Daily Archives: January 3, 2009

TAWOP Round-Up 2008

The Blog started in July 2008 and has had a good response. The review of 2008 is broken down into sections with links to the relevant posts.

Predictions for 2009

News Round-Up for 2008

17 Research Studies from 2008

Blogs Reviewed in 2008

Books Reviewed in 2008

Social Psychiatry/Policy Documents Reviewed in 2008

Medical Articles Reviewed in 2008

Psychology/Psychotherapy Articles Reviewed in 2008

Thank you readers for your support in 2008!

Predictions for 2009

Here are some of my predictions for 2009

1. President Obama’s science advisers will introduce new science policies in the next year and these will be widely covered in the media

2. The Productive Wards Series will spread rapidly within the NHS and will be rolled out into different services (e.g community teams) influencing practice.

3. The financial crisis will lead to rising unemployment with the associated difficulties and for various reasons there will be reduced funding for science which will slow the accelerating number of biomedical studies although there will still be an overall increase in the number of studies.

4. There will be a continued media focus on Rember, Dimebon and Etanercept

5. There will be further clarification of the relationship between cardiovascular disease and depression

6. There will be further published research on cellular reprogramming

7. There will be increasing numbers of novel genetic findings resulting from genomic sequencing

8. Mild Cognitive Impairment will continue to be a focus for research

9. There will be further research on predicting conversion from Mild Cognitive Impairment to Dementia

10. Telemedicine will become more prominent

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.

Social Psychiatry/Policy Articles Reviewed in 2008

Here are the social psychiatry/policy documents reviewed on the blog in 2008

Mental Capacity Act 2005. Deprivation of Liberty Safeguards. Department of Health Consultation Document on the Deprivation of Liberty Safeguards.

Medicines Management: Everybody’s Business. Department of Health document by service users on medication issues.

DOH Guidance on cCBT. Department of Health document on use of computerised CBT.

ECT Survey in England – January-March 2002. Survey of ECT practice in the UK.

Best Practice in Managing Risk. Department of Health document on managing risk.

Action on Stigma. Department of Health’s campaign against mental health discrimination in the workplace.

Global Mental Health Series – Commentaries. Global Mental Health Series.

Barriers to Development of Services. Global Mental Health Series.

Mental Health Systems in Countries. Global Mental Health Series.

Treatment and Prevention in Low and Middle Income Countries. Global Mental Health Series.

Scarcity, inefficiency and inequity. Global Mental Health Series.

No Health without Mental Health. Lancet Global Mental Health Series.

Religious Education, Midlife Observance and Dementia. Longitudinal study looking at religious education and lifestyle interactions with dementia.

Factors influencing children being taken into care. A large Swedish registry study looking at factors influencing children being taken into care.

Unemployment, social isolation and psychosis. Study looking at the interaction between unemployment, social isolation and psychosis.

Modelling Disease Frequency in Schizophrenia Epidemiology. Paper looking at building mathematical models for use in epidemiology of schizophrenia.

The Growth of PTSD in Anxiety Research. Study looking at the number of research articles published in this area over time.

Exposure to ‘the Troubles’ in Northern Ireland influences the presentation of Schizophrenia. Paper looking at the interaction between traumatic exposure and presentation of schizophrenia.

Prevalence of Schizophrenia in China. Large epidemiological study in China.

Developing Mental Health Services in Nigeria. Paper about developing mental health services in Nigeria.

Community Treatment Orders. Review of a debate about Community Treatment Orders.

The Influence of Culture on Psychiatry in China. This post looks at a paper on prevalence of depression in China.

Demoralisation Syndrome. Review of a study examining the construct of a demoralisation syndrome.

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.

Psychology/Psychotherapy Articles Reviewed in 2008

Here are the psychology/psychotherapy articles that were reviewed in 2008.

Predictors of Driving Cessation in Mild-To-Moderate Dementia. Study looking at predictive factors for driving cessation in people with dementia.

Anxiety in Dementia: A Critical Review. Critical review of the occurrence of and assessment of anxiety disorders in dementia.

Whatever happened to Little Albert. Interpretation of a review of an unethical study.

20 Years Experience of the Impact of Events Scale. Review of 20 years experience of this popular scale.

The Subjective Experience of Pain. Imaging study looking at subjective experience of pain.

Phenomenology of Delirium. Study looking at phenomenological features of delirium.

The Impact of Events Scale. 1979 paper outlining the construction of the Impact of Events Scale.

Pathobiology of Visceral Pain. Review article looking at the neural representation of visceral pain.

The Insular Cortex and Neuropsychiatric Disorders. Paper looking at evidence for involvement of Insular Cortex in Neuropsychiatric Disorders.

The Implications of Bereavement Theory for Art Therapy. A paper which translates theoretical models with practical interpretations.

Recovery in Schizophrenia. Examination of the concept of recovery in schizophrenia.

Dissociative Identity Disorder and Schizophrenia. Paper comparing and contrasting dissociation and psychosis.

Should Antisocial Behaviour Play a Role in Defining Psychopathy? Analysis of the construct of psychopathy.

