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PsychDigest April 2007

From the editors..................................................................................................................................................3 IN THE NEWS ....................................................................................................................................................5

Substance Abuse ............................................................................................................................................5 Mood disorders ...............................................................................................................................................5

Antidepressants may reduce alcohol consumption in depressed men.......................................................5 Physical symptoms of depression may be early signs of artery disease ....................................................6 Heart rate variability biofeedback useful for major depression disorder .....................................................6

Adjustment disorders ......................................................................................................................................7 'Stages of grief' theory challenged ..............................................................................................................7

Impulse control disorders ................................................................................................................................7 Intermittent Explosive Disorder — more common than believed? ..............................................................7

Chromosomal abnormalities ...........................................................................................................................8 Drug may treat mental symptoms of Down's syndrome..............................................................................8

Therapies: studies and developments................................................................................................................9 Music therapy and music in therapy ...............................................................................................................9

The effect of music on post-stress recovery ...............................................................................................9 Music therapy may be effective for children and adolescents with psychopathology.................................9

REVIEW ARTICLES .........................................................................................................................................10 Therapies ......................................................................................................................................................10

Cognitive-behavioural therapy – how effective is it? By Dr Thomas Groenewald, Psych & Soma ..........10 ORGANIC MENTAL DISORDERS ...............................................................................................................13

Alzheimers & Dementia — Prevention and Intervention ...........................................................................13 DISORDERS OF PSYCHOLOGICAL DEVELOPMENT ..............................................................................14

The early detection of autism spectrum disorders in young children ........................................................14 The etiology of schizophrenia....................................................................................................................17

DRUGS & MEDICATION .................................................................................................................................20 Drugs & medication in the news ...................................................................................................................20

Antipsychotics and sedatives may hasten deterioration in Alzheimer's disease ......................................20 Zyprexa will remain the gold standard for the treatment of schizophrenia through 2015 .........................21 Invega may help with schizophrenia symptom control..............................................................................21

Drug approvals..............................................................................................................................................21 Cymbalta approved for generalised anxiety disorder................................................................................21 Escitalopram approved for OCD in the EU ...............................................................................................22

SPYKER: NEWS OF THE UNUSUAL .............................................................................................................22 Birds plan for the future .............................................................................................................................22

FROM THE ARCHIVES ...................................................................................................................................23 Forensic psychology .....................................................................................................................................23

Solving cryptic crosswords may impair your ability to recognise faces.....................................................23 Web Resources ................................................................................................................................................24

Websites of interest.......................................................................................................................................24 Case studies from the Australian Institute of Professional Counsellors....................................................24

Podcasts .......................................................................................................................................................24 Ethics in medicine and mental health........................................................................................................24 Good and evil ............................................................................................................................................24 Do the right thing .......................................................................................................................................24

NEW BOOKS & PUBLICATIONS ...................................................................................................................25

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Methodology

Information for PsychDigest is harvested from the most reliable, relevant, current and comprehensive sources available, including information from leading publishers such as Elsevier, John Wiley & Sons, American Psychological Association (APA), American Psychiatric Publishing (APPI), Springer, Taylor & Francis, British Psychological Society, the American Medical Association, the Australian Academic Press, Guilford Press, Blackwell Publishing, Cambridge University Press, International Universities Press, Sage Publications, Routledge Mental Health, and Psychology Press. Psych & Soma also has access to databases such as ScienceDirect, EbscoHost, Proquest, PsycINFO, Academic Research Library, IngentaConnect, PubMed, SpringerLink, Medline, CurrentContents (Web of Science), Clinical Pharmacology, and Sabinet and SA Media. In addition to subscription-based journals, Psych & Soma also monitors quality-controlled scientific and scholarly open-access journals, which offer free and usually full text articles. We also keep an eye on more popular journals such as Science magazine, Scientific American, and New Scientist. These lists are by no means exhaustive, and new sources are added on a regular basis. All of these sources are not only monitored for relevant news items, but are also continuously reviewed for suitability. Various methods are used to keep up-to-date with the most current news in the fields of psychology and psychiatry: journal contents alerts, email alerts, website-monitoring software and services, RSS feeds (RSS stands for ‘real simple syndication’), blog news (‘blog’ is shorthand for ‘web log’; these are continuously updated news and article sites owned by individuals, groups or companies). Regular topical searches of databases and websites are further undertaken. Our expertise is based on an MA in humanities, an N.Dip in Library and Information Studies, and 17 years in the information and technical editing fields (Martie), and a D.Phil in Human Resources Development (Thomas).

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The subscriber agrees to use PsychDigest at her/his sole risk. The content of PsychDigest is for the sole purpose of being informative and developmental. The content of PsychDigest is not and should not be used or relied upon as medical or other advice. The content should not be used in place of a visit, call, consultation or the advice of the subscriber’s physician or other qualified health care provider. Although every endeavour is made, Psych and Soma Information and Resources CC makes no representations or warranties about the accuracy, reliability, currentness, completeness, or timeliness of the content of PsychDigest. Under no circumstances will Psych and Soma Information and Resources CC, its members or its employees be liable for any loss or damage caused by a subscriber’s reliance on information obtained from PsychDigest. It is the responsibility of the subscriber to evaluate the accuracy, completeness or usefulness of any of the content of PsychDigest. In no event shall Psych and Soma Information and Resources CC or any third parties mentioned be liable for any damages (including, without limitation, direct, indirect, incidental, special, consequential or punitive damages, personal injury/wrongful death, lost profits, or damages resulting from practice interruption) resulting from the use of the content of PsychDigest.

April 2007. Vol. 1, No. 1

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FROM THE EDITORSFROM THE EDITORSFROM THE EDITORSFROM THE EDITORS

It is said to be fairly common, especially for first-time mothers, to watch their baby's due date come and go without so much as a contraction. Gynaecologists know that inducing labour is not like turning on a faucet: if the body is not ready, an induction may fail and is not without risk. All of this to say: The expected delivery date of the first edition of PsychDigest was 1 April 2007. Psych and Soma Information and Resources CC has devoted the time of a full-term pregnancy in building up good quality sources and systems, in order to give birth to PsychDigest. An unexpected attack of publishing gremlins, the ‘flu, and the side-effects of the prescribed medication caused complications during the last month. We sincerely apologise for the late birth of Vol. 1, No. 1 of PsychDigest, and we hope that it was worth the wait!

We had so much interesting material in our archives that we decided to offer you brief literature reviews of four topics in addition to some shorter news items, instead of a larger number of shorter items. These reviews focus on the effectiveness (or not) of cognitive-behavioural therapy; possible causes of, and intervention in the progress of Alzheimer’s disease; the early detection of autism spectrum of disorders; and new discoveries on the aetiology of schizophrenia.

Were you aware that solving of cryptic crosswords can impair your ability to recognise faces? And that ‘road rage’ can be blamed on a legitimate disorder described in the DSM-IV and the ICD-10? This issue contains news on these and many other interesting topics. We sincerely hope that you enjoy the journey.

Please send us your comments, criticisms, corrections etc. on this edition and the news items in it (contact details below). What would you, as subscriber, like to see more of? Less of? What did you like, and what can we do to improve our service to you? We will publish (at our discretion) any commentary, letters, short viewpoint articles, case studies, mini-research articles, reviews (literature, books), news items etc. if you give us your written permission. We will publish them anonymously, pseudononymously, or under your own name, as you prefer. Please include any details you wish us to publish with the item: your name, speciality, qualifications, even a short CV or biography if you wish.

Please note that, while some of the sources cited in PsychDigest can be accessed freely on the web, some articles or sources may require you to register as a user of a website or source. Such registration is usually free, and involves choosing a user name and password, and sometimes filling in a form with information that the owners or publishers of the site can use for user or marketing surveys. The sites are reputable, and will not use your information for other purposes than stated. Once registered, you can access all items from a particular website with your login details. Of course there are also the subscription-based items, which you either need to purchase, or have access to through a personal subscription or the subscription of a library or other institution. Should you have difficulty in accessing specific articles, Psych & Soma is prepared to serve as intermediary, and will charge only the actual cost of retrieving and providing the item: printing, postage, and where applicable the purchase of an article. In the case of article purchases, we may have to quote you an estimate based on the value of the Rand against the US$, British £, the Euro or other applicable currency, and any costs that may be associated with retrieving the article, such as interlibrary loans and document delivery (where we do not have access to full-text content). You will be charged only for the actual cost. The abstracts of articles are usually available from the publisher at no cost.

The next issue of PsychDigest will include news and comments from experts on the preliminary results from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) Project, articles on bipolar affective disorder in children and the elderly, new discoveries about the body clock, a simple test to distinguish between bipolar disorder and depression, a possible improved test for post-traumatic stress syndrome (PTSD), biodegradable medicinal products, and ethics in the mental health profession (download and listen to the interviews on ethics in the current issue).

