Interventions for childhood trauma

Childhood trauma can lead on to mental-health problems such as depression, anxiety and post-traumatic stress disorder (PTSD). An analysis of treatments for childhood trauma carried out by researchers at the U.S. Centers [sic] for Disease Control and Prevention in Atlanta looked into the effectiveness of individual and group cognitive behaviour therapy (CBT), play therapy, art therapy, psychodynamic therapy, psychological debriefing and drug therapy in people under 21. CBT was proven to be effective but there was a lack of evidence to support the other interventions.



You can find out more about this research at



http://www.mentalhelp.net/poc/view_doc.php?type=news&id=113046&cn=109

Antipsychotic side effects in youngsters

Second-generation, or atypical, antipsychotic drugs used to treat children and adolescents with early-onset schizophrenia are no better than first-generation drugs according to a study of 119 young people by researchers at the University of North Carolina. The study compared the second-generation drugs olanzapine and risperidone to the first-generation one molindone. All three drugs had similar response rates and magnitude of reduction of symptoms and all three had frequent adverse effects. But the two atypical antipsychotics carried a significantly higher risk of weight gain and olanzapine led to a risk of increases in cholesterol, low-density lipoprotein, insulin and liver transaminase. Molindone was linked to a greater risk of akathisia (extreme and unpleasant restlessness). In the long-term the metabolic side effects of the medications could lead on to cardiovascular problems.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=113142&cn=7

Bulimia in pregnant women

Eating disorders can occur at any age although they often begin in adolescence and women are ten times more likely to develop them than men. A study of 41,000 pregnant women taking part in the Norwegian Mother and Child Study found that 96 suffered from bulimia in the first trimester of their pregnancies, 67 had suffered from bulimia six months before their pregnancy, while 26 had developed bulimia after becoming pregnant. The women with bulimia reported lower self-esteem and less satisfaction with life and their relationship with their partner and also had a higher prevalence of symptoms associated with anxiety and depression. Women with bulimia reported a higher prevalence of life-long physical abuse, sexual abuse and major depression compared to other women.

You can read more about this research at

http://psychcentral.com/news/2008/09/18/eating-disorders-among-pregnant-women/2960.html

ICUs and PTSD

Post-traumatic stress disorder (PTSD) is usually associated with people who have been involved in warfare or traumatic incidents such as car accidents etc. However, research by scientists at the University of Washington School of Medicine in Seattle has found that people who have passed through intensive care units (ICUs) may also suffer from PTSD. Using data from 15 previously published studies the authors evaluated PTSD symptoms in 1,745 former ICU patients. The studies took place in the UK, US and a number of European countries. It found that 19% of patients developed PTSD after ICU treatment. Those who had had mental-health problems before going into an ICU were more likely to develop PTSD as were those people who had been sedated with benzodiazepines and those who had had frightening experiences in the ICU.

You can read more about this research at

http://psychcentral.com/news/2008/09/18/ptsd-among-icu-survivors/2962.html

Sweet smells, sweet dreams

Researchers in Germany looked into the links between smells and people's dreams. They exposed people who were asleep to the smells of rotten eggs or roses and then asked them about their dreams when they were woken up. Those who had been exposed to the pleasant smell were more likely to have had pleasant dreams, while those who had been exposed to the rotten eggs were more likely to have had unpleasant ones.

You can read more about this research at

http://psychcentral.com/news/2008/09/22/smell-may-influence-dreams/2977.html

Telephone therapy for depression

A review of studies by researchers at Northwestern University's Feinberg School of Medicine in the U.S. looked into the effectiveness of telephone therapy for depression. People with depression often have problems with motivation and of those expressing an interest in psychotherapy only 20% actually show up for a referral and half later drop out of treatment. Patients can have trouble with transportation and in finding the time to see a therapist. The review found that the average drop out rate for telephone therapy was only 7.6% compared to nearly 50% for face-to-face therapy. Telephone therapy was also found to be as effective as face-to-face therapy in reducing the symptoms of depression.