Comparison of Cognitive Profiles in Schizophrenia and Obsessive-Compulsive Disorder. Findings from a comparison study.

Social Cognition in Schizophrenia. Outline of models of social cognition in schizophrenia.

A Meta-analysis of Couples Therapy. Examination of evidence for couples therapy in depression.

Humanistic and Integrative Therapies. Overview of the humanistic/integrative therapies.

The relevance of Freud to Modern Psychiatry. Brief overview of relevance of Freud in modern psychiatry.

Winnicott on Anxiety. Paper by Winnicott on anxiety.

A Meta-analysis of Relaxation Training. Meta-analysis of relaxation training.

Nature and Technology in Harmony. A paper looking at approaches to antipsychotic related weight gain including exercise.

CBT and Structured Care for Medically Unexplained Symptoms. A study looking at approaches to Medically Unexplained Symptoms.

Can we predict coping abilities in schizophrenia. Review of a study looking at executive functioning in predicting coping ability in people with schizophrenia.

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.

Medical Articles Reviewed in 2008

Here are the medical papers which were reviewed in 2008.

MRI measures of Temporoparietal Atrophy During Prodromal Alzheimer’s Disease. Study examining factors that predict conversion from MCI to Alzheimer’s Disease.

How do you feel? Craig expands upon his model of interoception.

Clinical Prediction of Progression from Mild Cognitive Impairment to Alzheimer’s Disease. Study looking at factors that may influence progression from MCI to Alzheimer’s Disease.

Enigma of the Peripheral Benzodiazepine Receptor. A look at the mysterious peripheral benzodiazepine receptor.

MR Visualisation of the Insula. Characterising the anatomical boundaries of the Insular Cortex using an MRI study.

A case of neurogenic T-Wave inversion. Case study of a person who develops an infarct in the Insular Cortex and who also develops T-wave inversion.

Interoception and the Insular Cortex. A Craig paper developing his model of interoception.

The Relationship of Blood Pressure to Subcortical Lesions. Examination of relationship between BP and subcortical lesions in healthy elderly.

Insular Cortex Infarction in Middle Cerebral Artery Territory Stroke. Study examining relationship between insular cortex infarc and cardiovascular function.

Striatal Glutamate Levels and Cognitive Decline in the Elderly. Relation of striatal glutamate levels to cognitive decline.

Serotonin and Depression. Cowen’s model of serotonin and depression.

Crow on Psychosis revisited. Crow on psychosis. I reclassified this as a medical article.

Donepezil and Psychosocial Approaches in Dementia. Brief paper looking at Donepezil and/or psychosocial approaches in dementia.

Containdicated Medication in a Memory Disorder Clinic. Study looking at innappropriate medication in the elderly.

Effect of Dimebon on Mild-to-Moderate Alzheimer’s Disease. Well publicised paper looking at Dimebon in Alzheimer’s Disease.

Medication Treatment of Residual Depression Symptoms. Paper looking at the benefits of treatment of residual symptoms in depression.

Mirtazapine for Generalised Anxiety. Study looking at Mirtazapine in the treatment of generalised anxiety.

Computer-assisted medication prescribing in the elderly. Study looking at the effects of computer aided prescribing in the elderly.

A Roadmap for Preventing Dementia. Leon Thal symposium on strategies for preventing dementia.

Crow on genes in schizophrenia. Crow’s summary of his theory of language development in relation to psychosis.

Pulsed Clomipramine Infusion in Depression. Study looking at IV and oral administration of Clomipramine in Depression.

Maintaining People on Antidepressants. Finnish study looking at factors influencing concordance with antidepressants.

Monitoring Kidney Function with Lithium. Paper on monitoring kidney function in people taking Lithium.

115 and a Sharp Cookie. Case study of a 115 year old lady and also a review of neuropathological process in Alzheimer’s Disease.

GABA Receptors in Anxiety. Imaging study looking at GABA receptor occupancy in people with panic disorder.

The Benefits of Exercise. Exercise in people with and without dementia.

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.

Podcast Review: January 2008 1st Edition

In the Science Podcast of December 5th 2008 there is coverage of foetal immunity to maternal antigens using T-cells in a different way to adults.There is also discussion of a study of the ‘placebo effect’ with evidence for a genetic variation in serotonin production in those who responded to placebo in a social anxiety scenario. In drawing this final conclusion we must make a number of assumptions including a negligible background variation in confounders, the existence of the placebo effect as a valid biological construct and not representative of statistical confounders and the efficient and relevant to the experimental paradigm expression of the gene.

In the Science Podcast of December 19th 2008 there is coverage of a number of big science stories from 2008 and these included new gene sequencing technologies, the sequencing of human genomes and cell reprogramming. Predicted big stories for next year are speciation genes, that is genes that keep species from interbreeding, and also neuroscience in courts.

In the Science Podcast of December 23rd 2008 there is coverage of stories from 2008 including an MRI study of decision making in which activation was found to precede conscious awareness of the decisions by 10 seconds.

