Who stalks?

There has been a lot of media coverage about stalking lately, some of it very sensationalised but more rigorous scientific studies have also confirmed substantial rates of stalking in the UK. The 1998 British Crime Survey found that 12% of respondents of both sexes had suffered persistent and unwanted attention at some time over the age of 16 and the 2001 British Crime Survey found that 8% of women and 6% of men had been stalked during the past year. However, understanding of the nature of stalking behaviours has not kept pace with the increasing awareness of stalking and much of the research into it has looked at victims rather than perpetrators. A study of 362 patients admitted to Broadmoor looked at their case histories to identify incidents of stalking. The researchers found that 33 of them (9.1%) could be classified as stalkers. They were mostly male, yound, unmarried, minimally educated and unemployed. They had inflicted a wide range of unwanted intrusions and communications on their victims and both threats (55%) and assaults (45%) were common. The types of stalkers were more or less equally split between intimacy seeking, rejected suitors, resentful and predatory with only a tiny group being incompetent suitors.

Whyte, Sean ... [et al] - Who stalks? A description of patients at a high security hospital with a history of stalking behaviour Criminal Behaviour and Mental Health 2008, 18, 27-38

Why Americans are having less senior moments

A study of 11,000 people in the U.S. has found a significant decline in the levels of cognitive impairment between 1993 and 2002. The prevalence of cognitive impairment went down from 12.2% in 1993 to 8.7% in 2002. The researchers attributed this decline to increased rates of college education, greater personal wealth and better treatment for cardiovascular problems. In recent years research has suggested that the more education a person receives early in life the more his or her brain will be able to stay sharp later. During the time of the study the number of older people with a high-school diploma rose from 53% to 72% and the number of people with a college education rose from 11% to 17%. At the same time the use of cholesterol-lowering drugs and blood-pressure medication increased dramatically during the 1990s. This may have had the effect of reducing the incidence of vascular dementia - cognitive problems brought on by mini-strokes, strokes and decreased blood flow to and within the brain due to hardened or clogged arteries.

You can read more about this research at

http://psychcentral.com/news/2008/02/21/is-memory-loss-on-the-decline/1949.html

Empty nests or new friends ?

Traditionally it has been thought that children leaving home had a negative effect on parent's mental health - the empty nest syndrome. However, a study of 142 sets of parents by researchers at the University of Missouri has found that the changes parents feel are more positive than once believed. The study found that there were few differences in the way mothers and fathers felt and that many of the changes parents felt were positive as they moved from looking after their children to relating to them as peers, becoming mentors to them rather than telling them what to do. At the same time the parents continued to provide financial and emotional support to their children.

You can read more about this research at

http://psychcentral.com/news/2008/02/22/empty-nesters-may-be-content/1953.html

Stroke risk and memory loss

Although everyone loses some cognitive capacity as they age new research from the U.S. suggests that people at high risk for stroke also have the highest rate of cognitive decline. The study, of more than 17, 000 people found that those at high risk of stroke declined twice as fast as those at low risk. Those rated as having a 22% chance of having a stroke in the next ten years had double the rate of cognitive decline as those who were only thought to have a 2% chance. High blood pressure, diabetes and left ventricular hypertrophy were the three, specific, risk factors associated with memory loss.

You can find out more about this research at

http://psychcentral.com/news/2008/02/25/stroke-risk-factors-may-predict-cognitive-decline/1958.html

Review casts doubt on antidepressants

A review of data from drug trials submitted to the U.S. Food and Drug Administration has found that, compared to a placebo, SSRI antidepressants appear only to help people with very severe depression. The researchers found that placebos were able to duplicate 80% of the improvements achieved by the drugs fluoxetine, venlafaxine, paroxetine and nefazodone.

You can read the full text of this review at

http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0050045&ct=1&SESSID=1df302fc7bf05c70bb0c617dd6141e45

Adolescent depression - treating tough cases

Adolescent depression is a chronic, recurrent and impairing condition that accounts for a substantial proportion of physical injuries and premature deaths in teenagers. Untreated depression results in problems in school and interpersonal relationships and increases the risk for suicidal behaviour. Not all children respond well to antidepressant treatment so an alternative strategy is important. A U.S. study of 334 depressed 12 to 18 year olds who had not responded to SSRI* antidepressants after two months evaluated the effectiveness of four different treatment strategies: (i) switching to a different SSRI (ii) switching to a different SSRI and using cognitive behaviour therapy (iii) switching to venlafaxine (iv) switching to venlafaxine plus CBT. The results showed that adding CBT to the antidepressant treatment was more effective than simply changing drugs, either to another SSRI or to venlafaxine. There was no difference between changing to another SSRI and changing to venlafaxine.

