Computerized CBT and patient satisfaction

Cognitive behaviour therapy (CBT) is used to treat a variety of mental-health problems including depression and anxiety. However, it is not always available to service users because of a shortage of therapists and long waiting times. Alternative methods of provision have been developed including group therapy, bibliotherapy and computerized CBT (CCBT). There is evidence about the clinical effectiveness of CCBT but little information about its acceptability to service users. A review of 16 studies on the use of CCBT for depression found that although drop-out rates from CCBT were comparable to other forms of treatment, take-up rates were much lower. Overall there was limited information on patient satisfaction with CCBT but when treatment was completed several studies reported positive expectancies and high satisfaction.

Kattenthaler, E. ... [et al] - The acceptability to patients of computerized cognitive behaviour therapy for depression: a systematic review Psychological Medicine November 2008, 38(11), 1521-1530

Shame and eating disorders

Eating-disorder symptoms are associated both with negative emotionality in general and specific negative emotions, in particular chronic feelings of shame. Symptoms of eating disorders are also thought to be linked to problems with regulating emotions. A study of 154 undergraduates at Duke University in the U.S. looked at the relationship between shame, emotional regulation and eating disorder symptoms. The results showed that chronic shame predicted eating disorder symptoms over and above the general effects of negative emotions. Problems with emotional regulation were found to have an influence on the link between chronic shame and eating disorder symptoms; the worse people's emotional regulation the more their shame led on to eating disorder symptoms.

Gupta, Sumati ... [et al] - Emotion regulation skills mediate the effects of shame on eating disorder symptoms in women Eating Disorders October-December 2008, 16(5), 405-417

Eating disorders in the military

Elite athletes often develop eating disorders as they are under constant pressure to meet demanding weight and fitness standards. Members of the U.S. armed forces have also got to meet strict weight and fitness standards and can be placed on a remedial fitness programme and be denied promotion if they fail to match up to them. There have been a few surveys into this issue but because these are filled in by servicemen themselves they have produced unreliable results. The U.S. services' medical records are on a database and a survey of this database from 1998 to 2006 found that in any one year 0.3% of service personnel had an eating disorder. Eating disorders were diagnosed significantly more in 2006 than in 1998 and women were diagnosed significantly more than men. The majority of anorexia cases were in the Marines.

Antczak, Amanda J. and Brininger, Teresa L. - Diagnosed eating disorders in the U.S. military: a nine year review Eating Disorders October-December 2008, 16(5), 363-377

Dementia: out of the shadows

700,000 people are estimated to be suffering from dementia in the UK. The Alzheimer's Society has produced a report, Dementia: out of the shadows in which people with dementia speak out about the impact it has had on their lives and the stigma that goes with the condition. People report losing friends after their diagnosis, neighbours crossing the street to avoid them and professionals dismissing their symptoms as old age.

You can download a full copy of the report at

http://www.alzheimers.org.uk/downloads/Out_of_the_Shadows.pdf

Ethnicity and learning difficulties

It has long been recognised that people from different ethnic groups receive different levels of care from mental-health services. People from ethnic minorities have higher rates of compulsory admission, longer average lengths of stay and are more likely to be prescribed drugs or ECT rather than psychotherapy or counselling. They are also less likely to use mental-health services in the first place. Ethnicity and learning disability is an under-researched area although what research there is suggests that services often offer a 'tokenistic' approach in meeting individual needs, resulting in under usage of service and creating a general environment of 'lack of engagement'.

You can read more about the existing research on this topic and plans for future research at

http://www.library.nhs.uk/ethnicity/viewResource.aspx?resid=296479&code=13e349d0c83a1a920e3672f92df146f0

Cognitive adaptation training for schizophrenia

People with schizophrenia also have cognitive problems which, as well as generally making life more difficult, can also affect how well they adhere to their medication. Cognitive adaptation training (CAT) is an intervention that uses compensatory strategies and supports such as pill containers with alarms, organization of belongings and activity checklists to prompt and sequence adaptive behaviours in an individual's home environment. A Texan study of 95 outpatients with schizophrenia allocated them to three groups: full-CAT which focused on many different aspects of looking after oneself such as grooming, care of living quarters, leisure skills, social and role performance and medication adherence; pharm-CAT which just concentrated on medication adherence and treatment as usual. The treatment lasted for 9 months and participants were followed for 6 months after the withdrawal of home visits. Both full-CAT and pharm-CAT were superior to treatment as usual for improving adherence to medication even after the home visits were withdrawn. Full-CAT had a greater impact on outcome compared to the other two groups but only as long as the home visits were being made. Survival time to relapse was significantly longer in both the full-CAT and pharm-CAT groups compared to treatment as usual.

