Emotional problems and schizophrenia

Abnormalities in the way people process emotions are thought to be central to schizophrenia. People with schizophrenia have a number of different emotional problems including affective flattening, inappropriate affect, anhedonia (inability to experience pleasure), depression, anxiety and anger. They also have abnormalities in emotion perception, emotion experience, emotion regulation and emotional expression. A review of studies by researchers in the U.S. looked at people who were not suffering from schizophrenia but who were thought to be at high risk of the condition including those who had a family history of the illness but who had not developed psychosis themselves, those who were deemed to have schizophrenic tendencies and those who had sought treatment for their psychoses but who had not developed the full-blown condition. This was done to stop results being affected by the effects of the condition itself or the drugs used to treat it. The study found that the individuals at high risk demonstrated similar abnormalities to those with schizophrenia but a lower level. The most common emotional problems in this group were reduced emotional perception, anhedonia and increased negative affect (see post below).

Phillips, Laura K. and Seidman, Larry J. - Emotion processing in persons at risk for schizophrenia Schizophrenia Bulletin September 2008, 34(5), 888-903

Negative and positive affect and schizophrenia

Recent research on personality traits has tended to coalesce around the idea that there are three main variables - at least in part influenced by biology - in people's personality. Negative affect (NA) reflects individual differences in the extent to which a person views the world as threatening, problematic and distressing. People with high NA experience elevated levels of negative emotions and report a broad array of psychological and physical problems whereas people with low NA are calm, emotionally stable and satisfied with themselves and their lives. Positive affect (PA) involves an individual's willingness to engage with their environment. People with a high PA approach life actively, with energy and enthusiasm, cheerfulness and confidence and seek out and enjoy the company of others. In contrast those low on PA tend to be reserved and socially aloof and have lower levels of energy and confidence. The third variable is inhibition/disinhibition - individual differences in the tendency to behave in a controlled or uncontrolled manner. Researchers in the U.S. reviewed studies into NA and PA in people with schizophrenia. They found that people with schizophrenia reported a pattern of stably elevated NA and low PA throughout the course of their illness. The traits were found to be associated with variability in functional outcome, quality of life and stress reactivity.

Horan, William P. ... [et al] - Affective traits in schizophrenia and schizotypy Schizophrenia Bulletin September 2008, 34(5), 856-874

Trauma and hearing voices

The cognitive behavioural model of voice hearing states that it is not the occurence of voices per se that causes distress but the beliefs people hold about them that produce negative behavioural and emotional consequences. Whether voices are seen as malevolent or benevolent, powerful or benign is influenced - according to this theory - by core beliefs that are in turn influenced by people's life history. A Welsh study of 43 voice hearers compared those with predominantly positive beliefs about their voices to those with predominantly negative beliefs. Both groups had had a high prevalence of traumatic life events but those with negative beliefs about their voices were more likely to be experiencing a form of post-traumatic stress disorder (PTSD) and were more likely to have experienced childhood sexual abuse. Current trauma symptoms (re-experience, avoidance and hyper-arousal) were found to be a significant predictor of beliefs about voices and also accounted for a significant proportion of the variance in anxiety and depression.

Andrew, E.M., Gray, N.S. and Snowden, R.J. - The relationship between trauma and beliefs about hearing voices: a study of psychiatric and non-psychiatric voice hearers Psychological Medicine October 2008, 38(10), 1409-1417

Central coherence and eating disorders

Recent research has looked into the links between cognition problems and the development of eating disorders. People with eating disorders tend to have poorer performance in set-shifting tasks where they are asked to transfer their attention from one element to another. There has also been research into the links between central coherence and eating disorders; central coherence being the ability to understand context and see 'the big picture.' A review of 16 studies into central coherence and eating disorders has found that the majority of them found that people with eating disorders did have global processing difficulties i.e. a weak central coherence. However, there was little evidence that people with eating disorders had stronger 'local' processing in terms of tackling detailed, specific tasks.

Lopez, C. ... [et al] - Central coherence in eating disorders: a systematic review Psychological Medicine October 2008, 38(10), 1393-1404

Social phobia in childhood

A large body of research in adults indicates that social phobia is linked to social, educational and occupational functional impairment as well as depression, drug abuse and suicide attempts. Among children and adolescents estimates of the rate of social phobia range from 0.3% to 5.4%. However, only a small number of studies have looked at the characteristics of social phobia in children and this research has been limited to clinical samples. A U.S. study of 101 children compared 45 children with social phobia to 56 children who were anxious but who did not have social phobia. The children with social phobia feared and avoided a significantly greater number of social situations. They were more likely to have trouble making friends and to prefer being alone to being with other children. All the children with social phobia also met the criteria for at least one other mental-health problem. Greater severity of social phobia was significantly associated with poorer social skills, poorer leadership skills, greater attention difficulties and greater learning problems in the classroom.