Martie (Chief Editor) & Thomas Groenewald

Feedback can be mailed to Psych and Soma Informatio n and Resources, PO Box 252, Florida 1710 (South Africa), or emailed to [email protected]

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IN THE NEWSIN THE NEWSIN THE NEWSIN THE NEWS

SUBSTANCE ABUSE

Prescription drug abuse exceeds illicit street drug use world-wide

Abuse of prescription drugs is starting to overtake the use of illicit street narcotics world-wide. According to the UN-affiliated International Narcotics Control Board, a lethal new trade in counterfeit painkillers, sedatives, stimulants, tranquilisers and other medicines has sprung up. Unregulated markets in many countries make it easy for traffickers to peddle a wide variety of counterfeit drugs using courier services, the mail and the Internet. Prescription drug abuse has already outstripped traditional illegal drugs such as heroin, cocaine and ecstasy in parts of Europe, Africa and South Asia. In the USA, only marijuana is more popular than the non-medical use of prescription medication. Up to 50% of all drugs taken in developing countries are believed to be counterfeit. The very high potency of some of the synthetic narcotic drugs available as prescription drugs holds an ever higher overdose risk than the abuse of illicit drugs. Prescription drug abuse exceeds illicit street drug use worldwide, FoxNews.com, 1 Mar. 2007 (http://www.foxnews.com/)

Prescription drug abuse and diversion among adolescents in a southeast Michigan school district, by Carol J. Boyd, Sean Esteban McCabe, James A. Cranford, and Amy Young. Archives of Pediatrics & Adolescent Medicine, vol. 161, no. 3. Mar. 2007.

NIDA Responds to Escalating Prescription Drug Abuse, Psychiatric Times, vol. 22, no. 8. Jul. 2005.

U.S. drug prevention, treatment, enforcement agencies take on "doctor shoppers," "pill mills", Office of National Drug Control Policy, http://www.whitehousedrugpolicy.gov, 1 Mar. 2004.

MOOD DISORDERS

Antidepressants may reduce alcohol consumption in d epressed men

Antidepressants may decrease alcohol consumption in men with depression, but the same is not true for women. A Canadian study involving a surveyed sample of 14 092 Canadian residents between the ages of 18 and 76 found that both men and women with depression tend to drink more alcohol than their non-depressed counterparts. Whereas depressed men who took antidepressants had a similar level of alcohol intake as non-depressed men, depressed women drank more alcohol then non-depressed women, irrespective of whether they took antidepressants or not. The full text of the article is available for free from the Canadian Medical Association’s website http://www.cmaj.ca/:

Alcohol consumption and the use of antidepressants, by Kathryn Graham and Agnes Massak, Canadian Medical Association Journal, vol. 176, no. 5. 27 Feb. 2007.

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Source: Antidepressants may reduce alcohol consumption in depressed men, InPsychiatry.com, 1 Mar. 2007 (available online at http://www.inpsychiatry.com/news/article.aspx?id=64864

Physical symptoms of depression may be early signs of artery disease

Symptoms of depression, in particular physical symptoms such as fatigue and loss of appetite, may be early signs of coronary artery disease (CAD). There is considerable evidence that depression, anger and other negative emotions are associated with the risk for CAD. However, most studies have assessed the risk for heart attack or sudden cardiac death. In this study, regression analyses indicated that over a 3-year period, higher depressive symptoms at baseline were associated with a greater change in carotid intima-media thickness (IMT), a measure of the inner layers of the arteries that is related to early-stage CAD. On the other hand, anxiety symptoms, hostility, anger experience and anger expression were all unrelated to IMT change, suggesting that depression, but perhaps not anxiety and anger, may be involved in the initiation and/or progression of atherosclerosis.

Source:

Symptoms of depression linked to early stages of artery disease, Science Daily, http://www.sciencedaily.com, 20 Feb. 2007.

Heart rate variability biofeedback useful for major depression disorder

This abstract is published with kind permission from Springer Science and Business Media. Major depressive disorder (MDD) is a common mood disorder that can result in significant discomfort as well as interpersonal and functional disability. A growing body of research indicates that autonomic function is altered in depression, as evidenced by impaired baroreflex sensitivity, changes in heart rate and reduced,heart rate variability (HRV). Decreased vagal activity and increased sympathetic arousal have been proposed as major contributors to the increased risk of cardiovascular mortality in participants with MDD, and baroreflex gain is decreased. Study objectives: To assess the feasibility of using HRV biofeedback to treat major depression. Design: This was an open-label study in which all eleven participants received the treatment condition. Participants attended 10 weekly sessions. Questionnaires and physiological data were collected in an orientation (baseline) session and Treatment Sessions 1, 4, 7 and 10. Measurements and results: Significant improvements were noted in the Hamilton Depression Scale (HAM-D) and the Beck Depression Inventory (BDI-II) by Session 4, with concurrent increases in SDNN, standard deviation of normal cardiac interbeat intervals) an electrocardiographic estimate of overall measure of adaptability. SDNN decreased to baseline levels at the end of treatment and at follow-up, but clinically and statistically significant improvement in depression persisted. Main effects for task and session occurred for low frequency range (LF) and SDNN. Increases in these variables also occurred during breathing at one’s resonant frequency, which targets baroreflex function and vagus nerve activity, showing that subjects performed the task correctly. Conclusions: HRV biofeedback appears to be a useful adjunctive treatment for the treatment of MDD, associated with large acute increases in HRV and some chronic increases, suggesting increased cardiovagal activity. It is possible that regular exercise of homeostatic reflexes helps depression even when changes in baseline HRV are smaller. A randomized controlled trial is warranted.

Preliminary results of an open label study of heart rate variability biofeedback for the treatment of major depression, by Maria Katsamanis Karavidas, Paul M. Lehrer, Evgeny Vaschillo, Bronya Vaschillo, Humberto Marin, Steven Buyske, Igor Malinovsky, Diane Radvanski and Afton Hassett. Applied Psychophysiology and Biofeedback, vol. 32, no. 1. Mar. 2007. pp. 19-30.


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ADJUSTMENT DISORDERS

'Stages of grief' theory challenged

Researchers have found that the bereaved do go through stages of grief, but do not necessarily pass through the "five stages of grief" (disbelief, yearning, anger, depression and acceptance) predicted by the standard theory. They found that older people mourning a death by natural causes normally first go through the stage of yearning or pining for the lost loved one, followed by an acceptance of the loss. Acceptance is also the last emotion to reach its peak. Negative emotions such as anger had largely peaked by six months after the loss. This study suggests that if someone seems stuck in their grief after this time period, they may be having a more difficult time coping with their loss and may need counseling or additional support.

Study limitations

The study focused largely on a specific population: participants were predominantly white (97%), mostly spouses of the deceased (84%), and were an average of almost 63 years old. All of their loved ones had died of natural causes and had non-traumatic deaths. According to the study authors, this population represents the typical bereaved person in America. The study has been published in JAMA: Journal of the American Medical Association, 21 Feb. 2007.

More information on the study can also be found on the web from:

Stages of Grief Theory Put to the Test, HealthDay, 20 Feb. 2007 (http://www.healthday.com/)

Negative Grief Emotions Decline About 6-months After The Loss Of A Loved One, Science Daily</a>, 21 Feb. 2007 (http://www.sciencedaily.com/)

Negative grief emotions decline about 6 months after the loss of a loved one, EurekAlert, 20 Feb. 2007(http://www.eurekalert.org/pub_releases/2007-02/jaaj-nge021507.php)

IMPULSE CONTROL DISORDERS

Intermittent Explosive Disorder — more common than believed?

Intermittent explosive disorder (IED), a little known mental disorder marked by explosive outbursts that are disproportionate to the activating event, may be more prevalent than previously thought. A survey done in the USA from 2001 to 2003 revealed that as many as 7.3% of adults may suffer from the disorder, and that the mean age of onset of was 14. In the DSM-IV, IED is classified as an impulse-control disorder in which people have difficulty in controlling violent impulses that could result in serious assaults or the destruction of property. Some incidences of 'road rage' or domestic violence may be ascribed to this disorder. Symptoms usually appear during childhood or adolescence, and often exhibits co-morbidity with other mood disorders, particularly bipolar disorder, obsessive-compulsive disorders and anxiety disorders. Therapeutic intervention includes tricyclic antidepressants and serotonin reuptake inhibitors, GABAergic mood stabilizers and anticonvulsive drugs, and anxiolytics, depending on the pathopsychological symptoms and co-morbid disorders. Psychotropic drugs are most effectively used together with cognitive-behavioural therapy to help the patient achieve impulse-control, manage anger and relieve the emotional stress and affective changes that accompany or precede the outbursts.

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More detailed information about IED is available fr om:

The prevalence and correlates of DSM-IV intermittent explosive disorder in the national co-morbidity survey replication, Ronald C. Kessler, Emil F. Coccaro, Maurizio Fava, Savina Jaeger, Robert Jin, and Ellen Walters. Archives of General Psychiatry, vol. 63, no. 6. Jun. 2006. pp. 669-678.

Intermittent Explosive Disorder, Stephen J. Hucker, ForensicPsychiatry.ca, http://www.forensicpsychiatry.ca/impulse/explosive.htm, c2005, 2006 (accessed online on 30 Mar. 2007).

Intermittent explosive disorder affects up to 16 million Americans, BJ Sullivan, Science Blog, 6 Jun. 2006, http://www.scienceblog.com (accessed online on 21 Feb. 2007.