Velligan, Dawn I. ... [et al] - The use of individually tailored environmental supports to improve medication adherence and outcomes Schizophrenia Bulletin May 2008, 34(3), 483-493

Information campaign key to early intervention for psychosis

How long someone is ill with psychosis before they receive treatment, the duration of untreated psychosis (DUP) is a risk factor for a poorer response to treatment and a poorer outcome of treatment. A Scandinavian study used an intensive information campaign targeting the general public, schools and GPs and low-threshold emergency detection teams to reduce the duration of untreated psychosis and this proved successful compared to service as normal in other areas which acted as a control group. At the end of the trial the publicity campaign stopped but one of the areas still kept its early-detection team allowing researchers to see what the effect of the information campaign had been. They found that once the information campaign had stopped the DUP reverted back to its pre-existing levels and service users were iller by the time they came into contact with health professionals.

Joa, Inge ... [et al] - The key to reducing duration of untreated psychosis: information campaigns Schizophrenia Bulletin May 2008, 34(3), 466-472

Gender and coping strategies

Research studies have shown that women are twice as likely to suffer from anxiety and major depression than men. This could be because women are biologically more vulnerable to stress or because men and women use different coping strategies to deal with problems. Men are more likely to use problem-focused coping, seeking practical ways to deal with the root cause of the problem whereas women are more likely to use emotion-focused coping to try and change the way they feel about difficult and stressful situations. Emotion-focused coping is predictive of higher levels of psychopathology and functional impairment. A study of 107 people in the U.S. looked into the relationships between gender and coping strategies and depression and anxiety. Women who used less positive reframing (attempting to see problems in a positive light) had higher levels of depression than other women and higher levels of depression than men irrespective of what coping strategy the men used. Women who were more prone to blame themselves had higher levels of anxiety although men who blamed themselves did not.

Kelly, Megan M. ... [et al] - Sex differences in the use of coping strategies: predictors of anxiety and depressive symptoms Depression and Anxiety 2008, 25(10), 839-846

Gender differences in OCD

In the last two decades there has been a growing interest in gender differences in obsessive-compulsive disorder (OCD) and in the different aspects of the condition which researchers now suspect may have different causes. A study of 186 people with OCD in Barcelona looked not only at the links between gender and different aspects of OCD but also at the links between tic disorders and OCD and the effect of the age of onset of OCD on which symptoms were experienced. The study found that a preoccupation with contamination and cleaning was more common in women than men whereas a preoccupation with religious and sexual obsessions was more common in men than women. Symptoms of checking, symmetry/ordering and hoarding were equally common in both sexes. Patients who were obsessed with symmetry and ordering were more likely to have a history of tic disorders. Obsessions with symmetry/ordering and sexual and/or religious obsessions were both associated with an earlier onset of OCD.

Labad, Javier ... [et al] - Gender differences in obsessive-compulsive symptom dimensions Depression and Anxiety 2008, 25(10), 832-838

Vitamin B and Alzheimer's

A substance called homocysteine is known to be involved in neurological diseases, including Alzheimer's. Vitamin B is known to reduce levels of homocysteine in the body so some scientists wonder whether vitamin B supplements might help to stave off the condition. A study of 340 people by scientists from the Alzheimer's Disease Cooperative Study compared those participants taking a high-dose vitamin B supplement and those taking a placebo. Unfortunately the study found no differences in cognitive performance between the two groups and those taking the vitamin supplement were more likely to show symptoms of depression.

You can find out more about this research at

http://psychcentral.com/news/2008/10/16/vitamin-b-does-not-help-alzheimers/3146.html

Churches unsympathetic to mental illness

A survey of 293 people, all of whom had previously been diagnosed with a serious mental illness, by researchers at Baylor University in the U.S. has found that participants did not always get a sympathetic response when they approached members of the clergy for help. Nearly a third of the participants were told by their church pastor that they or their loved ones did not really have a mental illness but that their problem was solely spiritual in nature such as personal sin, a lack of faith or demonic involvement. Women were more likely than men to have their mental-health problems dismissed by the church and conservative churches were more likely than liberal ones to take an unsympathetic attitude towards mental distress.

You can find out more about this research at

http://psychcentral.com/news/2008/10/16/clergy-often-downplay-mental-illness/3147.html

Silver surfers, stimulated brains

Pursuing activities that keep the mind engaged may help to preserve brain health and cognitive ability. Traditionally these have tended to be activities such as reading, card games, Scrabble etc but more and more 'silver surfers' are using the Internet and new research has shown that searching the Web may help stimulate, and possibly improve, brain function. A team of researchers at the University of California, Los Angeles studied 24 volunteers with brain scanners as they read and surfed the Web. 12 of them had previous experience of using the Internet while the others did not but the two groups were chosen to be similar in every other respect. Reading was found to produce significant brain activity in all the participants in the parts of the brain that deal with language, reading, memory and visual abilities. Surfing the Net also stimulated these areas but was also found to stimulate parts of the brain to do with decision-making and complex reasoning. However, these areas were only stimulated in the experienced web users suggesting that they approached the process of surfing the Net in a different way from the other participants.

