Driving and depression

A study of 60 people by researchers at the University of North Dakota looked into the links between depression, antidepressant usage and driving skills. 31 people who were taking antidepressants and 29 people who were not taking any medication undertook a driving simulation test which tested steering, concentration and scanning. Those participants who were taking antidepressants were further divided into those with severe and mild symptoms. Participants who were taking antidepressants but who scored in the normal range for depression did no worse than the control group but those people taking antidepressants with a high number of symptoms of depression performed significantly worse.

You can read more about this research at

http://psychcentral.com/news/2008/08/18/driving-skills-can-be-impacted-by-antidepressants/2770.html

Genetic links in bipolar disorder

Brain cells communicate with one another via special channels where they exchange sodium and calcium ions. Researchers believe that malfunctions in these channels could contribute towards bipolar disorder. Previous studies have painted an unclear picture about the links between genetics and bipolar disorder but an international study of 10,596 people - 4,387 of them with bipolar disorder - pooled data from previous research. It found that the two most significant genes were Ankyrin3 and CACNAIC.

You can find out more about this research at

http://psychcentral.com/news/2008/08/18/genetic-link-for-bipolar/2771.html

Hope therapy for depression

Optimism has been defined as a generalized expectation that good things will happen whereas hope involves having goals, along with the desire and plan to achieve them. Researchers at the University of Alabama, Birmingham have been looking at ways of instilling hope in people. They aimed to build on the strengths people already had and help them to develop them and live up to their potential. A study of 32 people found that those taking part in the 'hope therapy' - given over eight, two-hour group sessions had reduced depressive symptoms compared to a control group.

You can find out more about this research at

http://psychcentral.com/news/2008/08/19/hope-therapy-for-depression/2778.html

Suicidal students in the States

An Internet survey of 26,000 students in the U.S. has found that more than half of them had had at least one episode of suicidal thinking at some point in their lives. 15% had seriously considered attempting suicide and 5% had made at least one suicide attempt. 6% of undergraduates and 4% of graduate students reported seriously considering suicide within the 12 months prior to answering the survey. The most common reasons for contemplating suicide were: wanting relief from emotional or physical pain, problems with romantic relationships, the desire to end their life and problems with college work. 19% of undergraduate suicide attempters and 28% of graduate attempters required medical attention.

You can find out more about this research at

http://psychcentral.com/news/2008/08/20/suicidal-thoughts-among-college-students/2789.html

Variability key in diagnosing dementia

Developing strategies to improve the prediction and diagnosis of dementia can help to improve the treatment of the condition. There are a number of neuropsychological tests used for diagnostic purposes which measure an individual's level of performance against healthy individuals to determine cognitive impairment. However people's performance can vary from tesst to test, something not taken into account in this approach. Researchers in the U.S. studied 897 people aged 70 and over who had follow up visits every 12-18 months during which they underwent detailed neurological and neuropsychological evaluations. The researchers tested for verbal IQ, attention/executive function and memory. The study found that the degree of variability in performance between the tests improved the prediction of dementia above and beyond people's level of performance on each test alone.

You can find out more about this research at

http://psychcentral.com/news/2008/08/20/testing-for-dementia/2791.html

Homelessness and drug use

Homelessness and drug and/or alcohol abuse often go hand-in-hand. Homeless people who abuse drugs and alcohol are more likely to demonstrate ineffective coping skills, low levels of self-efficacy and to end up in prison. They are also vulnerable to hepatitis and HIV, victimization, sexually-transmitted diseases, unwanted pregnancy, depression and suicidality. A focus-group study of 54 homeless and drug-using people between the ages of 18 and 24 looked into their attitudes to drugs and what they saw as the facilitators of and barriers to good-quality health care. Participants saw substance abuse as a health risk and a barrier to care but also as an adaptive response to psychological pain and survival on the streets. Facilitators to care and suggestions for improved health delivery and quality of care included using health mentors to assist in navigating the medical system, culturally-competent care, improved amenities in waiting rooms and expanded pharmaceutical services.

