http://www.biomedcentral.com/bmcpsychiatry/ The latest research articles published by BMC Psychiatry 2009-11-19T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ Background: Several risk factors for alcohol and other substance use disorders (SUDs) have been identified, but it is not well understood whether their associations with SUD are independent of each other. In particular, it is not well known, whether the associations between behavioral and affective factors and SUDs are independent of other risk factors. The incidence of SUDs peaks by young adulthood making epidemiological studies of SUDs in young adults informative. Methods: In a comprehensive population-based survey of mental health in Finnish young adults (aged 21-35 years, n=605), structured clinical interview (SCID-I) complemented by medical record data from all lifetime hospital and outpatient treatments were used to diagnose SUDs. We estimated the prevalences of lifetime DSM-IV SUDs, and investigated their associations with correlates from four domains representing: (1) behavioral and affective factors, (2) parental factors, (3) early initiation of substance use, and (4) educational factors. Independence of the association of behavioral and affective factors with SUD was investigated. Results: Lifetime prevalences of abuse or dependence of any substance, alcohol, and any illicit substance were 14.2%, 13.1%, and 4.4%, respectively. Correlates from all four domains were associated with SUD. The associations between behavioral and affective factors (attention or behavior problems at school, aggression, anxiousness) and SUD were largely independent of other correlates, whereas only daily smoking and low education associated with SUD after adjustment for behavioral and affective factors. Conclusions: Alcohol use disorders are common in Finnish young adults, whereas other SUDs are less common than in many other developed countries. Our cross-sectional analyses suggested that the association between behavioral and affective factors and SUD was only partly accounted for by other correlates, such as early initiation of substance use and parental alcohol problems. In contrast, associations between many other factors and SUD were non-significant when adjusted for behavioral and affective factors. http://www.biomedcentral.com/1471-244X/9/73 Antti Latvala Annamari Tuulio-Henriksson Jonna Perala Samuli Saarni Terhi Aalto-Setala Hillevi Aro Tellervo Korhonen Seppo Koskinen Jouko Lonnqvist Jaakko Kaprio Jaana Suvisaari BMC Psychiatry 2009, 9:73 2009-11-19T00:00:00Z doi:10.1186/1471-244X-9-73 BMC Psychiatry 1471-244X 9 73 2009-11-19T00:00:00Z PDF Background: The aim of this work is to estimate the French frequencies of dispensed psychotropic prescriptions in children and adolescents. Prevalence estimations of dispensed prescriptions are compared to the frequencies of use of psychotropic reported by 17year-old adolescents. Methods: Prescription data is derived from national health insurance databases. Frequencies of dispensed prescriptions are extrapolated to estimate a range for the 2004 national rates.Self-report data is derived from the 2003 and 2005 ESCAPAD study, an epidemiological study based on a questionnaire focused on health and drug consumption. Results: The prevalence estimation shows that the prevalence of prescription of a psychotropic medication to young persons between 3 and 18 years is about 2.2 %.In 2005, the self-report study (ESCAPAD) shows that 14.9% of 17year-old adolescents took medication for "nerves" or "to sleep" during the previous 12 months. The same study in 2003 also shows that 62.3% of adolescents aged 17 and 18 reporting psychotropic use, took the medication for anxiety and 56.8% to sleep. Only 49.7% of these medications are suggested by a doctor. Conclusions: This study underlines a similar range of prevalence of psychotropic prescriptions in France to that observed in other European countries. Nevertheless, the proportion of antipsychotics and benzodiazepins seems to be higher, whereas the proportion of methylphenidate is lower.Secondly, a disparity between the prevalence of dispensed prescriptions and the self-report of actual use of psychotropics has been highlighted by the ESCAPAD study which shows that these treatments are widely used as "self-medication". http://www.biomedcentral.com/1471-244X/9/72 Eric Acquaviva Stephane Legleye Guy Auleley Jean Deligne Didier Carel Bruno Falissard B BMC Psychiatry 2009, 9:72 2009-11-17T00:00:00Z doi:10.1186/1471-244X-9-72 BMC Psychiatry 1471-244X 9 72 2009-11-17T00:00:00Z PDF Background: : We have previously reported that the expression of the messenger ribonucleic acid (mRNA) for the NR2A subunit of the N-methyl-D-aspartate (NMDA) class of glutamate receptor was decreased in a subset of inhibitory interneurons in the cerebral cortex in schizophrenia. In this study, we sought to determine whether a deficit in the expression of NR2A mRNA was present in the subset of interneurons that contain the calcium buffer parvalbumin (PV) and whether this deficit was associated with a reduction in glutamatergic inputs in the prefrontal cortex (PFC) in schizophrenia.MethodS: We examined the expression of NR2A mRNA, labeled with a 35S-tagged riboprobe, in neurons that expressed PV mRNA, visualized with a digoxigenin-labeled riboprobe via an immunoperoxidase reaction, in twenty schizophrenia and twenty matched normal control subjects. We also immunohistochemically labeled the glutamatergic axon terminals with an antibody against vGluT1. Results: : The density of the PV neurons that expressed NR2A mRNA was significantly decreased by 48-50% in layers 3 and 4 in the subjects with schizophrenia, but the cellular expression of NR2A mRNA in the PV neurons that exhibited a detectable level of this transcript was unchanged. In addition, the density of vGluT1-immunoreactive boutons was significantly decreased by 79% in layer 3, but was unchanged in layer 5 of the PFC in schizophrenia. Conclusions: : These findings suggest that glutamatergic neurotransmission via NR2A-containing NMDA receptors on PV neurons in the PFC may be deficient in schizophrenia. This may disinhibit the postsynaptic excitatory circuits, contributing to neuronal injury, aberrant information flow and PFC functional deficits in schizophrenia. http://www.biomedcentral.com/1471-244X/9/71 B Bitanihirwe M Lim J Kelley T Kaneko T-u Woo BMC Psychiatry 2009, 9:71 2009-11-16T00:00:00Z doi:10.1186/1471-244X-9-71 BMC Psychiatry 1471-244X 9 71 2009-11-16T00:00:00Z PDF Background: Bipolar disorder, particularly in children, is characterized by rapid cycling and switching, making circadian clock genes plausible molecular underpinnings for bipolar disorder. We previously reported work establishing mice lacking the clock gene D-box binding protein (DBP) as a stress-reactive genetic animal model of bipolar disorder. Microarray studies revealed that expression of two closely related clock genes, RAR-related orphan receptors alpha (RORA) and beta (RORB), was altered in these mice. These retinoid-related receptors are involved in a number of pathways including neurogenesis, stress response, and modulation of circadian rhythms. Here we report association studies between bipolar disorder and single-nucleotide polymorphisms (SNPs) in RORA and RORB. Methods: We genotyped 355 RORA and RORB SNPs in a pediatric cohort consisting of a family-based sample of 153 trios and an independent, non-overlapping case-control sample of 152 cases and 140 controls. Bipolar disorder in children and adolescents is characterized by increased stress reactivity and frequent episodes of shorter duration; thus our cohort provides a potentially enriched sample for identifying genes involved in cycling and switching. Results: We report that four intronic RORB SNPs showed positive associations with the pediatric bipolar phenotype that survived Bonferroni correction for multiple comparisons in the case-control sample. Three RORB haplotype blocks implicating an additional 11 SNPs were also associated with the disease in the case-control sample. However, these significant associations were not replicated in the sample of trios. There was no evidence for association between pediatric bipolar disorder and any RORA SNPs or haplotype blocks after multiple-test correction. In addition, we found no strong evidence for association between the age-at-onset of bipolar disorder with any RORA or RORB SNPs. Conclusion: Our findings suggest that clock genes in general and RORB in particular may be important candidates for further investigation in the search for the molecular