Computerised CBT - the evidence so far

Depression and anxiety are common mental disorders, usually treated by GPs. Recognition of both disorders by GPs is often poor and the proportion of people who actually receive treatment is low. Medication is usually the first, and often the only treatment, offered but it can have unwanted side effects. There is substantial evidence to support the use of psychological therapies, particularly cognitive behavioural therapy (CBT) but it is expensive and there is a shortage of therapists leading to long waiting lists. Alternative methods of providing CBT have been developed, including computerised CBT (CCBT). A study of CCBT in the British Journal of Psychiatry reviewed previous research on the technique and found that 'there is some evidence to support the effectiveness of CCBT for the treatment of depression.' However, the studies examined had considerable drop-out rates and little evidence was presented regarding participants' preferences and the acceptability of the therapy.

Kaltenthaler, Eva ... [et al] - Computerised cognitive behavioural therapy for depression: systematic review British Journal of Psychiatry September 2008, 193(3), 181-184

Antipsychotics and stroke - definitive evidence?

Concerns about an increased risk of stroke among people taking antipsychotic drugs, particularly in people with dementia, were first raised in 2002 and in 2004 the Committee on Safety of Medicines recommended that these drugs should not be used in people with dementia. This policy has now been vindicated by a study done by researchers at the London School of Hygiene and Tropical Medicine. The researchers looked at data from the General Practice Research Database which contains information from more than six million patients. They assessed the effect of exposure to antipsychotic medication on the incidence of stroke in 6,790 patients with a recorded incident of stroke and at least one prescription of an antipsychotic between January 1988 and the end of 2002. The authors of the study found that people with dementia taking the drugs were 3.5 times more likely to have a stroke, and people without dementia 1.7 times more likely than at times when they were not taking antipsychotics.

You can find out more about this research at

http://psychcentral.com/news/2008/08/29/antipsychotic-drugs-increase-risk-of-stroke/2850.html

Antidepressants in men and women

A U.S. study of 2,876 men and women with a diagnosis of major depression has found intriguing differences in the way in which men and women respond to the antidepressant citalopram. Researchers from the University of Michigan Depression Center [sic] looked into people taking citalopram over a number of weeks with the doses increasing over time. All of the patients had been experiencing depression for years; on average 12 years. Women were 33% more likely to achieve a full remission of their depression, despite the fact that they were more severely depressed than the men when the study began.

You can find out more about this research at

http://psychcentral.com/news/2008/09/02/antidepressant-response-varies-by-gender/2861.html

Family therapy for bipolar disorder

Between a half and two-thirds of patients with bipolar disorder develop the condition before the age of 18. Early onset of illness is associated with an unremitting course of illness, frequent switches of polarity, a high risk of suicide and poor functioning or quality of life. A study of 58 adolescents by researchers at the University of Colorado, Boulder, looked into the effectiveness of family therapy and pharmacotherapy compared to pharmacotherapy and usual care. The researchers found no difference between the two groups in rates of recovery or in the amount of time that elapsed before a subsequent mood episode. However, patients in the family-therapy group recovered from depressive symptoms more quickly, spent fewer weeks in depressive episodes over the two-year period and had an overall more favourable trajectory of depressive symptoms.

You can find out more about this research at

http://psychcentral.com/news/2008/09/02/family-therapy-helps-bipolar-teens/2862.html

Older fathers and bipolar

Older paternal age has been linked to a higher risk of complex neurodevelopmental disorders, including schizophrenia and autism. Now a Swedish study of 80,568 people has also linked older fathers to an increased likelihood of bipolar disorder. Researchers compared 13,428 people with bipolar to 67,140 controls and found that people with fathers over the age of 29 were at an increased risk of developing the condition. The offspring of fathers over the age of 55 were found to have a 37% higher risk than those of fathers who were between 20 and 24. The offspring of older mothers also had an increased risk but it was less-pronounced than that of having an older father.

