Getting to grips with the neuroscience of Alzheimer's

Researchers from Rush University Medical Center in Chicago have been using MRI scans to investigate what happens in people's brains when they develop Alzheimer's disease. They followed 52 people with mild cognitive impairment, often seen as a forerunner of dementia, over five to six years; 23 of them went on to develop full-blown Alzheimer's. The researchers concentrated on a region deep within the brain called the substantia innominata. They found that although this region was unaffected the parts of the cerebral cortex (which is responsible for reasoning and memory) that received signals from it were significantly thinner in those people who went on to develop Alzheimer's.

Children's memories and trauma

Psychologists have researched how people's memories of a traumatic event can effect how likely they are to develop post-traumatic stress disorder (PTSD) as a result of it. They've found that among adults with PTSD and acute stress disorder (ASD) trauma memories are fragmented and disorganised; are expressed more through the senses than words, and show increased emotional content. However, there has been much less research into how this process works in children. Researchers from the Institute of Psychiatry, King's College London studied 50 children being treated in hospital after an assault or a road-traffic accident. Some of the children developed ASD while others didn't and the children were asked to write the story (or narrative), both of the traumatic event itself and of another event which was unpleasant, but not traumatic. The children with ASD had significantly higher levels of disorganization in their trauma narrative compared to children without ASD and with their own non-trauma narrative. For all the children trauma narratives had significantly higher sensory content and lower positive emotion content than the comparison story. The severity of the children's ASD symptoms was significantly predicted by the level of disorganisation in the trauma narrative and the child's negative appraisals (e.g. 'this event has ruined my life,' 'I'm going mad to feel like this.') of the event.

Salmond, C. H. ... [et al] - The nature of trauma memories in acute stress disorder in children and adolescents Journal of Child Psychology and Psychiatry doi: 10.1111/j.1469-7610.2010.02340.x

Mothers' mental health and children's feeding problems

Mothers' eating disorders, depression and anxiety are all known to cause feeding difficulties in their children, however, there have been few studies investigating how eating disorders interact with mothers' other mental-health problems to create feeding difficulties in children. A team of researchers from the Institute of Psychiatry, King's College London studied 10,902 women taking part in the long-term Avon Longitudinal Study of Parenting and Children. They found that mothers having an eating disorder had a direct effect on children's feeding problems and also had an indirect effect by making women more depressed and anxious. Having a child with feeding difficulties also increased the mothers' distress over time.

Micali, Nadia ... [et al] - Maternal eating disorders and infant feeding difficulties: maternal and child mediators in a longitudinal general population study Journal of Child Psychology and Psychiatry DOI: 10.1111/j.1469-7610.2010.02341.x

Homeless youngsters' drug problems

Compared to other young people homeless youngsters are more likely to start taking drugs at a younger age and to take them more often. However, little research has been done into the specific factors that lead homeless youngsters into drug taking. A team of researchers from the University of California, Los Angeles looked into this issue in a sample of 156 homeless youngsters, aged between 15 and 25. They found that the youngsters who perceived their health as being worse and who had poorer coping strategies were more likely to have bigger drug problems.

Nyamathi, Adeline ... [et al] - Correlates of Substance Use Severity Among Homeless Youth Journal of Child and Adolescent Psychiatric Nursing, 23(4), 214–222

Schizophrenia, metabolic syndrome and quality of life

Metabolic syndrome is a collection of factors that can add to people's risk of developing heart disease and other health problems and includes having a pot belly, high cholesterol, being overweight, having high blood pressure and having difficulty controlling one's blood sugar. People with schizophrenia are prone to developing metabolic syndrome, partly because the drugs they take make them put on weight. A team of Spanish researchers looked at the effects of metabolic syndrome on quality of life in a study of 136 people with schizophrenia, of whom 49 had metabolic syndrome. They found that the older people were, the longer they had been ill and the longer they had taken antipsychotics the more likely they were to have metabolic syndrome. Metabolic syndrome was also associated with a lower quality of life and mobility problems. Quality of life was negatively affected most strongly by age but also by metabolic syndrome and mobility problems.

