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Research round-up
Insight
Research round-up Courtesy of Crown Copyright Fera/Science Photo Library
Treating anorexia nervosa
For more on in-patient treatment of anorexia nervosa, see BMC Psychiatry 2014; published online Sept 6. http://dx.doi.org/10.1186/ s12888-014-0258-z For more on the renin-angiotensin system and memory see Am J Psychiatry 2014; published online Aug 15. http:// dx.doi.org/10.1176/appi. ajp.2014.13111543 For more on violence against people with psychiatric illness see Psychol Med 2014; published online Sept 4. http://dx.doi.org/10.1017/ S0033291714001962 For more on the persistence of disruptive behaviour see Biol Psychiatry 2014; published online Sept 4. http://dx.doi.org/10.1016/j. biopsych.2014.08.017 For more on obsessivecompulsive disorder and schizophrenia see JAMA Psychiatry 2014; published online Sept 3. http://dx.doi.org/10.1001/ jamapsychiatry.2014.1011 For more on depression in youth see JAMA 2014; published online Aug 27. http://dx.doi.org/10.1001/ jama.2014.9259
Studies to explore why some patients with anorexia nervosa do not respond to in-patient treatment are needed, propose the authors of an interventional study. In the study by Schlegl and colleagues, patients with anorexia nervosa aged 18 years or older received a multifaceted in-patient treatment regimen. 435 patients were included in the analysis, with a mean in-patient stay of 92 days (SD 44). Body-mass index increased from 14·56 kg/m² (SD 1·74) to 17·18 kg/m² (1·86) after treatment (p<0·001) and all aspects of the Eating Disorder Inventory-2 (EDI-2) were significantly improved. Reliable improvement in the EDI-2 global score occurred in 28% of patients, with clinically significant change occurring in 36%; non-response or deterioration was associated with higher prevalence of post-traumatic stress disorder and comorbid recurrent severe depressive disorder.
2–8 times more likely to experience sexual and domestic violence than the general population’, highlight Khalifeh and colleagues. In their survey of 303 individuals with severe psychiatric illness, 27% of women (36/133) reported domestic violence in the past year compared with 9% of control women (1085/12 288) (adjusted odds ratio 2·7, 95% CI 1·7–4·0). The prevalence of sexual assault since the age of 16 years in women with severe psychiatric illness was 61% (79/1290) compared with 21% (2587/12 289) in controls (adjusted odds ratio 5·8, 95% CI 3·9 –8·6), and 23% (36/157) in men with severe psychiatric illness compared with 3% (321/10 317) in controls (6·2, 3·7–10·4). ‘Healthcare professionals need to work closely with the voluntary sector and criminal justice system in order to effectively address the high burden of violence in this population’, concluded the authors.
Renin-angiotensin system and memory
Persistence of disruptive behavior
Genetic variants of the reninangiotensin system might be associated with cognitive decline, suggest the researchers of a longitudinal study of 138 adults aged 60–84 years. During the 4-year follow-up, hippocampal volume was measured at baseline and during follow-up using MRI, and participants underwent annual neurocognitive assessment. Of four AGTR1 (angiotensin II receptor, type 1) SNP genetic variants studied, three were linked with right hemisphere hippocampal volume loss (p<0·05), with homozygosity being associated with greater hippocampal volume loss and worse episodic memory performance.
Insight into the persistence of childhood antisocial behaviour into adolescence is provided by results from a longitudinal study. The study included adolescents (mean age 17·7 years) who had committed a first criminal offence before the age of 12 years. The participants underwent a Monetary Incentive Delay task with functional MRI being done simultaneously to measure neural responses. Adolescents with persistent disruptive behaviour disorder (n=22) had lower neural responses during reward feedback in the right ventral striatum and higher neural responses during loss feedback in the right amygdala compared with controls (n=23) and participants who had a previous (not current) diagnosis of disruptive behaviour disorder (n=23). Some association between callousunemotional traits and lower neural
Violence against people with psychiatric illness ‘Men and women with severe mental illness who are under the on-going care of psychiatric services are 334
responses in the amygdala during reward feedback was noted.
OCD and schizophrenia The authors of a Danish cohort study suggest that there might be some overlapping pathways for the development of obsessivecompulsive disorder (OCD) and schizophrenia. With data from national registers, 3 million people were followed-up from 1995 to 2012; 16 235 developed schizophrenia of whom 447 had a previous hospital contact for OCD (adjusted incident rate ratio 4·99, 95% CI 4·53–5·48). The risk of developing a schizophrenia spectrum disorder was also increased by a previous OCD diagnosis (5·18, 4·80–5·58). The risk of developing schizophrenia imparted by having an OCD diagnosis was greater than that associated with having a previous diagnosis of attention-deficit/hyperactivity disorder (2·12, 1·89–2·37). Parental OCD also increased the likelihood of schizophrenia in off spring.
Depression in youth Integration of mental health services into primary care for young people with depression can improve their symptoms, note the authors of a randomised controlled trial. In their study, adolescents with depression were randomly assigned to receive a collaborative care intervention (including education, engagement, and treatment) or usual care (including a written summary of test results and encouragement to start depression care). At 12 months, Child Depression Rating Scale-Revised scores in the collaborative care group had decreased from 48·3 to 27·5 and in the usual care group from 46·0 to 34·6 with statistically greater improvements with the intervention than with the control over time (p<0·001).