You can find out more about this research at

http://psychcentral.com/news/2008/09/23/teletherapy-aids-depression-care/2989.html

Narcissism and social networking

Around 100 million people now use the social-networking site Facebook. Researchers at the University of Georgia looked into the links between people's Facebook page and their personality, and, in particular, how the content of people's pages correlated with the personality trait of narcissism. Narcissists are superficially charming people who often end up using people for their own advantage and who have difficulty in forming healthy long-term relationships. They often hurt the people around them and hurt themselves in the long run. The study administered questionnaires to nearly 130 Facebook users, analyzed the content of their pages and asked untrained strangers to view their pages and rate their impression of the owner's narcissism. The study found that the number of friends and wall posts a person had correlated with narcissism reflecting the fact that narcissists tend to have numerous but shallow relationships. The untrained observers used quantity of social interaction, attractiveness of the individual and the degree of self-promotion in their profile picture to rate people's narcissism and were fairly accurate in their judgements. Narcissists were also more likely to choose glamorous, self-promoting photos as their profile picture, whereas other people tended to choose snap shots.

You can find out more about this research at

http://psychcentral.com/news/2008/09/23/social-networking-ids-narcissism/2988.html

Risk factors for medication non-adherence

Antipsychotic medications are a cornerstone of treatment and recovery for people with schizophrenia. However, many people have difficulty adhering to prescribed treatments and the average rate of non-adherence for schizophrenia is 50%. Failure to take medication is the most important risk factor leading to relapse and can result in a fivefold increase in the rate of relapse. An Australian study of 81 service users looked into the factors behind medication omission, including the participants' levels of insight into their condition and their experience and feelings of stigma as a consequence of their mental illness. Most participants had insight into their illness and were aware of the stigma attached to it. Around 70% of them had experienced annoying side effects while nearly half admitted alcohol consumption. About a fifth admitted they had missed taking medication in the previous week. A younger age, the perception of negative side effects and lack of access to a psychiatrist all made it less likely that people would adhere to their medication.

McCann, T.V.., Boardman, G. and Clark, E. - Risk profiles for non-adherence to anti-psychotic medications Journal of Psychiatric and Mental Health Nursing October 2008, 15(8), 622-629

Perfectionism and anorexia

Perfectionism is the tendency to set and pursue unrealistically high standards despite the occurence of adverse consequences. Perfectionism has long been known to be linked to anorexia but there have been relatively few long-term studies into this link. A Swedish study of 68 patients assessed their eating disorder symptoms, mental-health and perfectionism 8 and 16 years after their first use of child and adolescent psychiatric services. Even after the participants' anorexia symptoms and general mental health had improved their levels of perfectionism stayed the same and the more perfectionist they were the longer it took them to recover.

Nilsson, Karin, Sundbom, Elisabet and Hagglof, Bruno - A longitudinal study of perfectionism in adolescent onset anorexia nervosa - restricting type European Eating Disorders Review September-October 2008, 16(5), 386-394

Day hospitals for eating disorders

Day hospital treatment of eating disorders is growing in importance and has financial and clinical advantages in comparison to inpatient settings. It is cheaper and day-hospital treatment allows patients to maintain their social contacts and to apply the lessons learnt in the course of their treatment in their everyday lives. A study of 83 eating-disorder patients in Germany (47 with anorexia and 36 with bulimia) assessed them before treatment in a day hospital, at the end of their treatment and 18 months after treatment. Outcome measures were body-mass index, disturbed eating attitudes and behaviours, frequencies of binging and purging and general mental health. At the end of the day-hospital treatment significant improvement could be found on all outcome variables and the effects were maintained or improved until follow-up. At follow-up 40.2% of anorexia patients and 40.4% of bulimia patients could be classified as remitted and the patients' general mental health was also significantly improved.

Fittig, Eike ... [et al] - Effectiveness of day hospital treatment for anorexia nervosa and bulimia nervosa European Eating Disorders Review September-October 2008, 16(5), 341-351

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