In the Nature Podcast of December 11th 2008 there is a discussion of the effect of the financial crisis on world food supplies and the potential benefits of increasing funding for agricultural research to address these issues. There is also a discussion of the so-called ‘smart drugs’ and the ethics of making these more widely available. One of the authors of a Nature article on this topic appears on the podcast to discuss this further including estimated figures of between 4 and 25% of people on campuses using these.

In the Nature Podcast of December 18th 2008 there is discussion of learning in songbirds where it was found that a single type of song presented on two occasions was sufficient to produce learning. There is also a discussion of the construction of the first artificial genome as well as personal genomics.

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.

TAWOP Annual Review 2008

2008 was a great year for psychiatry related research! Here are some of the studies covered earlier on this blog.

Research into Dementia

There are many theories of how different forms of dementia arise and more are being developed. Alzforum provides a useful overview of current hypotheses. There were a number of theories covered in the blog. A potential marker of glial cell activity was identified in one study which found increased uptake of the compound [11C]DAA1106 in people with Alzheimer’s Disease suggesting that glial cell activity might be increased. There was some indirect evidence for a more protective role of the Val-Met form of Brain derived Neurotrophic Factor compared to the Val-Val form. The association of polyunsaturated fats and the healthy aging brain were reviewed in one paper. Gingival bleeding was associated with reduced performance on the Serial Digit Learning Test and loss of periodontal attachment was associated with impairment in the Symbol Digit Substitution Test in the NHANES III Community sample of 5138 participants aged 20 to 59 years old. Perhaps dental health over a long time period may be of relevance to dementia although the evidence should ideally come from longitudinal studies. A variant of the KIBRA gene has been associated with risk of Alzheimer’s Disease and episodic memory. In Nature there was a discussion of a gene for regulating Calcium that has been implicated in Alzheimer’s Disease. Vascular resistance was associated with vascular dementia but not Alzheimer’s in another study. Sarkar and Rubisztein review the process of autophagy, whereby a cell breaks down its own constituents and review a number of promising related agents that may be useful in neurodegenerative disorders. Evidence for predictors of Alzheimer’s Disease affecting cognitive performance in childhood has been found in one study. An association between the nicotinic acetylcholine receptor (CHRNA7 – T allele of rs6494223) and delusions in Alzheimer’s Disease is suggested by research published in Neuromolecular Medicine. A post-mortem of 124 people with diabetes  found there were less neuritic plaques if they had been taking insulin together with their medications. The authors of a post-mortem study in people with Huntington’s Disease found a significant reduction in hypocretin-1 neurons compared to controls in the prefrontal cortex and CSF although the clinical significance is unclear. The findings in a study of Rem Sleep Behavioural Disorder in Parkinson’s Disease suggest that this may be a sub-type of Parkinson’s Disease. They found that if the sleep disorder occurred, then the tremor was less marked in the Parkinson’s Disease, that people were less responsive to the medication and had a higher frequency of falls. The rate at which the brain atrophies has been associated with cognitive decline and also with the risk of progressing to dementia. ‘Theory of mind’ has been found to be impaired in Alzheimer’s Disease and Frontotemporal Dementia relative to healthy controls with an evidence base building up for the relationship with dementia.

There were a few drug trials covered, looking from different perspectives. Thus in the prospective Rotterdam study involving 6992 subjects, taking statins was associated with a significant reduction in the risk of Alzheimer’s Disease – the Hazards Ratio was 0.57 with a 95% confidence interval of 0.37-0.90. A 16-week double-blind placebo-controlled trial of Galantamine in 69 people with Parkinson’s Disease without dementia found no improvement on a number of cognitive, behavioural or motor outcomes although there was a statistically significant drop-out due to GI side-effects and worsening Parkinson’s Disease symptoms. The relationship between anticholinesterase inhibitors and circadian rhythms was reviewed in one paper. Administration of Memantine to women at risk of Alzheimer’s impaired memory and verbal learning while improving executive functioning.

A few studies looking at different aspects of service delivery were also covered. Thus the delivery of a telephone-based service for carers of people with dementia was found to lead to significant improvements in caregiver burden scores. The authors of a systematic review of common activities of daily living scales used in dementia conclude that further data on their psychometric properties is needed to justify their widespread use. Krinsky-McHale and colleagues published the results of a new test which can help in the early identification of Alzheimer’s disease in people with Down’s syndrome.

Studies building on established knowledge were covered. Thus doubling times for the incidence of Alzheimer’s Disease was found to be approximately 5 years in one recent study which showed no significant geographic difference in these doubling times. A study of 3303 brains has shown that in 53% of cases, dementia consists of mixed pathology. The authors conclude that synucleopathies uncommonly occur alone. A recent post-mortem study of 524 people who had dementia showed a breakdown of Alzheimer’s Disease – 42%, vascular dementia – 24%, combined Alzheimer’s and vascular – 22% and fronto-temporal dementia – 4%. 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.