You can read more about this research at

http://psychcentral.com/news/2008/02/26/adding-psychotherapy-to-meds-change-helps-depressed-teens/1969.html

*Serotonin Specific Reuptake Inhibitors which work by increasing the amount of the 'feel-good' chemical serotonin in the brain.

Personality and schools of therapy

Recent research has looked into the links between people's personality types and the schools of counselling and psychotherapy they belong to. A mis-match between a therapist's outlook on life and the kind of therapy they practice can lead to dissatisfaction, poorer quality therapy and even to people leaving the profession. A survey of 84 people doing counselling training at universities in the UK tested them with the Myers-Briggs personality test and asked them which method of psychotherapy they were using. The survey found that those who scored highly for planning and coming to conclusions and for being practical and interested in facts and details were more likely to use cognitive-behaviour therapy. Those who were more interested in taking a broader overview, gave less weight to logic and who liked planning were more likely to use psychodynamic therapy and those who took a broad overview, gave less weight to logic and were more flexible were more likely to use person-centred therapy.

Varlami, Evi and Bayne, Rowan - Psychological type and counselling psychology trainees' choice of counselling orientation Counselling psychology quarterly December 2007, 20(4), 361-373

Depression and treatment history

Depression can be described as a chronic rather than an acute illness and single, isolated episodes of depression are rare. In fact, the risk of repeated episodes is said to exceed 80% and patients can expect an average of four episodes of depression in their lifetimes. The risk of relapse has been linked to the number of prior episodes a patient has experienced and patients who have experienced three or more prior episodes have a greatly increased risk of relapse. One study reported that with each additional episode there is an 18% increase in the risk of recurrence. However, there has been little research into people's psychotherapy 'careers' and little data regarding the relationship of these prior treatments and responsiveness to psychotherapy. An Australian study of 48 individuals with major depression turning up for treatment at a community-based psychotherapy facility found that 90% of them had received some form of prior psychotherapy or counselling, with on average 3.5 previous episodes of care. Those receiving psychotherapy at the time of intake showed higher levels of improvement over the following year suggesting that those actively engaged in some therapy experience at intake benefited more than those with an 'interrupted' psychotherapy career.

Grenyer, Brin F.S., Deane, Frank P. and Lewis, Kate L. - Treatment history and its relationship to outcome in psychotherapy for depression Counselling and Psychotherapy Research March 2008, 8(1), 21-27

Australian women - who seeks counselling ?

Despite the increasing incidence of mental-health problems in the population a growing body of research suggests that the great majority of those who are psychologically distressed receive no mental health care. Women report much higher rates of mental-health problems than men and middle-aged women report more problems than other age groups. An Australian study of 11,201 women between the ages of 50 and 55 examined which of them had consulted a counsellor, psychologist or social worker in the past 12 months. The study used data from the Australian Longitudinal Study on Women's Health and found that although studies have found 36% of the Australian population to be suffering from psychological distress only 7% of the women had consulted someone about their mental health in the previous year. The women who had had counselling were found to be more stressed and less optimistic but to have higher levels of satisfaction with their lives and a greater feeling of control. They were also more likely to have had significant life events over the previous year, changed health status, to be taking more medication, to live in urban areas, to be university educated and to live alone.

Schofield, Margot J. and Khan, Asaduzzaman - Australian women who seek counselling: psychosocial, health behaviour, and demographic profile Counselling and Psychotherapy Research March 2008, 8(1), 12-20

Anxious mothers, anxious children

It is well known that there is an increased rate of anxiety among the parents of anxious children and a recent study showed that two thirds of mothers of a sample of children being treated for anxiety suffered from it themselves. At the same time maternal anxiety has been found to predict the outcome of a child's treatment for anxiety almost halving the success rate in some studies. A study of 22 children and their mothers by researchers at the University of Reading saw them receiving cognitive behavioural therapy aimed at reducing their children's anxiety. Of the 12 mothers who met the criteria for an anxiety disorder 6 received CBT and assessments were made of the mother-child interactions of the participants. Those children whose mothers had an anxiety disorder did less well but treatment of the mothers' anxiety disorders did not, in itself, improve outcomes for their children. Maternal overinvolvement and expressions of fear were associated with poorer outcomes though suggesting that it was the anxious mothers' parenting styles rather than their anxiety per se that had the biggest effect on outcomes, and that attempting to alter these parenting styles would be more effective than tackling mothers' anxiety in helping children.

