News Round-Up: September 8th-14th 2008

In the week of the big-bang experiment at the Large Hadron Collider, there was also lots of news in the world of psychiatry.

Affective Disorders

A meta-analysis of structural imaging studies (performed between 1987 and 2007 and involving 98 studies) in Bipolar Illness showed an association with lateral ventricle enlargement and hyperintensities in the deep white matter. The authors also make recommendations for future imaging studies in this area. A role for the mitochondria in Bipolar Illness is discussed in one paper including the relationship with synaptic plasticity and oxidative phosphorylation. 71 elderly people with depression were MRI scanned and found to have a pattern of changes more likely to represent a dementia prodrome rather than a stress model. Reduced DLPFC and VLPFC activation was detected using fMRI in first-degree relatives of people with schizophrenia when they were performing working memory tasks. Total grey matter volume was correlated with length of illness in bipolar disorder in this study 1.5T MRI study. The authors now recommend the need for a longitudinal study to investigate the possibility of neurodegeneration.

Schizophrenia and Related Illnesses

A new approach to studying visual hallucinations is described in cortex involving presentation of transient flashes of light in combination with neuroimaging. A study of 119 people with first-episode psychosis showed impaired reinforcement learning and that this correlated with negative symptoms. A national survey of psychiatrists found that commencing depot antipsychotics was a function of medication (inversely correlated with 2nd generation antipsychotics), psychiatrist characteristics (e.g male) and patient characteristics (e.g. normal or above average IQ, number of previous admissions).  A study looking at stigma campaigns in schizophrenia found that identifying either a biogenetic or psychosocial aetiology had different effects in different groups (e.g. medical students). The blame attribute was reduced in the biogenetic approach but also resulted in psychology students predicting a poorer prognosis. The authors recommend a balanced approach in stigma campaigns. An fMRI study of 17 relatives of people with schizophrenia showed reduced dorsolateral Prefrontal Cortex Activity when performing the Stroop test compared to 17 controls. A retrospective study of 85 people started on aripiprazole found that the most common cause for discontinuation was agitation (35%), that it was effective in monotherapy or combination in 60% of cases and that it was more effective if the person hadn’t previously been trialed on clozapine.

In the CLAMORS study People with schizophrenia or related illnesses treated with antipsychotics had an almost 3-fold risk of 10-year coronary heart disease risk if they had metabolic syndrome. This was a multi-centre study, recruiting 117 psychiatrists and 1452 patients with schizophrenia or related illnesses, 24% of whom had metabolic syndrome. Metabolic Syndrome also predicted greater illness severity on the PANSS and CGI. The ratio of N-acetylaspartate(NAA) to Choline containing compounds (Cho) detected by Magnetic Resonance Spectroscopy in 49 people with schizophrenia was compared to the ratio in 37 controls.  A decreased ratio is interpreted as neuronal damage. In this study, there was found to be a reduced ratio in people with schizophrenia in the thalamus bilaterally compared to the control group. Those with schizophrenia and  auditory hallucinations had a lower ratio in the right thalamus compared to people with schizophrenia without auditory hallucinations and controls. Cardiovascular and metabolic measurements on a birth cohort were undertaken when the people were age 15/16 (n=5410) . 21 people developed psychosis and there was no evidence that they had developed a metabolic syndrome prior to the onset of psychosis. This is an interesting finding which raises more questions about the relationship between metabolic syndrome and psychosis.

A study of 93 people with first-episode psychosis (FEP), 72 with recurrent psychotic illness and 175 controls found evidence for significant grey matter reductions in FEP compared to controls and this occurred in multiple cortical networks. There was evidence for further reduction in those with recurrent illness in areas which included the basal ganglia as well as the frontal and temporal regions. A 6% reduction in the left hippocampus in first-degree relatives of people with schizophrenia relative to controls was noted in this MRI study involving 88 relatives and 53 controls. Attributing negative events to oneself was found to be associated with poorer response to antipsychotics in people with schizophrenia and related disorders. A feasibility study found that using a virtual-reality paradigm in people with persecutory delusions was safe. People with high schizotypy traits were found to score poorly on a test of emotional intelligence (the Mayor-Salovey-Caruso Emotional Intelligence Test) and that this was associated with verbal episodic memory. Another study found that autistic traits were more common in adolescents with schizotypal traits but that they did not predict later psychosis.

