Twins, watches and depression in Belgium

The personality trait of neuroticism is related to the tendency to develop negative thoughts in the face of stress. Efforts to research this link have been hampered by the fact that it is difficult to apply information gathered in lab-based questionnaires to 'real' life. A study of 279 pairs of twins in Belgium gave them wristwatches which beeped at random intervals throughout the day. When the watches beeped the twins filled out forms about their current thoughts, what they were doing, how they felt about the situation and their current mood. All the twins were female as it is thought that men and women react differently to stress. Those people with a twin who had suffered from depression at some point in their lives showed a stronger propensity for negative moods at times of stress. The link was stronger in identical than non-identical twins suggesting there may be a genetic component to this.

Wichers, Marieke ... [et al] - Genetic risk of depression and stress-induced negative affect in daily life British Journal of Psychiatry 191: 218-223

Ageing, white matter and depression

Changes to the white matter in the brain are strongly associated with depression in older people but it is unclear whether changes to the brain cause depression, or depression causes changes to the brain or if a third, unknown, factor causes both the depression and the white matter changes. A pan-European study of 639 older adults gave them brain scans and tested them for cognitive function, quality of life, disability and depression. When the tests were repeated after a year severity of white matter changes was shown to 'independently and significantly' predict depressive symptoms.

Teodorczuk, A. ... [et al] - White matter changes and late-life depressive symptoms British Journal of Psychiatry 191: 212-217

Antidepressants in pregnancy

Mood disorders affect twice as many women as men and often emerge during women's childbearing years. Depression is not uncommon during pregnancy and symptoms may occur more frequently during pregnancy than in the postnatal period. Antenatal depression has been associated with low maternal weight gain and increased use of alcohol, cigarettes and drugs. However, a number of studies have shown that using antidepressants during pregnancy can lead to premature births. A study of 90 women in California has found that women taking antidepressants were more likely to have babies at a lower gestational age, had higher rates of pre-term birth and were more likely to have their babies admitted to a special care unit than women who were depressed but not taking medication.

Suri, Rita ... [et al] - Effects of antenatal depressant treatment on gestational age at birth and risk of preterm birth American Journal of Psychiatry 2007 164: 1206-1213

Depression and attrition

In order for the treatment of depression to be most effective people need to keep taking their medication and stay in contact with therapists and clinicians. Unfortunately many people drop out of their treatment ; something researchers call attrition. An American study looked at 4,041 people being treated for depression with a drug called Citalopram. They found there was an overall dropout rate of 26%. Of those people who dropped out of treatment 34% dropped out immediately, 59% dropped out by week 12 and 7% dropped out after 12 weeks. Immediate attrition was linked to younger age, less education and being less severely depressed. Dropping out of treatment later was associated with younger age, less education and being Black. Those people who had experienced more than one episode of depression were less likely to drop out of treatment.

Warden, Diane ... [et al] - Predictors of attrition during inital (Citalopram) treatment for depression : a STAR*D report American Journal of Psychiatry 2007, 164: 1189-1197

Depression, distraction and inhibition

Aaron Beck, the famous psychotherapist and one of the founding fathers of cognitive behaviour therapy, thought that people with depression had automatic negative thoughts about situations, created by pessimistic assumptions and underlying negative thought processes. Research has confirmed these theories but there has been less study of inhibition in depression. It's impossible to pay attention to everything going on in the world around us as this would be overwhelming so inhibition helps us to choose which stimuli to pay attention to and which to ignore ; it's what helps us to listen to a particular conversation in a crowded room. Researchers in Canada thought that people with depression would find it harder to screen out negative stimuli. They studied 111 people, with and without depression, attempting to distract them from completing a task using positive, neutral and negative words. Overall depressed people were more easily distracted and they were particularly distracted by negative words. The more prone people were to negative thoughts and rumination (literally chewing negative thoughts over and over) the more easily distracted they were by negative stimuli.

