Adolescents, drink, and drugs therapy

Alcohol dependence is a common problem in adolescents with both regular and binge-drinking patterns occuring. Adults often have drug treatment, along with psychotherapy, for alcohol problems but little research has been done into drug therapy for adolescents with drink problems. An Indian study of 58 adolescents divided them into two groups. One group received disulfiram while the other group received naltrexone and the study lasted for six months. The adolescents who had a relapse lasted longer (84 days on average) before relapse when taking disulfiram, than when taking naltrexone (average 51 days). Nearly 80% of participants taking disulfiram remained abstinent compared to just over 50% of those taking naltrexone. However, those taking naltrexone had less cravings for alcohol than those taking disulfiram. The researchers concluded that more research needed to be done into the effectiveness of these drugs with larger samples of participants in a variety of settings.

De Sousa, Avinash and De Sousa, Alan - An open randomized trial comparing disulfiram and naltrexone in adolescents with alcohol dependence Journal of Substance Use December 2008, 13(6), 382-388

Learning disability and health

The British learning disability charity Mencap has launched a new initiative aimed at improving physical health care for people with learning disabilities. The project called Getting it Right follows the publication of Mencap's report into inequalities in health care experienced by people with a learning disability 'Death by Indifference'.

You can find out more about Mencap's campaign and download a copy of Death by Indifference by clicking on the link in the title of this post.

MIND launches legal campaign

The mental-health charity MIND has launched a campaign called Time to Challenge which aims to help people with mental-health problems who have experienced discrimination to get their cases through the courts. The charity is looking for cases that concern points of law that, if changed, could potentially set a legal precedent and have positive implications for all mental-health service users.

You can find out more about the Time to Challenge initiative by clicking on the link in the title of this post.

Latest drug guidance

The Medicines and Healthcare products Regulatory Agency has issued its latest bulletin on the safety of drugs. This includes guidance on the use of typical (first-generation) antipsychotics in people with dementia.

You can download a copy of the guidance by clicking on the link in the title of the post.

Depression in Parkinson's disease

Depression affects up to half of people with Parkinson's disease. A study of 52 people with Parkinson's disease and depression compared the effects of nortriptyline (an older, tricyclic antidepressant), paroxetine (a selective serotonin reuptake inhibitor or SSRI) and a placebo. The study found that the participants who took nortriptyline were five times more likely to see an improvement in their depression as those who took paroxetine. SSRIs affect the level of serotonin in the brain, whereas tricyclic antidepressants affect the level of norepinephrine. However, tricyclic antidepressants can lead to an increased risk of overdose and death due to toxic effects on the heart and brain.

You can find out more about this research by clicking on the title of this post.

Nature and brainpower

Being in nature can improve people's memory and attention according to research carried out by psychologists from the University of Michigan. Participants in the research completed a task designed to test their memory and attention; they then went for a walk either in a park or in central Ann Arbor. After their walk the participants returned to the lab and were retested on the task. Those who had taken a walk in the park showed a greatly improved performance but those who had walked in the city showed no improvement. A second group of participants took part in a similar experiment but this time instead of going for a walk they were simply shown photographs of either an urban or a natural environment before retaking the tests. The group who were shown the nature photographs did much better on the second test than the other group. The authors suggested that this could be because urban environments provide a relatively complex and often confusing pattern of stimulation which requires effort to sort out and interpret.

You can find out more about this research by clicking on the link in the title of this post.

Low IQ and mental-health problems

There is increasing evidence that children and adolescents who score lower on intelligence tests may be more vulnerable to mental-health problems later in life. However, much of the evidence is based on individuals whose disorders were severe enough to require admission to hospital. A study of 3,258 men whose intelligence was measured during their military service and whose mental health was assessed when they reached middle age has found that lower cognitive ability was associated with an increased risk of a number of mental-health problems

Mental-health problem	Odds of developing it (1 = average risk, 2= double the risk) for people of lower IQ
Any mental-health problem	1.32
Depression	1.43
Anxiety	1.2
Alcohol abuse or dependence	1.39
Post-traumatic stress disorder (PTSD)	2.5

The association between lower IQ and mental-health problems remained statistically significant even after a number of other factors had been taken into account.

Gale, Catharine R. ... [et al] - Cognitive ability in early adulthood and risk of 5 specific psychiatric disorders in middle age Archives of General Psychiatry December 2008, 65 (12), 1410-1418

Diversity and the Mental Capacity Act

The Mental Health Foundation has just published a report on how the 2007 Mental Capacity Act has affected people from Black and minority ethnic communities. You can download a copy of the report by clicking on the title of this post.

Social anxiety and alcohol problems

Social anxiety disorder is associated with high rates of alcohol problems. People with social anxiety (SA) are nearly three times as likely to develop problems with alcohol and among people seeking treatment for alcohol problems 23-39% meet the diagnostic criteria for social anxiety disorder. A study of 5,877 people by researchers at the University of Michigan found that SA was related to alcohol dependence even after allowing for a number of other factors. People with social anxiety who were also alcoholics had a higher usage of health care, other mental-health problems and greater interpersonal stress than other people with SA. For the majority of people their social anxiety came before their alcohol problems, suggesting that SA increases people's vulnerability to alcohol problems.