Dementia

A qualitative study involving interviews with 11 people with mild Alzheimer’s Disease found that their most significant concerns were about a loss of dignity and status. A study of 65 Community Psychiatric Nurses in Glasgow looked at repertoire of memory rehabilitation approaches and made recommendations for specialist training in this area. Another study looking at people with vascular dementia and alzheimer’s disease found that BSPD scores (behavioral and psychological symptoms in dementia) predicted functional independence. Neurocognitive measures however, did not predict BSPD scores. A galantamine placebo-controlled study looked at 285 people with Alzheimer’s Disease plus cerebrovascular disease. 60.5% of the people on Galantamine improved on the ADAS-cog 11 as did 46% of the people on placebo. Almost double the proportion of people on Galantamine improved by more than 4 points compared to the placebo-group and this was highly significant (p < .003).

A study involving 6892 people over 65 without dementia found that 42% of them had Mild Cognitive Impairment. Furthermore, those with MCI who converted to dementia had different risk factors depending on whether they were male or female. In women, being on anticholinergic medication and having depression predicted conversion. In men, stroke predicted conversion. In both groups, other predictive factors included APoE4, age and functioning (ADL).

Liaison Psychiatry

A study looking at post-myocardial-infarct found that in 333 depressed people and 383 non-depressed controls, depression predicted survival but that night-time heart rate  also predicted survival in both groups. Following hospital admission with acute coronary syndrome, 213 patients with depressive symptoms (179 at 3 years) on admission were associated with occurrence of PTSD at 1 and 3 years (roughly 12% of people having PTSD at these times). Recurrence of cardiac symptoms was also correlated with PTSD at 3 years. A study of people with Chronic Fatigue syndrome found reduced performance on spatial recognition tasks as well as reduced speed on motor tasks. A prospective cohort study (the Rotterdam Study) involving 4424 without stroke found that depressive symptoms in men was predictive of stroke particularly ischaemic stroke (HR 3.21 95%CI 1.62-6.38). A short, 24-week study showed that fluoxetine 20mg daily was associated with a significant reduction in new enhancing lesions (e.g. 25% with fluoxetine v 41% in the placebo group p=0.04). The authors recommend further studies in this area.

Child and Adolescent Psychiatry

Family Focused Therapy in 58 adolescents (12-17) with bipolar depression improved depressive symptoms and reduced the time to remission.

Learning Disability and Autistic-Spectrum Disorders

A neuroimaging study found decreased grey matter volume in the prefrontal cortex, hypothalamus and insula as well as altered volume gradients in the amygdala, hippocampus and vermis in Fragile X syndrome. A 25% reduction in fusiform gyrus activity in children with autism when attending to strangers faces compared to normally developing children was found in this fMRI study of 11 children with ASD and 11 matched controls. Another study examined the comorbidity of epilepsy and autism, finding that epilepsy was more common in girls with autism than boys and more likely if there was an IQ below 70.

Anxiety and Related Disorder

A genome-wide association study of neuroticism in 1227 people involved 420,000 gene markers and found a highly significant association with MAMDC1 which was replicated.

Substance Misuse

In one study of 51 alcohol dependent people and 52 controls, a significance reduction in the volume of the amygdala and craving predicted relapse. A study looking at smokers with low mood finds preliminary evidence linking smoking behaviour to various receptor genotypes including DRD2, C957T, SLC6A3, DRD4 and others.

Eating Disorders

In one study of 22 women with anorexia compared with 24 women with bulimia and 30 controls, peripheral mRNA expression of Atrial Natriuretic Peptide (ANP) was decreased. ANP acts through a variety of mechanisms to reduce blood pressure and there is an established literature showing altered ANP homeostasis in anorexia.

Miscellaneous

An fMRI study of episodic memory showed preferential activation of the medial temporal lobe and it was suggested that this area helps us to remember the ‘gist’ of new information we are presented with. A meta-analysis of studies looking at the effects of ‘positive psychological health and well-being’ showed a significant (in both p < 0.05) reduced mortality in the healthy population (combined hazard ratio 0.82 (0.76-.089)) and the disease populations (although the hazards ratio was 0.98, the 95% CI crossed 1). Just under 23% of the US population had a 3-month prevalence of headaches and this was associated with increased odds of physical and mental illness comorbidity. An 18-month observational study found that lamotrigine reduced aggression in women with a diagnosis of borderline personality disorder (using the State-Trait Anger Expression Inventory (STAXI). Cerebral microbleeds (CMB’s) were found to be more common in men than women in this birth cohort study (1907-1935) involving 820 men and 1142 women. The cerebral cortex was affected in 70% of cases and were significantly associated with the APOE4 genotype. An fMRI study of taxi-drivers led by Dr Hugo Spiers (who I had the great pleasure to complete a previous study with) found that the hippocampus was activated when the drivers needed to replan their routes (the study involved a playstation 2 virtual simulation of a journey).

Request

If there is any important news or research that has been missed, please leave a comment including the relevant information.

Appendix

STT

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.

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