Mild cognitive impairment is an area of increasing research activity and a number of papers were covered. In a study of 1969 people (329 with MCI) the group with MCI were found to have an OR of 8.12 for delusions (95% CI 2.92-22.60) which however were rare in both groups. Apathy was more common in both groups with an OR of 4.53 although interestingly the OR for depression was 2.78. A paradox which needs explaining is the finding that the risk of MCI conversion to dementia decreases as time progresses. In another study there was a finding that nearly half of cases of vascular cognitive impairment non-dementia resolved spontaneously. In a post-mortem study (open-access article) of people with Alzheimer’s Disease or mild cognitive impairment, the authors concluded that when the disease is widespread that agreement between pathologists is good but in the initial stages of the disease there is a need for standardisation of the sampling method and also a need for two pathologists to confirm the results. 45% of people with vascular cognitive-impairment non-dementia reverted in this 1-year follow-up study. A phase II trial of AL-108 in mild cognitive impairment showed an improvement in memory whilst a combination of oral diabetes drugs and insulin results in less amyloid plaques (which accumulate in Alzheimer’s Disease) in the brain.

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). Developing this theme further, there have been a number of studies reinforcing the importance of the hippocampus in memory and also looking at factors which may influence hippocampal volume. Thus Hippocampal volume has been found to be predictive of memory performance in aging pilots. Being an ApoE4 carrier also had some predictive value. An MRI study of hippocampal volume in medical doctors and controls with no tertiary education found no significant difference between the doctors and the control group. Length of time in medical practice also had no effect on volume. The authors conclude that as there is an effect for taxi drivers, hippocampal volume is most likely to increase in volume in response to a need for large scale spatial mapping. A study of 21 women has found that there are variations in hippocampal volume with the menstrual cycle, with an increase in anterior hippocampal volume and decrease in right dorsal basal ganglia volumes after menstruation, as well as an improvement in verbal declarative memory during this time. A link has been suggested between vascular endothelial growth factor and the size of the hippocampus. There is a special issue of Hippocampus dedicated to grid cells. These are special types of cells in the Entorhinal Cortex similar to place cells except that they code for a larger part of the environment.

There were also a number of studies that looked at the molecular biology of plaque formation including plaque precursors covered. A new in vivo screening process for compounds which interfere with the development of ABeta plaques was developed and involved the use of folate. There is evidence for Amyloid deposition in Lewy Body Dementia but very low levels in Parkinson’s Disease(PDD) or PDD+. ABeta42 levels were found to be lowest in people with Lewy Body Dementia compared to other types of dementia in one study but highest in Alzheimer’s Disease. In a study of 35 older adults, serum Beta-Amyloid levels were correlated with worse peformance on cognitive testing.

In a study of apathy (measure using the Apathy Evaluation Scale) in people with dementia, apathy was more likely if the person was living with someone other than their spouse and was also associated with irritability and functional impairment. Executive dysfunction predicted functional abilities in the elderly with cognitive impairment in one study.

Research into Psychosis

Prediction of developing schizophrenia from those at high risk was the focus for a number of studies. Thus Ultra-high risk of conversion to schizophrenia was associated with metabolic processing in the corpus callosum and in another study with the structure of the anterior cingulate cortex. A study published in the journal Psychological Medicine looking at 900,000 schoolchildren found that those who received an E grade had a higher risk of developing schizophrenia. This suggests that in some people who are having difficulties with exams this may be an early sign of developing a psychotic illness. A cautionary note however is that this finding is non-specific. People may have difficulties with exams for a number of reasons and people who do well at school may go on to develop psychosis. Enuresis in childhood has been associated with later development of schizophrenia – although it should be emphasised this is an association study and not causal. There was also some evidence of childhood bullying leading to an increased likelihood of psychosis. In this cohort study of 6872 people, there was found to be a 4 fold increase in prevalence of schizophrenia spectrum disorders with maternal haemoglobin concentrations less than 10gm/dl and the authors recommend further studies to confirm the relationship. The results of one study suggest that If mothers in second month of pregnancy during the six day war they were 4.2 more likely to have children with schizophrenia than mother’s pregnant at other times. The authors of a case study found an association between schizophrenia and middle ear disease.

There were various studies looking at cultural aspects of psychosis and related conditions from many different perspectives. A study of unmet need in East Timor looked at 1544 people in urban and rural areas and found a DSM-IV point prevalence of 1.35% for psychosis and 1.47% for PTSD and that psychosis was usually treated by traditional healers. There was found to be a significant inverse relationship between Gross Domestic Product and duration of untreated psychosis in this study in the British Journal of Psychiatry. A chinese study of 137 families with 2 or more members with schizophrenia showed significant familial aggregation in a number of categories including the DSM-IV categories of schizophrenia and positive symptoms.  ‘The Truman Show’ delusion was reported on in this article – based on case studies where people believe their lives are similar to the character from the Truman show. In this film, Jim Carrey’s character is living in a television program and provides the ‘entertainment’ for television viewers following his life (unbeknown to him!). Occurrence of paranoid ideation in a group of healthy volunteers from Iran was comparable with results from Europe.