Road rage’ gets a medical diagnosis, MSNBC.com, 5 Jun. 2006. http://www.msnbc.msn.com/id/13152708/

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR®), 4th ed., Text Revision, American Psychiatric Association, c2000.

Intermittent explosive disorder, Wikipedia, http://en.wikipedia.org/wiki/Intermittent_explosive_disorder (accessed online on 30 Mar. 2007).

CHROMOSOMAL ABNORMALITIES

Drug may treat mental symptoms of Down's syndrome

PTZ (pentylenetetrazole), an old drug once used to study epilepsy, can help improve learning in mice with a form of Down's syndrome, and might also help people. The beneficial effects of the drug continued for two months after treatment, suggesting that the drug, like some other psychiatric drugs, can make long-term changes in the brain. The finding can also help scientists understand what causes the mental retardation seen in Down's syndrome patients. PTZ is no longer approved for use in people. More information can be obtained from: Drug could improve learning in Down's syndrome, DrugResearcher.com, http://www.drugresearcher.com, 26 Feb. 2007.

Drug shows promise for Down syndrome, Science Daily, http://www.sciencedaily.com/, 26 Feb. 2006.

Old drug pentylenetetrazole may improve learning and memory in Down syndrome victims, News-Medical.Net, http://www.news-medical.net/, 26 Feb. 2007.

Stanford University research shows drug treatment effective for mice who have symptoms of Down's syndrome, Down’s Syndrome Association press release, http://www.dsa-uk.com/, 25 Feb. 2007.


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THERAPIES: THERAPIES: THERAPIES: THERAPIES: STUDIES ASTUDIES ASTUDIES ASTUDIES AND ND ND ND DEVELOPMENTSDEVELOPMENTSDEVELOPMENTSDEVELOPMENTS

MUSIC THERAPY AND MUSIC IN THERAPY

The effect of music on post-stress recovery

This abstract is published with kind permission from Springer Science and Business Media. The purpose of this study was to compare the effects of music and white noise on the recovery of physiological measures after stressful visual stimulation. Twenty-nine participants took part in the experiment. Visual stimulation with slides eliciting disgust was followed by subjectively pleasant music, sad music, and white noise in three consecutive sessions. The spectral power of the frontal and temporal EEG, skin conductance, heart rate, heart period variability, facial capillary blood flow, and respiration rate were recorded and analyzed. Aversive visual stimulation evoked heart rate deceleration, increased high frequency component of heart period variability, increased skin conductance level and skin conductance response frequency, decreased facial blood flow and velocity, decreased temporal slow alpha and increased frontal fast beta power in all three sessions. Both subjectively pleasant and sad music led to the restoration of baseline levels on most parameters; while white noise did not enhance the recovery process. The effects of pleasant music on post-stress recovery, when compared to white noise, were significantly different on heart rate, respiration rate, and peripheral blood flow. Both positive and negative music exerted positive modulatory effects on cardiovascular and respiratory activity, namely increased heart rate, balanced heart period variability, increased vascular blood flow and respiration rate during the post-stress recovery. Data only partially supported the “undoing” hypothesis, which states that positive emotions may facilitate the process of physiological recovery following negative emotions. Effects of music on the recovery of autonomic and electrocortical activity after stress induced by aversive visual stimuli, by Estate M. Sokhadze. Applied Psychophysiology and Biofeedback, vol. 32, no. 1. Mar. 2007. pp. 31-50. Accessed online on 27 Mar. 2007 at http://www.springerlink.com/content/1573-3270/

Music therapy may be effective for children and ado lescents with psychopathology

A recent study has found music therapy to be effective for children and adolescents with psycho-pathology, but its effectiveness in routine practice is unknown. The study focused on individual music therapy as provided in outpatient services. The authors assessed symptoms, competencies, and quality of life in children and adolescents with psychopathology (N=136) before and after weekly sessions of individual music therapy or corresponding waiting time. No significant interaction effects were identified, although music therapy seems to have improved quality of life for the participants. The impact of the therapy depended on the presence and severity of co-morbid medical conditions. The authors conclude that music therapy as provided in routine practice is effective for some, but not all groups of clients.

Effectiveness of music therapy for children and adolescents with psychopathology: A quasi-experimental study, by Christian Gold, Tony Wigram, and Martin Voracek, Psychotherapy Research, vol. 17, no. 3. pp. 1050-3307. Accessed online on 29 Mar. 2007 at http://www.informaworld.com/10.1080/10503300600607886

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REVIEW ARTICLESREVIEW ARTICLESREVIEW ARTICLESREVIEW ARTICLES

THERAPIES

Cognitive-behavioural therapy – how effective is it ? By Dr Thomas Groenewald, Psych & Soma

There is often zealous disagreement about which psychotherapy is the more effective. The viewpoint that one therapy is just as effective as another has been coined the ‘Dodo Bird verdict’ [2, p. 18], based on a line from Alice of Wonderland: “All have won and all must have prizes”. Psych & Soma’s acquisition and synthesis of trends and current topics in the field of psychotherapy rendered twelve articles and one report on the use and outcomes of cognitive-behavioural therapy (CBT), published during the last three years. This review presents a synopsis of the findings. By early 2005 there were more than 325 published articles [2] on cognitive-behavioural interventions. The ongoing adaptation of CBT for an expanding range of disorders and problems are mostly the reason for the proliferation of literature. In the eight years between 1986 and 1993, more than 120 controlled clinical trials were undertaken on the impact of CBT on the patient. A review of 16 meta-analyses [2] suggests that CBT is highly effective for adult and adolescent unipolar depression, generalised anxiety disorder (GAD), panic disorder with/without agoraphobia or social phobia, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), schizophrenia, anger management, bulimia nervosa, internalising childhood disorder, sexual offences and chronic pain. The review furthermore suggests strongly that the effects of CBT is maintained, across many disorders, for considerable periods after treatment has ended.

Anxiety and depression

In contrast to the previous review, a recent [10] meta-analysis comparison of CBT vs. other bona fide non-CBT psychotherapies for anxious and depressed children did not show a notable greater impact for CBT than for the other therapies. This is consistent with the Dodo Bird conjecture. An earlier meta-analysis [9] of 71 studies, comparing the effects of behavioural parent-training (BPT) vs. CBT, found that BPT interventions may be more effective for youths in the 6-12 years old range, because these children are dependant on their parents. The analysis recommends careful consideration of the effect of the treatment setting of BPT and CBT.

Juvenile delinquency

A meta-analysis [6] was done of 58 experimental and quasi-experimental studies into the effect of CBT for reducing recidivism among adult and juvenile offenders. The analysis affirmed the positive effect of CBT, but no significant differences in the effect of the various versions of CBT were found. Close monitoring of the quality and adequate training of CBT providers are shown to be essential. The effect of CBT on offenders with a high risk of recidivism is very encouraging, as the therapy targets criminogenic factors, including criminal thinking patterns.

General anxiety disorder

Meta-analyses to assess the ability of CBT to reduce anxiety symptoms in patients with (GAD) mostly used general measures of anxiety to assess symptom severity and improvement. However, these studies do not provide sufficient data to measure the ability of CBT to reduce the cardinal symptom of GAD, pathological worry[3]. A meta-analysis of the impact of CBT on pathological worry in patients with GAD found the largest gains for younger adults, but also notable gains for geriatric patients [3]. These gains were maintained over the 6- and 12-months follow-up periods. The analyses also revealed that certain specific treatment CBT packages may be more effective than others, but more research is needed into this issue.


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A second meta-analysis [5] of 25 studies shows that CBT can alleviate the anxiety symptoms in patients with GAD. CBT was more effective than usual treatment or a waiting list control in achieving a clinical response after treatment, at 46% versus 14% of patients, respectively. CBT was also very effective in reducing the secondary symptoms of worry and depression. However, none of these studies looked at the long-term effectiveness of CBT, and there were too few data to determine whether CBT was more effective than other psychological therapies. Patients responded slightly better to CBT than to psycho-dynamic therapy, but there was only one trial comparing these two psychotherapies.

Schizophrenia spectrum disorders

The first-line treatment of schizophrenia spectrum disorders is usually antipsychotic drugs, which are thought to have the greatest effect on the positive symptoms of schizophrenia such as delusions, auditory hallucinations and thought disorder. However, medication does not always completely resolve these symptoms. A meta-analysis of 14 studies [13], including 1484 patients and published between 1990 and 2004, showed that, compared with other therapies such as waiting-list, treatment as usual and supportive counseling, CBT is a promising adjunctive treatment for the positive symptoms in schizophrenia. Moreover, the therapeutic effects are present at follow-up, suggesting that the CBT has long-term effects. The authors point out, however, that the global mean weighted effect is very modest. The results also show that CBT is more effective for patients in an acute psychotic episode than for stabilized chronic patients suffering from persistent psychotic symptoms.

Body-image disturbance

Body image (BI) has attitude, behaviour and perceptual components [8]. BI-attitude has two dimensions, namely the degrees of satisfaction and of importance given to appearance. BI-disturbance is revealed in difficulties experienced with one or more of these areas. A meta-analysis of the effectiveness of CBT on BI found that CBT that addresses all three components of BI are more effective than when only behaviour and attitude are addressed.

