Narcissism and leadership

Researchers from Ohio State University at Newark have found that in groups without leaders it is often narcissists who step into the breach. This could be worrying as narcissists tend to be self-centred, exaggerate their talents and abilities and lack empathy for others. In one study 432 undergraduate students completed personality tests, which measured narcissism and were put into groups of four. They were given a hypothetical task selecting next year's director of the student union and afterwards completed a questionnaire evaluating the leadership of themselves and other group members. Those who scored highest on one dimension of narcissism - the desire for power - were more likely to say they wanted to lead the group, were more likely to say they did lead the group discussion and were more likely to be viewed as group leaders by the other group members. In another experiment 408 students were placed in groups of four and asked to choose 15 items from a list to help them survive on a desert island. Again the narcissists were more likely to emerge as leaders of the groups although when their list was compared to a list compiled by survival experts they were no more effective at choosing the best items than other students. In a third study 153 business managers enrolled on an MBA programme were given a task of assuming the role of a school board deciding how to allocate a large donation from a fictional company. This time trained observers sat in on the group and assessed who emerged as the leaders. Once again those highest in narcissism were more likely to emerge as leaders.

You can find out more about this research at

http://psychcentral.com/news/2008/10/08/narcissistic-individuals-are-often-leaders/3087.html

St John's Wort and depression

St John's Wort has long been used in folk medicine to treat depression and sleep disorders. The plant produces a number of different substances that may have anti-depressant properties although it is thought that the whole extract is more effective than its individual constituents. A review of 29 different studies, covering 5,489 participants, whose depression was assesse using the same methodology found that it was superior to placebos and as effective as standard antidepressants with fewer side effects. However, the researchers stressed that people should still see their doctor in the first instance as St John's Wort can interfere with the effectiveness of other medication and not all preparations of St John's Wort are equally effective.

You can find out more about this research at

http://psychcentral.com/news/2008/10/08/st-johns-wort-can-help-with-depression/3089.html

Procaine for dementia

Procaine, or novocaine, is conventionally used as a local anaesthetic. However, it has also been touted as an anti-ageing drug that could improve, or even reverse, the symptoms of dementia. Procaine preparations are available in more than 70 countries and it has been estimated that more than 100 million people might use them. They are officially banned in the U.S. but people can buy them over the Internet. A review of studies into the effectiveness of procaine in treating cognitive impairment has found that 'there is no evidence that it does anything at all and even some evidence that it is toxic'. Side effects can include restlessness, dizziness, migraines and systemic lupus erythematosus, a disease in which a person's immune system attacks itself.

You can find out more about this research at

http://psychcentral.com/news/2008/10/08/procaine-does-not-relieve-dementia/3090.html

Magic magnets licensed in the U.S.

Transcranial Magnetic Stimulation therapy (TMS) has been licensed for the treatment of severe depression in the U.S. The therapy does not involve drugs or invasive procedures and works by stimulating nerve cells in an area of the brain that is linked to depression by delivering highly-focused magnetic pulses. The treatment takes around 40 minutes and does not require anaesthesia or sedation. Over 10,000 treatments performed so far have produced only minor side effects of mild-to-moderate scalp pain.

You can find out more about Transcranial Magnetic Stimulation therapy at

http://psychcentral.com/news/2008/10/13/last-chance-therapy-for-depression/3119.html

Alcohol and brain shrinkage

Moderate consumption of alcohol is known to have a protective effect against heart disease but sadly it appears that it does not have a similar protective effect on the brain. A study of 1,839 adults by researchers at Wellesley College in the U.S. who had an average age of 60 used an MRI scan to measure the size and health of participants' brains. The participants were also asked how much alcohol they consumed per week, their age, sex, education, height, weight, body-mass index and stroke risk. The more alcohol people consumed the lower their brain volume; an effect which was more pronounced in women than men.

You can read more about this research at

http://psychcentral.com/news/2008/10/13/the-more-you-drink-the-more-brain-shrinks/3123.html

I'm not anxious - I'm having a heart attack!