Buckner, Julia D. ... [et al] - Implications of comorbid alcohol dependence among individuals with social anxiety disorder Depression and Anxiety December 2008, 25(12), 1028-1037

Antidepressants and activation syndrome

Serotonin selective reuptake inhibitors (SSRIs) are a type of antidepressant and, like any other drug, they can have side effects. One of the most worrying side effects is a cluster of symptoms sometimes referred to as activation syndrome. These symptoms can include: anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (extreme restlessness and fidgitiness) and mania. Apart from being unpleasant in itself activation syndrome has also been linked to an increased risk of suicide. A Japanese study of 729 patients who had been prescribed antidepressants found that 4.3% of them developed activation syndrome. The incidence of activation syndrome was not associated with gender or age but it was linked to a diagnosis of personality disorder which quadrupled the risk.

Harada, Tsuyoto, Sakamoto, Kaoru and Ishigooka, Jun - Incidence and predictors of activation syndrome induced by antidepressants Depression and Anxiety December 2008, 25(12), 1014-1019

Depression, motherhood and body clocks

Major depression during pregnancy or shortly after birth can be a devastating illness for mothers, impair the neurocognitive and socio-emotional development of the child and increase the risk of mental and medical disorders in the offspring later in life. Many people with mood disorders have disturbed body clocks. Oestrogen and progesterone are known to affect people's body clocks and it could be that changes in the levels of these substances in and around pregnancy disrupt people's body clocks and contribute towards depression. A substance called melatonin, which is secreted at night time, plays an important role in governing people's body clocks. Researchers from the University of California, San Diego, measured melatonin levels in pregnant women and new mothers with and without major depression. They found that melatonin levels were significantly lower in pregnant women with major depression but significantly higher in new mothers with major depression.

Parry, Barbara L. ... [et al] - Plasma melatonin circadian rhythym disturbances during pregnancy and postpartum in depressed women and women with personal or family histories of depression American Journal of Psychiatry 165(12), 1551-1558

Sleep disturbance in depression

Sleep disturbance is one of the most common problems facing older adults with nearly 60% of them reporting sleep problems at least a few nights a week. Unfortunately sleep problems are often considered to be a normal part of ageing despite the fact that sleep disturbance is linked to declines in health, increases in mortality and depression. People who have had depression before tend to be more at risk of having it in the future but little research has been done into whether lack of sleep contributes to a recurrence of depression. A U.S. study of 351 older adults compared 145 people with a history of depression to 206 people who had never had any mental illness. 16.9% of the people who had previously had depression developed it again over the course of the 2-year study compared to only one person in the group who had never had mental illness. Within the group who had previously had depression recurrence was predicted by sleep disturbance; a link that was independent of other depressive symptoms, chronic medical disease and antidepressant medication use.

Cho, Hyong Jin ... [et al] - Sleep disturbance and depression recurrence in community-dwelling older adults: a prospective study American Journal of Psychiatry December 2008, 165(12), 1543-1550

Depression, anxiety and cardiovascular risk

A study of 6,576 men and women participating in the Scottish Health Survey looked into the links between emotional distress, lifestyle and cardiovascular problems. At the start of the study the participants completed a 12-question survey designed to measure their general happiness, symptoms of depression or anxiety and any sleep disturbances they might have. The participants were also assessed for risk factors for heart disease and asked about their lifestyles. Their health was monitored over a 7-year period. Researchers from University College London found a significant and direct link between increasing psychological distress and an increasing risk of cardiovascular illness and death. After age and sex were taken into account people with depression and anxiety had a 50% increased risk of heart problems. However, when the researchers took people's lifestyles into account they found that smoking and physical inactivity alone explained nearly two-thirds of the increased cardiovascular risk.

You can find out more about this research at

http://psychcentral.com/news/2008/12/16/depression-and-anxiety-stress-the-heart/3511.html

Blood pressure and cognition

A study into blood pressure and thinking in older adults has found that those people who already had high blood pressure saw a significant decrease in their reasoning ability when their blood pressure rose even higher temporarily. People whose blood pressure was normal most of the time didn't suffer a decline in their cognitive abilities when their blood pressure rose temporarily. The results of the study imply that older people might find it harder to think logically in stressful situations.

You can find out more about this research at

http://psychcentral.com/news/2008/12/16/high-blood-pressure-clouds-thinking/3512.html

CBT for eating disorders

Eating disorders are a major cause of physical and psychosocial impairment in young women, affecting at least one in twenty between the ages of 18 and 30. Anorexia nervosa accounts for around one in ten cases of eating disorders, bulimia about a third with the remainder of cases being made up of atypical disorders which are a combination of different features of anorexia and bulimia. In 2004 a form of cognitive behaviour therapy (CBT) developed by Professor Christopher Fairburn from the University of Oxford became recognised by the National Institute for Clinical Excellence (NICE) as the leading treatment for bulimia and was recommended for use across the NHS. Now, a new study by Professor Fairburn has shown that an enhanced version of the treatment is not only more effective than the older version but can be used to treat atypical eating disorders as well. 154 people were recruited for the study which was based in Oxfordshire and Leicestershire. The researchers found that the majority of patients responded well and rapidly to the new treatment and that the changes were sustained over the following year. Approximately two-thirds of those who completed treatment made a complete and lasting response with many of the remainder showing a substantial improvement. Another trial investigating the enhanced version of the therapy is showing promising results in people with anorexia.