You can find out more about this research at

http://psychcentral.com/news/2008/09/02/older-fathers-linked-to-bipolar-children/2864.html

Low birth-weight and mental-health problems

Low birth weight has been associated with a range of health problems in later life including mental-health problems in childhood. A study of 823 children in Detroit looked into the effects of low birth weight on children's mental health and compared 413 children from a socially-disadvantaged community to 410 children from a middle-class suburban one. In both groups children with low birth weights were more likely to have externalising (bad behaviour) and internalising (unhappiness and anxiety) problems. Low-birth-weight children from the socially-disadvantaged community were also more likely to have problems with attention which is important as attention problems at the start of schooling are linked to lower academic achievement later.

You can find out more about this research at

http://psychcentral.com/news/2008/09/03/low-birth-weight-kids-at-risk-for-mental-problems/2870.html

Exercise and memory

An Australian study of 170 people aged 50 and over has added further evidence to the links between exercise and mental health. The participants in the study were divided into two groups: a control group and a group which took 2 1/2 hours of physical activity a week, ranging from walking and swimming to ballroom dancing. The participants' cognition was tested at intervals over an 18-month period and those who took part in physical activity continually out-scored the control group, which actually reported an overall decline in cognition.

You can find out more about this research at

http://psychcentral.com/news/2008/09/03/exercise-can-help-memory/2872.html

Zen and the art of dealing with distractions

Distracting thoughts have been implicated in a number of different mental-health problems including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), anxiety and major depression. One way of dealing with distracting thoughts is by meditation and a study of 24 people by researchers at Emory University School of Medicine has found that people who practise Zen meditation are able to recover from distractions more quickly than other people. Researchers compared 12 experienced Zen meditators with 12 non-meditators. Participants in the study took part in breathing exercises and were distracted at periodic intervals by a task in which they had to distinguish between real and nonsense words. At the same time participants' brains were scanned using magnetic resonance imaging (MRI). The participants who were experienced Zen meditators were able to bring activity in a region called the default mode network - associated with spontaneous thoughts and mind-wandering - under control after the interruptions more quickly than non-meditating participants.

You can find out more about this research at

http://psychcentral.com/news/2008/09/03/zen-training-clears-brain/2873.html

Intrusive mental images in grief

Intrusive mental images can be defined as 'fragments of specific autobiographical events or imaginal extensions of such events that predominantly possess sensory qualities and enter awareness suddenly and unintentionally.' Flashbacks have long been known to be part of post-traumatic stress disorder (PTSD) but intrusive mental images have also been implicated in depression, anxiety and other mental disorders. A team of Dutch researchers looked into intrusive images in grief, studying a sample of 131 mourners. They examined the frequency and correlates of four specific types of intrusive image: positive intrusive memories of the deceased, intrusive images of the death, re-enactment fantasies, and negative images of the future. All were common and all were correlated with the severity of complicated grief symptoms. Intrusive images of death, re-enactment fantasies and negative images of the future were all correlated with the severity of symptoms of depression and anxiety.

Boelen, Paul A. and Huntjens, Rafaele J. C. - Intrusive images in grief: an exploratory study Clinical Psychology and Psychotherapy July-August 2008, 15(4), 217-226

Emotional-regulation, self-harm and CBT

Emotional-regulation has been defined as 'the awareness, understanding and acceptance of emotions, as well as the ability to control behaviour in the context of emotional distress.' People who deliberately harm themselves often have trouble with emotional-regulation having lower emotional awareness and clarity, lower acceptance of emotions and difficulty in controlling their behaviour when experiencing negative emotions. A trial on 90 people aged between 15 and 35 looked at how cognitive behaviour therapy (CBT) affected people's tendency to harm themselves. The study found that the most important factor in the effectiveness of CBT was how much it was able to improve the participants' emotion-regulation, particularly their impulse control and goal-directed behaviours rather than its effect on depression, anxiety and suicidal cognitions.