Bernstein, Gail A. ... [et al] - Symptom presentation and classroom functioning in a nonclinical sample of children with social phobia Depression and Anxiety 65(9), 752-760

Child abuse and OCD

Childhood trauma - physical, emotional or sexual abuse, and emotional or physical neglect - has been linked to a variety of mental-health problems including depression, anxiety and eating and personality disorders. However, the relationship between childhood trauma and obsessive-compulsive disorder (OCD) has not been well studied. A U.S. study of 938 college students found that 13-30% of them met the criteria for childhood trauma with emotional neglect the most commonly reported experience. There was an association between emotional abuse, physical abuse and high levels of OCD symptoms which remained significant even after allowing for the effects of co-occuring anxiety. There were also associations between emotional neglect, sexual abuse and conscientiousness and between conscientiousness and OCD symptoms suggesting that this could be an indirect route by which childhood trauma leads to OCD.

Mathews, Carol A., Kaur, Nirmaljit and Stein, Murray B. - Childhood trauma and obsessive-compulsive disorder Depression and Anxiety 25(9), 742-751

New gene linked to depression and anxiety

Attempts to establish a link between people's genes and their tendency to suffer from anxiety and depression have only been partially successful. A study of 3,107 people in Germany and the U.S. looked into the genetic origins of neuroticism. Neuroticism is a personality trait that reflects a tendency towards negative mood states and has been consistently associated with the likelihood of having symptoms of anxiety and depression. The study tested more than 420,000 genetic markers for their association with neuroticism. The most 'promising' gene for neuroticism, i.e. the one with the strongest link, was a gene called MAMDC1 on the 14th chromosome.

van den Oord, Edwin J.C.G. ... [et al] - Genomewide association analysis followed by a replication study implicates a novel candidate gene for neuroticism Archives of General Psychiatry September 2008, 65(9), 1062-1071

Access and sucess in drug services

Health services in England have been urged to develop integrated care pathways for both drug and alcohol misusers in order to standardize elements of care, improve treatment efficiency and effectiveness and deliver value for money. However, the factors that influence client access to treatment and subsequent completion of detoxification programmes are complex. A study of 6,745 people admitted to an independent sector inpatient detoxification service between January 1995 and March 2003 looked into the factors that influenced completion of treatment and compared those who had referred themselves to the service with those who had been referred by GPs or other health professionals. Factors predictive of treatment completion were found to be older age, being female, being employed and being referred by a GP. People with a stable address were more likely to be referred to the service by a GP, leading to fears that young men, with an unstable housing situation, could be excluded from treatment.

Webb, Lucy, Ryan, Tony and Meier, Petra - Care pathways to in-patient alcohol detoxification and their effects on predictors of treatment completion Journal of Substance Use August 2008, 13(4), 255-267

Drug treatment and health

Misusing illegal drugs can have a number of negative affects, both on drug users themselves and on their families. Jobs may be lost, relationships with families and friends jeopardized, children neglected or abused and time spent in prison. Illegal drug users can also experience a variety of health problems as a direct consequence of their drug use but there has been little research into the health benefits of drug treatment in the UK. A study of 566 drug addicts in Scotland inteviewed them as they started their treatment and again after 8, 16 and 33 months. The study found that decreases in people's use of illegal drugs, or their dependence on them, was associated with significant improvements in physical and psychological health and in reductions in attendance at A&E departments.

Mcintosh, J., Bloor, M. and Robertson, M. - The health benefits of reductions in individuals' use of illegal drugs Journal of Substance Use August 2008, 13(4), 247-254

Psychosis in children - hallucinations-on-Avon

Many mental illnesses occur on a continuum with many more people showing at least some symptoms of them without being diagnosed with the full-blown condition. Several studies have indicated that psychosis could fall into this category with some people in 'non-clinical' populations displaying psychosis-like symptoms. A study of 6,455 12-year-old children in Avon looked into the prevalence of psychotic symptoms (auditory and visual hallucinations, and delusions) and how they were linked to IQ. There is a link between IQ and the risk of schizophrenia (the risk rises as IQ falls) but the relationship between IQ and psychosis-like symptoms is not clearly established. The researchers found that in the last 6 months 13.7% of the children had had at least one psychotic symptom. Those who had below-average IQ scores had an increased risk of such symptoms but for children of average, or above-average IQ there was no link between IQ and psychosis-like symptoms.

Horwood, Jeremy ... [et al] - IQ and non-clinical psychotic symptoms in 12-year-olds: results from the ALSPAC birth cohort British Journal of Psychiatry September 2008, 193(3), 185-191

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