Cancer patients

A meta-analysis [11] of 20 studies indicated that CBT can help breast cancer patients control their distress and pain. The findings are congruent with the positive effects of CBT on cancer patients in general. Data suggest further that hypnosis, a common CBT intervention used with cancer patients, may be especially effective (with some or all of the CBT techniques of distraction, relaxation, imagery and visualisation).

Trauma and PTDS

A 3-year follow-up study [1] found that trauma survivors with acute stress disorder benefited more from CBT or CBT with hypnosis in the initial month after their trauma than those treated with supportive counselling. They experienced fewer PTDS symptoms, in particular re-experiencing and hyperarousal symptoms. In contrast, there is evidence that 70% of patients diagnosed with acute stress disorder still experienced PTSD two years after the trauma. These findings point to long-term benefits of CBT for trauma survivors. In this study, CBT with hypnosis did facilitate recovery, but the impact was not evident at the 6-month or 3-year follow-up assessments. This finding may indicate that hypnosis does not enhance the treatment gains of CBT, or that the researchers’ use of hypnosis was not optimal. They note that previous studies have indicated that the addition of hypnosis to CBT techniques do lead to greater symptom reduction across a range of disorders.

CBT in routine clinical practice

The outcome data [12] from the routine clinical practice of a National Health Service (NHS) psychology service suggest that CBT is an effective treatment in a routine clinical practice context, as opposed to CBT in research trials. However, CBT may not be as effective in ordinary clinical settings as in research trials. This study represents probably the largest sample of routinely treated CBT patients.

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The ‘third wave’ CBT therapies: emphasis on behavio ural aspects

Acceptance and Commitment Therapy (ACT) is a branch of cognitive-behavioural therapy that uses acceptance and mindfulness strategies, together with commitment and behaviour change strategies, to increase psychological flexibility (Wikipedia, Acceptance and Commitment Therapy, available online at http://en.wikipedia.org/wiki/Acceptance_and_Commitment_Therapy). This is just one of a new generation of CBT-based therapies, the so-called ‘third wave’ of CBT, that focus on the behavioural aspects of CBT as opposed to the cognitive aspects, placing an increasing emphasis on behavioural change, constructivism and attentional control. Advocates of these new behavioural therapies argue that the challenging of thoughts is superfluous in CBT [7], in part because CBT treatments often show a rapid symptomatic improvement before the effects of cognitive modification should have been evident – the so-called “rapid early response”. However, an empirical examination [7] undertaken of the status of cognitive interventions in CBT found that there is no difference in the effectiveness of the behavioural and the cognitive elements of CBT, if they are used separately. Cognitive interventions did not provide “added value” to behavioural intervention. In addition, studies that dismantle the components of CBT might be flawed, as they neutralise what makes the therapy effective: the interaction of cognitive and behavioural techniques. Research on “rapid early response” was also reviewed, and it was found that evidence for such an effect was lacking.

A lack of empirical evidence

Numerous studies have shown that CBT is effective for a range of psychological disorders. However, one researcher emphasises that, for CBT to develop, it must keep sight of its empirical roots [7]. There is a worrying lack of empirical support for some of the fundamental tenets of CBT, such as that cognitive interventions, which form the core of CBT, are differentially effective in reducing distress. There is also a lack of evidence that cognitive variables mediate therapeutic change [7]. These gaps in knowledge make the development more effective therapeutic interventions difficult. [1] Bryant, R.A., Moulds, M.L., Nixon, R.D.V., Mastrodomenico, J., Felmingham, K. & Hopwood, S. 2006. Hypnotherapy and cognitive behaviour therapy of acute stress disorder: a 3-year follow-up. Behaviour Research Therapy, 44: 131-1335.

[2] Butler, A.C., Chapman, J.E., Forman, E.M. & Beck, A.T. 2005. The empirical status of cognitive-behavioural therapy: a review of meta-analyses. Clinical Psychology Review, 26: 17-31.

[3] Covin, R., Quimet, A.J., Seeds, P.M. & Dozois, D.J.A. 2007. A meta-analysis of CBT for pathological worry among clients with GAD. Journal of Anxiety Disorders, article in press.

[4] Durham, R.C., Chambers, J.A., Power, K.G., Sharp, D.M., Macdonald, R.R., Major, K.A., Dow, M.G.T. & Gumley, A.I. 2005. Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland. Health Technology Assessment, 9(42), November.

[5] Hunot, V., Churchill, R., Silva de Lima, M. & Teixeira, V. 2007. Psychological therapies for generalised anxiety disorder. Cochrane database of systematic reviews, 1.

[6] Landenberger, N.A. & Lipsey, M.W. 2005. The positive effects of cognitive-behavioral programs for offenders: a meta-analysis of factors associated with effective treatment. Journal of Experimental Criminology, 1: 451-476.

[7] Longmore, R.J. & Worell, M. 2007. Do we need to challenge thoughts in cognitive behaviour therapy. Clinical Psychology Review, 27: 173-187.

[8] Jarry, J.L. & Ip, K. 2005. The effectiveness of stand-alone cognitive-behavioural therapy for body image: a meta-analysis. Body Image, 2: 317-331.

[9] McCart, M.R., Priester, P.E., Davies, W.H. & Azen, R. 2006. Differential effectiveness of behavioural parent-training and cognitive-behavioural therapy for antisocial youth: a meta-analysis. Journal of Abnormal Child Psychology, 34 (4): 527-543.


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[10] Spielmans,G.I., Pasek, L.F. & McFall, J.P. 2007. What are the active ingredients in cognitive and behavioural psychotherapy for anxious and depressed children? a meta-analytical review. Clinical Psychology Review, article in press.

[11] Tatrow, K. & Montgomery, G.H. 2006. Cognitive behavioural therapy techniques for distress and pain in breast cancer patients: a meta-analysis. Journal of Behavioural Medicine, 29(1): 17-27.

[12] Westbrook, D. & Kirk, J. 2005. The clinical effectiveness of cognitive behaviour therapy: outcome for a large sample of adults treated in routine practice. Behaviour Research and Therapy, 43: 1243-1261.

[13] Zimmerman, G., Favrod, J., Trieu, V.H. & Pomini, V. 2005. The effect of cognitive behavioural treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophrenia Research, 77: 1-9.

ORGANIC MENTAL DISORDERS

Alzheimers & Dementia — Prevention and Intervention

An active brain may delay the onset of Alzheimer's

Several recent studies seem to confirm that mind-stimulating activities such as studying, reading or doing crossword puzzles can delay or prevent the development of Alzheimer's disease. At the University of California, Irvine, hundreds of mice genetically engineered to develop Alzheimer's disease were trained to remember the location of an 'escape platform' in a tank of water. One group of mice was allowed to swim in the tank at regular intervals until they were 18 months old, and their ability to remember and find the platform was tested after each session. A control group received only one 'lesson'. The brains of all the mice were then examined for the beta amyloid plaques and tangles of hyperphosphorylated-tau that are typical signs of Alzheimer's disease. Up to the age of 12 months, the mice in the learning group had 60% fewer plaques and tangles in their brains. They also had better learning and memory skills than the mice in the control group. However, despite the surprisingly huge effect that this mild learning had in delaying the development of the disease, the short training sessions were not enough to prevent the disease, and by the time the mice in the "learning" group were 15 months old, their brains and their memory and learning ability had degenerated to the same degree as that of the mice in the non-learning group. The scientists now plan to find out if more frequent and intense learning exercises would have more lasting effects on slowing the decline of a brain with Alzheimer's disease. One hopeful sign is the preliminary finding of a second study, that the ability to speak more than one language can delay the onset of dementia by up to four years. Researchers at the Rotman Research Institute in Toronto, Canada, found that people who are fully bilingual and speak both languages every day for most of their lives, have a mean onset of dementia symptoms of 75.5 years, compared to those who speak only one language (71.4 years). The extra effort involved in using more than one language appears to boost blood supply to the brain and ensure that nerve connections remain healthy, factors which are believed to help fight off dementia. The team plans to continue research into the possible beneficial effects of bilingualism.

Something for the coffee lovers

Three cups of coffee a day might slow down the decline in cognitive functioning, according to researchers who studied the coffee-drinking habits of 676 elderly men from Finland, Italy and the Netherlands. They warn, however, that the results of this study will have to be confirmed by further studies, and that coffee could have adverse health effects.

