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Early psychological intervention in prehospital emergency care systems.

J Emerg Med. 2009 May;36(4):404-6

Authors: Cunha S, Soares-Oliveira M, Pereira N

PMID: 18385002 [PubMed - indexed for MEDLINE]

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Virtual reality and persecutory delusions: safety and feasibility.

Schizophr Res. 2008 Sep;104(1-3):228-36

Authors: Fornells-Ambrojo M, Barker C, Swapp D, Slater M, Antley A, Freeman D

OBJECTIVE: Virtual reality (VR) has begun to be used to research the key psychotic symptom of paranoia. The initial studies have been with non-clinical individuals and individuals at high risk of psychosis. The next step is to develop the technology for the understanding and treatment of clinical delusions. Therefore the present study investigated the acceptability and safety of using VR with individuals with current persecutory delusions. Further, it set out to determine whether patients feel immersed in a VR social environment and, consequently, experience paranoid thoughts. METHOD: Twenty individuals with persecutory delusions and twenty non-clinical individuals spent 4 min in a VR underground train containing neutral characters. Levels of simulator sickness, distress, sense of presence, and persecutory ideation about the computer characters were measured. A one-week follow-up was conducted to check longer-term side effects. RESULTS: The VR experience did not raise levels of anxiety or symptoms of simulator sickness. No side effects were reported at the follow-up. There was a considerable degree of presence in the VR scenario for all participants. A high proportion of the persecutory delusions group (65%) had persecutory thinking about the computer characters, although this rate was not significantly higher than the non-clinical group. CONCLUSIONS: The study indicates that brief experiences in VR are safe and acceptable to people with psychosis. Further, patients with paranoia can feel engaged in VR scenes and experience persecutory thoughts. Exposure to social situations using VR has the potential to be incorporated into cognitive behavioural interventions for paranoia.

PMID: 18571899 [PubMed - indexed for MEDLINE]

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Factors affecting antipsychotic drug discontinuation in the treatment of schizophrenia: evidence from a naturalistic, retrospective, 18-month follow-up study.

Schizophr Res. 2008 Sep;104(1-3):302-4

Authors: Vita A, Corsini P, Bonomi S, Sacchetti E, Cesana BM

PMID: 18692993 [PubMed - indexed for MEDLINE]

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Impact of stress on paranoia: an experimental investigation of moderators and mediators.

Psychol Med. 2009 Jul;39(7):1129-39

Authors: Lincoln TM, Peter N, Schäfer M, Moritz S

BACKGROUND: Vulnerability-stress models ascribe stress a pivotal role in the development of psychosis. However, moderating and mediating mechanisms translating stress into psychosis and the specificity of the association are not clearly established. It is hypothesized that stress will trigger paranoid ideation in vulnerable individuals through an increase in negative emotion. METHOD: Using a repeated-measures design, 64 healthy participants with varying levels of vulnerability [psychosis symptoms assessed by the Community Assessment of Psychic Experiences (CAPE)] were assigned to a stress and a non-stress condition in random order. Stress was induced by exposing participants to building-site noise (75 dB) applied concurrently with difficult knowledge questions. Symptoms of paranoia, depression and obsessive compulsive disorder (OCD) were assessed by state-adapted versions of clinical scales. RESULTS: In the stress condition there was an increase in paranoia, depression and negative emotion. Multilevel linear modeling (MLM) revealed the increase in paranoia under stress to be moderated by the level of vulnerability and mediated by anxiety. Although participants generally showed an increase in anxiety under stress, anxiety was more strongly related to paranoia in participants with higher baseline symptomatology. CONCLUSIONS: The results support and specify the role of emotional reactions to stressors on the pathway from vulnerability to psychosis and highlight the relevance of anxiety.

PMID: 18940024 [PubMed - indexed for MEDLINE]

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Are gender-associated differences in quality of life in colorectal cancer patients disease-specific?

Qual Life Res. 2009 Jun;18(5):547-55

Authors: Giesinger J, Kemmler G, Mueller V, Zabernigg A, Mayrbaeurl B, Thaler J, Ofner D, Pegger C, Rumpold G, Weber B, Sperner-Unterweger B, Holzner B

PURPOSE: The purpose of this study was to investigate gender-associated differences in quality of life in colorectal cancer patients and compare such differences to the general population. METHODS: Colorectal cancer patients attending three oncological centres in Austria were consecutively recruited and assessed with the EORTC QLQ-C30. For the purpose of comparison, a gender- and age-matched healthy control group was drawn from a representative sample of the Austrian general population. RESULTS: About 206 patients (47.1% women; mean age 64.8 years) with colorectal cancer were included and compared with 206 persons from the general population. A two-way analysis of variance showed significant main effects (gender and colorectal cancer vs. healthy) for most EORTC QLQ-C30 scales, but a significant interaction effect was only found for diarrhea. This means that gender-associated differences specific for colorectal cancer patients were only found for diarrhea. CONCLUSION: The vast majority of studies on gender-associated differences in quality of life compare male and female oncological patients and neglect the issue of the disease-specificity of such differences. Our study revealed that women and men suffering from colorectal cancer scored differently across many aspects of quality of life, but with the exception of diarrhea, these differences were also found in the general population, i.e. they indicated no gender-specific reaction to disease.