Christiani, Ashley ... [et al] - Attitudes of homeless and drug-using youth regarding barriers and facilitators in delivery of quality and culturally sensitive health care Journal of Child and Adolescent Psychiatric Nursing August 2008, 21(3), 154-163

Short-term psychoanalytic supportive psychotherapy

Short-term psychoanalytic supportive psychotherapy was developed in Amsterdam in 1992. It is a six-month treatment made up of 16 sessions based on psychoanalysis. Researchers in Amsterdam pooled data from three clinical trials to compare the effectiveness of this therapy to drug treatment and to a combination of the therapy and drugs in treating depression. There were no differences in symptom reduction between the therapy and the drugs although therapists and patients preferred the therapy. Combined therapy was found superior to drug therapy by patients, therapists and independent observers. As far as quality of life was concerned the patients found no differences between psychotherapy and drugs or between psychotherapy and combined therapy but they did find combined therapy superior to drugs.

de Maat, Saskia ... [et al] - Short psychodynamic supportive psychotherapy, antidepressants, and their combination in the treatment of major depression: a mega-analysis based on three randomized clinical trials Depression and Anxiety 25(7), 565-574

Telephone help for overweight and depressed women

A study of 401 overweight women in California looked at the effectiveness of a phone and Internet based behavioural intervention designed to improve behaviours such as diet and exercise. Previous studies have shown that psychotherapy for depression can be delivered successfully by telephone or via the Internet and other studies have shown that exercise and weight loss can help people to feel less depressed so as well as their weight and exercise levels the study also monitored the women's mood. After 12 months those receiving the intervention significantly decreased their depression scores compared to a control group and those with probable depression showed clinically important improvements. The participants who engaged more readily with the intervention were more likely to reduced their depression scores.

Kerr, Jacqueline ... [et al] - Randomized control trial of a behavioral intervention for overweight women: impact on depressive symptoms Depression and Anxiety 25(7), 555-558

Borderline personality disorder - characteristics and causes

Borderline personality disorder is a severe personality disorder whose features include impulsivity, changeable moods, relationship problems and identity problems. It is associated with interpersonal and occupational impairment, an increased risk for suicide and higher rates of treatment in both medical and psychiatric settings. A study of 5,496 twins, between the ages of 18 and 86, from the Netherlands, Belgium and Australia looked into the characteristics of people with borderline personality disorder and attempted to see how much of the condition could be attributed to genetic factors and how much to environmental ones. The study found that women and young people were more likely to have the condition. 42% of the variations in the condition could be explained by genetic factors and 58% by environmental ones.

Distel, M.A. ... [et al] - Heritability of borderline personality disorder features is similar across three countries Psychological Medicine September 2008, 38(9), 1219-1229

Previous studies have shown that about 1% of the population have borderline personality disorder. It can improve over time but it affects the life and development of young adults over decades and about 10% of people with the condition kill themselves. Stress is thought to play an important role in producing the behaviour associated with borderline personality disorder and a study of 135 people in The Netherlands aimed to examine this link more closely. The study compared 44 people with borderline personality disorder, 42 people with psychosis (which is also known to be brought on by stress) and 49 unaffected controls. It found that the participants with borderline personality disorder reacted much more strongly to the stresses and strains of everyday life than people with psychosis and the control group; after stressful events their negative mood increased more and their positive mood decreased more than participants in the other two groups.

Glaser, J.-P. ... [et al] - A momentary assessment study of the reputed emotional phenotype associated with borderline personality disorder Psychological Medicine September 2008, 38(9), 1231-1239

Risk factors for suicide in new mothers

Although suicide by mothers after the birth of a child is very rare its effects are profound and terrible. Researchers from the University of Washington School of Medicine compared 335 women who had been hospitalized for suicide attempts with a control group of 1420 women. The researchers found that women who had previously been hospitalized for psychiatric disorders were more than 27 times as likely to attempt suicide. Women with a history of substance abuse were six times as likely to attempt suicide while psychiatric hospitalization and substance abuse together increased the risk by 11 times.