Tomás Sánchez-Araña Moreno ... [et al] - Quality of life in a sample of schizophrenic patients with and without metabolic syndrome Journal of Psychiatric Intensive Care (2010), 6(2): 101-108

Reducing seclusion on mental-health wards

People with severe mental-health problems are sometimes locked in a room on their own for the protection of themselves and other people. This practice is known as seclusion and is very controversial with critics seeing it as degrading and traumatising. There is also the risk that patients might get hurt as they struggle to avoid being placed in the rooms and may come to harm as they are left in isolation; and there are also worries that seclusion can damage people's mental health. In the U.S. a treatment known as sensory modulation is used to reduce the incidence of people being placed in seclusion; this can include weighted blankets, multisensory treatment rooms - which might contain paintings, music and reading material - portable music players and optical lamps. At the same time clinicians often try to assess which things might trigger people to become severely agitated and what the patients themselves feel would be the best things to calm them down. A team of researchers from the Alfred Hospital and Monash University - both in Melbourne - studied the use of sensory modulation and an assessment scheme called Safety Tool in a 30-bed psychiatric intensive-care unit. Before the use of these techniques 65% of the patients had previously been secluded but after their introduction only 26% were. 76% of the staff on the unit thought that Safety Tool should be part of standard care.

Lee, Stuart J. ... [et al] - Sensory assessment and therapy to help reduce seclusion use with service users needing psychiatric intensive care Journal of Psychiatric Intensive Care 6(2) 83-90

Major review backs family interventions for schizophrenia

People with schizophrenia are more likely to suffer a relapse if they come from families where they experience high levels of criticism and hostility and where family members blame themselves for the sufferer's illness. There are a number of ways in which psychologists and health professionals try to reduce these emotions but their effectiveness has not been proven. A team of researchers led by Fiona Pharaoh from Oxford and Buckinghamshire Mental Health NHS Foundation Trust reviewed 53 trials of these techniques involving a total of 4,708 patients. They found that family interventions led to a reduction in relapses, significantly reduced hospital admissions, improved patients' social functioning and encouraged them to take their medication.

Motivation, depression and psychotherapy

Over the last 20 years researchers have begun to recognise that other factors - apart from the kind of treatment used and the nature of people's mental-health problems - affect whether psychotherapy gets people better or not. Two of the most important factors are the therapeutic alliance - the relationship between a psychotherapist and their client - and autonomous motivation which is defined as the extent to which people feel they have gone into treatment of their own free will and without external pressure. A team of researchers from the University of Toronto and McGill University in Montreal studied 74 people being treated for depression who each received 16 sessions of interpersonal therapy. Their study found that overall both the therapeutic alliance and autonomous motivation predicted remission from depression. However, for those patients whose depression was highly-recurrent autonomous motivation had no effect at all in whether they got better.

McBride, Carolina ... [et al] - Autonomous and controlled motivation and interpersonal therapy for depression: Moderating role of recurrent depression British Journal of Clinical Psychology Volume 49, Number 4, November 2010, 529-545

Internet therapy - how many people drop out?

The internet is used more and more to deliver treatment for mental-health problems and research has shown that internet-based treatment is effective for a number of different psychological conditions. However, there are worries about the number of people who drop out of internet-based treatment and researchers from Griffith University in Brisbane and Queensland University of Technology reviewed 19 studies into this issue carried out between 1990 and April 2009. The studies had dropout rates between two and 83% with the average rate being 31%. The researchers also found that there was little evidence to suggest which factors made it more likely that people would drop out of internet therapy.

Melville, Katherine M.; Casey, Leanne M.; Kavanagh, David J. - Dropout from Internet-based treatment for psychological disorders British Journal of Clinical Psychology 49 (4), November 2010, 455-471

Do worry guts children walk less?

Pedometers, which count the number of steps people take, are used both as a research method to monitor people's physical activity and a way of motivating people to take more exercise. In the course of their studies researchers have noted a phenomenon called reactivity in which people's activity increases in response to the fact that they are conscious of being monitored. This can be useful if the object of the exercise is to get people to become more active but not so good if the purpose is to measure people's activity as it distorts the results. Getting children to become more active is very important to prevent childhood obesity and researchers from Hong Kong University studied 156 children aged between nine and 12 to look at whether rehearsal - a tendency to constantly chew over upsetting experiences - is linked to increased pedometer reactivity. The researchers' theory was that the upsetting effect of being monitored would lead to a greater increase in activity in the children who were prone to more rehearsal as they would spend more time thinking about the implications of being monitored. In week one of the study this was, indeed, the case but by week three the children who 'rehearsed' more were showing a decrease in activity levels from week one and were taking far less exercise than average for children of their age group. The study showed both that the effects of reactivity were short-lived and that children who are sedentary may be more prone to dwell on things.