basis of bipolar disorder. http://www.biomedcentral.com/1471-244X/9/70 Casey McGrath Stephen Glatt Pamela Sklar Helen Le-Niculescu Ronald Kuczenski Alysa Doyle Joseph Biederman Eric Mick Stephen Faraone Alexander Niculescu Ming Tsuang BMC Psychiatry 2009, 9:70 2009-11-12T00:00:00Z doi:10.1186/1471-244X-9-70 BMC Psychiatry 1471-244X 9 70 2009-11-12T00:00:00Z XML Background: Patients with depression demonstrate cognitive impairment on a wide range of cognitive tasks, particularly putative tasks of frontal lobe function. Recent models of frontal lobe function have argued that the frontal pole region is involved in cognitive branching, a process requiring holding in mind one goal while performing sub-goal processes. Evidence for this model comes from functional neuroimaging and frontal-pole lesion patients. We have utilised these new concepts to investigate the possibility that patients with depression are impaired at cognitive 'branching'. Methods: 11 non-medicated patients with major depression were compared to 11 matched controls in a behavioural study on a task of cognitive 'branching'. In the version employed here, we recorded participant's performance as they learnt to perform the task. This involved participants completing a control condition, followed by a working memory condition, a dual-task condition and finally the branching condition, which integrates processes in the working memory and dual-task conditions. We also measured participants on a number of other cognitive tasks as well as mood-state before and after the branching experiment. Results: Patients took longer to learn the first condition, but performed comparably to controls after six runs of the task. Overall, reaction times decreased with repeated exposure on the task conditions in controls, with this effect attenuated in patients. Importantly, no differences were found between patients and controls on the branching condition. There was, however, a significant change in mood-state with patients increasing in positive affect and decreasing in negative affect after the experiment. Conclusion: We found no clear evidence of a fundamental impairment in anterior prefrontal 'branching processes' in patients with depression. Rather our data argue for a contextual learning impairment underlying cognitive dysfunction in this disorder. Our data suggest that MDD patients are able to perform high-level cognitive control tasks comparably to controls provided they are well trained. Future work should replicate these preliminary findings in a larger sample of MDD patients. http://www.biomedcentral.com/1471-244X/9/69 Nicholas Walsh Marc Seal Steven Williams Mitul Mehta BMC Psychiatry 2009, 9:69 2009-11-10T00:00:00Z doi:10.1186/1471-244X-9-69 BMC Psychiatry 1471-244X 9 69 2009-11-10T00:00:00Z XML Background: The mental health of the Armed Forces is an important issue of both academic and public interest. The aims of this study are to: a) assess the prevalence and risk factors for common mental disorders and post traumatic stress disorder (PTSD) symptoms, during the main fighting period of the Iraq War (TELIC 1) and later deployments to Iraq or elsewhere and enlistment status (regular or reserve), and b) compare the prevalence of depression, PTSD symptoms and suicidal ideation in regular and reserve UK Army personnel who deployed to Iraq with their US counterparts. Methods: Participants were drawn from a large UK military health study using a standard two phase survey technique stratified by deployment status and engagement type. Participants undertook a structured telephone interview including the Patient Health Questionnaire (PHQ) and a short measure of PTSD (Primary Care PTSD, PC-PTSD). The response rate was 76% (821 participants). Results: The weighted prevalence of common mental disorders and PTSD symptoms was 27.2% and 4.8%, respectively. The most common diagnoses were alcohol abuse (18.0%) and neurotic disorders (13.5%). There was no health effect of deploying for regular personnel, but an increased risk of PTSD for reservists who deployed to Iraq and other recent deployments compared to reservists who did not deploy. The prevalence of depression, PTSD symptoms and subjective poor health were similar between regular US and UK Iraq combatants. Conclusion: The most common mental disorders in