2009 starts with more interesting research studies including a finding on standardised mortality rates for all causes in women who received inpatient treatment for anorexia although the authors draw a number of cautions.
Research in Mood Disorders
There is an interesting editorial in the latest BJPsych by Professor Gordon Parker from the Black Dog Institute which looks at some of the reasons why a meta-analysis might produce results different from those seen in clinical practice. This follows on from the 2007 meta-analysis by Kirsch and colleagues. There are some really good points made here amongst which are the sample population in RCT’s (many people with more serious depression may be excluded from trials) as well as expectations of improvement which needs to be compared with pre-morbid functioning* (STT2). A 12-week double-blind trial (n=485) of Aripiprazole v Haloperidol (5-15mg) in bipolar mania or mixed states found both to be significantly better than placebo in improving Young Mania Rating Scale scores* (STT2).
Research into Eating Disorders
A retrospective cohort study of Swedish women treated for anorexia in an inpatient setting showed a Standardised Mortality Ratio for all causes of death of 6.2. The authors caution that as treatment was in the inpatient setting it was likely to represent more severe illness. The risk was still elevated some 20 years after the initial admission although this decreased over time (STT2).
Research in Psychosis
There is a critical period hypothesis which states that there is a critical period of a psychotic illness during which time deterioration occurs more rapidly. In an 8 year prospective cohort study of people with first-episode psychosis the duration of untreated psychosis predicted outcome at the end of the study. However due to the study type there was no comparison group. The authors suggest that the prodromal period should be included within the critical period (STT3). An imaging study with 17 people at risk of psychosis, 10 with psychosis and 15 controls found that there were intermediate patterns of activation in the at-risk group between controls and those with psychosis. Specifically this involved the anterior cingulate cortex and inferior frontal cortex in a verbal fluency task and the dorsolateral prefrontal cortex, inferior frontal cortex and parietal cortex in the N-back task (STT4).
Research in Dementia
A relatively large 12-month follow-up study of 325 people who had undergone 123I-FP-CIT-SPECT scans found that the SPECT scans were useful in discriminating Lewy Body from non-Lewy Body Dementia. A rating panel utilised other clinical measures of the presentation. These ratings were then compared with the SPECT scan results. In the probably Lewy Body Dementia group the sensitivity was 63% and the specificity was 100%. It would be interesting to see the results at two years (STT2). There is a description of a care pathway for advance decisions and power of attorney for use in people with Huntington’s Disease (STT2).
* A Declaration of Interest statement is included in the article
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