Lau, Mark A. ... [et al] - Inhibitory deficits for negative information in persons with major depressive disorder Psychological Medicine 2007, 37, 1249-1259

Brain training and depression

In addition to all its other effects depression can cause impairment in people's cognitive functioning, particularly in the areas of decision-making and memory. Cognitive remediation which aims to improve cognitive functioning by using targeted, repetitive exercises has been shown to help schizophrenia patients with similar cognitive problems and a study of 46 people in Canada found that using a computerized cognition retraining package for 10 weeks helped people with depression to improve their attention, verbal learning and memory, co-ordination and decision-making although it did not improve their depression which still needed to be tackled with the appropriate therapy and drugs.

Elgamal, Safa ... [et al] - Successful computer-assisted cognitive remediation therapy in patients with unipolar depression : a proof of principle study Psychological Medicine 2007, 37, 1229-1238

Torture and mental health

A review of the literature has found that people who have survived torture are a frequent but undetected group among people using mental health services and in the general population. People who have been tortured often suffer from post-traumatic stress disorder (PTSD), chronic pain and depression ; long-lasting symptoms which can be hard to treat. The review also draws attention to the ethical implications of torture including confidentiality, the duty to report torture and the obligation not to take part in it.

Wenzel, Thomas - Torture Current Opinion in Psychiatry 2007, 20: 491-496

Autism, learning disabilities and mental health

A review of the literature on children and adolescents with autism and intellectual disabilities has found that they also have a higher than usual incidence of attention deficit/hyperactivity disorder, mood disorder, catatonia and repetitive behaviour although drugs can be effective in treating these conditions. Children with autism and intellectual disabilities have a higher rate of use of mental health services. Autism was found to occur with Smith-Lemli-Optiz syndrome and 22q11.2 deletion syndrome.

McCarthy, Jane - Children with autism spectrum disorders and intellectual disability Current Opinion in Psychiatry, 2007, 20: 472-476

Mixed results for assertive outreach

Intensive case management - or assertive outreach - aims to ensure that people with severe mental illness spend the minimum amount of time possible in hospital. Each person with severe mental illness and at high risk of readmission is allocated a nurse, social worker or other clinician (a case manager) who is usually responsible for between 10 and 20 patients. The case manager takes primary responsibility for keeping contact with the patient, assessing their needs and ensuring that their needs are met. There is usually a team of people responsible for delivering care which meets daily, includes nurses, social workers, psychologists and doctors and which is available 24 hours a day. However, a number of trials over the last 35 years have failed to show that assertive outreach reduces the use of hospital care. Some showed a large reduction, others found no effect while some actually showed an increase in hospital care. A review of studies into assertive outreach has found that when hospital use is high intensive case management can reduce it but it is less successful when hospital use is already low so that the benefits of assertive outreach could be marginal in places that have already achieved a low rate of bed use. The review also found that team organisation was more important than the details of staffing and that it might not be necessary to apply the full model of assertive community treatment to achieve reductions in inpatient care.

Burns, Tom ... [et al] - Use of intensive case management to reduce time in hospital in people with severe mental illness : systematic review and meta-regression British Medical Journal August 18, 2007, 336-340

E-mails and phone calls can help people with panic disorder

Studies have shown that there are now several effective treatments for panic disorder. However, not everyone with the condition gets them. This can be due to a shortage of skilled therapists and/or long waiting lists. People in rural areas can have difficulty reaching services and those with agoraphobia may be reluctant to leave the house to seek help. A Swedish trial divided 60 people with panic disorder into two groups. One group received cognitive behaviour therapy (CBT) delivered via telephone or e-mail while the other group was put on a waiting list. After 10 weeks those in the CBT group had improved significantly on all the measurements, an improvement maintained at a 9-month follow-up. By the end of the trial 77% of the treated group no longer showed symptoms of panic disorder while all those in the control group still suffered from it.