Slee, Nadja ... [et al] - Emotion regulation as mediator of treatment outcome in therapy for deliberate self-harm Clinical Psychology and Psychotherapy July-August 2008, 15(4), 205-216

Parents and students - the secrets of their success

Gaps between parents' real expectations of their student offspring and what the students themselves think is expected of them could add to the stress of being a college student according to new research from the U.S. A study of 174 first- and second-year students, 138 of their mothers and 72 of their fathers asked about personal maturity, academic achievement, dating and how well parents and students thought they communicated with one another. While most students were meeting or exceeding their parents' expectations those who thought they weren't (because they thought their parents' expectations were higher than they were) reported lower self-worth and more trouble adjusting to college. In another study the researchers found that those students who had at least one authoritative parent - one whose parenting style combined warmth, a demanding nature and democracy - adjusted better to college than those whose parents were too authoritarian, permissive or neglectful.

You can find out more about this research at

http://psychcentral.com/news/2008/08/21/parental-expectations-affect-college-students-identity/2797.html

Spanking in the USA

There has been a lot of debate about spanking recently and a US study of 1,435 mothers in North and South Carolina has found that those mothers who had spanked their children in the past year were nearly three times more likely to say that they had also used harsher forms of punishment including beating, burning, kicking, hitting and shaking. The mothers who used an object to hit their child on the buttocks were more than nine times as likely to report committing other physical abuse. 45% of the mothers reported that they had spanked their child, 25% reported spanking with an object on their buttocks and 4% reported even harsher forms of punishment. Only 2% of the mothers who reported no spanking reported the use of physically abusive punishment, compared to 6% of the mothers who spanked and 12% of those who spanked with objects.

You can find out more about this research at

http://psychcentral.com/news/2008/08/21/new-study-finds-spanking-linked-to-physical-abuse/2800.html

Leadership and mental health

Qualities associated with good leadership include treating employees considerately and truthfully, providing social support and providing inspirational motivation and intellectual stimulation. A Finnish review of the effects of leadership on employee's health and wellbeing found that workers with good leadership were 40% more likely to have low rates of anxiety, depression and job stress. Good leadership was also associated with a 27% reduction in sick leave and a 46% reduction in disability pensions.

You can find out more about this research at

http://psychcentral.com/news/2008/08/22/good-leadership-at-work-aids-mental-health/2806.html

Recovered memories and egg-salad sandwiches

There has been a lot of controversy over 'recovered memories,' particularly in people who claim to have been abused as children. In a series of experiments reported in the journal Psychological Science researchers falsely suggested that participants had become ill after eating egg salad as a child. Afterwards the researchers offered different kinds of sandwiches to the participants, including one with an egg-salad filling. Four months later the participants were asked to be in a separate study evaluating different kinds of food. Those who had been given the false memories gave the egg-salad sandwiches much lower ratings than those in the control group and were much more likely to avoid eating them.

You can read more about this research at

http://psychcentral.com/news/2008/08/22/false-memories-can-influence-future-behavior/2807.html

New study adds to confusion on antipsychotics for older people

Elderly people are often prescribed antipsychotic medication to treat mental health symptoms and reduce aggressive behaviour. In recent years clinicians have increasingly prescribed second-generation drugs which generally have fewer side effects than older ones. However, in 2005, after studies suggested that the newer drugs could increase the risk of death by 60% there was a move away from the second-generation drugs. A study of 37,241 elderly people taking antipsychotics in British Columbia between 1996 and 2004 found that first-generation medicines actually increased the risk of death from cardiovascular or respiratory diseases.

You can find out more about this research at

http://psychcentral.com/news/2008/08/25/first-generation-meds-are-risky-for-eldery/2817.html

Autism in the interrogation room

People cope with police interviews and being locked up in different ways, making some vulnerable to making false confessions which can lead to miscarriages of justice. It is not clear whether people with autism are more vulnerable at interviews, or more prone to respond negatively to questioning. A study by researchers at the Institute of Psychiatry compared 26 people with high-functioning autism to a control group of 27 unaffected people. People with autism were rated as significantly more compliant than the controls and also had higher scores on measures of depression, anxiety, fear of negative social evaluation and paranoia. The researchers concluded that people with autism may be more eager to please, or to avoid confrontation and conflict, than other people and may be more prone to respond compliantly to requests and demands.