PMID: 19337852 [PubMed - indexed for MEDLINE]

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Structural brain alterations at different stages of schizophrenia: a voxel-based morphometric study.

Schizophr Res. 2008 Sep;104(1-3):44-60

Authors: Meisenzahl EM, Koutsouleris N, Bottlender R, Scheuerecker J, Jäger M, Teipel SJ, Holzinger S, Frodl T, Preuss U, Schmitt G, Burgermeister B, Reiser M, Born C, Möller HJ

Structural alterations in schizophrenia have mainly been regarded as the result of neurodevelopmental processes. However, it remains unresolved whether the pattern of morphological brain changes differs between different stages of disease. We examined structural brain changes in 93 first-episode (FES) and 72 recurrently ill (REZ) patients with schizophrenia (SZ) and 175 matched healthy control subjects (HC) using cross-sectional and conjunctional voxel-based morphometry (VBM) of whole-brain MRI data in a three-step approach. We found significant grey matter density (GMD) reductions in FES compared to HC bilaterally in the temporal and prefrontal areas, including the anterior cingulate gyrus, as well as in both thalami. Hippocampus and amygdala were affected on the left side (P<0.05, corrected). In REZ patients this pattern was spatially extended. The basal ganglia were exclusively reduced in the recurrently ill group compared to controls. Common to both disease groups were reductions in the bilateral perisylvian regions, the opercular region, the insula, prefrontal cortex, left inferior temporal gyrus, limbic system including hippocampus and amygdala, and the thalami. In FES patients there were no regions affected that were not also affected in REZ patients. In contrast, REZ patients showed extended alterations within the frontal and temporal regions, the hippocampus, amygdala and exclusively in the basal ganglia relative to the FES patients. Our findings suggest a system-specific involvement of neuronal networks in schizophrenia. Furthermore, our data suggest that in the advanced stages of schizophrenia additional cortical and subcortical brain areas become involved in the disease process. Longitudinal data will be required to further test this hypothesis.

PMID: 18703313 [PubMed - indexed for MEDLINE]

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Youth Internet use: risks and opportunities.

Curr Opin Psychiatry. 2009 Jul;22(4):351-6

Authors: Guan SS, Subrahmanyam K

PURPOSE OF REVIEW: The Internet has become all pervasive in the lives of young people and this paper will review studies that examine the risks and opportunities that it affords. We will examine research that investigates the more negative aspects of youth online behavior such as addiction as well as online risks such as harassment/cyber bullying and sexual solicitation. In addition, positive aspects of Internet use such as its potential for learning and enhancing social relations as well as delivering health interventions will be examined. RECENT FINDINGS: The results show that online risks such as addiction, cyber bullying, and sexual solicitation are associated with negative consequences for youth. It is important to note that not all children are equally susceptible and more research is necessary to identify the youth most at risk as well as to develop effective interventions. The Internet can also provide benefits in the areas of cognitive, social, and physical development, and can also be used to deliver treatment interventions. SUMMARY: The Internet represents both risks and opportunities for young people. To protect youth who are at risk for online addiction, bullying, and solicitation, we need more research to understand which youth may be most susceptible and to develop targeted interventions to protect them. The Internet also has many positive aspects and can be used to enhance youth learning and empowerment; although it is a tremendous health resource and can be used to cheaply deliver interventions, we need to understand how to better implement them to enhance their effectiveness.

PMID: 19387347 [PubMed - indexed for MEDLINE]

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Detecting depression during pregnancy and associated lifestyle practices and concerns among women in a hospital-based obstetric clinic in Jamaica.

Gen Hosp Psychiatry. 2009 May-Jun;31(3):254-61

Authors: Pottinger AM, Trotman-Edwards H, Younger N

OBJECTIVE: Antenatal depression, despite its association with increased maternal morbidity risks, is understudied in the developing world. We determined the rate and predictors of depression throughout pregnancy and the use of medication in women attending an obstetric clinic. METHOD: Prospective longitudinal study of 452 women newly registered at the antenatal clinic at the University Hospital of the West Indies between September 2005 and February 2006. Sociodemographic data, clinical information and self reports of depression using Edinburgh Postnatal Depression Scale (EPDS) were gathered over three trimesters. RESULTS: On average, 25% of women were identified as having a probable depressive disorder over the three trimesters. Independent demographic predictors were youth and unemployment (P<05). Planned pregnancy, exercising, not smoking, being married and support from physician and family were protective factors (P<.05). Using a multivariable model, prior history of depression was the strongest predictor of depression during pregnancy. Of those taking medication for depression prior to pregnancy, only 1.6% remained on medication during the pregnancy. CONCLUSIONS: Poverty-related factors and lifestyle are associated with higher EPDS scores during pregnancy in Jamaican women. A protocol of psychosocial management in obstetric care is discussed along with recommendations for future research.