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More information on the studies mentioned can be fo und in these articles:

Learning slows physical progression of Alzheimer's disease, Science Daily, http://www.sciencedaily.com, 24 Jan. 2007

Keeping your mind active may delay Alzheimer's, Medical News Today, http://www.medicalnewstoday.com, 24 Jan. 2007

‘Learn’ to slow Alzheimer’s, Psych Central News, http://psychcentral.com, 24 Jan. 2007

Learning decreases Aß*56 and Tau pathology and ameliorates behavioral decline in 3xTg-AD mice, by Lauren M. Billings, Kim N. Green, James L. McGaugh, and Frank M. LaFerla. The Journal of Neuro-science, vol. 27, no. 4. Jan 2007. pp. 751-751 (accessed online on 22 Feb. 2007 http://www.jneurosci.org)

Bilingualism as a protection against the onset of symptoms of dementia, Ellen Bialystok, Fergus I.M. Craik and Morris Freedman. Neuropsychologia, vol. 45, no. 2. Feb. 2007. pp. 459-464

Coffee consumption is inversely associated with cognitive decline in elderly European men: the FINE Study, B M van Gelder, B Buijsse, M Tijhuis, S Kalmijn, S Giampaoli, A Nissinen, and D Kromhout. European Journal of Clinical Nutrition, vol. 61, no. 2. 2007. pp. 226–232

Proposed and current research

Researchers are studying various possibilities of intervening in the progress of Alzheimer's pathology. Some speculate that an exercise program may help prevent memory loss from getting worse, and may improve the daily functioning and attitudes of those diagnosed with probable Alzheimer’s disease. The University of Kansas Medical Centre has launched a Brain Aging Project, a part of which will measure the effects of exercise and cardiorespiratory fitness on age-related brain changes. A third study will assess the effect of cognitive training, in particular a computerized training program, on the cognitive function in older persons with normal cognition, mild cognitive impairment, and early dementia.

Although there is no cure for Alzheimer's disease, there are medications that can help to prevent memory loss and dementia. Ingested Interferon Alpha, a novel anti-inflammatory agent, is one possibility. Researchers hope to prove that it would modulate the inflammation that contributes to neurodegeneration in Alzheimer's disease. New studies are also looking at the effectiveness of supplements such as vitamin E and selenium; DHA (docosahexaenoic acid), an Omega 3 Fatty Acid; and growth hormone releasing hormone.

Donepezil (Aricept) have shown modest cognitive and behavioural benefits, and researchers will be trying to establish if the drug is also capable of halting the progress of the disease by slowing down the speed of the atrophy of the hippocampus. Also being investigated is whether donepezil can normalise brain activity patterns in people who are at risk for developing Alzheimer’s.

Two antibiotics, doxycycline and rifampicin, may affect the production of biomarkers found in the cerebro-spinal fluid of people with Alzheimer's disease, thus slowing the progress of the disease.

Information on Clinical Trials from CounsellingResource.com, http://trials.counsellingresource.com/

DISORDERS OF PSYCHOLOGICAL DEVELOPMENT

The early detection of autism spectrum disorders in young children

Early intervention can change the course of cognitive and language development and academic achievement in children with autism spectrum disorders (ASD). If autism-susceptibility genes can be identified, it will not only be easier to develop better medications to improve the health and neuro-development of children with autism, but also easier to develop methods to screen for autism at the perinatal and newborn stages, allowing for early intervention.


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The Autism Genome Project : identifying autism-susc eptibility genes

The Autism Genome Project (AGP), formed in 2002, is a global research consortium dedicated to identifying genes that may lead to autism in children. Scientists from 50 institutions in 19 countries are participating in the research. Current knowledge points to the possibility that five or six major genes, and as many as 30 other genes, are involved in autism. The first phase of the AGP, which includes a scan of the world's largest collection of DNA samples from families affected by autism, has pinpointed two genetic links that may predispose people to autism. Neurexin 1, part of a family of genes concerned with the neurotransmitter glutamate, has previously been linked to autism. A gene on chromosome 11 has also been identified as leading to a higher risk of being born with autism. The specific gene has not yet been pinpointed.

Autism spectrum disorders more prevalent than belie ved?

A report has been released stating that as many as one in 150 children in the USA could be diagnosed with an ASD. The report, from the US Centers for Disease Control and Prevention (CDC), contain the results from the first and largest summary of prevalence data from 14 US communities participating in an ASD surveillance project. All children in the studies were eight years old, as previous research has shown that most children with an ASD have been diagnosed by this age. Up to now, the best estimate for the prevalence of autism was four to five per 10 000 children. More recent studies from multiple countries, using current diagnostic criteria but conducted with different methods, have indicated that there is a range of ASD prevalence between 1 in 500 children and 1 in 166 children.

Although the majority of children with ASDs in the areas studied, between 51% and 88%, had shown signs of development concerns before the age of three, about half of the diagnoses had been made much later, when the children were between four and a half and five and a half years old. The most commonly documented concerns were in language development, followed by social development. The CDC cautions that it is not possible to tell if there is a true increase in ASDs, or if the results are due to improved research methods. There has also been much debate over the diagnostic criteria used to identify children with ASDs in these studies, with

many believing that the study had used a too-broad definition of the spectrum of diseases. Better diagnosis and a wider public awareness of the disorder can also account for the perception of an increase in ASD cases.

Online course in early detection of autism in very young children

Medscape, an accredited provider of continuing medical education (CME) in the USA, has made a course available online to show clinicians how to detect autism and autism spectrum disorders in toddlers.

The course counts towards Continuing Medical Educat ion (CME) points for physicians in the US, valid until March 2008.

Making the difficult diagnosis: detecting autism in a toddler has been designed by Catherine Lord, Professor of Psychology, Psychiatry, and Pediatrics at the University of Michigan Autism and Communication Disorders Center. It is intended to help psychiatrists, primary care practitioners, and allied healthcare professionals to evaluate parents' concerns and make appropriate referrals if necessary; identify the behaviour, language, and social abnormalities characteristic of autism spectrum disorders in children; discuss with parents the role of professionals and caregivers in the therapy of a young child with autism; and counsel parents on the likely developmental trajectories of young children diagnosed with an autism spectrum disorder. The course can be accessed online at http://www.medscape.com/viewprogram/6876_pnt

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The financial implications of early detection

The Journal of Child and Family Studies has published the results of research into the financial implications of the increased prevalence of autism in the US state of Texas. They compared the costs associated with 18 years of special education to the costs associated with the implementation of an average of 3 years of Discrete Trial Training as an Early Intensive Behavioral Intervention (EIBI) in an effort to minimise the need for special education. They found that the State of Texas would save US$208 500 per child across 18 years of education with EIBI. When applied to the conservative estimate of 10 000 children with autism in Texas, the State would save a total of $2.09 billion with EIBI.

Learn the signs: Act early

The CDC has a public awareness campaign titled Learn the Signs: Act Early, designed to increase the awareness of child development by educating parents, health care professionals and childcare providers on the importance of tracking a child's social and emotional development, including the potential early warning signs of autism and other developmental disabilities. More about the campaign is available from the CDC at http://www.cdc.gov/actearly.

Can patients ‘recover’ from autism?

Although an early diagnosis of ASD is usually stable over time, some report cases of children who have ‘recovered’ from ASD. The term ‘recovery’ used in the context of ASD is controversial, and most prefer to speak of an improvement in the symptoms of ASD, causing a person to move off the autism spectrum. Improvement is usually thought to be due to intensive early training. The concept of a recovery was first introduced in 1987 by Lovaas (see references below), who found that 47% of children who received intensive behavioural treatment achieved normal intellectual and educational functioning. Another 40% were mildly retarded, and only 10% were profoundly retarded. Lovaas’ research methods and conclusions are highly disputed by many clinicians and researchers. The Journal of Autism and Developmental Disorders (vol. 37, no. 1) reports on a study of 13 two-year old children who ‘lost’ the diagnosis by age 4, at which time they scored within the normal range on standardized measures of cognitive and adaptive functioning. However, the authors note that children diagnosed with pervasive development disorder (PDD) were significantly more likely than those with full autistic disorder to move off the spectrum which, although the researchers tentatively conclude that the results support the idea that some toddlers with ASD can lose the diagnosis, could serve to highlight the difficulty in accurately placing a child on the spectrum of autism disorders. Most of the children who ‘lost’ the diagnosis retained some symptoms in the language, attention and social domains.

Sources:

Predictors of Optimal Outcome in Toddlers Diagnosed with Autism Spectrum Disorders, Saasha Sutera, Juhi Pandey, Emma L. Esser, Michael A. Rosenthal, Leandra B. Wilson, Marianne Barton, James Green, Sarah Hodgson, Diana L. Robins, Thyde Dumont-Mathieu, Deborah Fein, Journal of Autism and Developmental Disorders, vol. 37, no. 1.

Lovaas, O. I. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Counseling and Clinical Psychology, 55, 3–9.

High frequency of neurexin 1β signal peptide structural variants in patients with autism, by Jinong Feng, Richard Schroer, Jin Yan, Wenjia Song, Chunmei Yang, Anke Bockholt, Edwin H. Cook, Jr., Cindy Skinner, Charles E. Schwartz and Steve S. Sommer. Neuroscience Letters, vol. 409, no. 1. Nov. 2006. pp. 10-13. The article can be purchased from ScienceDirect for US$ 30).

Autism in US more prevalent than thought, University of California, San Francisco, http://pub.ucsf.edu/, 12 Feb. 2007.

Autism may be more prevelant [sic] than previous estimates, Science Daily, http://www.sciencedaily.com, 8 Feb. 2007.