You can find out more about this research at

http://psychcentral.com/news/2008/08/07/risk-of-post-partum-suicide/2711.html

STAR*D study of persistent depression

Non-response to antidepressants is one of the major problems in mental health (see post below). Only about half of adult patients respond to the first antidepressant they try, with only a third achieving remission. Patients can either switch to a new drug altogether or augment the first drug with another one although it is not clear which of these strategies is the more effective. The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study is the largest study into this issue ever undertaken and has found that both options are equally effective. The study also found that with persistent trial and error 7 out of 10 adult patients will eventually find a treatment that works.

You can find out more about this research at

http://psychcentral.com/news/2008/08/08/quest-for-a-better-antidepressant/2718.html

Postnatal depression and hormones

Up to 80% of women experience at least a few weeks of low mood after the birth of a child, 10-15% experience more severe depression that may last a month or more and 1-5% experience severe psychosis that can last up to a year. New research by scientists at the Medical College of Georgia's School of Medicine has been looking at the effects of a substance called interleukin-1 beta which is produced in the uterus immediately after childbirth. This creates more serotonin transporters in the brain leading to a relative deficit in serotonin, low levels of which have been linked to depression.

You can find out more about this research at

http://psychcentral.com/news/2008/08/11/biological-link-to-postpartum-depression/2728.html

Brain imaging and opiate receptors

A brain-imaging study of 23 people in Germany looked into the links between brain chemistry, personality and addiction. Healthy volunteers were given a personality test to measure novelty seeking, harm avoidance, reward dependence and persistence. They then underwent a brain scan. Those people with a high reward dependence had a high concentration of opiate receptors in an area of the brain called the ventral striatum which is considered to be very important in the development of addictive behaviour. These people have a relative shortage of endorphins to link up with their opiate receptors and could, therefore, be more likely to turn to illegal substances, or indeed alcohol or tobacco, to make up the deficit.

You can find out more about this research at

http://psychcentral.com/news/2008/08/13/brain-imaging-helps-explain-behavior-2/2745.html

Exercise and mental health

A study of 5,952 pairs of twins, 1357 of their siblings and 1,249 of their parents looked into the links between genetics, exercise and depression. Lack of regular exercise has been associated with anxiety and depression in a number of studies but it is not known whether this effect is due to the lack of exercise itself or another unknown factor present in people who take little exercise and suffer from anxiety and/or depression. The study - carried out in the Netherlands - found that the links between exercise and anxiety and depression were small and best explained by common genetic factors. In identical twins the twin who exercised more did not display fewer anxious or depressive symptoms than the twin who exercised less and over time increases in exercise participation did not predict decreases in anxious and depressive symptoms.

De Moor, Marleen H. M. ... [et al] - Testing causality in the association between regular exercise and symptoms of anxiety and depression Archives of General Psychiatry August 2008, 65(8), 897-905

What happens when the (first) drugs don't work?

Major depression is usually very hard to treat. Studies have shown that only 11-30% of patients reach remission with initial treatment, even after 8-12 months. Most patients require a 'second-step' treatment but there is little information about the relative effectiveness of different drugs as a second step and prescribing tends to be done on a 'trial-and-error' basis. A U.S. study of 727 patients, between the ages of 18 and 75 looked at which factors were associated with a remission in patients being treated with 'second-step' medication. The researchers found that remission was more likely among participants who were White, employed, cohabiting or married and who had made no prior suicide attempts. Remission was less likely among patients who were also suffering from anxiety, obsessive-compulsiv disorder, panic disorder, post-traumatic stress disorder and social phobia. People with substance abuse problems were also less likely to improve when treated with a 'second-step' drug.

Rush, John A. ... [et al] - Selecting among second-step antidepressant medication monotherapies: predictive value of clinical, demographic, or first-step treatment features Archives of General Psychiatry August 2008, 65(8), 870-881

Antipsychotics - who wins in the generation game?

