News Round-Up: 31st August-7th September 2008

Bipolar Disorder and Depression

A study involving 13,500 people with Bipolar Disorder and published in the Archives of General Psychiatry has found that as a father’s age increases so too does his chances of having children with Bipolar Disorder. A study in the British Journal of Psychiatry shows lower rates for antidepressant prescribing in areas with a higher proportion of black and asian people. One study in the Archives of General Psychiatry has shown that levels of the serotonin transport protein in the brain changes with the seasons particularly in the autumn and winter suggesting a mechanism that may account for seasonal affective disorder.

Schizophrenia

Research in this month’s issue of the Archives of General Psychiatry suggests difficulties with the way the brain processes sounds in both people with schizophrenia and their close relatives. A remarkable story of cross-disciplinary collaboration has shown a possible pathway from genes to schizophrenia. Essentially the disease linking three different genes together was Bardet-Biedl Syndrome which affects the eyes, kidneys as well as behaviour. The three genes were BBS4, PCM1 and DISC1 which have been shown to act in concert during neural development. Confirmatory research has been conducted in families with schizophrenia but there will undoubtedly be many more pieces of the jigsaw to fit together. A case study in the British Journal of Psychiatry (BJPsych) has found an association between schizophrenia and middle ear disease. The authors of another paper in the BJPsych found that motor coordination and neurological signs were found more frequently in people presenting with first episode psychosis compared with controls and when controlling for IQ. Another study in the BJPsych found that a longer the period of untreated psychosis predicted poor social outcome. Changes in the white matter tracts near the left fronto-occipital fasciculus have been found in association with  psychosis. Such a specific hypothesis is ‘relatively’ easy to test and replications of such studies will be awaited with interest. Researchers in inpatient forensic settings found that violence was associated with psychopathy scores in people with schizophrenia and not with severity of illness or measures of neuropsychological functioning (VLPFC or DLPFC functioning). The implication is that when assessing risk of violence there should be an examination of comorbid personality traits and this was suggested as a future direction of research (particularly exploring the relationship of VLPFC and DLPFC function to personality traits).

Child and Adolescent + Neonatal Psychiatry

A meta-analysis published in the Journal of the American Academy of Child and Adolescent Psychiatry shows an increased prevalence of depression in adolescent girls in young offenders units (29% aged 10-19). Young people in offenders units are at risk of many different mental illnesses (STT2). A difference in a mother’s brain activation when responding to a newborn’s cry has been found between mothers who underwent caesarean-section versus natural birth. The general conclusion drawn by the authors is that natural birth mothers are more sensitive to their baby crying. However there are a number of assumptions between the activation findings and the general conclusion. Nevertheless there have been suggestions of a link with Oxytocin (STT4). A study of 800 children found that those of low birth weight were more likely to develop anxiety and depression. In a study in the British Journal of Psychiatry there was found to be an association between lower IQ and psychotic symptoms (bear in mind that we are talking about symptoms rather than a diagnosis e.g. schizophrenia) The full article is available here.

Psychotherapy

The authors of a meta-analysis of 103 papers looking at computerised CBT concluded that there was some evidence of effectiveness. Indeed evidence that Beating the Blues was better than the usual treatment for depression was discussed. There are many questions that remain unanswered however (e.g what is the role of the therapist).

Anxiety and Related Disorders

People with panic disorder have reduced 5-HT1A binding pre and post-synaptically compared to controls using PET scanning and a 5-HT1A tracer. A fascinating study has found that people with PTSD are less likely to respond to CBT if they have impairments in verbal memory. The relationship between verbal memory and PTSD is an area to keep an eye on.

Dementia

Research at the Institute of Psychiatry has shown a difference in attitudes towards caring for elderly relatives with Dementia between White, Asian and Black British caregivers. The qualitative research looked at ‘traditional’ and ‘non-traditional’ carers roles. In traditional caring roles the caregivers role is thought of as ‘natural’  and ‘virtuous’. Black and asian british caregivers were found to be more likely to have ‘traditional’ carers roles than their white british equivlents (STT3). Hippocampal volume has been found to be predictive of memory performance in aging pilots. Being an ApoE4 carrier also had some predictive value. 123I-FP-CIT SPECT scanning was found to have 78.6% sensitivity and 87.9% specificity in differentiating between Alzheimer’s Disease and Lewy Body Dementia – a remarkable result. Executive dysfunction predicted functional abilities in the elderly with cognitive impairment in one study. This contrasts with a recent featured study (in this blog) on executive functioning in schizophrenia. A study of 217 patients on rivastigmine, showed that of the 135 who remained in the 2-year study, 80% had stabilisation of their cognitive decline (less than or equal to a 4 point drop on the MMSE –  67% for the ADAS-cog). Predictors of conversion from mild cognitive impairment to Alzheimer’s Disease including MRI Hippocampal and Entorhinal Cortex volumes as well as performance on a smell test (UPSIT) and selective reminding test (SRT). Evidence for predictors of Alzheimer’s Disease affecting cognitive performance in childhood has been found in one study. A post-mortem of 124 people with diabetes  found there were less neuritic plaques if they had been taking insulin together with their medications. This supports a protective role for insulin and there is a theory that Alzheimer’s Disease is a type 3 diabetes.

Miscellaneous

Research using an inflammatory marker – nuclear factor kB – has shown an increase in people following partial sleep deprivation. Potentially this research has important implications. Research in Brazil has produced some interesting findings. There are 6000 psychiatrists in the United Healthcare System and three times as many psychologists but only 3119 nurses! In the south-east of the country there are 5 psychiatrists per 100,000 of the population and in the north-east there is only 1 psychiatrist per 100,000. An analysis of UK Radio DJ’s comments on alcohol reveals a tendency towards encouraging alcohol use. A comparison of 20 people with trichotillomania and 19 controls revealed increased grey matter changes in the left striatum, amygdala and hippocampus as well as many areas bilaterally. In depersonalisation disorder a person’s emotional, bodily and reality experiences are ‘dampened’. In this fMRI study, the researchers found that when processing emotional facial expressions, the depersonalisation group had a quicker haemodynamic response but a lower magnitude of response. This is posited to be the underlying mechanism for depersonalisation. The term ‘discomgooglation’ has been given to the frustration at being removed from an internet connection.

Literature

In the British Journal of Psychiatry September 2008 issue, several books are reviewed including ‘What is Mental Disorder. An Essay in Philosophy Science and Values’, ‘Handbook of PTSD Science and Practice’, ‘Coaching and Mentoring at Work: Developing Effective Practice’, ‘Essential Philosophy of Psychiatry’, ‘Humanizing Psychiatry and Mental Health Care: The Challenge of the Person-Centred Approach’, ‘The Premenstrual Syndromes: PMS and PMDD’ and ‘Attachment in Psychotherapy’. Nassir Ghaemi, himself an author, reviews the book ‘Comfortably Numb: How Psychiatry is medicating a Nation’ by Charles Baber.

Disclaimer

The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.