In the news this week, there has been wide reporting of a new screening test for Alzheimer’s Disease developed by a group in Cambridge. A Japanse group has also identified a new CSF protein that may be a surrogate marker for the disease process also. There have also been a number of findings presented at a recent sleep conference and some interesting findings in PTSD.
Research in Mood Disorders
A small case-control study involving people with Bipolar Disorder, unaffected first-degree relatives and controls and using Diffuse Tensor Imaging found evidence of reduced structural integrity in the corpus callosum genu as well as the left superior and right inferior longitudinal fasciculus. There was also evidence of distributed areas of reduced structural integrity in unaffected relatives but it will be interesting to see the results of larger replication studies (Chaddock et al, 2009). In a study with 86 subjects, people with intermediate onset bipolar disorder were found to have increased a significant reduction in sulcal index in the right prefrontal cortex compared to controls and people with early onset bipolar disorder (Penttilä et al, 2009).
Research in Liaison Psychiatry
In a systematic review which included 27 studies comparing medical care in those with mental illness and 10 in those with substance misuse versus a control group the results were heterogenous. Some of the studies showed evidence of decreased medical care while others showed improvement in some areas (Mitchell et al, 2009).
Research in Dementia
A recent study in Brain provided evidence for discriminating primary progressive aphasia (semantic type) from semantic dementia including changes in the middle and superior temporal gyri and inferior and medial temporal lobes (Mesulam et al, 2009). Putamen volume was found to be decreased in people with Frontotemporal dementia compared to people with Alzheimer’s Disease in one small structural MRI study (Looi et al, 2009). A retrospective post-mortem study provided further evidence of an overlap between Alzheimer’s Disease, Frontotemporal Dementia and Lewy Body Dementia using current diagnostic criteria (Piguet et al, 2009). A recent secondary analysis provided evidence that the Clinical Dementia Rating scale has remained valid for over three decades by correlating the scores with those of other psychometric measures (Williams et al, 2009). In a location-matching task – a visual task there was found to be less activation on fMRI in people treated with Galantamine for 3 months in this small study (Bokde et al, 2009). A swedish follow-up study of up to 40 years showed a significant increase in risk of all-type dementia in people with mid-life obesity (odds ratio 1.59 p=0.002) as well as an increased risk of Alzheimer’s Disease and Vascular Dementia (Hassing et al, 2009).
Research in Psychosis
Lurasidone was found to significantly improve Brief Psychiatric Rating Scale scores in people with schizophrenia and an acute psychosis in this 6-week randomised double-blind placebo-controlled trial (n=90 in each arm of the trial) in Japan (Nakamura et al, 2009). In a small open-label trial of augmentation with Donepezil in 28 people with schizophrenia there were found to be significant improvements in attention, memory and other cognitive measures (Chung et al, 2009).
Research in Neurotic, Stress-Related and Somatoform Disorders
In a study which looked at 532 Norwegian people who had experienced the 2004 Tsunami in South-East Asia, the authors repeated measurements of the perceived life threat using a 5-point Likert scale which appears to have been designed for use in this study and which appears to have been validated within the study by correlating with other measures of danger perception. The authors describe an effect they refer to as recall amplification whereby the perceived threat of the original event increased with time. The authors conclude that their data suggests the current diagnostic criteria for PTSD should be reconsidered particularly as the recall amplification occured independently of the type of events or severity of PTSD symptoms* (Heir et al, 2009).
Research in Learning Disability
In a large study which involved the use of 11,700 questionnaires for primary school children and the use of the Special Educational Needs register (and ICD-10 research criteria) in Cambridgeshire, the authors produced a revised prevalence estimate of 157 cases of autistic spectrum disorder in every 10,000 (Baron-Cohen et al, 2009).
News in Brief
A tool that takes roughly 5 minutes to complete has been validated in a study which was published in the BMJ and detected 93% of people with Alzheimer’s Disease. Further studies will be needed but this has potential as a clinically useful tool (This paper has been reported widely in the media e.g. here, here, here, here and here). Researchers in Japan have identified a new CSF peptide (APL1beta28) that is associated with brain levels of ABeta42. Another study looked at risk factors that discriminated those who developed cognitive impairment from those who did not and found evidence that protective factors included exercise, not smoking, education and living with a partner. Mild cognitive impairment was associated with a 50% increase in mortality compared to controls and Alzheimer’s Disease was associated with a 300% increase in mortality compared to controls in this longitudinal study with 10-year follow-up. Intermittent exotropia in boys was associated with a higher use of psychiatric services in one study and it will be interesting to see follow-up studies in this area to validate and further clarify the association. Preliminary evidence suggests a reciprocal relationship between APP and a protein called Reelin where higher levels of Amyloid Precursor Protein are associated with lower levels of Reelin.