A number of drug trials looked at different aspects of treatment ranging from receptor occupancy to various neuropsychological outcomes. A SPECT study in 46 people with schizophrenia looked at striatal D2 receptor occupancy rates in the case of four antipsychotics. They found the following upper limits for receptor occupancy: Risperidone – 75%, Olanzapine – 84%, Clozapine – 53% and Quetiapine – 64%. In a study of 15 people with schizophrenia, a benzodiazepine-like compound acting at the GABAa receptor was found to improve markers of prefrontal cortical function including performance on the N-back task (an open source game based on this task is freely available here) and in EEG gamma oscillations during preparation for tasks. A complex relationship has been found between the dosage of an antipsychotic and adherence to medication, with adherence varying according to time after initiation of medication and also between antipsychotics. A study funded by a number of pharmaceutical companies and presented in an open-access paper has found that a partial dopaminergic agonist Bifupronex (20mg) significantly reduced total PANSS scores in people with schizophrenia compared with a placebo group in this 6/52 double-blind placebo-controlled trial. In the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Schizophrenia Trial, estimated 10-year risk for CHD was compared in 1125 people followed who had been followed for 18 months. There was found to be a significant increase for the Olanzapine group of 0.5% (SE 0.3) and for Quetiapine of 0.3% (SE 0.3). The risk was decreased for perphenazine -0.5% (SE 0.3), Risperidone -0.6% (SE 0.3) and Ziprasidone -0.6% (SE 0.4). A study of 33 people with schizophrenia looked at smooth pursuit eye movements before treatment (patients were drug naive) and after treatment with olanzapine or risperidone. After treatment there was found to be a reduction in the gain of the eye movements which the authors speculate is related to serotonin’s role in sensorimotor processing. In a very interesting study in which medications were donated by a number of different pharmaceutical companies, there was found to be no difference in incidence of EPSE’s or in scores of EPSE’s between groups treated with first or second generation antipsychotics. There were a number of findings in the secondary analysis for individual antipsychotics.

There have also been studies examing neurodevelopmental and neurodegenerative models of schizophrenia. There have also been a number of very specific hypotheses with evidence to support them. In a study of twin pairs, the healthy twin of a sibling with schizophrenia was found to have greater whole brain volume reduction and frontal/temporal gray matter volume reduction over 5-years compared to twin pairs without schizophrenia. There is an article on neurodevelopment in childhood-onset schizophrenia showing a 2% slower rate of growth in the right hemisphere compared to controls. This is interesting in the context of a theory proposed by Crow. 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. 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. 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. A study found ‘Theory of Mind’ deficits in Schizophrenia but also found that the patterns of these deficits differed from one person to another. Evidence was found for changes in the expression of genes for sphingolipid/glycolipid metabolism in people with schizophrenia.

There were also a number of studies looking at neuropsychological function, adding to the already extensive evidence base in this area. Interventions including prompting recall of events and looking at identity improved autobiographical memory in people with schizophrenia. In a study of 119 people with first-episode psychosis (plus 107 controls) there was found to be an impairment in reinforcement and reversal learning (learning different responses for two stimuli and then reversing the responses). There was not a significant difference between the affective and non-affective psychosis groups. There was a significant association between reinforcement learning and negative symptoms however. One study showed a relationship between self-referential source memory (keeping track of one’s own responses) and social cognition in people with schizophrenia. In first episode psychosis, processing speed was found to be significantly reduced compared to controls and this was related to working memory problems and prognosis at one year. There was found to be a relationship between lissencephaly genes and executive dysfunction in schizophrenia and bipolar disorder. This might be signal a trend towards relating genes to components of an illness (e.g. executive function, memory etc), where these components come together produce an illness and would fit with the evidence suggesting the involvement of many genes.

Longer term outcomes including relapse were also covered. In a 2-year follow-up of first episode psychosis, concurrent substance misuse was the most significant predictor of relapse. Another study in the BJPsych found that a longer the period of untreated psychosis predicted poor social outcome.

One article suggested a trend towards OCD occuring prior to schizophrenia when it was a comorbidity although the authors suggest a need for further research to examine this relationship. In another study, people with schizophrenia were found to be less likely to receive treatment for medical conditions. An Australian study has found no difference between CBT for psychosis and treatment as usual in a group of 94 people with psychosis randomised to either group. The authors give a number of reasons why this might be so.

Research into Depression

In a Romanian study involving 170 subjects there was found to be no difference in effect on Beck Depression Inventory scores for Fluoxetine, Cognitive Therapy and Rational Emotive Behavioural Therapy. However the latter two were found to be more cost-effective. There was an open-label study of Citalopram in 54 people with traumatic brain injury (tbi) and major depressive disorder (mdd) treated for 6 weeks or 26 people (with tbi and mdd) treated for 6 weeks. The authors found that at 10 weeks, 26.9% of people were in remission and that the results were less than previous studies in people with tbi but equivalent to results in the general population. However it should be noted that there is no placebo group although this does reflect real world practice where both the patient and doctor know which treatment is being prescribed. The authors of a meta-analysis concluded that there was a 67.1% response rate for Mirtazapine and 62.1% response rate for SSRI’s with different side-effect profiles for each. A hydrolysed protein form of the tryptophan diet was found to have an advantage in effect on mood compared to other tryptophan diets or placebo. A cohort study (1946 British Cohort) found that 10 years after taking antidepressants, people were less likely to experience a mental disorder although the odds ratio of 0.3 had a 95% Confidence Interval of 0.1-1. Interestingly only a quarter of people were still taking antidepressants. In this randomised double-blind augmentation study in major depressive disorder, Fluoxetine plus Quetiapine achieved a more rapid improvement in insomnia but not a more rapid improvement in depression scores compared to fluoxetine alone. Quality of life improved in a large randomised double-blind placebo controlled trial of escitalopram in major depressive disorder or generalised anxiety disorder. However quality of life scores approached that of a community sample in remission in major depression but was less in generalised anxiety disorder. An intriguing application of N-Acetylcysteine, which is used in the treatment of paracetamol overdose, has been found to have some benefit in depression. N-Acetylcysteine is a precursor of Glutathione which is used in various cellular processes. Other research has found a reduction of Glutathione in depression although the relationship is probably far from straightforward

