Suicide and mental illness

People who have already tried to kill themselves are 30-40 times more likely to commit suicide than other people. A Swedish study of 39,685 people who were admitted to hospital for attempted suicide between 1973 and 1982 looked at which mental-health problems increased the risk of these people going on to kill themselves. The study lasted until 2003 and the strongest predictor of completed suicide was schizophrenia, which increased the risk by a factor of 4.1 in men and 3.5 in women. Bipolar disorder and depression increased the risk by a factor of 3.5 in men and 2.5 in women. Increased risks were also found for anxiety disorders, alcohol misuse in women, drug misuse and personality disorders.

Tidemalm, Dag ... [et al] - Risk of suicide after suicide attempt according to co-existing psychiatric disorder: Swedish cohort study with long-term follow-up British Medical Journal December 6, 2008, 1328-1331

AMHPs get sectioning powers

The Government has opened the way to nurses being able to section people. Nurses will be allowed to become approved mental-health professionals (AMHPs) as will occupational therapists, social workers and chartered psychologists. AMHPs will have to take a postgraduate diploma learning about mental-health legislation, child and adult protection, the functions of courts and mental-health review tribunals, drug abuse and risk assessment. After qualification they will specialise in assessing a person's needs, care and treatment and will have a role in decisions to detain patients.

You can download the full text of the 2007 Mental Health Act at

http://www.opsi.gov.uk/acts/acts2007/pdf/ukpga_20070012_en.pdf

Recovery Network expands web site

The Recovery Network, which helps people to recover from drug and alcohol addictions has expanded its website. The site now has a social networking and education section focusing on mental health and provides help for people suffering from depression and anxiety attacks.

You can find the new, improved site at

www.trntv.co.uk

New web site on online therapy

A new website about online therapy has been set up for mental-health professionals. The site contains articles, discussion boards and resources and will look into issues such as therapists' roles on 'virtual world' sites such as Second Life.

You can find the site at

www.onlinetherapyinstitute.com

Exercise and mental health

Research suggests that exercise reduces anxiety, depression and negative mood and improves self-esteem and cognitive functioning as well as providing a number of physical-health benefits. However, there is little or no mention of exercise in most mental-health textbooks. Researchers from Leeds and Bristol universities looked into the experiences of 11 men with serious mental illness, aged between 24 and 43 who were involved in a variety of exercise activities. They found that exercise contributed strongly towards the participants' feelings of social support.

Carless, David and Douglas, Kitrina - Social support for and through exercise and sport in a sample of men with serious mental illness Issues in Mental Health Nursing December 2008, 29(11), 1179-1199

Helping sex offenders with learning disabilities

The Sex Offender Treatment Services Collaborative

www.sotsec.org

is a group of professionals who provide treatment for men with intellectual disabilities who are at risk of sexual offending. The group provides a forum for the discussion of treatment issues as well as training and support for clinicians who are delivering group cognitive behavioural treatments for men with intellectual disabilities who sexually abuse. One of the modules in the programme uses a four-stage model - motivation to abuse, overcoming internal and external inhibitions and overcoming victim resistance - to help offenders understand their steps to offending. An article in this month's British Journal of Learning Disabilities looks at the progress of four men going through this programme and discusses some of the issues around this work.

Goodman, Wendy ... [et al] - Group treatment for men with learning disabilities who are at risk of sexually offending: themes arising from the four-stage model to offending British Journal of Learning Disabilities December 2008, 36(4), 249-255

Risperidone: longer-acting for harder cases

A depot injection is given via a long-lasting injection and aims to promote compliance in people with particularly severe mental illness, thereby enhancing relapse prevention. Risperidone is the first second-generation antipsychotic to be available in a depot format. The effects of this form of the drug have been extensively studied in trials prior to its introduction but the kinds of people who might take it have not. A Dutch study, using dispensing data from 53 community pharmacies in the north-east of the Netherlands looked to see what kind of chronic antipsychotic users switched to long-acting Risperidone. They found that the predictors for switching from an oral to a depot form of drugs were: being a man, a previous use of depot antipsychotics, recent anticholinergic drug use, and a gap in 'antipsychotic dispensation history,' i.e. a patchy history of drug-taking. Predictors of switching to depot Risperidone from a depot first-generation antipsychotic were previous use of a depot antipsychotic and consulting a specialist. The researchers concluded that compared with oral antipsychotics service users receiving a depot injection were likely to be less compliant and to suffer from worse side effects. People receiving depot risperidone as opposed to a depot first-generation antipsychotic tended to be more severely ill. The researchers concluded that the long-lasting risperidone was being used for the most severely-ill people; something that will need to be borne in mind when assessing its effectiveness.