the UK military are alcohol abuse and neurotic disorders. The prevalence of PTSD symptoms remains low in the UK military, but reservists are at greater risk of psychiatric injury than regular personnel. http://www.biomedcentral.com/1471-244X/9/68 Amy Iversen Lauren van Staden Jamie Hacker Hughes Tess Browne Lisa Hull John Hall Neil Greenberg Roberto Rona Matthew Hotopf Simon Wessely Nicola Fear BMC Psychiatry 2009, 9:68 2009-10-30T00:00:00Z doi:10.1186/1471-244X-9-68 BMC Psychiatry 1471-244X 9 68 2009-10-30T00:00:00Z XML Background: Dropout (DO) is common in the treatment of eating disorders (EDs), but the reasons for this phenomenon remain unclear. This study is an extensive review of the literature regarding DO predictors in EDs. Methods: All papers in PubMed, PsycINFO and Cochrane Library (1980-2009) were considered. Methodological issues and detailed results were analysed for each paper. After selection according to inclusion criteria, 26 studies were reviewed. Results: The dropout rates ranged from 20.2% to 51% (inpatient) and from 29% to 73% (outpatient). Predictors of dropout were inconsistent due to methodological flaws and limited sample sizes. There is no evidence that baseline ED clinical severity, psychiatric comorbidity or treatment issues affect dropout. The most consistent predictor is the binge-purging subtype of anorexia nervosa. Good evidence exists that two psychological traits (high maturity fear and impulsivity) and two personality dimensions (low self-directedness, low cooperativeness) are related to dropout. Conclusion: Implications for clinical practice and areas for further research are discussed. Particularly, these results highlight the need for a shared definition of dropout in the treatment of eating disorders for both inpatient and outpatient settings. Moreover, the assessment of personality dimensions (impulse control, self-efficacy, maturity fear and others) as liability factors for dropout seems an important issue for creating specific strategies to reduce the dropout phenomenon in eating disorders. http://www.biomedcentral.com/1471-244X/9/67 Secondo Fassino Andrea Piero Elena Tomba Giovanni Abbate Daga BMC Psychiatry 2009, 9:67 2009-10-09T00:00:00Z doi:10.1186/1471-244X-9-67 BMC Psychiatry 1471-244X 9 67 2009-10-09T00:00:00Z XML Background: Despite a huge well-documented literature on cognitive deficits in schizophrenia, little is known about the own perception of patients regarding their cognitive functioning. The purpose of our study was to create a scale to collect subjective cognitive complaints of patients suffering from schizophrenia with Tunisian Arabic dialect as mother tongue and to proceed to a validation study of this scale. Methods: The authors constructed the Self-Assessment Scale of Cognitive Complaints in Schizophrenia (SASCCS) based on a questionnaire covering five cognitive domains which are the most frequently reported in the literature to be impaired in schizophrenia. The scale consisted of 21 likert-type questions dealing with memory, attention, executive functions, language and praxia. In a second time, the authors proceeded to the study of psychometric qualities of the scale among 105 patients suffering from schizophrenia spectrum disorders (based on DSM- IV criteria). Patients were evaluated using the Positive and Negative Syndrome Scale (PANSS), the Global Assessment Functioning Scale (GAF scale) and the Calgary Depression Scale (CDS). Results: The scale's reliability was proven to be good through Cronbach alpha coefficient equal to 0.85 and showing its good internal consistency. The intra-class correlation coefficient at 11 weeks was equal to 0.77 suggesting a good stability over time. Principal component analysis with Oblimin rotation was performed and yielded to six factors accounting for 58.28% of the total variance of the scale. Conclusion: Given the good psychometric properties that have been revealed in this study, the SASCCS seems to be reliable to measure schizophrenic patients' perception of their own cognitive impairment. This kind of evaluation can't substitute for objective measures of cognitive performances in schizophrenia. The purpose of such an evaluation is to permit to the patient to express his own well-being and satisfaction of quality of life. http://www.biomedcentral.com/1471-244X/9/66 