Seema Kang www.thelancet.com/psychiatry Vol 1 October 2014
Research round-up Courtesy of Crown Copyright Fera/Science Photo Library
Treating anorexia nervosa
For more on in-patient treatment of anorexia nervosa, see BMC Psychiatry 2014; published online Sept 6. http://dx.doi.org/10.1186/ s12888-014-0258-z For more on the renin-angiotensin system and memory see Am J Psychiatry 2014; published online Aug 15. http:// dx.doi.org/10.1176/appi. ajp.2014.13111543 For more on violence against people with psychiatric illness see Psychol Med 2014; published online Sept 4. http://dx.doi.org/10.1017/ S0033291714001962 For more on the persistence of disruptive behaviour see Biol Psychiatry 2014; published online Sept 4. http://dx.doi.org/10.1016/j. biopsych.2014.08.017 For more on obsessivecompulsive disorder and schizophrenia see JAMA Psychiatry 2014; published online Sept 3. http://dx.doi.org/10.1001/ jamapsychiatry.2014.1011 For more on depression in youth see JAMA 2014; published online Aug 27. http://dx.doi.org/10.1001/ jama.2014.9259
Studies to explore why some patients with anorexia nervosa do not respond to in-patient treatment are needed, propose the authors of an interventional study. In the study by Schlegl and colleagues, patients with anorexia nervosa aged 18 years or older received a multifaceted in-patient treatment regimen. 435 patients were included in the analysis, with a mean in-patient stay of 92 days (SD 44). Body-mass index increased from 14·56 kg/m² (SD 1·74) to 17·18 kg/m² (1·86) after treatment (p<0·001) and all aspects of the Eating Disorder Inventory-2 (EDI-2) were significantly improved. Reliable improvement in the EDI-2 global score occurred in 28% of patients, with clinically significant change occurring in 36%; non-response or deterioration was associated with higher prevalence of post-traumatic stress disorder and comorbid recurrent severe depressive disorder.
2–8 times more likely to experience sexual and domestic violence than the general population’, highlight Khalifeh and colleagues. In their survey of 303 individuals with severe psychiatric illness, 27% of women (36/133) reported domestic violence in the past year compared with 9% of control women (1085/12 288) (adjusted odds ratio 2·7, 95% CI 1·7–4·0). The prevalence of sexual assault since the age of 16 years in women with severe psychiatric illness was 61% (79/1290) compared with 21% (2587/12 289) in controls (adjusted odds ratio 5·8, 95% CI 3·9 –8·6), and 23% (36/157) in men with severe psychiatric illness compared with 3% (321/10 317) in controls (6·2, 3·7–10·4). ‘Healthcare professionals need to work closely with the voluntary sector and criminal justice system in order to effectively address the high burden of violence in this population’, concluded the authors.
Renin-angiotensin system and memory
Persistence of disruptive behavior
Genetic variants of the reninangiotensin system might be associated with cognitive decline, suggest the researchers of a longitudinal study of 138 adults aged 60–84 years. During the 4-year follow-up, hippocampal volume was measured at baseline and during follow-up using MRI, and participants underwent annual neurocognitive assessment. Of four AGTR1 (angiotensin II receptor, type 1) SNP genetic variants studied, three were linked with right hemisphere hippocampal volume loss (p<0·05), with homozygosity being associated with greater hippocampal volume loss and worse episodic memory performance.
Insight into the persistence of childhood antisocial behaviour into adolescence is provided by results from a longitudinal study. The study included adolescents (mean age 17·7 years) who had committed a first criminal offence before the age of 12 years. The participants underwent a Monetary Incentive Delay task with functional MRI being done simultaneously to measure neural responses. Adolescents with persistent disruptive behaviour disorder (n=22) had lower neural responses during reward feedback in the right ventral striatum and higher neural responses during loss feedback in the right amygdala compared with controls (n=23) and participants who had a previous (not current) diagnosis of disruptive behaviour disorder (n=23). Some association between callousunemotional traits and lower neural
Violence against people with psychiatric illness ‘Men and women with severe mental illness who are under the on-going care of psychiatric services are 334
responses in the amygdala during reward feedback was noted.
OCD and schizophrenia The authors of a Danish cohort study suggest that there might be some overlapping pathways for the development of obsessivecompulsive disorder (OCD) and schizophrenia. With data from national registers, 3 million people were followed-up from 1995 to 2012; 16 235 developed schizophrenia of whom 447 had a previous hospital contact for OCD (adjusted incident rate ratio 4·99, 95% CI 4·53–5·48). The risk of developing a schizophrenia spectrum disorder was also increased by a previous OCD diagnosis (5·18, 4·80–5·58). The risk of developing schizophrenia imparted by having an OCD diagnosis was greater than that associated with having a previous diagnosis of attention-deficit/hyperactivity disorder (2·12, 1·89–2·37). Parental OCD also increased the likelihood of schizophrenia in off spring.
Depression in youth Integration of mental health services into primary care for young people with depression can improve their symptoms, note the authors of a randomised controlled trial. In their study, adolescents with depression were randomly assigned to receive a collaborative care intervention (including education, engagement, and treatment) or usual care (including a written summary of test results and encouragement to start depression care). At 12 months, Child Depression Rating Scale-Revised scores in the collaborative care group had decreased from 48·3 to 27·5 and in the usual care group from 46·0 to 34·6 with statistically greater improvements with the intervention than with the control over time (p<0·001).
Seema Kang www.thelancet.com/psychiatry Vol 1 October 2014