You can find out more about this research at

http://psychcentral.com/news/2008/10/16/web-searches-may-improve-brain-function/3136.html

ADHD - a walk in the park could be a breath of fresh air

Research on children with ADHD has suggested that playing outside in a green area can help to control the condition but a lot of the evidence is anecdotal and there has been little systematic comparison with other activities. Researchers from the University of Illinois took children on three different walks: one in a park, one in a city centre and one in a suburban area. The walks were the same for all the children, none of them were on medication and they all walked with the same adult. At the end of the walks they were given a test - reciting a series of numbers backwards - designed to measure their level of attention. This particular test does not improve with practice and none of the testers knew which child had been on which walk. The walk in the park was found to be more effective than the other walks at improving concentration and its effect was as good as, if not better than, medication.

You can find out more about this research at

http://psychcentral.com/news/2008/10/17/walk-in-the-park-may-help-kids-with-adhd/3152.html

Consequences of early drug use

A long-term study of nearly 1,000 New Zealanders tracked them from birth through to 32. The study looked at those people who began drinking and using marijuana regularly before their 15th birthday. Some of the children came from abusive, criminal or substance-abusing households and had behaviour problems while others came from more stable backgrounds. The children from the more stable backgrounds who were early drug users ended up with the same problems as the at-risk children who did not take drugs and were 3.6 times more likely to be dependent on substances at 32. They were also more likely than the other children from stable backgrounds to end up with a criminal conviction and/or a herpes infection. Early pregnancies, a pattern of school failure, substance dependence, sexually-transmitted disease and criminal convictions were common patterns among the early drug users.

You can find out more about this research at

http://psychcentral.com/news/2008/10/17/early-teen-drug-use-harms-health/3155.html

ADHD ups divorce risk

A study of 488 children and their families in Pittsburgh, U.S. has found that families with young children with Attention Deficit Hyperactivity Disorder (ADHD) were almost twice as likely to divorce, although there was no difference in the divorce rate after the child reached eight. The study found that for families with children with ADHD having a father with antisocial behaviour was the biggest risk factor for divorce. Other risk factors were: mothers who had substantially less education than their fathers; children being diagnosed with ADHD at a younger age; being from an ethnic minority and children who also had serious problems with 'oppositional defiant disorder' (not doing what they were told) and 'conduct disorder' (being naughty).

You can find out more about this research at

http://psychcentral.com/news/2008/10/22/childs-adhd-increases-divorce-risk/3176.html

Depression and heart disease - measuring the extra burden

There is a well-established link between depression and heart disease and it is known that depression can impede people's recovery after a heart attack. However, there has been little research into the level of the burden that depression in heart-attack victims places on health services. A Canadian study of nearly 2,000 heart-attack patients found that depression contributed to a 9% increase in heart-related hospitalizations, a 24% increase in total re-hospitalization days and a 43% increase in non-heart-related hospitalization visits following discharge after a heart attack. The study also found that depression caused the greatest increase in those patients with a lower cardiac illness severity.

You can read more about this research at

http://psychcentral.com/news/2008/10/22/link-between-depression-and-cardiac-care/3177.html

Education and Alzheimer's disease

Better educated people have a lower risk of developing Alzheimer's disease but it is unclear whether education has a protective effect against the condition or that people with more brainpower (cognitive reserve) to begin with can cope with the ravages of Alzheimer's better. The cognitive reserve theory has been given a boost by researchers in Milan who administered brain scans to 242 people with Alzheimer's, 72 with mild cognitive impairment and 144 healthy controls. Better-educated people had less glucose metabolism (which is produced by brain activity) in the posterior temporoparietal cortex and precuneus areas of the brain than less well-educated people who had the same level of cognitive functioning suggesting that although their brains had suffered more damage the better-educated people were more able to cope with it.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=114025&cn=231

What is the future for mental health?

The Foresight Unit at the Cabinet Office looks into the future and tries to see what issues and problems might arise for the Government. One of the issues it has been looking into is mental health and you can see the results of a Powerpoint presentation on this at

http://www.cabinetoffice.gov.uk/~/media/assets/www.cabinetoffice.gov.uk/strategy/mental_capital_wellbeing_071011%20pdf.ashx

New web site for mental-health medication

A new website Choice and Medication has been set up with the aim of offering service users and their carers access to comprehensive information and advice on mental-health conditions and medication groups. The website has been produced by the United Kingdom Psychiatric Pharmacy Group, the College of Mental Health Pharmacists, the Pharmaceutical Schizophrenia Initiative and the National Institute for Mental Health in England. It contains information on over 100 mental-health drugs, 17 mental-health problems, tables comparing the main treatments used and how the drugs are thought to work.

http://www.choiceandmedication.org.uk/en/

New NICE guidance for older adults

The National Institute for Health and Clinical Excellence (NICE) has published new public-health guidance on occupational therapy interventions and physical activity interventions to promote the mental wellbeing of older people in primary and residential care.

You can download a copy of the NICE guidance at

http://www.nice.org.uk/nicemedia/pdf/PH16Guidance.pdf