So-called 'second-generation' antipsychotic drugs have traditionally been seen as providing the same level of effectiveness as first-generation ones with far fewer side effects. However, comparisons have usually been made with a highly potent first generation drug such as haloperidol. Researchers at the University of New Mexico, U.S. looked at trials which compared second-generation antipsychotics with less powerful first-generation ones and found that the effectiveness and side effects of the two types of drugs were comparable. The authors of the study concluded that clinicians should look at the unique pharmacological and side effect profile of each drug before making prescribing decisions.

Bonham, Caroline and Abbott, Christopher - Are second generation antipsychotics a distinct class? Journal of Psychiatric Practice July 2008, 14(4), 225-231

Suicide and suicide attempters

Every year, worldwide, around 1 million people kill themselves. Many other people make unsuccessful attempts at ending their lives and there is some debate about whether people who commit suicide are different to those who make an attempt. An Italian study compared 94 people who killed themselves between 1994 and 2004 with 94 outpatients who had made at least one suicide attempt over the same period. Suicide victims were more likely to be unmarried, have poor social support and to have had more voluntary and compulsory admissions to hospital than suicide attempters. Suicide victims were less likely to have had stressful events during their childhood and adolescence and to be divorced and widowed than suicide attempters.

Innamorati, Marco ... [et al] - Completed versus attempted suicide in psychiatric patients: a psychological autopsy study Journal of Psychiatric Practice July 2008, 14(4), 216-224

Keeping the mentally ill off the streets

A recent study in London, Ontario (Canada) found that 194 people had been discharged from psychiatric facilities onto the street in 2002. This is usually disastrous for the people concerned leading to re-hospitalization and prolonged homelessness. An intervention was developed in which people were given immediate assistance in accessing housing and help in paying their first and last month's rent. Participants in the study were divided into two groups, one receiving the intervention and the other receiving treatment as usual. After 3 and 6 months all the individuals in the intervention group had retained their housing. All but one of the people in the control group remained homeless and that person only got accomodation by becoming involved in prostitution. The results of the study were so dramatic that the control group was immediately discontinued with all the participants receiving the intervention.

Forchuk, C. ... [et al] - Developing and testing an intervention to prevent homelessness among individuals discharged from psychiatric wards to shelters and 'no fixed address' Journal of Psychiatric and Mental Health Nursing September 2008, 15(7), 569-575

Specialist learning disability units

In the past people with learning disabilities often spent long periods of time as hospital inpatients. This is no longer considered to be acceptable and the current UK policy is for long-stay hospitals for people with learning disabilities to be reduced in size and, eventually, closed. However, there is still a need for people with learning disabilities to receive assessment and treatments that may still involve a period of admission to a specialist facility. A study of such a facility by researchers in Northern Ireland found that the main reasons for admission were challenging behaviour and mental-health problems. The study found that there were significant reductions in these problems following admission to the unit, which was staffed by a multidisciplinary team, mostly made up of nurses.

Slevin, E. ... [et al] - People with learning disabilities admitted to an assessment and treatment unit: impact on challenging behaviours and mental health problems Journal of Psychiatric and Mental Health Nursing September 2008, 15(7), 537-546

Nicotine and schizophrenia

Nicotinic acetylcholine receptors are thought to be deficient in people with schizophrenia and one of the reasons why people with this condition tend to smoke heavily may be because they are trying to stimulate these receptors. A U.S. study of 31 patients looked at the effects of a substance called DMXB-A which it was thought would have the same effect as nicotine from tobacco but without the health consequences. DMXB-A was found to alleviate anhedonia (the inability to experience pleasure) and alogia (poverty of speech) and to improve vigilance and working memory. But it had little overall effect on cognition and caused mild nausea in nearly all of the participants and mild tremor in five of them.

Freedman, Robert ... [et al] - Initial phase 2 trial of a nicotinic agonist in schizophrenia American Journal of Psychiatry August 2008, 165(8), 1040-1047