CDC releases new data on autism spectrum disorders (ASDs) from multiple communities in the United States, CDC press release, http://www.cdc.gov/od/oc/media/pressrel/2007/r070208.htm, 8 Feb. 2007.


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Researchers Participate in Autism that Suggests New Genetic Links, University of California Newswire, 20 Feb. 2007, http://www.ucnewswire.org/news_viewer.cfm?story_PK=6675

Autism gene identified by researchers at Yale working with a global research consortium, EurakAlert, 13 Mar. 2007, http://www.eurekalert.org/

Decoding autism genes: international effort between scientists, parent groups to pool DNA may hold key to genetics of disease, Newsday.com, 1 Mar. 2007, http://www.newsday.com/

Cost comparison of early intensive behavioral intervention and special education for children with autism, by Gregory S. Chasson, Gerald E. Harris and Wendy J. Neely. Journal of Child and Family Studies, published online on 17 January 2007 at http://www.springerlink.com/content/52q6k240l5125294.

SCHIZOPHRENIA, SCHIZOTYPAL AND DELUSIONAL DISORDERS

The etiology of schizophrenia

A complex problem

Current research on the etiology of schizophrenia suggests that genetics, early environment, neuro-biology, and psychological and social processes are important contributory factors to the disease. It is also thought that processes in early neuro-development are important, particularly prenatal processes (Wikipedia, Schizophrenia, http://en.wikipedia.org/wiki/Schizophrenia). The extent to which these factors influence the likelihood of being diagnosed with schizophrenia is debated widely, although there is some consensus that the disease has a complex etiology, and that several factors have to be present to raise an individual's risk of developing schizophrenia.

Brain and genetic differences in schizophrenic indi viduals

Particular focus has been placed on the function of the neurotransmitter dopamine in the mesolimbic pathway of the brain. The mesolimbic pathway is one of the four major pathways where dopamine is found, and disruption of dopamine function (particularly, an excess of dopamine) in this area has been linked to psychosis and the 'positive symptoms' of schizophrenia (particularly delusions and hallucinations). Successful antipsychotic medication is therefore thought to have its effect by blocking dopamine receptors in this pathway. (Wikipedia, Mesolimbic pathway, http://en.wikipedia.org/wiki/Mesolimbic_pathway). University of Iowa researchers are studying a genetic variation, the HOPA12pb gene variation, which causes a change in the portion of the protein that regulates the development of dopamine-releasing neurons. Although the gene variation accounts for only an estimated 0.3% of all schizophrenia, nearly three of every 100 Caucasians have the gene variation. Since most mutations associated with psychosis are found in only one in 10 000 or 100 000 individuals, these mutations do not lend themselves as study models. HOPA, being a relatively common mutation, is therefore valuable for research. One protein that is crucial for dopamine-mediated neuronal communication in animals is DARPP-32. Researchers at the US National Institutes of Health have shown that the gene that encodes DARPP-32 exhibits genetic variation. DARPP-32 shapes and controls a circuit coursing between the human striatum and prefrontal cortex that affects key brain functions implicated in schizophrenia, such as motivation, working memory and reward related learning. Preliminary analysis indicates that this variant might be associated with an increased risk of schizophrenia. The variant is also associated with increased performance in a number of cognitive tests, including IQ and memory tests, raising the possibility that a gene variant favoured by evolution due

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to its advantages may translate into a disadvantage if the prefrontal cortex is impaired, as in schizophrenia. A study published in the Archives of General Psychiatry (vol. 63, 2006. pp. 844-854) reveals that mutations in the pericentriolar material 1 (PCM1) gene alters the shape of the brain in some people with schizophrenia, which could help explain why the disease often strikes at adolescence. PCM1 plays a role in cell division, which in the brain occurs more actively at adolescence. Schizophrenia patients with mutations had a significantly lower volume of grey matter in their orbitofrontal cortex, which might explain symptoms such as poor judgement and inappropriate social behaviour. Researchers examining postmortem prefrontal cortical brain tissue of adults who had been diagnosed with schizophrenia found that levels of certain gene-regulating molecules called microRNAs were lower among schizophrenia patients than in persons who were free of psychiatric illness. The basic activity of this "executive" brain region is the orchestration of thoughts and actions in accordance with internal goals. By studying genetically engineered mice and the genetic makeup of schizophrenic individuals, MIT and Japanese scientists have pinpointed mutations of the PPP3CC gene, as well as other genes in the early growth response (EGR) gene family (specifically, EGR3), as likely suspects for a higher risk of developing schizophrenia. These genes are critical in the signalling pathway for the brain enzyme calcineurin. Calcineurin is prevalent in the central nervous system, where it plays a role in many neuronal functions whose disturbances would cause many of the characteristics of schizophrenia, such as disorganized thinking, attention deficits, and memory and language problems. Researchers at the Shanghai Jiao Tong University in China have identified the chitinase 3-like 1, or CHI3L1, gene as a potential schizophrenia-susceptibility gene. The gene acts as a survival factor in response to adverse environments, countering various types of physiological stress such as inflammation, nutrient deprivation, and oxygen deficiency. The gene is located on chromosome 1q32.1, a region that has previously been shown to have a weak correlation to schizophrenia.

High maternal homocysteine tied to schizophrenia

Fetuses exposed to elevated homocysteine levels in the third trimester of pregnancy seem to be more than twice as likely to develop schizophrenia later in life. Researchers came to this conclusion after having studied children born from 1959 through 1967, with follow-up for schizophrenia from 1981 through 1997. Should a causal link be confirmed, it might be possible to prevent schizophrenia through relatively simple measures such as folic acid supplementation in the later part of pregnancy.

Toxoplasma gondii

The offspring of mothers infected by Toxoplasma gondii may be at increased risk to develop schizophrenia before the age of 18. In 2003, the US Centers for Disease Control and Prevention (CDC) published an article in which a possible link between T. gondii and schizophrenia was pointed out. It is also known that maternal infections with T. gondii in the first trimester of pregnancy may lead to severe problems, including intracerebral calcifications, retinochoroditis, hydrocephaly or microcephaly, and mental retardation. Infections later in pregnancy have been known to have ocular and neurological consequences, but assumed to have no psychiatric consequences; this must now be reconsidered in the light of the findings of a new study in which researchers studied blood samples collected at birth from 71 patients with schizophrenia, 186 with schizophrenia or related disorders, 26 with bipolar affective disorder, and 258 with any affective disorder. All of the participants had developed their disorders by the age of 18 years. Samples from patients who were later diagnosed with schizophrenia had significantly higher levels of immunoglobulin (Ig)G against T. gondii than controls. There were also strong indications that perinatal infections contracted during the first trimester, including T.gondii, are not important risk factors for schizophrenia in later life. T. gondii is a plausible candidate to cause a persistent neuropsychiatric disease such as schizophrenia for a variety of reasons. It is neurotropic, affects both neurons and glia, is known to directly affect neurotransmitters, affects cognitive function, and is inhibited in cell culture by some antipsychotics and mood stabilizers. However, the new study supports an association between T. gondii and early-onset


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schizophrenia, not a direct link. Further studies are needed to establish if the association is causal, and if it would extend to people who develop schizophrenia after the age of 18.

Trauma and child abuse

In contrast to the possible organic causes found in recent studies, two researchers are proposing that environmental factors, in particular child abuse, are to blame for the disease. In June 2006, University of Manchester researcher Paul Hammersley and New Zealand clinical psychologist Dr John Read argued at a public debate at the Institute of Psychiatry in London that child abuse is a major, if not the major, cause of schizophrenia. They believe that many schizophrenic symptoms are actually caused by traumatic events that reshape the brain. They base their theory on 40 studies that revealed childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric patients, and a review of 13 studies of schizophrenics, which found abuse rates from as low as 51% to as

high as 97% in people with schizophrenia. They claim that psychiatric patients who report abuse are much more likely to experience flashbacks and hallucinations, or hear voices that bully them as their abuser did, thus causing paranoia and a mistrust of people close to them. They admit that not all schizophrenics suffered trauma, and not all abused people develop the illness, but believe less traumatic childhood maltreatment, rather than actual abuse, may be an important difference. This theory is contentious, with mainstream psychiatrists arguing that the strongest predictor of schizophrenia is a family history of the disorder. They also warn that the psychiatric community should not revert to blaming the parents for their child’s mental disorder. Research does support the idea that social stress and family stress may play a roll in development of schizophrenia for people who are biologically or genetically predisposed, but there is no rigorous evidence to support Hammersley and Read's theory that child abuse causes a significant portion or "the majority" of cases of schizophrenia. The Schizophrenia Daily News Blog, 16 Jun. 2006, (http://www.schizophrenia.com/sznews/archives/ 003511.html) points to several errors that they believe the two researchers made, including the misuse of terminology. They do not acknowledge that the definition of schizophrenia as a psychiatric disorder has evolved much over the past century, and they do not refer to current diagnostic criteria for the disease, but rather to data such as the “schizophrenia scale”, part of a commonly given personality test that is typically not used diagnostically, or to their own conception of the “schizophrenia construct”.