There have been a number of studies looking at neuroanatomical changes in depression. There was found to be a reduction in Anterior Cingulate Cortex volume in people with depression in a recent study and there was evidence that this was mediated both by depression and short term treatment. The Right Anterior Insula was activated in people with depression when anticipating painful stimuli in one study (together with the Anterior Cingulate Cortex and the Right Amygdala) perhaps suggesting a reduced ability to modify emotional responses in depression. In this prospective study of 38 patients with major depression (30 controls) there was found to be a significant reduction in grey matter volume in the hippocampus, right dorsomedial prefrontal cortex, left amygdala and anterior cingulum. There were also found to be differences in the grey matter volume changes between remitters and non-remitters

There were also some studies looking at predictive models of depression. A new scale for measuring ruminative thought – the ruminative thought style questionnaire has been developed to reduce bias from depressive symptoms. This has been found to differ from the standard measure the Response Style Questionnaire in both the constructs being measured and also displaying improved prediction of future depression. The Health in Men study found a correlation between Homocysteine levels and risk of depression. 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. A study of 800 children found that those of low birth weight were more likely to develop anxiety and depression.

There were also a number of studies looking at the relationship between cardiovascular (or related) disease and depression. Licht and colleagues found decreased heart rate variability in 774 people with major depression in remission, 1075 with current major depression versus 524 controls in the Netherlands Study of Depression and Anxiety and that this was correlated with use of antidepressants. Vogelzangs and colleagues in a study of 2088 people, found that depression measured at baseline was significantly associated with increased visceral fat and sagittal diameter at 5 years. There was found to be an association between major depressive disorder and CRP as well as a relationship between major depressive disorder and ischaemic heart disease which was independent of CRP in the EPIC-Norfolk study. In the Baltimore Longitudinal Study there was found to be no relationship between depression and carotid intimal media thickness in 566 participants examined between 1 and 15 years after inclusion (age 20-93 years).

Overcrowding on wards was associated with staff’s use of antidepressants in another study. 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. 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). People with panic disorder have reduced 5-HT1A binding pre and post-synaptically compared to controls using PET scanning and a 5-HT1A tracer. Research in Biological Psychiatry has further validated the concept of vascular depression in the elderly. The research showed remarkable specificity and sensitivity when using deep white matter lesions as criteria.

Research into Bipolar Disorder

An expert consensus meeting concluded that the Bipolar Disorder was more likely to be a neurodegenerative disorder than a neurodevelopmental one for some types of cognition. 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. In a placebo-controlled trial looking at augmentation of Valproate or Lithium with Aripiprazole (15-30mg daily) in the treatment of mania (treatment number = 253, placebo number = 131), the researchers found that there was significant improvement in Young Mania Rating Scale scores after six weeks (-13.3 v -10.7) and that improvement was noticeable after one week. 300 people with Bipolar I disorder (with mania) were randomised into treatment with Lithium or Valproate. The trial was relative short in duration at 12-weeks but non-inferiority of Valproate to Lithium was demonstrated using Young Mania Rating Scale scores. In the Archives of General Psychiatry there is free online access to a NIH funded study on Bipolar Disorder in children. This was an eight year follow-up study of 108 children (initially aged 7-16) showing at follow-up a higher prevalence of mania than the general population assessed using the WASH-U-KSADS. Research into bipolar disorder in children has produced a lot of debate.

Research into PTSD

Research indicates that Uganda has the highest prevalence of Post-Traumatic Stress Disorder in the world – estimated at just over 54%. The study was published in June in BMC Psychiatry. Researchers looked at more than 1200 people in 2006 during which time there was a war in northern Uganda. An alternative diagnostic process to DSM-IV criteria for diagnosing PTSD in children was used in this study and the researchers found that for the age group 7-10 years old, a combination of the child and parent’s report were better able to predicts PTSD, which in this case followed a motor accident. There were some other implications from this study in terms of diagnosis. PTSD was found to influence mortality rates in people who received implantable defibrillators. A study of PTSD in WWII prisoners of war found that higher IQ appeared to be a protective factor against developing PTSD and that PTSD was associated with performance on certain frontal lobe tests