PMID: 19410104 [PubMed - indexed for MEDLINE]

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Psychiatric morbidity in gynecological and otorhinolaryngological outpatients: a comparative study.

Gen Hosp Psychiatry. 2009 May-Jun;31(3):233-9

Authors: Leithner K, Assem-Hilger E, Fischer-Kern M, Loeffler-Stastka H, Sam C, Ponocny-Seliger E

OBJECTIVE: Assessment of the point prevalence of psychiatric disorders in a gynecological outpatient population compared to a control group consisting of otorhinolaryngological outpatients. METHODS: During an 11-month period of time, 150 unselected, consecutive gynecologic outpatients and 150 matched controls (otorhinolaryngological outpatients) were enrolled in the study. Patients were screened for psychiatric disorders using the Patient Health Questionnaire (PHQ). Sociodemographic data, psychiatric and medical history including inpatient treatments and outpatient contacts, and utilisation of the health care system were assessed. RESULTS: Within the gynecological group, 45.3% fulfilled the diagnostic criteria for at least one psychiatric diagnosis according to the PHQ, compared to 27.3% of the otorhinolaryngological control group (P=.002). With respect to distinct diagnoses, gynecological patients suffered significantly more often from somatoform disorders (P=.001) and depressive disorders (P=.003) than controls. Less than half of subjects of either group with any psychiatric diagnosis had ongoing psychiatric or psychotherapeutic treatment. CONCLUSIONS: We found a significant group difference in the number of psychiatric diagnoses between gynecological and otorhinolaryngological female outpatients. Psychiatric disorders may be frequent and unrecognised in women presenting in an outpatient setting, especially in those seeking medical care for gynecological problems. The PHQ may be a useful tool to detect psychiatric disorders even in busy clinical settings.

PMID: 19410102 [PubMed - indexed for MEDLINE]

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The family oriented musical training for children with cochlear implants: speech and musical perception results of two year follow-up.

Int J Pediatr Otorhinolaryngol. 2009 Jul;73(7):1043-52

Authors: Yucel E, Sennaroglu G, Belgin E

OBJECTIVE: The purpose of this study is to determine whether children can gain benefit from training on pitch and music perception. Our main goals were to prepare a tool for training pitch and rhythm perception and evaluate musical attitude in children, to determine whether pitch and rhythm perception improve more rapidly through training and to assess the impact of training on speech perception. METHOD: A family centred habilitation program based on musical training is developed. Nine newly implanted children who were switched on in HiRes and trained from the outset and 9 children using HiRes strategy who did not receive training both undergo assessments to determine pitch and rhythm perception skills and speech perception assessments. Music group was formed by the children who were implanted consecutively. As a control group, children who are being followed for another study which examines “the changes of sound quality perception, speech understanding, speech production, and communication mode” are included. The speech perception test battery contains a comprehensive range of age appropriate tasks covering detection, discrimination, identification, recognition and comprehension abilities. Also meaningful auditory integration scale (MAIS) or infant-toddler MAIS (if more appropriate) and the meaningful use of speech scale (MUSS) were administered in order to collect information about children’s use of sound in everyday situations such as device bounding, alerting to sound and deriving meaning from auditory stimuli. Musical training program was based on a take-home electric keyboard which is used for listening to different pairs of notes. For this study, three octaves and one extra note at the high end of the keyboard were used. Children were expected to discriminate a pair of notes. Assessments of speech perception at pre-implant, 1-, 3-, 6-, 12-, 24-months post switch-on. By the end of the first and second years, parents were given the ‘musical stages questionnaire’ which covers some of the key areas of musical development to compare both groups’ musical development. RESULTS: Children who were involved in music study demonstrated significant familiarity in both determining pitch differences. No significant difference was found between music group compared with the non-trained group in terms of speech perception (p>0.05). However, by the end of 3rd month, music group came into prominence particularly at the rate of being linguistically/developmentally ready to carry out formal modified open-set speech perception evaluation (p<0.05). Both groups seemed to be developed similarly in sound awareness and general reaction, differentiating melody, dynamic, rhythmical changes and emotional aspects of musical development (p>0.05) whereas music group had more exposure to music at the end of the first year (p<0.05). However, by the end of the second year music group developed more than the control group in all aspects of musical skills (p<0.05). CONCLUSION: Music training program helps appreciation of music and may enhance their progress in other auditory domains after cochlear implantation in children. While, effects of the musical training program on daily listening attitudes and social aspects such as closer parent-child relationship were significantly observed future training programs that should strive to improve satisfaction with music listening and its effect on auditory perception.

PMID: 19411117 [PubMed - indexed for MEDLINE]

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