Schizophrenia risk: abnormalities in eye movement a nd attention

A study published in the February 2007 issue of the Journal of Abnormal Psychology suggests that abnormalities in eye movements and attention can be used to determine a person's risk of developing schizophrenia. The researchers speculate that the manner in which the eyes can follow a target, together with how well a person can pay attention, help to pinpoint risk factors related to schizophrenia. There has been much debate in the field of psychiatry on whether the risk for schizophrenia was graded or more binary in nature. This study suggests that people can be divided into two groups (binary), those at risk and those not at risk.

Sources:

Schizophrenia, Wikipedia, http://en.wikipedia.org/wiki/Schizophrenia, accessed online on 15 Mar. 2006.

Possible genetic link to schizophrenia identified, Science Daily, http://www.sciencedaily.com/, 9 Feb. 2007.

Brain growth link to schizophrenia, New Scientist, 12 Aug. 2006. p.16.

Study reveals value of schizophrenia-related gene variation, Science Daily, http://www.sciencedaily.com, 23 Feb. 2007.

Study shows genetic link for schizophrenia, Science Daily, http://www.sciencedaily.com, 20 Feb. 2007.

Brain Tissue Reveals Possible Genetic Trigger For Schizophrenia, Medical News Today, http://www.medicalnewstoday.com, 1 Apr. 2007.

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Genetic association and brain morphology studies and the chromosome Pericentriolar Material 1 (PCM1) gene in susceptibility to schizophrenia, by Hugh M. D. Gurling, Hugo Critchley, Susmita R. Datta, Andrew McQuillin, Ekaterina Blaveri, Srinivasa Thirumalai, Jonathan Pimm, Robert Krasucki, Gursharan Kalsi, Digby Quested, Jacob Lawrence, Nicholas Bass, Khalid Choudhury, Vinay Puri, Owen O’Daly, David Curtis, Douglas Blackwood, Walter Muir, Anil K. Malhotra, Robert W. Buchanan, Catriona D. Good, Richard S. J. Frackowiak and Raymond J. Dolan. Archives of General Psychiatry, vol. 63. 2006. pp. 844-854.

Elevated prenatal homocysteine levels as a risk factor for schizophrenia, by AS Brown, T Bottiglieri, CA Schaefer, CP Quesenberry, L Liu, M Bresnahan, and ES Susser, Archives of General Psychiatry, vol. 64, no. 1. Jan. 2007. pp. 132-253. (accessed online on 23 Feb. 2007 at http://archpsyc.ama-assn.org/cgi/content/abstract/64/1/31

Functional variants in the promoter region of Chitinase 3–Like 1 (CHI3L1) and susceptibility to schizophrenia, by Xinzhi Zhao, Ruqi Tang, Bo Gao, Yongyong Shi, Jian Zhou, Shengzhen Guo, Jing Zhang, Yabing Wang, Wei Tang, Junwei Meng, Sheng Li, Hongsheng Wang, Gang Ma, Chuwen Lin, Yue Xiao, Guoyin Feng, Zhiguang Lin, Shaomin Zhu, Yangling Xing, Hong Sang, David St. Clair and Lin He. The American Journal of Human Genetics, vol. 80, no. 1. 2007. pp. 12-18.

High maternal homocysteine tied to schizophrenia, Medscape Today, http://www.medscape.com, 12 Jan. 2007.

Common gene version optimizes thinking – but with a possible downside, EurekAlert, http://www.eurekalert.org/, 8 Feb. 2007.

Elevated prenatal homocysteine may raise schizophrenia risk, Schizophrenia Daily News Blog, http://www.schizophrenia.com/sznews/archives/004476.html, 12 Jan. 2007.

Toxoplasma gondii as a risk factor for early-onset schizophrenia: analysis of filter paper blood samples obtained at birth, by Preben Bo Mortensen, Bent Nørgaard-Pedersen, Berit Lindum Waltoft, Tina L. Sørensen, David Hougaard, E. Fuller Torrey, and Robert H. Yolken. Biological Psychiatry, vol. 61, no. 5. 1 Mar. 2007. pp. 688-693.

Maternal T. gondii infection 'risk factor for early-onset schizophrenia', InPsychiatry.com, http://www.inpsychiatry.com/news/article.aspx?id=64863, 1 Mar. 2007

Maternal T. gondii infection 'risk factor for early-onset schizophrenia', MedwireNews, http://www.medwirenews.med/, 7 Mar. 2007.

Child abuse can cause schizophrenia, Psychcentral.com, http://psychcentral.com/news/2006/06/13/child-abuse-can-cause-schizophrenia/, 13 Jun. 2006

Unraveling the risk for schizophrenia: eye movement and attention focus of new study, Science Daily, http://www.sciencedaily.com, 22 Feb. 2007.

DRUGSDRUGSDRUGSDRUGS &&&& MEDICATION MEDICATION MEDICATION MEDICATION

DRUGS & MEDICATION IN THE NEWS

Antipsychotics and sedatives may hasten deteriorati on in Alzheimer's disease

The Journal of Neurology, Neurosurgery, and Psychiatry reports that Alzheimer’s patients who were taking antipsychotic drugs and sedatives had a significantly higher risk of deterioration than those who were taking none, with the risk highest in those who were taking both together. Patients taking drugs licensed for dementia, drugs affecting the renin–angiotensin system, and statins had a significantly lower risk of deterioration than those who were not taking any of these drugs.


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The effects of commonly prescribed drugs in patients with Alzheimer’s disease on the rate of deterioration, by J Ellul, N Archer, C M L Foy, M Poppe, H Boothby, H Nicholas, R G Brown and S Lovestone. Journal of Neurology, Neurosurgery, and Psychiatry, vol. 78. 2007. pp. 233-239.

Zyprexa will remain the gold standard for the treat ment of schizophrenia through 2015

Decision Resources (http://www.decisionresources.com), one of the world's leading research and advisory firms focusing on pharmaceutical and health care issues, has found Zyprexa superior in efficacy to all other current therapies, particularly on measures that are most important to prescribers, such as impact on global symptoms and responder rate. The report, entitled Schizophrenia: Turning Physician Insight into Projected Patient Share, notes that the most commercially important emerging antipsychotics (Janssen's Invega, Organon BioSciences' asenapine, and Wyeth/Solvay/Lundbeck's bifeprunox) scored lower than Zyprexa, indicating that Zyprexa will remain unsurpassed during Decision Resources' forecast period. However, Zyprexa scored less favourable than the other drugs in terms of safety and lower than risperidone in terms of delivery features. Schizophrenia: turning physician insight into projected patient share, Decision Resources press release, http://www.decisionresources.com/press_releases/pr_02_28_2007.htm, 28 Feb. 2007.

Invega may help with schizophrenia symptom control

Clinical trials have shown that longer-term treatment with Invega (paliperidone) extended-release tablets, approved in December 2006 for the treatment of schizophrenia, can help patients control symptoms and maintain improvements in personal and social functioning. Paliperidone is the principal active metabolite of risperidone (marketed as Belivon, Rispen and Risperdal), which is already being used for treating schizophrenia. The new treatment is designed to deliver the active ingredient through a technology that allows the drug to remain in the body over a longer period of time. The most commonly reported adverse events were restlessness, extrapyramidal symptoms (movement disorders), rapid heart beat and sleepiness. The total mean change in bodyweight was an average of 1.1 kg. Invega is not approved for the treatment of patients with Dementia-Related Psychosis. More information is available from the following sources: Study suggests INVEGA™ (paliperidone) helps patients with schizophrenia maintain symptom control, Medical News Today, http://www.medicalnewstoday.com, 2 Apr. 2007

FDA approves new drug for schizophrenia, FDA News, http://www.fda.gov/, 20 Dec. 2006

FDA approves J&J antipsychotic named "Invega", Schizophrenia Daily News Blog, http://www.schizophrenia.com/sznews/archives/004387.html, 20 Dec. 2006

DRUG APPROVALS

Cymbalta approved for generalised anxiety disorder

The US Food and Drug Administration (FDA) has approved the antidepressant Cymbalta (duloxetine HCl) for the treatment of generalised anxiety disorder (GAD). The safety and efficacy of Cymbalta for this use was established in three randomized, double-blind, placebo-controlled studies in more than 800 non-depressed adults with GAD. On average, participants treated with Cymbalta for GAD experienced a 46%

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improvement in anxiety symptoms, compared to 32% for those who took placebo, as measured by the Hamilton Anxiety Scale. Participants also experienced a 46% improvement in functional impairment, as measured by the Sheehan Disability Scale, including improved ability to perform everyday activities at work, home, and in social situations, compared with 26% for who took placebo. More information from Market Wire, http://www.marketwire.com, 26 Feb. 2007 and Medical News Today, http://www.medicalnewstoday, 27 Feb. 2007.

Escitalopram approved for OCD in the EU

Escitalopram (Cipralex, Lexapro), a selective serotonin reuptake inhibitor (SSRI), has been approved as treatment for obsessive compulsive disorder (OCD) by the Swedish Medical Products Agency (MPA), one of the leading regulatory authorities in the EU. Clinical studies involving more than 750 participants demonstrated that escitalopram is an effective and well-tolerated drug in the treatment of OCD, with the added benefit of significantly reducing the risk of relapse in OCD patients. More information is available from: Anxiety Insights, http://www.anxietyinsights.info/, 13 Jan. 2007

Medscape Today, http://www.medscape.com, 23 Jan. 2007

Therapeutics Daily, http://www.therapeuticsdaily.com, 18 Jan. 2007.