Ling, F. C., Masters, R. S. and McManus, A. M. , Rehearsal and pedometer reactivity in children. Journal of Clinical Psychology, n/a. doi: 10.1002/jclp.20745

Autism, IQs and emotion recognition

Problems in recognising emotions have been seen as one of the main symptoms of autism but previous laboratory studies have produced mixed results and have had a number of flaws including a small sample size, participants with a narrow range of IQs and an over concentration on visual tests which ignores the ways in which people perceive emotions. A team of researchers led by Catherine R.G. Jones from the Institute of Education in London studied 156 teenagers comparing their ability to recognise emotions both in faces and in voices. They found 'no evidence of a fundamental emotion recognition deficit' in the teenagers with autism and both groups tended to make the same mistakes. The only emotion the teenagers with autism were worse at detecting was surprise. The most important factor in how well the youngsters did was IQ, with the teenagers with a higher IQ doing better on the tests.

Jones, C. R., Pickles, A., Falcaro, M., Marsden, A. J., Happé, F., Scott, S. K., Sauter, D., Tregay, J., Phillips, R. J., Baird, G., Simonoff, E. and Charman, T. A multimodal approach to emotion recognition ability in autism spectrum disorders. Journal of Child Psychology and Psychiatry doi: 10.1111/j.1469-7610.2010.02328.x

Adoption, institutions and executive function

Previous research has shown that children who have spent at least some part of their life in an institution tend to have problems with executive function - which is defined as a combination of working memory, the ability to inhibit one's behaviour, forward planning and the ability to move from one task to another - and attention. Past research has concentrated on children aged between six and 11 so researchers at the University of Pittsburgh studied 418 children who had been adopted from institutions in Russia where they had been psychologically, but not physically, deprived. 130 of the children were pre-school age while the rest were older. The study found that the older the age the children had been adopted at the worse their executive function was and that those who were adopted after they were 18 months old had worse executive function than those who had been adopted when they were younger. The onset of adolescence was associated with a greater increase in executive function deficits for children adopted after 18 months than for those adopted when they were younger.

Merz, E. C. and McCall, R. B. Parent ratings of executive functioning in children adopted from psychosocially depriving institutions Journal of Child Psychology and Psychiatry doi: 10.1111/j.1469-7610.2010.02335.x

Problem-solving and binge eating

Previous studies have shown that people with eating disorders often have poor interpersonal problem-solving skills and a lot of therapy for these problems aims to improve these skills. However, there has been little research into problem-solving skills in people with binge-eating disorder. Researchers from the University of Freiburg in Germany compared 25 women with binge-eating disorder to 30 women who were overweight but who did not have a problem with binge-eating. The women were tested using a series of scenarios which were designed to measure their problem-solving abilities. These started with a problem and ended up with a solution but the women had to come up with the intervening steps themselves. The scenarios were: an argument with a partner; making friends in a new neighbourhood; being avoided by friends or difficulties with one's boss. The women with binge-eating disorder produced less effective and less specific solutions than the group without them and the worse their solutions were the more likely they were to binge.

Svaldi, J., Dorn, C. and Trentowska, M. - Effectiveness for interpersonal problem-solving is reduced in women with binge eating disorder European Eating Disorders Review doi: 10.1002/erv.1050








Publication History

Article first published online: 19 OCT 2010

Social cognition and schizophrenia

People with schizophrenia often have problems with their cognition, including what psychologists call social cognition - perceiving people's emotions, recognising social cues and working out what other people are thinking. A team of researchers led by Shaun M. Eack from the University of Pittsburgh studied 133 people in an attempt to find out more about this. 70 of the participants were relatives of people with schizophrenia and were therefore thought to be at greater risk of developing the condition themselves while the rest of them were unaffected controls. The 'at-risk' participants were significantly more likely to assign emotions to neutral faces and to assign the faces negative emotions. They also found it harder to ascertain emotions on faces that were expressing different moods. There was no link between other cognition problems and social cognition. The more people attributed meanings to neutral faces the greater their symptoms of developing schizophrenia were

Eack, Shaun M. ... [et al] - Social cognition deficits among individuals at familial high risk for schizophrenia 36 (6), 1081–1088, 2010
Schizophrenia Bulletin

Child abuse and psychosis

There is a growing recognition that having a difficult or traumatic childhood can increase the likelihood of people developing psychosis later in life but it is difficult to disentangle what types of trauma or abuse are linked to an increased risk. A team of researchers from the Institute of Psychiatry, King's College London looked into this further in a study of 428 people, 182 of whom had psychosis. The researchers asked people about difficulties and problems in their childhood and found that people with psychosis were three times more likely to report severe physical abuse by their mother before they were 12. There was also some - although not statistically significant - evidence that 'severe maternal antipathy' was linked to an increased risk of psychosis. However, paternal maltreatment and other forms of adversity were not linked to an increased risk of psychosis.