Carlbring, Per ... [et al] - Remote treatment of panic disorder : a randomized trial of Internet-based cognitive behavior therapy supplemented with telephone calls American Journal of Psychiatry 2006; 163: 2119-2125

New drug tackles weight gain in child patients

Second-generation, or atypical, antipsychotic drugs have been increasingly used to treat mental-health problems in children in the U.S .over the last decade. They can help with cognitive deficits, mood disorders, impulse control and excitability, and, in some respects, have less side effects than older drugs. However, they are also associated with weight gain which can affect the body's ability to manage its blood sugar level - leading to diabetes - and also lead to heart disease. Lifestyle change (more exercise and a better diet) has been the preferred option to tackle these changes but a recent trial of a drug called metformin has shown promising results. The study of 39 children between the ages of 10 and 17 who were all taking antipsychotic drugs and whose weight had increased by at least 10% after a year of taking them compared one group taking metformin with another group taking a placebo. After 16 weeks the group taking metformin had stabilized their weight while the group taking the placebo were still putting on an average of a third of a kilogram a week. The placebo group also had more problems managing their blood sugar than the group taking metformin.

Klein, David J. ... [et al] - A randomized, double-blind, placebo-controlled trial of metformin treatment of weight gain associated with initation of atypical antipsychotic therapy in children and adolescents American Journal of Psychiatry 2006; 163: 2072-2079

Depression and heart disease

A long-term study of 1,196 elderly (over 64) people in Finland has shown that depression can lead to heart disease over a long period of time as well as in the short-term. The study measured people's levels of depression at the start, deliberately excluding anyone who already had heart disease symptoms, then followed them up over the next 12 years to see what illnesses they developed. Stronger symptoms of depression at the start of the study were linked to a higher rate of death from heart disease in both men and women.

Ahto, Merja ... [et al] - Stronger symptoms of depression predict high coronary heart disease mortality in older men and women International Journal of Geriatric Psychiatry 2007, 22: 757-763

Stroke risk increases bipolar risk

Studies have now established a link between the risk factors for stroke in elderly people and an increased risk of depression but it is not clear whether there is a link between stroke risk factors and late-onset bipolar disorder. A study of 50 people in Leicestershire compared those with early-onset (first occuring before the age of 60) and late-onset bipolar disorder to see what the differences were between the two groups. They found that both groups had similar levels of cognitive function and physical health but that the older group - even taking their increased age into account - had a higher risk of stroke suggesting that this could be an important factor in the development of bipolar disorder in later life.

Subramaniam, Hari, Dennis, Michael S. and Byrne, E. Jane - The role of vascular risk factors in late onset bipolar disorder International Journal of Geriatric Psychiatry 2007, 22: 733-737

Evidence supports Drug Treatment Orders

Drug Treatment and Testing Orders were introduced as part of the 1998 Crime and Disorder Act. They compel drug addicts who fall foul of the law to undergo treatment at a specified place for between six months and three years and to be tested regularly for drug use, and they give the courts powers to review people's progress where necessary. A 1-year study of the orders in Portsmouth and Southampton compared their effectiveness to the standard treatments for people with a drug problem. By the end of the study the researchers found that those people given the orders had significantly reduced their drug use and were more satisfied with their treatment than those in the comparison group.

Naeem, Farooq ... [et al] - A controlled trial of the effectiveness of drug treatment and testing orders (DTTO) with standard care Journal of Substance Use August 2007, 12(4), 253-265

No smoking ? No thanks !

The proportion of people in psychiatric hospitals who smoke is far higher than that of smokers in the general population and at least three quarters of people with a drug problem also smoke. This makes it particularly hard to implement a no-smoking policy in inpatient units. A study of 77 service users receiving inpatient treatment for drug and alcohol dependence has found that patients generally had a negative attitude towards a no-smoking policy on the wards with three-quarters of them saying that they would be unlikely to accept treatment if such a policy were implemented. Although staff members recognised the benefits of a no-smoking policy they worried that it would lead to increased difficulties for patients and to patients leaving the unit before they had overcome their other addictions. Although a quarter of patients wanted to give up smoking it was generally felt that this was too difficult during treatment and both patients and staff felt that the introduction of a no-smoking policy would be unattractive and potentially disruptive to treatment.