An organisation working with vulnerable children, The Kids Company, are working together with the Institute of Psychiatry on research into the effects of trauma on children. In this article, there is an interesting comment on the funding that goes into supporting families with vulnerable children and the funding of superprisons, posing the question of whether it might be possible to prevent crime rather than manage it when it occurs by diverting resources. A study looking at Venlafaxine Extended release form in PTSD found that it had a variable effect on resilience scores using the Connor Davidson Resilience Scale. The authors recommend the use of such measures in evaluating response in PTSD. A fascinating study has found that people with PTSD are less likely to respond to CBT if they have impairments in verbal memory. An association has been found between an ice storm in Quebec and developmental delay in children born to mothers who were pregnant during the storm. In the journal Child and Adolescent Psychiatry and Mental Health, a study followed up children with juvenile dissociative disorder and found that 83% of the people met criteria for a psychiatric disorder (an average of 12 years later). Furthermore just over 25% still experienced a dissociative disorder.

Research into ADHD

A Magnetic Resonance Spectroscopy study of 31 children with ADHD who had not been treated with psychostimulants and 36 healthy controls found that membrane phospholipid precursor levels in the prefrontal cortex were  decreased in the ADHD group and were higher in the inferior parietal region. The authors interpreted this to mean this as a developmental dysfunction in cortico-striato-thalamo-cortical networks .

Research into Anxiety Disorders

A meta-analysis of internet and computer based CBT packages found them to be superior to placebo, waiting list and therapist delivered CBT across a range of anxiety disorders although the authors comment that large scale studies are required to confirm their findings. In another study there was found to be an increased risk of developing a heart attack of 1/3 in those who had panic disorder under the age of 50.

Research into OCD

A small randomised double-blind placebo study in the American Journal of Psychiatry suggests that compared to placebo, Olanzapine leads to higher weight gain and reduction of obsessive symptoms. The authors advise that further trials are warranted to replicate these findings. 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.

Research into Personality Disorder

There were a number of large studies looking at Personality Disorder and adding to the knowledge base of these complex diagnostic categories. In a Norwegian twin study involving 2794 members of the Norwegian Institute of Public Health Twin Panel, one of the genetic factors was found to predispose generally to Personality Disorder rather than to specific subtypes while two others related to high impulsivity and introversion. There was also found to be a lower prevalence of borderline personality disorders in Spanish immigrants compared to the indigenous population particularly in Asia and Sub-Saharan people. Three subtypes of Narcissistic Personality Disorder are proposed on the basis of one survey of 1200 clinicians and includes the fragile subtype, malignant/grandiose subtype as well as the high-functioning and exhibitionist subtype. In the National Epidemiologic Study on Alcohol and Related Conditions (n = 43093) there was an association between higher than normal body weight and paranoid, avoidant and antisocial personality disorders in women, being underweight and schizoid personality disorder in women and being underweight and paranoid personality disorder in men. One study reported that prison psychiatric inpatients with tattoos are more likely to have antisocial personality disorder.  This study was carried out in prison, where there is a higher prevalence of antisocial personality disorder. This provoked lots of responses including points about tattoos being a cultural phenomenon (e.g. depending on fashion) and also different types of tattoos may vary in their significance. Check out the Shrink Rap Blog for a perspective on this study.

Research in Learning Disability Psychiatry

In one study People with Cornelia de Lange syndrome were found to have a higher rate of severe autistic phenotypes. In a Japanese study of 84 people with high-functioning autism and 208 controls there was found to be a significant association between paternal age and high-functioning autism.

Eating Disorders (and related) Research

Ghrelin and Obestatin secretion was found to be subtly altered in women with anorexia compared to controls. A study involving 3000 children and looking at a variation of the FTO gene, which has been implicated in obesity, has shown that those with the gene were less likely to feel full than those without that variant of the gene.  Metabolic syndrome was associated with individual and neighbourhood socioeconomic status in women but not men. In an analysis of the Rotterdam study it was found that total cholesterol was positively correlated with sleep duration.

Liaison Psychiatry

In a study of 193 people admitted to hospital with coronary artery disease perceptions of serious consequences of CAD were found to influence adherence. One of the strongest predictors was ‘social desirability’. The World Mental Health Survey which included 18 population surveys of households in 17 countries using the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI) found that people with Rheumatoid Arthritis had an OR of 1.9 for mood and anxiety disorders and 1.5 for alcohol abuse/dependence when compared to people without Rheumatoid Arthritis. A study by Christodolou and colleagues characterised people who were transferred from medical/surgical beds to a psychiatric ward finding higher rates of mood disorders and specific demographics such as being single, living alone and belonging to a lower socioeconomic class. A meta-analysis of non-pharmacological treatments for cancer-related fatigue has found that both exercise and a range of psychological interventions are roughly similar in their benefits.