Fisher, H.L. ... [et al] - The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder Psychological Medicine (2010), 40, 1967–1978

Major review gives thumbs up to self-help

In guided self-help patients take home a standardized psychological treatment and work through it more or less independently. The treatment can be written down in a book or be available via a web site, television, video or audio and some support is given by a professional therapist or coach. P. Cuijpers from the VU University in Amsterdam reviewed 21 studies, including 810 participants, comparing face-to-face therapy with guided self-help. They concluded that guided self-help was just as effective as face-to-face therapy, that its effects lasted for a year and that people were just as likely to carry on with their treatment.

Cuijpers, P. ... [et al] - Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies Psychological Medicine (2010), 40, 1943–1957

Boosting self-esteem in patients with eating disorders

People with eating disorders can often have low self-esteem, difficulties in relating to others and feelings of dissatisfaction about their relationships. A team of researchers from Barcelona looked into the effectiveness of a group-therapy programme, aimed at boosting self-esteem and social skills, in a study of 160 patients attending a day-hospital treatment programme. At the start of the study the patients with bulimia had lower self-esteem and less confidence in their social skills. After eight sessions of therapy both those with bulimia and those with anorexia showed significant improvements in their perceptions of their physical appearance, their self-esteem, their happiness and their sociability with the patients with bulimia showing a greater improvement.

Lazaro, L. ... [et al] - Effectiveness of Self-esteem and Social Skills Group Therapy in Adolescent Eating
Disorder Patients Attending a Day Hospital Treatment Programme European Eating Disorders Review DOI: 10.1002/erv.1054

Parents' death and adolescent suicide risk

Most young people who lose a parent actually adjust remarkably well but a minority go on to develop mental-health problems which are, in turn, known to be a risk factor for suicide, something attempted by 5-8% of adolescents in Western societies. A Danish study - by researchers from the University of Southern Denmark and Odense University Hospital - looked into the links between parental death and suicide in a sample of 72,765 teenagers. They found that young people who had lost one biological parent had a 71% greater risk of going on to kill themselves than those whose parents were still alive while young people who lost more than one parent had a risk that was 2.7 times greater.

Jakobsen, Ida Skytte and Christiansen, Erik - Young people’s risk of suicide attempts in relation to parental death: A population-based register study Journal of Child Psychology and Psychiatry  (2010)doi:10.1111/j.1469-7610.2010.02298.x

9/11 and mental health

Hardly surprisingly the attacks of September 11, 2001 had a huge psychological impact on those who were caught up in them but most studies so far have focused on the prevalence of post-traumatic stress disorder (PTSD) and depression rather than other types of mental-health problem. Researchers from the University of Manitoba in Canada used data from the National Epidemiologic Survey on Alcohol and Related Conditions involving 34,683 people. The participants in the study were asked about their mental health and classified into four groups: no experience of 9/11; indirectly experienced 9/11 (i.e. watched it happen on television); close friend of family member injured or died in 9/11 and directly experienced and/or injured in 9/11. The study found that the more people had been exposed to 9/11 the more likely they were to develop mental-health problems including anxiety as well as PTSD and depression. People who had directly experienced 9/11 had six times the risk of developing PTSD, two-and-a-half times the risk of having an anxiety disorder and nearly double the risk of having any mental-health problem.

Christine A. Henriksen, James M. Bolton and Jitender Sareen - The psychological impact of terrorist attacks: examining a dose-response relationship between exposure to 9/11 and axis I mental disorders Depression and Anxiety 27: 993-1000 (2010)

Non-adherence and crisis in Newcastle

In the U.K. people with mental-health problems who are very ill are referred by community mental-health services to crisis-resolution home treatment (CRHT) services which decide whether to treat them themselves or to refer them on to hospital. Both these things are very expensive so anything which cuts down on their use could potentially save a lot of money. Researchers from Northumberland Tyne and Wear NHS Trust and Newcastle University looked into the impact of non-adherence (people not taking their drugs properly) on referral to CRHTs. They found that 30% of people referred to CRHTs had not been taking their medication properly in the month beforehand. These people were three times as likely to have a drug problem as well as a mental-health one and were two-and-a-half times as likely to be admitted to a psychiatric hospital.

Sreenath, San ... [et al] - Medication adherence in crisis? Journal of Mental Health, October 2010; 19(5): 470–474