There is a certain amount of overlap between the symptoms of coronary heart disease (CHD) and anxiety which can both cause chest pain, shortness of breath and an irregular heartbeat. Researchers in the U.S. used clinical vignettes (fictional case studies) to see how these symptoms were interpreted by health professionals and found that if a patient was a woman their symptoms were more likely to be interpreted as anxiety than as CHD. The doctors read four vignettes about a 56-year-old woman and a 47-year-old man (the risk of CHD is the same for both). There were two vignettes each about the man and the woman; one in which they had recently experienced a certain amount of stress, the other in which they hadn't. There was no evidence of bias when the vignettes were presented without the stress but in the vignettes which included stress women were much less likely to receive a CHD diagnosis (15% vs 56%), a referral to a cardiologist (30% vs 62%) or a prescription for cardiac medication (13% vs 47%).

You can read more about this research at

http://psychcentral.com/news/2008/10/13/womens-heart-disease-misdiagnosed-as-anxiety/3118.html

Infestations, delusions and medication

Delusional parasitosis (DP) is a rare but debilitating condition characterized by the false belief that one is infested by parasites, mice and vermin. It occurs particularly in middle-aged or elderly men who live alone. Primary DP occurs on its own, whereas secondary DP occurs in conjunction with another mental or physical health problem. A review of 63 case studies looked into the effectiveness of second-generation antipsychotics (SGAs) in treating DP. It found that the drugs were effective after about 10 days with the maximum effect occuring after 6 weeks. For those people who stuck with treatment for 8 weeks all cases responded at least partially. Partial or full remission was reached in 69% of the situations where an SGA was introduced. Secondary DP was more likely to respond to SGAs than primary DP. Risperidone and olanzapine were most widely used and resulted in full or partial remission in 69 and 72% of cases respectively. More research is needed into this topic as such reviews of case studies are considered less reliable than other research.

Freudenmann, Roland W. and Lepping, Peter - Second-generation antipsychotics in primary and secondary delusional parasitosis: outcome and efficacy Journal of Clinical Psychopharmacology October 2008, 28(5), 500-508

Drugs, aggression and schizophrenia

Recent research into schizophrenia has focused on some of the cognitive deficits associated with the condition which can have a greater impact on everyday activities than psychotic symptoms and have also been associated with violence. Some studies have suggested that second-generation antipsychotics are more effective at tackling cognitive deficits than earlier drugs while others have reported no advantage. Researchers in the U.S. studied 100 physically-aggressive inpatients with schizophrenia. A third were given clozapine, a third olanzapine and a third haloperidol. Olanzapine was much more effective at reducing participants' cognitive problems. In participants taking olanzapine - but not the two other drugs - improvements in cognition were associated with a reduction in violence. Clozapine was also found to markedly reduce violence but without improving participants' cognition.

Krakowski, Menachem I., Czobor, Pal and Nolan , Karen A. - Atypical antipsychotics, neurocognitive deficits, and aggression in schizophrenic patients. Journal of Clinical Psychopharmacology October 2008, 28(5), 485-493

Long and short-term psychotherapy. Is brief always better?

Long-term psychodynamic psychotherapy (LTPP) has suffered at the expense of briefer forms of therapy, such as cognitive and family therapy. However, a review of studies into the effectiveness of LTPP has found that it can have a large and positive effect. The review looked at 11 randomised controlled trials and 12 observational studies. The pooled results suggested that psychodynamic therapy could work better for people with complex mental illnesses than briefer alternatives.

JAMA 2008; 300:1551-1565

Day hospitals for suicidal patients

It is often assumed that people who are thinking about killing themselves need to be treated in an overnight hospital. However, sometimes service users who would otherwise be treated in an inpatient ward are offered treatment in an acute psychiatric day hospital of which there are 73 in England. There have been a number of different studies into the effectiveness of psychiatric day hospitals which suggest that they are as effective as inpatient care. A study of 206 suicidal service users by researchers at the University of London compared those using a day hospital with those using conventional inpatient treatment. The study found that patients with a high level of suicidal ideation showed greater symptom reduction during a day hospital treatment although this effect did not persist 3 or 12 months after discharge. There was no significant difference in terms of days spent in readmissions after discharge and only two suicides occured during the study period; one from each treatment group.

