Debt and mental health

Following the credit crunch it is increasingly likely that more and more people will get into debt. A survey by the mental-health charity MIND has looked into the links between mental-health problems and debt and found that 91% of people said that the experience of being in debebt had worsened their mental health. The report In the Red: debt and mental health found that people with mental-health problems were almost three times more likely to be in debt. People with bipolar disorder, which can cause extravagant spending patterns, were four times more likely to get into debt. Fewer than 1 in 3 people with problem debt informed their creditors of their mental-health problems and 83% of those who did were still harassed by them.

You can view a non-printable copy of In the Red: debt and mental health at

http://www.mind.org.uk/NR/rdonlyres/B8ACA0C3-C16C-45DE-886D-84F0745A1C9D/0/Mw08reportWeb.pdf

The pathway to recovery

The Healthcare Commission has published the results of its review of NHS acute inpatient mental health services - The Pathway to Recovery. The review identified a number of high-performing trusts where there was a therapeutic environment and patients were engaged in meaningful activities but one in four patients were being treated by trusts rated as 'weak', 50% of patients had no say as to what was included in their care plan or the treatment they received and some mental-health wards were seen as hostile and unsafe.

You can download the full text of the report at

http://www.healthcarecommission.org.uk/_db/_documents/The_pathway_to_recovery_-_summary.pdf

While we are waiting

The Mental Health Foundation has produced a report into the long waiting times experienced by those waiting for psychological therapy. The report called While we are waiting says that patients can often wait more than 6 months for treatment. The report says that mental-health problems, people's relationships and their work situations can all suffer terrible damage while they are waiting for treatment. The report calls for PCTs to

• make psychological therapies available within 3-10 days if urgently needed
• to tell patients about the different kinds of treatment available so they can get the right one for them
• to offer weekend and evening appointments for those who can't make it during the day
• make sure that therapy services are sensitive and accessible to children and young people

You can download the full text of the report at

http://www.mind.org.uk/NR/rdonlyres/FBC70E3F-15E5-492D-8D53-D38397409DE6/0/WhilewearewaitingJul08.pdf

Gene link to anxiety

A study by German and U.S. authors has found that people with a particular variation of a gene are more prone to anxiety disorders than others. People carrying two copies of the met158 variation of the catechol-o-methyltransferase (COMT) gene showed greater anxiety on a standard personality test and were significantly more startled than others when shown a series of unpleasant pictures.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=112300&cn=1

Bullying - what makes children victims?

Peer victimization (bullying) is increasingly recognized as a major social problem with international statistics showing that up to 1 in 10 youths are the target of physical attacks, hostile words and social aggression from their peers during their school years. The same children tend to be bullied throughout the course of their childhood and adolescence and the consequences can include depression, loneliness, low self-esteem, physical health problems, alcohol and drug abuse, self-harm and suicidal ideation. A study of 1,970 children in Quebec, Canada, tracked them from 3 to 6 and then asked them, and their teachers, about their experience of bullying at 7. The researchers found that high levels of harsh, reactive parenting, physical aggression by the children themselves and low parental income were all linked to an increase risk of children being victimized.

Barker, Edward D. ... [et al] - Predictive validity and early predictors of peer-victimization trajectories in preschool Archives of General Psychiatry October 2008, 65(10), 1185-1192

Maternal iron and schizophrenia

Although schizophrenia usually begins in adolescence or young adulthood there are a number of theories which suggest its roots are in early childhood or even before. Fetal hypoxia (a lack of oxygen for the child developing in the womb) and maternal nutritional deficiencies have both been implicated but nobody has looked at the role of mother's iron levels despite the fact that iron is essential for a number of processes within the developing brain. Researchers in the U.S. looked at blood tests from 6,872 pregnant women taken between 1959 and 1967 and looked to see whether their children had developed schizophrenia between 1981 and 1997. The children of mothers with a low concentration of iron in their bloodstream had a nearly fourfold increase in their risk of developing schizophrenia and the more iron there was in the mother's bloodstream, the less their children's chance of developing schizophrenia was.