Creswell, Cathy ... [et al] - Treatment of child anxiety: an explorartory study of maternal anxiety and behaviours in treatment outcome Clinical Psychology and Psychotherapy January-February 2008, 15(1), 1-14

CBT and coming off benzodiazepines

Problems in coming off benzodiazepines can be related to rebound, where the initial problem (e.g. anxiety, sleep problems) is intensified, short-term withdrawal symptoms and re-ocurrence of the original problem for which the medication was originally prescribed. 80% of people who give up benzodiazepines subsequently relapse and even when people are weaned off the drugs gradually a significant number experience distress. For some time there has been a consensus that these problems can benefit from non-medical interventions and psychotherapy and a study of 86 people attempting to withdraw from Benzodiazepines in Montreal compared the effectiveness of cognitive behaviour therapy (CBT) and group therapy. Both were more effective than a control group although CBT did produce higher levels of self-efficacy (people's confidence that they could achieve their goals). Over all 86 participants a high initial level of psychological distress, anxiety and dosage predicted a poor outcome but increase in self-efficacy contributed towards a successful outcome. Although there was a decrease in positive mood during the course of the withdrawal there was no significant increase in negative mood.

O'Connor, Kieron ... [et al] - Cognitive-behavioral, pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine Clinical Psychology and Psychotherapy, January-February 2008, 15(1), 1-14

Panic and pregnancy

Female reproductive hormones can have a significant influence on anxiety disorders throughout a woman's life but little is known about the interactions between pregnancy and panic disorder (PD) which can affect between 1-3.8% of women over the course of their lives and is twice as frequent in women. Researchers in Turkey assessed 512 women in the third trimester of pregnancy for panic disorder and also compared 13 pregnant women with panic disorder to 19 non-pregnant controls. Among all the pregnant women the prevalence rate for PD was 2.5%. Among the 13 pregnant women with PD 7 had developed it during their pregnancy while the other 6 were suffering from it before they became pregnant. There was no difference between the pregnant and non-pregnant women as far as the severity of PD symptoms was concerned.

Guler, Ozkan ... [et al] - The prevalence of panic disorder in pregnant women during the third trimester of pregnancy Comprehensive Psychiatry 2008, 49, 154-158

Children with conduct disorder

An Italian study of 198 children with conduct disorder found that those who were referred for the condition before puberty tended to come from more deprived backgrounds. Their condition was more severe when they were referred although they responded to treatment as well as those whose conduct disorder began in adolescence. They were more aggressive and more likely to suffer from attention-deficit hyperactivity disorder (ADHD). The girls in the study tended to be older and come from more deprived backgrounds. The girls' condition was worse when they started treatment and they were more likely to harm themselves but they responded better to treatment than the boys. Rates of ADHD were lower than in the boys. Those who did not respond to treatment were worse when they were first referred, more physically and verbally aggressive, had a higher rate of drug abuse and were more likely to commit pre-meditated violence rather than lashing out impulsively. Psychosocial interventions were found to be effective for this group of children.

Masi, Gabriele ... [et al] - Conduct disorder in referred children and adolescents: clinical and therapeutic issues Comprehensive Psychiatry 2008, 49, 146-153

Consumer satisfaction with mental health services

Consumer satisfaction with mental-health services has begun to be seen as increasingly important in the last few years. A survey of 136 inpatients with psychotic or affective disorders in Maryland, U.S. looked at the modifiable factors influencing their levels of satisfaction. The study found that staff teaching patients about medication, illness management, substance abuse, outpatient treatment and living skills was significantly associated with greater levels of satisfaction with care reflecting the value service users placed on staff time, attention and communication.

Hackman, Anne ... [et al] - Consumer satisfaction with inpatient psychiatric treatment among persons with severe mental illness. Community Mental Health Journal December 2007, 43(6), 551-564

Feet in mouth on constant replay - post-event processing and social anxiety disorder

People with social anxiety disorder often conduct lengthy post-mortems after social events going over and over what they said and did wrong and castigating themselves for often imaginary faux pas mercilessly. Psychologists call this process post-event processing, or PEP for short. This reinforces people's negative beliefs about their social performance and distracts from any positive aspects of their social lives. A study of 125 people in Canada looked at 75 people attending a group therapy session for social anxiety and 50 people experiencing exposure therapy for the condition. Significant PEP occured after both events and the more anxious people were before both tasks the worse their PEP. The levels of PEP were about the same after both events and the participants' PEP was found to be specifically related to their social performance rather than being a general negative train of thought about life as a whole.