You can find out more about this research by going to

http://psychcentral.com/news/2008/12/16/behavioral-therapy-for-eating-disorders/3510.html

Rose-tinted spectacles might be real

It is something of a cliche that older people tend to see the past through rose-coloured spectacles but researchers at the University of Alberta and Duke University have found that there is some truth behind it. Younger and older participants in the study were shown standardized images that depicted either neutral or strongly-negative events. Thirty minutes later they were asked to recall them and the older participants remembered fewer negative images than the younger ones. At the same time the participants underwent brain scans. Both groups had similar levels of activity in the emotional centres of the brain but the older participants had less links between the centres and the hippocampus (which involves learning and memory) when shown the negative images. However, when they were shown the negative images the older participants had stronger connections with their dorsolateral frontal cortex, a brain region involved in higher thinking processes like controlling emotions. The older people were using thinking processes rather than feeling processes to store these emotional memories. Another study by the same group of researchers found that healthy older people were able to regulate emotion better than younger people so that they were less affected by upsetting events.

You can find out more about this research at

http://psychcentral.com/news/2008/12/17/aging-mellows-negative-memories/3519.html

Genetics of borderline personality disorder

Borderline personality disorder (BPD) is characterized by pervasive instability in moods, interpersonal relationships, self-image and behaviour and can lead to suicidal behaviour, substance abuse and failed relationships. It is more common than schizophrenia or bipolar disorder and is estimated to affect 2% of the population. A Dutch study of 711 pairs of twins and 561 parents looked into the genetic influences on BPD and found evidence for a link with chromosome 9. Another study by the same group of researchers looked at 5,496 twins in the Netherlands, Belgium and Australia and found that 42% of variation in BPD features was due to genetic factors and 58% due to environmental ones. There were no significant differences in the extent to which men and women inherited BPD and young adults displayed more BPD features than older ones.

You can find out more about this research by going to

http://psychcentral.com/news/2008/12/17/genetic-link-to-borderline-personality-disorder/3520.html

Don't panic, go surfing

Cognitive-behavioural therapy is a well-established treatment for panic disorder but dropout rates of 25% are common and those offered treatment only around a half might respond. As part of CBT people are often taught panic-control strategies, such as breathing exercises and relaxation but a more recent approach called 'panic surfing' encourages people to 'ride out' the wave of anxiety in an accepting manner instead of trying to control their symptoms. An Australian study of 18 participants used the 'panic surfing' technique to treat panic disorder. Significant improvements occurred over the course of the treatment and were maintained at a 1-month follow-up.

Lamplugh, Claire ... [et al] - A pilot study of cognitive behaviour therapy for panic disorder augmented by panic surfing Clinical Psychology and Psychotherapy November-December 2008, 15(6), 440-445

CBT for health anxiety

Hypochondriasis is an excessive preoccupation or worry about having a serious illness that persists even after a doctor has examined a patient and told them that they have nothing to worry about. It is thought to affect around 3% of the population and is often characterized by fears that minor bodily symptoms may indicate a serious illness, constant self-examination and self-diagnosis and a preoccupation with ones body. Cognitive-behavioural treatments (CBT) have been shown to be effective in treating hypochondriasis and so has CBT-based, short-term psycho-educational group treatment. A Dutch study of 140 people with health anxiety looked at how different people benefited, or failed to benefit from CBT. The study found that participants with high scores for health anxiety at the start of the study tended to continue to have high scores after treatment and at follow-up tests one and six months later. People with higher "background" levels of anxiety and who were older benefited least from CBT treatment.

Buwalde, Femke M. and Bouman, Theo K. - Predicting the effect of psychoeducational group treatment for hypochondriasis Clinical Psychology and Psychotherapy, December 2008, 15(6), 396-403

New drug for cognition in schizophrenia

Most of the drugs now used to treat schizophrenia were developed more through chance than through a targeted design of any particular brain circuit or neurotransmitter. However, researchers at the University of Pittsburgh have developed a chemical that boosts the flow of a neurotransmitter called GABA, low levels of which have been implicated in some of the cognitive deficits associated with schizophrenia. A small study of 15 men, aged between 18 and 50 divided them into two groups. One group took the chemical (MK-0777) and the other group took a placebo. Over the four weeks of the study the participants took various psychological and EEG tests to measure how well their working memory was performing. Both the psychological tests and the EEGs showed that the people taking MK-0777 had improved working memory function and the drug seemed to have few side effects. However, there will still be a lot of work to do before MK-0777 is licensed for general consumption.

You can find out more about this research by clicking on the link in the title of the post.