Ines Johnson Oussama Kebir Olfa Ben Azouz Lamia Dellagi Yasmine Rabah Karim Tabbane BMC Psychiatry 2009, 9:66 2009-10-08T00:00:00Z doi:10.1186/1471-244X-9-66 BMC Psychiatry 1471-244X 9 66 2009-10-08T00:00:00Z XML Background: In routine psychiatric treatment most clinicians inquire about indicators of suicide risk, but once the risk is assessed not many clinicians systematically focus on suicidal thoughts. This may reflect a commonly held opinion that once the depressive or anxious symptoms are effectively treated the suicidal symptoms will wane. Consequently, many clients with suicidal thoughts do not receive systematic treatment of their suicidal thinking. There are many indications that specific attention to suicidal thinking is necessary to effectively decrease the intensity and recurrence of suicidal thinking. We therefore developed a group training for patients with suicidal thoughts that is easy to apply in clinical settings as an addition to regular treatment and that explicitly focuses on suicidal thinking. We hypothesize that such an additional training will decrease the frequency and intensity of suicidal thinking.We based the training on cognitive behavioural approaches of hopelessness, worrying, and future perspectives, given the theories of Beck, McLeod and others, concerning the lack of positive expectations characteristic for many suicidal patients. In collaboration with each participant in the training individual positive future possibilities and goals were challenged.Methods/DesignWe evaluate the effects of our program on suicide ideation (primary outcome measure). The study is conducted in a regular treatment setting with regular inpatients and outpatients representative for Dutch psychiatric treatment settings. The design is a RCT with two arms: TAU (Treatment as Usual) versus TAU plus the training. Follow up measurements are taken 12 months after the first assessment.DiscussionThere is a need for research on the effectiveness of interventions in suicidology, especially RCT's. In our treatment program we combine aspects and interventions that have been proven to be useful in the treatment of suicidal thinking and behavior.Trial registrationISRCTN56421759 http://www.biomedcentral.com/1471-244X/9/65 Wessel van Beek Ad Kerkhof Aartjan Beekman BMC Psychiatry 2009, 9:65 2009-10-07T00:00:00Z doi:10.1186/1471-244X-9-65 BMC Psychiatry 1471-244X 9 65 2009-10-07T00:00:00Z XML Background: Schema Therapy (ST) is an integrative psychotherapy based upon a cognitive schema model which aims at identifying and changing dysfunctional schemas and modes through cognitive, experiential and behavioral pathways. It is specifically developed for patients with personality disorders. Its effectiveness and efficiency have been demonstrated in a few randomized controlled trials, but ST has not been evaluated in regular mental healthcare settings. This paper describes the study protocol of a multisite randomized 2-group design, aimed at evaluating the implementation of outpatient schema therapy for patients with borderline personality disorder (BPD) in regular mental healthcare and at determining the added value of therapist telephone availability outside office hours in case of crisis.Methods/DesignPatient outcome measures will be assessed with a semi-structured interview and self-report measures on BPD, therapeutic alliance, quality of life, costs and general psychopathology at baseline, 6, 12, 18 and 36 months. Intention-to-treat analyses will be executed with survival analysis for dichotomous variables, and one-sample t-tests and ANCOVAs for continuous variables with baseline as covariate and condition as between group factor. All tests will be two-tailed with a significance level of 5%.DiscussionThe study will provide an answer to the question whether ST can be effectively implemented and whether phone support by the therapist has an additional value.Trial RegistrationThe Dutch Cochrane Center, NTR (TC = 1781). http://www.biomedcentral.com/1471-244X/9/64 Marjon Nadort Arnoud Arntz Johannes Smit Josephine Giesen-Bloo Merijn Eikelenboom Philip Spinhoven Thea van Asselt Michel Wensing Richard van Dyck BMC Psychiatry 2009, 9:64 2009-10-06T00:00:00Z doi:10.1186/1471-244X-9-64 BMC Psychiatry 1471-244X 9 64 2009-10-06T00:00:00Z XML