Seclusion and restraint in Canada

Patients in psychiatric hospitals are often put on their own - in seclusion - for a while until they calm down and stop being a danger to either themselves or others. However, researchers don't know that much about how often it happens or which people are most likely to be placed in seclusion. Researchers from Montreal University studied 2,721 psychiatric patients. They found that 23.2% of them had been placed in seclusion and that 17.5% of them had been secluded with (physical) restraint. Being young; suffering from schizophrenia or psychosis; suffering from bipolar or personality disorder and having to stay in hospital for a longer time were all associated with seclusion while being young, having bipolar or personality disorder and staying for a longer time in hospital were all associated with having to be physically restrained.

Dumais, A. ... [et al] - Prevalence and correlates of seclusion with or without restraint in a Canadian psychiatric hospital: a 2-year retrospective audit Journal of Psychiatric and Mental Health Nursing doi: 10.1111/j.1365-2850.2010.01679.x

Hospital art - is it really a waste of money?

In times of budget cutbacks hospital art is often the first thing to go, however, a new piece of research suggests that this might be a false economy. Upali Nanda from American Art Resources in Houston led a study based in a lounge for psychiatric patients in a hospital in East Alabama. On different days either a picture of nature or a landscape; a piece of abstract art or no art at all was hung up in the lounge. The researchers then noted how much medication was prescribed on a pro re nata (PRN) (over and above patients' normal prescriptions) basis to deal with patients who had become agitated or anxious. The study found that there was a significant reduction in PRN medication on the days when natural and landscape art was hung in the lounge although some abstract art was found to make patients more agitated. The reduction in PRN medication was found to be around $30,000 per annum - more than enough to buy a few halfway-decent prints for the lounge.

Nanda, U. ... [et al] - Effect of visual art on patient anxiety and agitation in a mental health facility and implications for the business case Journal of Psychiatric and Mental Health Nursing
doi: 10.1111/j.1365-2850.2010.01682.x

Mindfulness and stress. Who does it help?

Mindfulness - being aware in the present moment in an open and non-judgemental fashion - is used to help with a number of different psychological problems. Mindfulness-based stress reduction (MBSR) has been shown to be helpful to people but there has been little research into whether it is more effective in certain people or not. Researchers from Santa Clara University in California studied 30 people. 15 of them formed a control group while 15 of them received MBSR. MBSR was found to increase mindfulness, wellbeing and empathy in assessments carried out two and 12 months later. However, those participants who already had the highest levels of mindfulness before the MBSR treatment started showed the greatest levels of improvement.

Shapiro, Shauna L. - The Moderation of Mindfulness-Based Stress Reduction Effects by Trait Mindfulness: Results From a Randomized Controlled Trial Journal of Clinical Psychology doi: 10.1002/jclp.20761

Executive dysfunction, problem-solving and depression

People with executive dysfunction have problems setting goals, planning, initiating and sequencing behaviour. Executive dysfunction is often a symptom of depression and a team of researchers from Weill Cornell Medical College in New York studied the effectiveness of two different kinds of therapy in combating it in a study of 221 older adults with depression. Problem-solving therapy (PST) helps patients identify the most important problems in their lives, select solutions and make concrete plans for dealing with them while supportive therapy (ST) is more like counselling being based on 'active listening' and offering support in a non-judgemental environment. The participants were divided into two groups, each having either PST or ST, and received 12 weekly sessions of therapy. After six weeks both groups had shown comparable levels of improvement, however, the group receiving PST showed greater improvements after nine and 12 weeks and this difference was still there 24 weeks after the end of treatment. PST was particularly helpful for people who had cognitive problems and who had had more previous episodes of depression.