Jones, Gemma ... [et al] - Treating suicidal patients in an acute psychiatric day hospital: a challenge to assumptions about risk and overnight care Journal of Mental Health August 2008, 17(4), 375-387

Service users' thoughts on anti-depressants

There has been a lot of research into the clinical and physiological effects of antidepressants but less into their social and psychological effects. Qualitative research aims to look into this kind of issue, looking at what service users say among themselves, in focus groups and in interviews with researchers and aiming to pull out themes from the material rather than numerical quantitative results. Researchers in the U.S. analysed 227 postings in Internet discussion groups for people taking antidepressant medication. They found that there were four main themes to the postings: general side effects, sexual side effects, giving advice and frustration with physicians. The posters saw themselves as ill and rather ineffective patients but at the same time felt that they deserved good treatment and that they had their own medical expertise.

Pestello, Frances G. and Davis-Berman, Jennifer - Taking anti-depressant medication: a qualitative examination of Internet postings Journal of Mental Health August 2008, 17(4), 349-360

Mental-health problems and euthanasia

In 1997 the state of Oregon, in the U.S. passed the Death with Dignity Act allowing doctors to assist terminally-ill patients to die. There are several safeguards in the Act to ensure patients are competent to make the decision to end their own life including referral to a psychologist or psychiatrist if there is a concern that a patient's judgement might be impaired due to mental illness but in 2007 none of the 46 people who died in this way were evaluated by a psychiatrist or psychologist. Researchers from Oregon Health and Science University assessed 58 people who were terminally ill and who had requested physician-assisted suicide. 13 of the participants met the criteria for anxiety and 15 of them met the criteria for depression, of whom 3 eventually ended their life. The researchers called for increased vigilance for mental-health problems among people seeking euthanasia although supporters of the practice argued that depression did not automatically affect people's competence to make a decision about assisted suicide.

You can read more about this research at

http://psychcentral.com/news/2008/10/08/assisted-suicide-depressed-patients-may-be-overlooked/3095.html

Smoking and mental illness

There has long been known to be a link between smoking and mental illness and a study of 280 service users in Melbourne, Australia has found that they were more than four times as likely to smoke as the rest of the population. 62% of the sample smoked and they consumed an average of 22 cigarettes a day, 50% more than in the general population with the heaviest smokers in the group smoking up to 80 a day. 59% of the smokers said that they wanted to give up and 74% wanted to cut down. The biggest cause of death among people with mental illness is cardiovascular disease and some service users can spend more than 20% of their income on cigarettes.

You can find out more about this research at

http://psychcentral.com/news/2008/10/09/smoking-accompanies-mental-illness/3099.html

Forecasting self-harm and suicide

The accuracy of weather forecasts is about 70% but if you say the weather tomorrow is going to be the same as today then you also have a 70% chance of success. In the same way the prediction of the behaviour of people with mental-health problems uses a mixture of assessments, questionnaires, the person's own predictions of their behaviour and the past history of their behaviour. Researchers at Harvard University compared the accuracy of people's forecasts of their own likelihood of engaging in self-injurious thoughts and behaviour (SITB) with forecasts based on their past history of such behaviour. Suicide is the third leading cause of death among adolescents in the U.S. and the study involved 64 adolescents with a past history of SITB. It found that their past histories of SITB was more accurate than their own predictions in forecasting future behaviour.

Janis, Irene Belle and Nock, Matthew K. - Behavioral forecasts do not improve the prediction of future behavior: a prospective study of self-injury Journal of Clinical Psychology October 2008, 64(10), 1164-1174

Parents and grief

The death of a child can be a devastating experience that places a parent at heightened risk of psychological suffering and impairments in functioning. The death of a child is out of sequence with the 'life-cycle' of a family and can often come unexpectedly. Although the majority of bereaved parents find a way to live productive lives some do experience severe and long-lasting mental-health problems. A study of 157 parents who had lost children, by reseachers at the University of Memphis Tennessee, found that the violence of the child's death, the age of the child at death and the length of bereavement all accounted for significant differences in grief symptoms. Cause of death was the only objective risk factor that significantly predicted the intensity of complicated (or more severe) grief. The most important predictor of the severity of grief was 'sense-making' with those parents who said they had made little or no sense of their child's death being more likely to report a greater intensity of grief.