Vehof, Jelle ... [et al] - Predictors for starting depot administration of risperidone in chronic users of antipsychotics Journal of Clinical Psychopharmacology December 2008, 28(6), 625-630

Incontinence and clozapine

Urinary incontinence is an embarrassing and distressing side effect of the antipsychotic drug clozapine and a Korean study followed 87 people who had taken the drug for 2 years to see if the symptoms persisted. At the start of the study 10.9% of the sample reported incontinence with 41.6% having clinically-significant lower-urinary-tract symptoms. After two years the participants' score on the International Prostate Symptom Score scale had increased (i.e. they had got worse) and so had the number of participants with lower-urinary-tract symptoms (43.7%) although the change was not statistically significant. The prevalence of lower-urinary-tract symptoms was higher in the people who had taken clozapine than in the general population of the same age.

Jeong, Seong Hoon ... [et al] - A 2-year prospective follow-up study of lower-urinary-tract symptoms in patients treated with clozapine Journal of Clinical Psychopharmacology December 2008, 28(6), 618-624

Fathers with psychosis

One in five men with chronic mental-health problems are fathers yet despite this no research has specifically investigated fathers with psychosis. A qualitative study of 10 fathers with psychosis being treated by community mental health services in West and North London looked at some of the ways psychosis affected fatherhood. The fear of one's children inheriting psychosis was a common concern among the group but they also identified positive aspects of fatherhood including: a sense of pride in the father role, a sense of purpose to one's life, a feeling of pleasure in the creation and development of life and the motivation to change for the better.

Evenson, Erik ... [et al] - The experience of fathers with psychosis Journal of Mental Health December 2008, 17(6), 629-642

Mental-health literacy and bulimia

Mental-health literacy can be defined as "knowledge and beliefs about mental disorders that aid their recognition, management or prevention." It is thought that poor mental-health literacy is a major factor in low or inappropriate treatment-seeking among individuals affected by mental disorders and this idea has been backed up by studies involving people with anxiety, mood and substance-use disorders. Researchers in Australia looked at mental-health literacy in 158 women who had bulimia or similar conditions. The participants believed that bulimia would be difficult to treat and that even if initial treatments were successful relapse would be likely. GPs, psychologists, counsellors and close friends were all perceived to be helpful. Lifestyle changes, including taking vitamins and minerals, were also highly regarded. However, the participants were ambivalent about psychiatrists and using medication to treat the condition. Most participants believed that bulimia was common among women in the community and many had occasionally or often thought that it 'might not be too bad' to have bulimia. Low self-esteem was thought to be the most likely cause of bulimia. The study concluded that the participants held some beliefs 'likely to be conducive to lower or inappropriate treatment seeking,' and called for poor mental-health literacy to be addressed in early-intervention programmes.

Mond, Jonathan M. ... [et al] - Mental health literacy and eating disorders: what do women with bulimic eating disorders think and know about bulimia nervosa and its treatment? Journal of Mental Health December 2008 17(6), 565-575

Keeping safe in mental health

The National Patient Safety Agency has produced new guidelines on the physical safety of service users in mental-health settings. You can download copies of the guidelines at

http://www.npsa.nhs.uk/nrls/improvingpatientsafety/patient-safety-tools-and-guidance/7steps/mental-health/

http://www.npsa.nhs.uk/nrls/alerts-and-directives/rapidrr/mental-health-resuscitation/

Sex differences and violence on the wards

Although there is a large body of research into what causes aggression among psychiatric inpatients there is less research into what characteristics of staff can cause, or prevent, violence. Age, skill and experience have been shown to have an impact on aggression but there have been mixed results from studies into the effects of gender. A study of a medium secure unit in the north-west of England examined this issue in two male and two female wards and found that patients were more likely to behave aggressively towards members of the same sex.

Knowles, Susan F., Coyne, Sarah M. and Brown, Stephen L. - Sex differences in aggressive incidents towards staff in secure services The Journal of Forensic Psychiatry and Psychology December 2008, 19(4), 620-631

The ART of reducing aggression

Aggression replacement training (ART) aims to prevent aggression by improving people's social skills, building up their impulse and anger control and developing their moral reasoning. It was originally developed for aggressive youths but is also available in a revised format for adult offenders. A study of 197 offenders by researchers at Leicester and Liverpool universities compared violent offenders who had been allocated to the programme with a control group. Those who had taken part in the training had a 13.3% reduction in reconviction. Those offenders who failed to complete the programme were more likely to reoffend than similar people who had never been on it or who had completed the course.