Alexopoulos, George S. ... [et al] - Problem-Solving Therapy and Supportive Therapy in Older Adults With Major Depression and Executive Dysfunction: effect on disability Archives of General Psychiatry January 2011, 68(1): 33-41

Bupropion and tobacco cravings

Bupropion hydrochloride was originally marketed as an antidepressant but it has also been found to be effective in helping people to give up smoking. It reduces people's cravings for cigarettes but noone knows quite how it works. A team of researchers from the University of California Los Angeles studied 30 people all of whom were hooked on cigarettes. Over an eight-week study half of them were given bupropion and half were given a placebo. The participants who had been given bupropion reported fewer cravings and less activation in the left ventral striatum, the right medial orbitofrontal cortex and the bilateral anterior cingulate cortex than those who were taking a placebo. All the participants showed reduced brain activity in the bilateral medial orbitofrontal cortex and the left anterior cingulate cortex when they were trying to resist tobacco cravings suggesting that bupropion works by dampening down these areas of the brain.

Culbertson, Christopher S. ... [et al] - Effect of Bupropion Treatment on Brain Activation Induced by Cigarette-Related Cues in Smokers Archives of General Psychiatry doi:10.1001/archgenpsychiatry.2010.193

Obesity and depression

Past research has shown that being obese can increase people's risk of depression by between 50 and 150%. However, a new study by researchers from the Group Health Research Institute in Seattle suggests that the relationship can work both ways and that treating fat people's depression can also help them lose weight. The study of 203 women, aged between 40 and 65 divided them into two groups. Both groups focused on weight loss but one group also included a treatment for depression. After six months 38% of the women whose depression symptoms had improved had lost at least 5% of their body weight compared to only 21% of those who showed little improvement. Unfortunately there was little further change in either the women's weight or their depression when they were assessed after 12, 18 and 24 months.

Naltrexone and alcoholism

Naltrexone is used in the treatment of alcoholism. It blocks the pleasurable feelings people get from drinking alcohol and reduces the motivation to drink. Michael Soyka and Suanne Roesner from the University of Munich reviewed 50 studies into the effectiveness of naltrexone covering a total of nearly 7,800 participants. They found that, compared to a placebo, people taking naltrexone were 17% less likely to return to heavy drinking. The trials tested naltrexone used in conjunction with counselling or a 12-step programme, like Alcoholics Anonymous, and the authors of the study warned that although it might help some people, it was not a miracle cure.

Eating disorders and mindfulness

Mindfulness - being aware of the present moment in an open and non-judgmental fashion - has become something incorporated into the treatment of more and more mental-health problems. People with eating disorders often have trouble regulating their emotional, cognitive and physical experiences and an inability to recognise when they feel hungry or full. Natasha Hepworth, who works in a private clinic in Melbourne, Australia, studied the effectiveness of a Mindful Eating Group in a study of 33 patients being treated there. The group was designed to increase the participants' awareness of hunger and satiety cues. After taking part in the group for 10 weeks the participants showed significant improvements in their scores on the Eating Attitudes Test-26 (EAT-26) assessment tool.

Hepworth, Natasha S. - A Mindful Eating Group as an Adjunct to Individual Treatment for Eating Disorders: a Pilot Study Eating Disorders, 19:6–16, 2011

Seniors, side effects and chemical cocktails

Older people who start taking antidepressants may already be taking other drugs for different problems. These drugs can interact with the antidepressants to create a number of side effects which can put people off taking antidepressants. Researchers from Thomson Reuters, the University of Southern California and Sanofi-Aventis studied 39,000 older people who started taking antidepressants between 2001 and 2006. More than 25% were prescribed antidepressants and another drug that could cause a major interaction and another 36% were at risk of less-severe drug interactions. The most common side effects caused by drug interactions were insomnia, somnolence and drowsiness which occurred in 2.6% of people with the next most common being dizziness (1.1%). Only 45% of people who had documented side effects refilled their prescription for the same antidepressant and a quarter stopped taking antidepressants altogether.

Schizophrenia and caeliac disease

People with schizophrenia are more likely to suffer from caeliac disease than the rest of the population. Scientists don't know why but a team of researchers from John Hopkins University in Baltimore looked into the prevalence of antibodies associated with gliadin, transglutinamase and endomysium - which are associated with caeliac disease - in a study of 2,301 people 1,401 of whom had schizophrenia. The researchers found that 23.1% of the schizophrenia patients had moderate-high levels of gliadin antibodies compard to 3.1% of the unaffected people. 5.4% of the schizophrenia patients had high levels of transglutaminase antibodies compared to 0.8% of the unaffected people.