North, Alice S., Russell, Ailsa J. and Gudjonsson, Gisli H. - High functioning autism spectrum disorders: an investigation of psychological vulnerabilities during interrogative interview Journal of Forensic Psychiatry and Psychology September 2008, 19(3), 323-324

Screening for personality disorders in prisoners

Many prisoners have personality disorders. It is important to get an accurate picture about how many people in prisons have personality disorders as this may determine service needs and have important implications for inmate management. The presence of these disorders may also predict the behaviour of some prisoners while in custody and after release. The ideal way of diagnosing personality disorders is through a clinical interview but this can be time consuming and expensive. Researchers in the UK looked into the effectiveness of a screening tool called SCID-II by using it on 496 prisoners. They found it 'retained good internal consistency with improved discrimination between personality disorders and clinical syndromes'.

Ullrich, Simone ... [et al] - Detecting personality disorders in the prison population of England and Wales: comparing case identification using the SCID-II screen and the SCID-II clinical interview Journal of Forensic Psychiatry and Psychology September 2008, 19(3), 301-322

PTSD and alcohol problems

Substance abuse is strongly associated with post-traumatic stress disorder (PTSD) and other psychological disorders that may occur after stressful and traumatic events. A study of 48,481 military personnel in the Journal of the American Medical Association looked into the links between military service and alcohol problems. Among Reserve or National Guard personnel who saw action the rate of new-onset heavy weekly drinking was 8.8% of new-onset binge drinking 25.6% and of new-onset alcohol problems 7.1%. Among regular soldiers the rates were 6%, 26.6% and 4.8% respectively. Women were more likely to report heavy weekly drinking but less likely to report binge drinking or alcohol problems. Those born after 1980 and those with PTSD and depression were all more likely to develop alcohol problems.

You can find out more about this research at

http://psychcentral.com/news/2008/08/14/members-of-reserve-and-guard-at-risk-for-alcohol-problems/2752.html

Anxiety, stress and allergy

There has long been known to be a link between stress and the immune system. Allergies occur when the immune system goes into overdrive and a study of 28 people by researchers at Ohio State University looked into the links between stress and allergies. The participants' anxiety levels were measured at the start of the study using a standardised questionnaire and they underwent pinprick tests to measure their reactions to allergens. The participants were also placed under stress by being asked to deliver a ten-minute talk and do maths questions without using a pen and paper (the stress condition). The researchers then measured the size of the weals on the participants' arms before and after they experienced the stress condition. Participants who had only moderate levels of 'background' anxiety had weals 75% larger after the stress experiment but for people who were already highly anxious at the start of the study their weals were more than twice as large after the stress test. Anxious people were four times more likely to have a stronger reaction to the skin test one day later after the stressful condition.

You can read more about this research at

http://psychcentral.com/news/2008/08/15/anxiety-and-stress-accentuate-allergies/2762.html

ADHD - behaviour therapy better than drugs

Parents whose children are diagnosed with ADHD often ask for, or are given, drugs for their children. However, research from the largest ever study into treatments for ADHD has found that behavioural interventions can lead to less use of medication and smaller dosages when it is used. Although medication can dampen down symptoms of ADHD such as restlessness and fidgeting they don't address the impairments caused by ADHD such as a lack of successful interactions with peers, deficits in reading and maths skills and difficult relationships with parents and family members. There is also some doubt over the physical effect of the drugs with some research suggesting that heavy doses over long periods may reduce a child's adult height by two inches.

You can find out more about this research at

http://psychcentral.com/news/2008/08/18/therapy-as-first-line-treatment-for-adhd/2769.html