Kocovski, Nancy L. and Rector, Neil A. - Post-event processing in social anxiety disorder: idiosyncratic priming in the course of CBT Cognitive Therapy and Research February 2008, 32(1), 23-36

'There is an art to read a man's construction in his face' - emotion recognition in schizophrenia

Many studies have found that patients with schizophrenia find it more difficult to recognise facial emotions. This makes it harder to work out other people's feelings leading to problems with social interactions and a declining sense of social worth. In healthy people the basic emotions - happiness, sadness, fear, anger, disgust and surprise - tend to be perceived in a categorised way with sharp, clear-cut boundaries between them. Recent research, using sophisticated animation techniques, has shown that in schizophrenia patients the categories are less sharp with more uncertain boundaries leading to more potential for misinterpretation. A French study which compared 26 patients with schizophrenia to 26 healthy controls found that people with schizophrenia had less distinct perceptual boundaries between different emotions which in turn led to confusion between emotions and the potential for reading people's emotions in a radically wrong way. The researchers suggested that these impairments in emotional perception could lead to false perceptions of others' emotions and the development or maintenance of delusional ideas.

Vernet, Mathilde, Baudouin, Jean-Yves and Franck, Nicolas - Facial emotion space in schizophrenia Cognitive Neuropsychiatry 2008, 13(1), 59-73

Psychosocial interventions for drug abuse

A review of psychosocial treatments for substance use disorders looked at 34 diffferent studies into a variety of treatments for drug abusers. Overall the study found that psychosocial treatments had a moderate, positive effect. They were most effective at stopping people using cannabis and least effective when people were abusing a variety of different drugs. The most effective type of treatment was contingency management in which drug users were rewarded when they stopped taking drugs and passed drug tests. Approximately a third of participants dropped out before treatment completion.

Dutra, Lissa ... [et al] - A meta-analytic review of psychosocial interventions for substance use disorders American Journal of Psychiatry February 2008, 14(2), 179-187

Behavioural activation for PTSD

Studies have found that, within the first year post-trauma 10-40% of individuals develop symptoms consistent with a diagnosis of post-traumatic stress disorder. Severely injured patients who require a standard inpatient admission are more likely to develop PTSD and benefit less from traditional cognitive-behavioural therapy (CBT) than patients who are less injured. Behavioural activation was originally developed as a treatment for depression and involves the identification and enactment of activities that are reinforcing for the individual and consistent with their long-term goals. In layman's terms this means getting people to do things which are beneficial, or part of everyday life, which they have been putting off doing because of their depression. In PTSD individuals avoid situations and experiences that may elicit trauma-related memories but such avoidance is believed to reinforce anxiety as people never confront and overcome their fears. Behavioural activation differs from exposure therapy as the emphasis is on confronting fears that prevent people from reaching their goals rather than on confronting them for their own sake. A small study of 8 PTSD patients in the U.S. compared behavioural activation with conventional treatment and found that it led to a greater improvement in symptom severity and physical functioning although not of patients' depression.

Wagner, Amy W. ... [et al] - Behavioural activation as an early intervention for posttraumatic stress disorder and depression among physically injured trauma survivors Cognitive and Behavioral Practice 2007, 14, 341-349

Drug abuse and domestic violence

Intimate partner aggression is a big problem in the U.S., as elsewhere, and surveys have found more than one in five couples reporting it within the past year. Both sexes have been found to engage in it, women more than men, although with less serious consequences. Intimate partner aggression can lead to depression, injury, shame, post-traumatic stress disorder and even suicide so much effort has been devoted to identifying its causes. Drug abuse is thought to be one of the main factors involved and a review of 96 different studies has found that increases in drug use and drug-related problems are significantly associated with increases in aggression between intimate partners. Cocaine was the drug with the strongest relationship to psychological, physical and sexual aggression although marijuana was also significant.

Moore, Todd A. ... [et al] - Drug abuse and aggression between intimate partners: a meta-analytic review Clinical Psychology Review 2008, 28, 247-274

Non-violent resistance - the way forward for parents?

Recently treatments for child-behaviour problems have shifted their emphasis from treating the children's behaviour to helping their parents to control them. Nonviolent resistance (NVR) is a new training model for parents which draws on the principles of the non-violent resistance movements of people like Gandhi and Martin Luther King and which aims to help parents deal effectively with their helplessness, isolation and escalatory interactions with their children. Parents commit themselves to restrain themselves form violent and humiliating responses to their children while at the same time not giving in to their demands. The parents are coached on how to prevent escalation by becoming aware of its signs as well as their own contribution to the process and alternative non-escalating reactions are discussed and implemented. A study of 73 parents in Israel found that in comparison with a control group parents who received training in NVR showed a decrease in parental helplessness and escalatory behaviours, an increase in social support and a decrease in their children's negative behaviour.

Weinblatt, Uri and Omer, Haim - Nonviolent resistance: a treatment for parents of children with acute behaviour problems Journal of Marital and Family Therapy January 2008, 34(1), 75-92