SPYKSPYKSPYKSPYKER: NEWS OF THE UNUSER: NEWS OF THE UNUSER: NEWS OF THE UNUSER: NEWS OF THE UNUSUALUALUALUAL

'Spyker' contains news of the strange, the bizarre, the interesting and the humorous side of life, not necessarily related to p sychology or psychiatry.

Birds plan for the future

At least one species of bird has been found to plan for tomorrow, raising the intriguing possibility that, like humans, birds may get anxious about the future. Research published in the journal Nature shows that western scrub-jays are able to plan for future food shortages by caching food. The birds are shown to have learned from their previous experiences of food scarcity, storing food for future use in places where they anticipate future slim pickings. This is believed to be the first known example of future planning in animals. Full story available from Science Daily, http://www.sciencedaily.com, Birds found to plan for the future, 22 Feb. 2007. Image courtesy of USDA Forest Service http://www.fs.fed.us/outdoors/naturewatch/Utah/wildlife/mt-nebo/index.shtml


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FROM THEFROM THEFROM THEFROM THE ARCHIVES ARCHIVES ARCHIVES ARCHIVES

Older, but still interesting articles from the Psyc h & Soma archives

FORENSIC PSYCHOLOGY

Solving cryptic crosswords may impair your ability to recognise faces

Eye-witnesses should not do cryptic crosswords immediately before identity parades. According to Michael Lewis of Cardiff University, while it may not be possible to improve a witness's performance in an identity parade, it is possible to prevent witnesses from passing the time with an activity that could negatively influence their face recognition ability. Lewis concentrated on two popular pastimes: reading and solving puzzles. Lewis gave 60 participants 14 different faces to memorise. Each face was seen for 3 seconds. The participants were then given a specific task to do. Some had to read a passage from Dan Brown's The Da Vinci Code, others were given one of three different kinds of puzzle to solve: a sudoku puzzle, a literal cross-word puzzle, or a cryptic crossword puzzle. (A cryptic crossword puzzle has cryptic clues involving double meanings, anagrams, wordplay and other means of disguising the answer. The actual words of the clue serve as a distraction, as their surface meaning usually has nothing to do with the answer. The idea is to look at the words in a different way to see beyond the distraction to the answer.)

After five minutes they were asked to look at 28 faces and identify the 14 target faces from among them. In between looking at each face, they continued reading or working on the puzzles for 30 seconds. The participants working on the cryptic puzzle fared significantly worse at face recognition (68% accuracy) than the other three groups, whose performance was roughly equal (80% for literal crosswords, 79% for Sudoku, and 76% for reading). Previous research showed that face recognition can

be impaired after reading the small letters of Navon stimuli. Navon stimuli are images in which numerous copies of an alphanumeric character are used to compose a different, larger letter or symbol (see image). Lewis speculates that both Navon stimuli and cryptic crosswords involve the suppression of obvious, irrelevant information – the large letter in the first case, or the literal meaning of a word in the latter case – and that this process could have a negative impact on face recognition. While the experiment does not explain how such suppression can influence the ability to recognise faces, Lewis suggests that it adds to our understanding of how faces are recognised.

Sources:

Eye-witnesses should not do cryptic crosswords prior to identity parades, M.B. Lewis, http://www.perceptionweb.com, Perception, vol. 35, no. 10, 2006. pp. 1433-1436.

Cryptic crosswords impair face recognition, BPS Research Digest, http://bps-research-digest. blogspot.com, 14 Nov. 2006.

Image: University of Waterloo, Assessing Attention in Unilateral Neglect, http://www.undergrad.ahs. uwaterloo.ca

PsychDigest

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WEB RESOURCESWEB RESOURCESWEB RESOURCESWEB RESOURCES

WEBSITES OF INTEREST

Case studies from the Australian Institute of Profe ssional Counsellors

The Australian Institute of Professional Counsellors (AIPC) specialises in providing high quality counsellor education, with a particular focus on external and distance education. Their websites offers informative articles on a variety of counselling articles topics, often in the form of case studies. Under ‘Grief Counselling’, for example, there are currently four case studies: • A person centred approach to grief and loss, by Liz Jeffrey • A case of grief and loss, by Sarah Shanley • A case of grief using an eclectic approach, by Jane Barry • A case of grief and loss, David Hayden – AIPC Private Assessor And one article, Grief and Loss: Another Perspective. The objective of these articles and case studies is to support the counselling learning process through providing valuable material to counselling students, professionals and enthusiasts. http://www.aipc.net.au/articles/counselling-articles.php

PODCASTS

Podcasts are sound files, usually in MP3 format, that can be downloaded and played on most computers, or burned to CD, which should play on most modern CD-players.

Ethics in medicine and mental health

This podcast contains an interview with Dr. Robert Klitzman M.D., Associate Professor of Clinical Psychiatry at Columbia University in the College of Physicians and Surgeons, and the School of Public Health, and a Research Scientist at the New York State Psychiatric Institute. He is the Director of the Ethics, Policy, and Human Rights Core of the HIV Center, and the Co-Founder of the Center for Bioethics at Columbia. He has written widely about ethical issues concerning genetics, HIV, and other areas. The podcast can be downloaded from http://media.libsyn.com/media/psychjourney/drklitzman.mp3.

Good and evil

Is there a biological basis for our sense of right and wrong? Author and cognitive evolution researcher Marc Hauser believes the answer is "yes". This New Scientist podcast explores Hauser's work on the "moral organ" and what it means to our notions of justice and fair play. Download from http://media.newscientist.com/data/av/podcast/newsci-20070305-good-and-evil.mp3

Do the right thing

An interview with Thomas G Plante, Ph.D., author of Do the right thing: living ethically in an unethical world. Thomas Plante is professor and chair of psychology at Santa Clara University and clinical


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professor of psychiatry and behavioural sciences at Stanford University School of Medicine. Download from http://media.libsyn.com/media/psychjourney/bfa4be9c-5efe-da12-2705-a18130b7aa62.mp3

NNNNEW BOOKSEW BOOKSEW BOOKSEW BOOKS & PUBLICATIONS & PUBLICATIONS & PUBLICATIONS & PUBLICATIONS

This issue highlights new books from Hogrefe & Huber (http://www.hhpub.com/). All of these books can be purchased from the publisher’s website.

Rorschachiana, Volume 28

In the series: Yearbook of the International Rorschach Society, by Sadegh Nashat (ed.) ISBN 978-0-88937-346-4

The Posttraumatic Embitterment Disorder

Definition, Evidence, Diagnosis, Treatment

by Michael Linden, Max Rotter, Kai Baumann, Barbara Lieberei ISBN 978-0-88937-344-0 Description from the publisher:

“One widely seen type of pathological reaction can be classified as “Posttraumatic Embitterment Disorder (PTED).” Like PTSD, this disorder is characterized not by a particular type of stressful events, but by a distinct psychological process (experiences of injustice and violation of basic beliefs) and by a highly specific psychopathological profile (embitterment and intrusions). While the incidence of PTSD rises in times of danger, such as war, PTED is seen more frequently in times of societal changes which force people to cope with reorganizations of their lives and prospects.”

Treating Victims of Mass Disaster and Terrorism

In the series: Advances in Psychotherapy – Evidence-Based Practice, Volume 6, by Jennifer Housley and Larry E. Beutler ISBN 0-88937-321-3

Schizophrenia

In the series: Advances in Psychotherapy – Evidence-Based Practice, Volume 5, by Steven M. Silverstein, William D. Spaulding, Anthony A. Menditto ISBN 0-88937-315-9

Childhood Maltreatment

In the series: Advances in Psychotherapy – Evidence-Based Practice, Volume 4, by Christine Wekerle, Alec L. Miller, David A. Wolfe, Carrie B. Spindel ISBN 0-88937-314-0

PsychDigest

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Clinical Handbook of Psychotropic Drugs

16th revised and expanded edition, by Kalyna Z. Bezchlibnyk-Butler, J. Joel Jeffries (eds.) ISBN 0-88937-308-6

Behavior and Medicine

4th edition, by Danny Wedding, Margaret L. Stuber (eds.) ISBN 0-88937-305-1

Understanding Rett Syndrome: A practical guide for parents, teachers, and therapists

2nd revised edition, by Barbro Lindberg ISBN 0-88937-306-X

Psyche in the lab: Celebrating brain science in Can ada

by Neil Seeman, Mary Seeman ISBN 0-88937-304-3 This book ommemorates the 25th anniversary of the Canadian Psychiatric Research Foundation.

Testing children: A practitioner's guide to assessi ng mental development in infants and young children

by Phyllis Preston ISBN 0-88937-296-9

Obsessive-Compulsive Disorder

In the series: Advances in Psychotherapy – Evidence-Based Practice, Volume 3, by Jonathan S. Abramowitz ISBN 0-88937-316-7

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