Keesee, Nancy J., Currier, Joseph M. and Neimeyer, Robert A. - Predictors of grief following the death of one's child: the contribution of finding meaning Journal of Clinical Psychology October 2008, 64(10), 1145-1163

Space Age depression treatment

Scientists at the National Space Biomedical Research Institute are developing a software programme that can provide self-guided treatment for depression. The programme is aimed at astronauts on long missions where isolation and close confinement with a limited group of people can lead to mental-health problems. The programme's multi-media approach includes graphics and a video featuring a psychologist who leads the user through a straightforward process called Problem-Solving Treatment which develops problem-solving skills, helps users plan and schedule enjoyable activities and provides preventative and educational information on depression. The system has been tried, with very positive feedback, on bases in the Antarctic and it is hoped that it can be rolled out to people in rural areas or other isolated settings such as commercial ships and oil rigs.

http://psychcentral.com/news/2008/09/25/next-generation-depression-treatment/3006.html

Brain structures and emotional regulation

The failure to successfully regulate emotions is thought to contribute to several mental-health problems but the brain processes that underly emotional regulation are not fully understood as yet. The prefrontal cortex is thought to play an important part in this process but there is relatively little evidence into how the prefrontal cortex interacts with areas deep in the brain that are responsible for our 'gut' reaction to events and people. Researchers at Columbia University in the U.S. found two pathways that linked the prefrontal cortex to these deep-brain regions. The pathway between the prefrontal cortex and the nucleus accumbens was associated with greater reductions in negative emotions while the pathway between the prefrontal cortex and the amygdala was associated with an increase in negative emotion.

You can find out more about this research at

http://psychcentral.com/news/2008/09/26/brain-activity-regulates-emotions/3014.html

NYPD blues

Researchers from the University of Buffalo in the U.S. have been looking into the effects of stress on police officers. Research so far has shown that officers are at greater risk of high blood pressure, insomnia, raised levels of stress hormones, heart problems, post-traumatic stress disorder and suicide. Officers over 40 were more at risk of heart problems than the national average, 72% of female officers and 43% of male officers had higher-than-average cholesterol levels and police officers as a group had higher-than-average pulse rates and blood pressure. Suicidal thoughts were found to be higher in women working on the day shift and in men working on the afternoon/night shift. The female police officers were found to have high cortisol levels - which have been linked to cardiovascular disease - throughout the day.

You can find out more about this research at

http://psychcentral.com/news/2008/09/29/stress-accompanies-law-enforcement/3021.html

Heart disease and depression

Depression is approximately three times more common in people with heart problems than in the general population and as many as 20% of heart patients meet the criteria for major depression with younger women in particular being at high risk. Depression is linked with increased morbidity and mortality, lower rates of cardiac rehabilitation and a poorer quality of life. The American Psychiatric Association has called for routine and frequent screening for depression in patients with chronic heart disease; help for patients with depression by a professional qualified to diagnose, and manage treatment for, depression; careful monitoring of patients to ensure adherence to their treatment plan and better coordination between healthcare professionals treating patients with combined medical and mental-health diagnoses.

You can find out more about this research at

http://psychcentral.com/news/2008/09/30/heart-patients-should-be-screened-for-depression/3035.html

Traumatic head injuries in juvenile delinquents

A study of 720 youths between the ages of 11 and 20 who were in rehabilitation facilities in Missouri has found that nearly one in five of them had suffered from a traumatic brain injury, defined as a head injury causing unconsciousness for more than 20 minutes. Fights and other assaults were a significant source of the injuries which were more common in boys than girls. The participants with the brain injury were significantly more likely to have used heroin, cocaine, crack, marijuana and ecstasy. They also had a significantly earlier onset of criminal and substance-using behaviours and more lifetime substance-abuse problems and suicidal tendencies than the other youths.

You can find out more about this research at

http://psychcentral.com/news/2008/09/30/mental-problems-among-delinquent-teens/3030.html