Hatcher, Ruth M. ... [et al] - Aggression replacement training with adult male offenders within community settings: a reconviction analysis The Journal of Forensic Psychiatry and Psychology December 2008, 19(4), 517-532

Sudden improvements, lasting gains

People going through psychotherapy often demonstrate sudden, dramatic improvements suggesting that they have had some kind of epiphany that has dramatically altered their outlook on life and way of thinking. These sudden changes represent genuine improvement in people's condition and those who show sudden improvements from one session to the next are more likely to show a greater and longer-lasting improvement after the end of therapy. A team of researchers at the University of Virginia in the U.S. looked into sudden improvement in 30 people going through a 12-week course of cognitive behaviour therapy (CBT) for panic disorder. 43% of the clients showed at least one dramatic burst of improvement during the course of therapy. Half of those who had had a dramatic improvement had had it between the first and second sessions, while the other half had experienced it later on. However, only the later improvers had better symptoms at the end of the study compared to people who had shown no dramatic improvement. The later improvers showed a greater improvement in their fear of anxiety-related symptoms at the end of their course of therapy, and at a six-month follow-up.

Clerkin, E., Teachman, B. and Janik, S. Smith - Sudden gains in group cognitive-behavioural therapy for panic disorder Behaviour Research and Therapy 2008

Depression and heart problems

Depression has long been recognised as a risk factor for cardiovascular problems in healthy people and for a worse prognosis in people with existing cardiovascular problems. A study by researchers at the VA Medical Center [sic] in San Francisco followed 1,017 outpatients with stable coronary heart disease for between 4-5 years. It measured their depression symptoms, levels of illness and behaviour over the course of the study. The researchers found that patients with depression had a 10% risk of a subsequent cardiovascular 'event' compared to only a 6.7% risk among those without depression. However, once the researchers adjusted for health behaviours (diet, smoking etc) and physical activity there was no longer a link between depression and subsequent heart problems. The researchers calculated that physical inactivity was associated with a 44% greater rate of cardiovascular 'events.'

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=114913&cn=5

Hearing deficits in autistic children

People with autism or Asperger's syndrome could hear 'slower' than other people, according to researchers in the department of radiology at the Children's Hospital of Philadelphia. The researchers exposed children to beeps, tones in pairs and vowels and sentences at different speeds, tones and frequencies. They used a technique called magnetoencephalography to measure the magnetic fields associated with brain activity and found that this occured a fraction of a second slower in autistic/Asperger's children.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=114991&cn=20

Improving health and work: changing lives

The Government has published its plans to get people off benefits and back into work. These include plans for 'fit notes' which will state what tasks people can do, rather than what they cannot. The Government's proposals are set out in 'Improving health and work, changing lives' which you can download from the link below.

http://www.workingforhealth.gov.uk/documents/improving-health-and-work-changing-lives.pdf

'Count me in' shows lack of progress

The Healthcare Commission's annual census of mental-health inpatients - 'Count Me In' - has painted a gloomy picture of a lack of progress on mixed-sex wards and racial equality. The census found that 68% of inpatients are still being housed on mixed-sex wards; no improvement on last year. Women (78%) were more likely than men (61%) to be treated in a mixed-sex ward. People from Black and minority-ethnic groups were three times more likely to be detained than average, and up to 65% more likely to be secluded. After three years of censuses there has been no sign of movement towards improving racial inequalities in mental-health care.

You can download the full report at

http://www.healthcarecommission.org.uk/_db/_documents/Count_me_in_census_2008_Results_of_the_national_census_of_inpatients_in_mental_health_and_learning_disability_services.pdf

ADHD and self-esteem

Attention Deficit Hyperactivity Disorder (ADHD) is estimated to affect between 3 and 7% of school-aged children. It can affect children's home, school and community life leading to poor peer relations, aggression and learning problems, which, in turn, can lead to academic failure and an increased risk of depression. However, there has been conflicting evidence about the relationship between ADHD symptoms and low self-esteem. A Swedish study of 1,714 children, which followed them between the ages of 8 and 13 measured their ADHD symptoms and self-esteem when they were eight and again when they were thirteen. The children with high levels of ADHD symptoms had lower scores in the aspects of self-esteem relating to "skills and talents" and "psychological well-being."

Edbom, Tobias ... [et al] - ADHD symptoms related to profiles of self-esteem in a longitudinal study of twins Journal of Child and Adolescent Psychiatric Nursing November 2008, 21(4), 228-237

Parental warmth and child psychology

Parents' psychological warmth has been consistently identified as being significantly related to psychological adjustment in children and adolescents. Regardless of culture, ethnicity or geographical location about a quarter of the variation in youths' psychological adjustment is accounted for by parents' perceived warmth. However, little research into this has been done among the U.S.'s Korean community despite the fact that this commmunity has trebled in number in the last twenty years. A study of 103 Korena Americans aged between the ages of 11 and 14 has found that low perceived maternal and paternal warmth did lead to a decline in the children's overall psychological adjustment. Low maternal warmth was particularly related to the children's poor psychological adjustment.

Kim, Eunjung ... [et al] - Psychological adjustment in young Korean American adolescents and parental warmth Journal of Child and Adolescent Psychiatric Nursing November 2008, 21(4), 195-201