Substance Misuse

A study looking at 40 men drinking beer in a bar found that louder music made them drink more quickly. Research has found a specific alteration of the immune response in people with alcohol dependence. The researchers found that the neutrophil’s ‘respiratory burst’ was reduced. When neutrophils ‘consume’ bacteria or foreign particles, they are thought to destroy them using this respiratory burst which involves the action of powerful enzymes such as Superoxide Dismutase. Other research has begun to identify some of the brain changes that might occur in Foetal Alcohol Spectrum Disorder (FASD). A survey of 289 members of Alcoholics Anonymous found an increase rate of smoking and that smokers reported that it impacted on their mood. An analysis of UK Radio DJ’s comments on alcohol reveals a tendency towards encouraging alcohol use. There was found to be evidence for reduced prefrontal cortical thickness in cocaine dependence which was correlated with reduced behavioural repertoire. There was also reduced cortical thickness heterogeneity and evidence of a neuroanatomical differences that may contribute to predisposition to dependence. A study looking at smokers and non-smokers associated the pleasurable feeling of smoking and going on to become a smoker with a variation in the nicotine receptor CHRNA5 (having the less common rs16969968 variant).

Child and Adolescent Psychiatry

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 and there were a very small number of mothers (12) who took part in the study. Further studies with larger numbers are required to draw firmer conclusions. Nevertheless there have been suggestions of a link with Oxytocin. In a study of 1970 children there was found to be a significant association between high or chronic levels of peer victimisation (using various measures) and parenting behaviours, parental income and physical aggression in children. Research has shown that the amount of REM sleep children and adolescents get can determine their likelihood to develop obesity.

The American Psychiatric Association has called on NBC to pull a program ‘The Baby Borrowers’ in which babies are looked after by another family for three days. Dr Richard Martini, an american Child and Adolescent Psychiatrist has suggested that the new Batman film, The Dark Knight, shouldn’t be watched by children under 10. His argument was that children find it difficult to differentiate between fantasy and reality and that the content was therefore unsuitable.

A study of 100 children who were exposed to irradiation prenatally from the Chernobyl nuclear reactor revealed differences between these children and 50 controls (classmates) including left brain neurological findings, lower IQ and a number of EEG finding. In Ireland, official figures released, show that 3600 children are awaiting assessment by a psychiatrist and of these 1000 children may have to wait more than a year. In the city of Chandigarh in India, a recent study was carried out showing that 25% of adolescents have mental health problems. Professor Arun’s study looked at 2000 children in 10 schools across the city.

Miscellaneous

2008 was the year of the Olympics and Great Britain returned in 4th place. Psychiatrist Dr Steve Peters, the coach for the olympic cycle team which achieved gold in the recent olympics was extensively covered in the news. Another big story, this time from the United States was some research showing that psychiatrists are doing less psychotherapy and more prescribing which was published in the Archives of General Psychiatry. This may reflect a changing role of psychiatrists. In the UK, there was a recent profession-wide statement released about the role of a doctor.

There was much discussion about the controversial topic of  internet addiction. The term ‘discomgooglation’ was given to the frustration at being removed from an internet connection.  Some recent research has drawn attention to the potential for fruit juices (orange, apple and grapefruit juice) to interact with certain medications. Harrison and Tunbridge argue in a review that the COMT gene may predispose men and women differently to psychiatric illnesses. Rathore and colleagues found in a study of 53,314 people receiving Medicare that those with a mental illness diagnosis had a higher 1-year mortality (41% v 36.2%) .

A National Conference on Depression has been held in Pakistan where it has been reported that there are 400 psychiatrists for each 1.6 million of the population and where alternative methods of treatment for mental illness may be favoured in some parts of the country. 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. A request by the Indian Psychiatric Association for judges to have psychiatric training has been made.

In the Whitehall II prospective study of 65000 civil servants published in the BMJ and also covered here the researchers found that those who had taken a long period of sick leave were 66% more likely to die early. In the Health Services Journal, Helen Bevan who has experience of over 70 national improvement initiatives writes very positively about the ‘Productive Ward’ covered earlier in the blog. Andrea Greatley commented on media portrayal of mental health issues.

A study has shown that gossip can help to establish reputation and helps people to trust each other. In 768 participants in the Rotterdam Study there was found to be a significant association between duration of sleep and total cholesterol levels which was predicted by length of time in bed and fragmented sleep. Paternal age was associated with impairment in social functioning if the father was less than 20 years old or over 45-years old. A qualitative study of 13 studies of brain injury found that there were no differences in functional outcome between men and women with moderate to severe brain injury. There was a discussion of planar cell polarity genes which determine the morphology of neurons and influence developmental trajectories. There have been a number of cases of transcranial magnetic stimulation being used with some degree of success in coma. In the editorial in Nature Genetics there is discussion of a study in the same issue in which relatively common polymorphisms in structural variants are found to account for much of the variation between individuals in a population. In an fMRI study in people with depersonalisation 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. Using medication to augment learning in behavioural therapy is an interesting approach and a meta-analysis of the use of D-cycloserine in exposure therapy has shown benefits for this method. A novel study to look out for is one about near-death experiences. The idea behind the study is that books will be placed on shelves that are only visible from the ceiling. People awaking after operations very occasionally describe these experiences of floating above their body and witnessing the operation.

There was certainly a lot of very interesting research carried out in 2008 and 2009 may be even more interesting yet!

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.