Insel, Beverley J. ... [et al] - Maternal iron deficiency and the risk of schizophrenia in offspring Archives of General Psychiatry October 2008, 65(10), 1136-1144

Three questions to diagnose postnatal depression

Postnatal depression is the most common problem new mothers confront but is often underdiagnosed. The condition is characterized by high levels of anxiety but screening is not routinely performed due to time and other constraints. Researchers at the Colorado Adolescent Maternity Programme have developed a simple three-item questionnaire based on a sub-scale of the Edinburgh Postpartum Depression Scale. The three-item questionnaire was more accurate than two other, longer, subscales and identified 16% more mothers as depressed than the original longer questionnaire. The three questions, which were answered on a five-point scale ranging from 'Yes, most of the time' to 'No, never' were:

• I have blamed myself unnecessarily when things went wrong
• I have felt scared or panicky for no very good reason
• I have been anxious or worried for no very good reason

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=112825&cn=5

ADHD medication and drug abuse

The use of stimulants, such as Ritalin, for children with Attention Deficit Hyperactivity Disorder (ADHD) is deeply controversial with concerns about the side effects and the ethics of prescribing this medication to children. One of the worries is that treatment with these drugs may increase the risk of drug and alcohol abuse. However, several studies of boys and young men with ADHD have found that stimulant treatment actually decreases the risk and delays the onset of substance abuse in adolescence although it does not affect the risk of using tobacco, alcohol or drugs in adulthood. A study of 114 girls (aged 6-18) with ADHD by researchers at Massachusetts General Hospital assessed them for tobacco, alcohol, marijuana and other drug use five years after they enrolled in the study. They compared the 94 participants who had received the stimulants with 20 who had not. The girls who had been treated with stimulants had half the risk of smoking, drinking alcohol and drug abuse as those who had not received treatment although the researchers could not say whether the stimulants had the same protective effects as the girls moved into adulthood.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=113656&cn=3

MRIs and social phobia

MRI scans are increasingly allowing researchers to look into the links between what, physically, goes on in people's brains and how they respond to stimuli and mental-health problems. Researchers from the U.S. National Institute of Mental Health used MRI technology to investigate social phobia. Social phobia is the most common anxiety disorder in the general population and is marked by a person fearing and avoiding social situations and fearing negative judgements by others. Those with the disorder run a greater risk of depression, drug and alcohol problems and suicide attempts. The researchers found that people with social phobia experienced greater blood flow in their amygdala and prefrontal cortex - areas of the brain linked to awareness of oneself, fear, emotion and stress - when they read negative comments about themselves. However, when they read negative comments about others, or neutral or positive comments about themselves or others, there was no change in blood flow in these parts of the brain.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=113753&cn=1

Brain chemistry of seasonal affective disorder

Seasonal affective disorder is a mood disorder which occurs in winter and is linked to a lack of energy, fatigue, overeating and a tendency to sleep longer as well as depressed mood. Researchers at the University of Toronto in Canada looked into the links between the seasons and the levels of a serotonin transporter in the brain. The serotonin transporter 'mops up' serotonin in the brain leading to reduced levels of serotonin, the brain's 'feel-good' chemical so the higher the levels of serotonin transporter the higher the risk of depression. The researchers found that the serotonin transporter was significantly more active in the autumn and winter and believe that light may have a direct effect on the activity of the protein. The study was based on brain scans of 88 volunteers carried out between 1999 and 2003.

You can find out more about this research at

http://news.bbc.co.uk/1/hi/health/7591342.stm

Continued fall in suicide rate

The latest report of the National Suicide Prevention Strategy for England presents an encouraging picture of the progress being made in preventing people from killing themselves. The overall suicide rate over the last three years was 8.3 deaths per 100,000 people compared to 8.5 per 100,000 in the three-year period before that. There was also a 7.5% fall in the rate of suicide among young (20-34) men. There were 145 suicides among mental-health inpatients in 2005, compared to 157 in 2004. The number of suicides among people in contact with mental-health services also fell between 2004 and 2005, from 1308 to 1277.

You can read the press release which accompanied the publication of the strategy at

http://nds.coi.gov.uk/environment/fullDetail.asp?ReleaseID=375715&NewsAreaID=2&NavigatedFromDepartment=False

New code of practice for Mental Health Act

The deprivation of liberty safeguards were part of the 2007 Mental Health Act and provide a framework by which people who lack the capacity to consent to care or treatment can be deprived of their liberty temporarily, in their own best interest. The Department of Health has just issued a Code of Practice containing guidance on the safeguards. As well as being used by health professionals the Code is also intended to provide information for people who are, or who could become, the subject of a deprivation of liberty; for families, friends or carers and for anyone who believes that someone is being deprived of their liberty unlawfully.

You can download a copy of the safeguards at

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_085476

The police and mental health

A new briefing paper from the Sainsbury Centre for Mental Health looks at the role of the police in dealing with people with mental-health problems. The paper says that the NHS should manage health care for people in police custody and take a more active role in diverting people with mental health problems to the service they need. The paper also calls for more training for police in dealing with people with mental-health problems and for assessment suites to be provided by mental health services so that police cells no longer have to function as 'places of safety' under the Mental Health Act.

