-psychological-stress/2599.html

Diagnosing dementia

The most commonly used screening test for cognitive problems in older adults is the Mini Mental-State Examination (MMSE). The maximum score is 30 and a score of 24 or less is typically used to detect people with cognitive dysfunction. A study of 1,141 people carried out by researchers at Texas Tech University looked at the accuracy of the MMSE's diagnosis in people with dementia, people with mild cognitive impairment and healthy older adults. It found that for older adults who were better educated a cut-off point of 27 on the MMSE would provide a more accurate diagnosis of cognitive problems. Better-educated people tend to decline and die more quickly after being diagnosed with Alzheimer's so it is particularly important to pick up problems in this group.

You can find out more about this research at

http://psychcentral.com/news/2008/07/15/new-dementia-assessment-for-highly-educated/2605.html

Eye problems and suicide

Eye conditions that lead to physical impairment can have a number of psychological, social and health consequences including impaired activities of daily living, social isolation, mental impairment, increased dependency on others, increased car crashes, falls and fractures, depression and poor health. A study of 137, 479 people in the U.S. found that even after allowing for age, sex, race, marital status and other health problems visual impairment was still associated with a 50% increase in death by suicide (although this was not considered statistically significant by the researchers). When eye problems were combined with poor self-rated health and other medical conditions they were found to significantly raise the risk of suicide.

You can read more about this research at

http://psychcentral.com/news/2008/07/15/visual-impairment-may-be-linked-to-suicide-risk/2606.html

Exercise and Alzheimer's

Keeping fit could help slow the progress of Alzheimer's disease according to researchers at the University of Kansas. 121 people aged 60 and over took fitness tests on a treadmill and had brain scans to measure their white matter, grey matter and total brain volume. 57 of the group were in the early stage of Alzheimer's disease while the rest were unaffected. Physical fitness had no effect on the brain in the healthy group but in those with early Alzheimer's people who were unfit had four times more brain shrinkage than fitter people.

You can read more about this research at

http://psychcentral.com/news/2008/07/15/exercise-slows-brain-shrinkage/2607.html

Stress and the immune system

It has long been known that stress can affect the immune system and now researchers at UCLA in the US have found out one of the ways in which this might happen. Every cell contains a tiny clock called a telomere, which shortens each time the cell divides. Short telomeres are linked to a range of diseases including HIV, osteoporosis and heart disease. When people experience stress the body boosts production of cortisol which helps with the 'fight or flight' response. Cortisol suppresses telomerase an enzyme which immune cells produce that maintains the length of their telomeres.

You can find out more about this research at

http://psychcentral.com/news/2008/07/15/stress-hormone-affects-immune-system/2608.html

SSRIs and gastrointestinal bleeding

There is evidence that selective serotonin reuptake inhibitors (SSRIs) which are used as antidepressants can increase the risk of bleeding in the upper gastrointestinal tract. However, more research is needed and a UK study of 11,321 patients has found that SSRIs did increase the risk of gastrointestinal bleeding particularly when people were also using nonsteroidal anti-inflammatory drugs. However, using other acid-suppressing drugs reduced the risk of bleeding.

de Abajo, Franciso J. and Garcia-Rodriguez, Luis A. - Risk of upper gastrointestinal tract bleeding associated with serotonin reuptake inhibitors and venlafaxine therapy: interaction with nonsteroidal anti-inflammatory drugs and effect of acid-suppressing agents Archives of General Psychiatry July 2008, 65(7), 795-803

Early interventions for psychosis

Some people think that there is a critical period - just after people become ill with psychosis - in which the potential exists to intervene and improve the long-term course of the illness. However, there is no evidence that indicates how long early interventions need to be active to prevent a relapse or how long the effects last. A Danish study of 547 patients with first-episode psychosis compared a two-year, intensive, early-intervention treatment made up of assertive community treatment, family involvement and social-skills training to standard treatment. There was an improvement in the early-intervention group after two years but after five years there was no difference between the two group as far as symptoms were concerned. But fewer of the early-intervention group were living in sheltered housing and they had had fewer days in hospital over the 5-year period.

Bertelsen, Mette ... [et al] - Five-year follow-up of a randomized multicenter trial of intensive early intervention vs. standard treatment for patients with a first episode of psychotic illness Archives of General Psychiatry July 2008, 65(7), 762-771