There has been a recent sleep conference in which a number of interesting findings were reported. Evidence that a number of interventions were effective in insomnia including meditation and CBT was provided while under certain circumstances there was an association between certain types of television and gaming use and insomnia or sleep debt. In a small fMRI study, people with chronic insomnia were found to have increased levels of activation particularly in visuospatial areas compared to a control group when tested on a working memory task***. In another study looking at adults with an average age of 40, less hours of sleep was associated with higher blood pressure. The researchers in a twin study found evidence that intrusive thoughts was associated with the stress-related insomnia. Increased sleep fragmentation was associated with a significant increase in mortality in this longitudinal study involving 5614 subjects. Older adults (aged 59-82) performed better than younger adults (aged 19-38) on cognitive tests after sleep deprivation in one study. In one study nearly 93% of people with SLE were found to psychiatric conditions including anxiety and depression while in another study 63% of people with Rheumatoid Arthritis were found to have psychiatric conditions predominantly depression and as with previous studies was associated with the characteristics of RA.
A recent study provided evidence that people conceptualise objects that are grouped together as more likely to share similar properties. Subjects were more likely to choose from a widely spaced group if they knew one or more of the objects had defective parts and more likely to choose from closely grouped objects if they knew one or more contained gift coupons**. Another study found that students were able to retain more information when presented with powerpoint slides without the use of animation to add information to the slide in stages. In a Swedish survey of 4500 people it was found that there were more older people (aged 65-79) online and that for all ages, 8% of online activity was spent in the ‘blogosphere’.
* However it can be argued that recall amplification may be secondary to recurring nightmares or flashbacks. The researchers noted for instance that if people had recall amplification, PTSD did not improve in severity between 6 and 24 months.
** From an evolutionary perspective, this complements the results of another study looking at chimpanzees and finding that they forage for fruits over wide distances and have good recall of trees that are bearing fruit in season. This ability to group objects would be helpful in scanning large areas for food and needing to economically remember where food of interest is located.
*** This may tie in with other research showing increased levels of metabolic activity in a ‘cortical hub’ in Alzheimer’s Disease.
Baron-Cohen S, Scott FJ, Allison C, Williams J, Bolton P, Matthews FE, Brayne C. Prevalence of autism-spectrum conditions: UK school-based population study. Br J Psychiatry. 2009 Jun;194(6):500-9.
Bokde AL, Karmann M, Teipel SJ, Born C, Lieb M, Reiser MF, Möller HJ, Hampel H. J Clin Psychopharmacol. 2009 Apr;29(2):147-56. Decreased activation along the dorsal visual pathway after a 3-month treatment with galantamine in mild Alzheimer disease: a functional magnetic resonance imaging study.
Chaddock CA, Barker GJ, Marshall N, Schulze K, Hall MH, Fern A, Walshe M, Bramon E, Chitnis XA, Murray R, McDonald C. White matter microstructural impairments and genetic liability to familial bipolar I disorder. Br J Psychiatry. 2009 Jun;194(6):527-34.
Chung YC, Lee CR, Park TW, Yang KH, Kim KW.World J Biol Psychiatry. 2009;10(2):156-62. Effect of donepezil added to atypical antipsychotics on cognition in patients with schizophrenia: an open-label trial.
Hassing LB, Dahl AK, Thorvaldsson V, Berg S, Gatz M, Pedersen NL, Johansson B. Int J Obes (Lond). 2009 Jun 9. [Epub ahead of print]. Overweight in midlife and risk of dementia: a 40-year follow-up study.
Heir T, Piatigorsky A, Weisaeth L. Longitudinal changes in recalled perceived life threat after a natural disaster. Br J Psychiatry. 2009 Jun;194(6):510-4.
Looi JC, Svensson L, Lindberg O, Zandbelt BB, Ostberg P, Orndahl E, Wahlund LO.AJNR Am J Neuroradiol. 2009 Jun 4. [Epub ahead of print]Putaminal Volume in Frontotemporal Lobar Degeneration and Alzheimer Disease:Differential Volumes in Dementia Subtypes and Controls.
Mesulam M, Rogalski E, Wieneke C, Cobia D, Rademaker A, Thompson C, Weintraub S.Brain. 2009 Jun 8. [Epub ahead of print] Neurology of anomia in the semantic variant of primary progressive aphasia.
Mitchell AJ, Malone D, Doebbeling CC. Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies. Br J Psychiatry. 2009 Jun;194(6):491-9.
Nakamura M, Ogasa M, Guarino J, Phillips D, Severs J, Cucchiaro J, Loebel A. J Clin Psychiatry. 2009 Jun 2. [Epub ahead of print] Lurasidone in the treatment of acute schizophrenia: a double-blind, placebo-controlled trial.
Penttilä J, Cachia A, Martinot JL, Ringuenet D, Wessa M, Houenou J, Galinowski A, Bellivier F, Gallarda T, Duchesnay E, Artiges E, Leboyer M, Olié JP, Mangin JF,Paillère-Martinot ML. Bipolar Disord. 2009 Jun;11(4):361-70. Cortical folding difference between patients with early-onset and patients with intermediate-onset bipolar disorder.
Piguet O, Halliday GM, Creasey H, Broe GA, Kril JJ. Int Psychogeriatr. 2009 Jun 4:1-8. [Epub ahead of print]. Frontotemporal dementia and dementia with Lewy bodies in a case-control study of Alzheimer’s disease.
Williams MM, Roe CM, Morris JC.Arch Neurol. 2009 Jun;66(6):773-7.Stability of the Clinical Dementia Rating, 1979-2007.
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