You can read the full text of the briefing paper at

http://www.scmh.org.uk/news/2008_police_briefing.aspx

Suicide rates in Scotland

Scotland's death toll from suicide rose in 2007 after several years of falls. 620 men and 218 women killed themselves in 2007 in a country which has a suicide rate higher than in other parts of the UK. However, based on three-year rolling averages there was a 13% fall in suicide rates between 2000-2002 and 2005-2007. Men were three times more likely than women to kill themselves and suicide rates were double the Scottish average in the most deprived areas, particularly Greater Glasgow and the Highlands.

You can find out more about this report at

http://www.mentalhealth.org.uk/information/news/?EntryId17=63057

Latest statistics on drug misuse

The latest statistics on drug misuse (which relate to the year 2006/7) show that nearly 80% of the people who died from using illegal drugs in 2006/7 were men. Men were more than twice as likely as women to be admitted to hospital for drug-related mental-health and behavioural disorders and more than twice as likely to access structured drug treatment. There were 1,573 deaths related to drug misuse in 2006. 13.2% of men reported taking illegal drugs, compared to 6.9% of women. You can read the full text of the report at

http://www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/drug-misuse/statistics-on-drug-misuse:-england-2008-full-report

English mental health services 'best in Europe'

A report on mental health services in Europe has concluded that services in England are among some of the best available. The World Health Organization report looked at funding levels, staffing, primary and secondary provision and mechanisms for monitoring human rights. England and Wales were the only places to offer outreach support to all people with mental disorders and one of only three places - together with Germany and Luxembourg - that enabled people to access early intervention. England was the only country to provide a network of specialist early intervention teams to target young people with the early stages of psychotic disorders.

You can download the full text of the report at

http://www.euro.who.int/InformationSources/Publications/Catalogue/20081009_1

New guidelines for antidepressants

The British Association for Psychopharmacology has produced new evidence-based guidelines for the pharmacological treatment of depression.

You can see a full copy of the guidelines at

http://www.bap.org.uk/consensus/antidepressant.pdf

Smoking and schizophrenia

People with schizophrenia are much more likely to smoke than the rest of the population and people suffering from depression and anxiety are also more likely to smoke as well. A study of 100 people with schizophrenia living in the North of England asked whether those who smoked had higher levels of anxiety and depression and whether suffering from anxiety and depression made the participants more likely to smoke. The researchers found that there was no significant difference 'in anxiety and depression scores as a function of smoking status' although men with schizophrenia were much more likely to smoke than women.

Martin, C.R. ... [et al] - Mood and smoking in schizophrenia Journal of Psychiatric and Mental Health Nursing November 2008, 15(9), 703-709

Service users or destructine whirlwinds?

Borderline personality disorder (BPD) is characterized by an unstable pattern of personal relationships, changeable moods (including intense anger), poor impulse control and self-mutilating behaviour. Psychiatric nurses often see service users with BPD in negative terms as manipulative, attention-seeking or troublemakers. A qualitative study of six psychiatric nurses in London and Hampshire used interviews to explore further nurses' perceptions of people with BPD. They found that nurses saw these people as a 'destructive whirlwind'; a powerful, dangerous, unrelenting force that leaves a trail of destruction in its wake. The major themes emerging from the study were: care giving; idealized and demonized; manipulation and threatening.

Woollaston, K. and Hixenbaugh, P. - 'Destructive whirlwind': nurses' perceptions of patients diagnosed with borderline personality disorder Journal of Psychiatric and Mental Health Nursing November 2008, 15(9), 703-709

Child bipolar disorder - new research

There has been an enormous increase in diagnoses of paediatric bipolar disorder lately although there is still a large amount of scepticism as to whether this condition really exists in children. Researchers at Washington University in St Louis studied 108 children who were diagnosed with bipolar disorder between 1995 and 1998. At the beginning of the study, and again during nine follow-up visits conducted over eight years the children and their parents were interviewed seperately about their symptoms, diagnoses, daily cycles of mania and depression and interactions with others. Over the course of the study the children had mood 'episodes' in 60.2% of weeks and episodes of mania in 39.6% of weeks. 87.8% recovered from their first episode of mania but 73.3% later relapsed. The episodes of illness were characterized by psychosis, daily cycling between mania and depression and a long duration. At the end of the follow-up period 54 of the participants were 18 or over of whom 44.4% continued to have manic episodes and 35.2% had substance-abuse disorders, a rate similar to those diagnosed with bipolar disorder as adults, strongly supporting the continuity between child and adult bipolar disorder.

You can find out more about this research at

http://psychcentral.com/news/2008/10/07/childs-bipolar-may-continue-into-young-adulthood/3081.html