Hill, Robert ... [et al] - 'Don't you think we're giving up enough already?' Attitudes of patients and staff on an in-patient addiction treatment service to a proposed 'No Smoking' policy Journal of Substance Use August 2007, 12(4), 225-231

Social anxiety disorder and depression

A study of 3,021 people in Munich looked at the incidence of social anxiety disorder and depression and examined the possible links between the two conditions. The ten-year study found that 11% of people suffered from social anxiety at some point with the peak age for the condition being between 10 and 19. 27% of people suffered from depression over the ten-year period although this tended to occur at an older age. Social anxiety disorder led to an increased risk of depression in later life.

Beesdo, Katja - Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life Archives of General Psychiatry August 2007, 64(8), 903-912

Schizophrenia and diabetes

Studies of people with schizophrenia have found a link between the condition and type 2 (adult-onset) diabetes. This could be due to the effect of schizophrenia itself, common genes which could lead to a vulnerability to developing schizophrenia and type 2 diabetes, the effects of antipsychotic medication, the unhealthy lifestyles of people with schizophrenia and the weight gain often associated with antipsychotic drugs. However, there have been very few studies into the links between schizophrenia and type 1 (childhood-onset) diabetes. A study of 5,009 people with type 1 diabetes in Finland has found that they were actually at less than half the risk of developing schizophrenia as people without diabetes.

Juvonen, Hannu ... [et al] - Incidence of schizophrenia in a nationwide cohort of patients with type 1 diabetes mellitus Archives of General Psychiatry 2007, 64(8), 894-899

Group psychotherapy for drug-taking mums

New mothers with drug problems often have a whole host of other difficulties to contend with. They are often single parents, lacking family and social support and can suffer from mental-health problems such as depression and anxiety. A study of 16 mother-and-baby pairs looked at the effects of a brief group therapy intervention which aimed to 'offer mothers the experience of care, which they, in turn, can give to their infants'. After 20-24 three-hour sessions the mother reported a happier relationship with their children and felt that they were getting on better with their peers.

Belt, Ritva and Punamaki, Raija-Lena - Mother-infant group psychotherapy as an intensive treatment in early interaction among mothers with substance abuse problems Journal of Child Psychotherapy 2007, 33(2), 202-220

Tackling prison suicides

The rate of suicide among prisoners has risen in recent years despite the fact that the suicide rate among the rest of the population has fallen. A study of 264 prisoners in four prisons has found that those judged to be at a high risk of self-harm or suicide had a significantly higher rate of mental illness than other prisoners and that there was a high level of suicide risk which had not been identified by the prison authorities. The study also found problems with the delivery of healthcare to at-risk prisoners and difficulties in the documentation of those prisoners' mental health issues and the researchers called for the care-planning and information-sharing processes within prisons and between prisons and other agencies to be improved.

Senior, Jane ... [et al] - The identification and management of suicide risk in local prisons The Journal of Forensic Psychiatry and Psychology 18(3), 2007, 368-380

Antipsychotics and osteoporosis

People taking antipsychotic drugs can be at an increased risk of developing osteoporosis as the drugs can reduce oestrogen and testosterone. A study of 31 female patients in a high-security hospital looked at which drugs they had been taking and for how long, the women's age, whether they smoked and their weight, then measured the women's bone density. The only variable that was linked to bone density was the women's weight with the chubbier women being less at risk of osteoporosis.

Orr, Jane and Jamieson, Liz - An audit of the association between the use of antipsychotic medication and bone density measurement in female patients within a special (high security) hospital The Journal of Forensic Psychiatry and Psychology 18(3), 317-330