Cascella, Nicola G. ... [et al] - Prevalence of Celiac Disease and Gluten Sensitivity in the United States Clinical Antipsychotic Trials of Intervention Effectiveness Study Population Schizophrenia Bulletin 37 (1), 94–100, 2011

Insight and psychosis

In a mental-health context insight can be defined as being aware that you have a mental-health problem; being aware that you need treatment and being aware that your symptoms are due to an illness. A team of Spanish researchers studied insight in a study of 110 patients with psychosis. They found that after two years of illness insight was poorer in people suffering from schizophrenia than in people suffering from other types of psychosis. The more severe people's psychosis the less insight they had. Being depressed when one develops psychosis; having poorer decision-making skills and a lower IQ, and going for a longer time without getting help were all associated with poorer insight as were reductions in frontal and parietal grey matter.

Parellada, Mara ... [et al] - Trait and state attributes of insight in first episodes of early-onset schizophrenia and other psychoses: a two-year longitudinal study Schizophrenia Bulletin 37 (1), 38–51, 2011

Spending cuts lead to revolving door for eating disorder patients

Spending cuts meant that many people with eating disorders are not admitted to an inpatient treatment programme until their weight has fallen to dangerously low levels. However, there has been little research into whether waiting this long to admit patients can affect their chances of recovering in the long run. Researchers from St George's Hospital in South London studied 82 people with anorexia being admitted to an eating-disorder ward. They found that people's weight when they were admitted to hospital didn't affect how much weight they put on during treatment. However, people who weighed less when they were admitted were kept in hospital no longer than those who were heavier meaning that, although they put on weight at the same rate, they were still lighter when they were discharged and were more at risk of having to go back to hospital within a year.

Sly, Richard and Bamford, Bryony - Why Are We Waiting? The Relationship Between Low Admission Weight and End of Treatment Weight Outcomes European Eating Disorders Review doi: 10.1002/erv.1061

Job losses and mental health - could they be less damaging than feared?

The economic downturn affecting large parts of the Western world has brought lots of job losses with it but new research from the New York University School of Medicine suggests that they may not have the effects on people's mental health that are sometimes feared. The researchers used data from 774 people in Germany who had been made redundant. The participants were taking part in the German Socioeconomic Panel Data study which collected information between 1984 and 2003. This allowed the researchers to collect data about the participants' happiness in the three years before they were made redundant and for four years afterwards. 69% had high and stable levels of life satisfaction before they lost their jobs. This group were more likely to be harder hit by being laid off but a year later their average life satisfaction had returned to pre-job-loss levels, even though this group was no more likely to get another job by the end of the study. 15% of the participants had actually been getting happier before being made redundant and this group showed only a levelling off of their happiness after losing their jobs. 13% were unhappy before losing work and their levels of happiness also stayed the same after getting laid off. 4% of people were becoming unhappier even before they lost their jobs. These people became even unhappier after they became unemployed but their happiness started rising again - albeit not to their original levels - by the third year of the study; this group was the least likely to be re-employed. Germany's economy is doing much better than many other European countries, however, and it has a reasonably generous welfare system so it would be interesting to see whether this research held true for other countries.

Are we right to go for happiness?

Most politicians and economists work on the assumption that economic growth is in itself a good thing. However, research by Richard Easterlin from the University of Southern California suggests that, whatever its other benefits, it does not bring happiness. Easterlin's study tracked the levels of happiness and economic growth in 37 countries over an average of 22 years. Even in countries such as Chile, China and South Korea were per capita income has doubled in less than 20 years levels of happiness were static, or in some cases slightly declining. Although richer countries, and within countries richer people, had higher levels of happiness there was absolutely no connection between economic growth and happiness over time.

Alzheimer's decay could start earlier than thought

Alzheimer's disease is thought to be caused by the build up of tangles, or plaques, of a protein called beta amyloid in the brain. However, researchers from Washington University School of Medicine in St Louis have found that in people who have a genetic variation linked to an increased risk of Alzheimer's disease the brain can start going downill even in the absence of amyloid plaques. The researchers studied 100 people with an average age of 62. None of them had amyloid plaques or any sign of the protein in their spinal fluid but half of them had a variation in the gene APOE4 which is linked to an increased risk of Alzheimer's. The participants with the genetic variation showed different functioning in a region of the brain - centred on a structure called the precuneus - called the default mode network. This region is thought to be connected to what the brain does when it is not thinking about anything in particular - wool-gathering or day-dreaming - but is also connected to lots of other regions so a deterioration here could have widespread effects on other thought processes.

Cyber-bullying rife but short-lived

Researchers from the University of Valencia have been looking into the incidence of bullying via mobile phones and the internet. They surveyed 2,101 teenagers between the ages of 11 and 17. 24.6% of them had been bullied via their mobile and 29% via the internet. In most cases the bullying lasted for less than a month but in 4% of cases it lasted between three and six month, and in 3% more than a year. Younger children were more likely to experience bullying via this method than older ones and girls likelier than boys. The bullying often took the form of invasions of privacy, spreading of rumours, and social exclusion.

Mothers' depression and babies' health

Up to one in five women experiences depression during pregnancy and postnatal depression is also a common problem. Researchers from the University of Michigan studied 154 pregnant women, over the age of 20, who were tested for depression at 28, 32 and 37 weeks into their pregnancy and again when they gave birth. The researchers took blood samples from the babies' umbilical cords to measure the levels of stress hormones and assessed the babies' motor skills and responses to stimuli and stress when they were two weeks old. The study found that the babies born to women who were depressed had higher levels of stress hormones, decreased muscle tone and other neurological and behavioural differences.

Uncovering the roots of unconscious memory

In In Search of Lost Time Proust describes a whole host of memories suddenly brought back to him when he dips a madeliene biscuit into a cup of lime tea. Psychologists call this process unconscious memory and researchers from the University of California Davis believe that they have found the region of the brain responsible for it. The researchers compared people with amnesia who had damage to an area of the brain called the perirhinal cortex to a group of healthy people. They gave the subjects a long list of words and asked them to think of any pleasant associations they brought to mind; later they were asked to think up words in different categories such as 'furniture.' The participants had MRI scans as they took the tests and in the healthy participants, who performed better in the tests, the perirhinal cortex showed increased activity. The study ties in with other research which shows that Alzheimer's disease often attacks the perirhinal cortex before other brain areas.

'Conduct disorder' and juvenile delinquency

12 and 13-year-olds with 'conduct disorder' are much more likely to engage in violent and delinquent behaviour as teenagers. Researchers from the Universite de Montreal studied 4,125 children, following them over a number of years. They found that the 12- and 13-year-olds with conduct disorder who displayed violent behaviour were six times as likely to sell illicit drugs, nine times as likely to join a gang and 11 times as likely to carry a weapon; they were also eight times as likely to be arrested. Children with conduct disorder who weren't violent were also more likely to behave badly being three times as likely to sell illicit drugs, four times as likely to join a gang and three times as likely to mug someone using a weapon.

'Good' cholesterol and Alzheimer's disease

Researchers from Columbia University in New York have been looking into the links between 'good' cholesterol - high-density lipoprotein (HDL) - and Alzheimer's disease. They studied 1,130 adults in northern Manhattan none of whom had dementia or cognitive impairment at the start of the study. As the participants were followed over time there were 101 new cases of Alzheimer's disease. Having higher levels of HDL cholesterol was associated with a decreased risk of developing Alzheimer's even after adjusting for vascular (blood vessel) risk factors and cholesterol-lowering treatments. Being Hispanic and having diabetes at the start of the study both increased the risk of developing Alzheimer's.