Tuesday, July 28, 2015

Physical Activity May Be Protective Against Suicidality in Bullied Adolescents

Physical activity appears to be inversely related to sadness and suicidality in adolescents and may be protective against suicidality in adolescents who are bullied, according to a report in the Journal of the American Academy of Child and Adolescent Psychiatry.

Using the 2013 National Youth Risk Behavior Survey (N=13,583), researchers from the University of Vermont analyzed the effect of physical activity on odds ratios for sadness, suicidal ideation, and suicide attempts according to whether students were bullied.

Overall, 30.0% of students reported sadness for at least two weeks, 22.2% reported suicidal ideation, and 8.2% reported suicide attempts in the previous 12 months. Bullied students were twice as likely to report feeling sad and three times as likely to report suicidal ideation or attempts.

But students who reported exercising four to five days per week had lower adjusted odds of sadness, suicidal ideation, or suicide attempts than students who exercised one day or less each week. After stratifying by bullying, similar but slightly weaker associations were observed. Overall, exercise for four or more days per week was associated with an approximately 23% reduction in suicidal ideation and attempts in bullied students.

“The consequences of bullying are well described, yet little is known about protective factors that may diminish the negative sequelae,” the researchers stated. “One possible factor, physical activity, improves mental health in general and clinical populations....We hypothesized that physically active students would be less likely to feel sad or report suicidal ideation or attempts, including bullied students."

For related information, see the Psychiatric News article "Effects of Bullying Don't End When School Does."

(Image: Jacek Chabraszewski/Shutterstock.com)

Monday, July 27, 2015

Sedentary Lifestyle in Early Adulthood May Contribute to Worse Cognitive Function in Midlife, Study Suggests

A study presented at the 2015 Alzheimer’s Association International Conference, held last week in Washington, suggests that frequencies of physical activity and television viewing in early adulthood may impact cognitive function in midlife.

To investigate whether an association exists between long-term patterns of low physical activity and high television viewing time in early adulthood and cognitive decline in midlife, Kristine Yaffe, M.D. (pictured left), the Roy and Marie Scola Endowed Chair and Vice Chair of Research in Psychiatry at the University of California, San Francisco, and colleagues analyzed data of more than 3,200 individuals, aged 18 to 30. The physical activity and television viewing of the participants were assessed at three or more visits over 25 years. At year 25 of the study, the researchers assessed the participants’ memory, executive function, and processing speed. The investigation was a part of the Coronary Artery Risk Development in Young Adults study.

The researchers found that participants who reported low physical activity (less than 300 kcal/50 min session, three times per week) in more than two-thirds of the follow-up visits had significantly worse cognition in midlife than individuals reporting less frequent physical inactivity—even after adjusting for education, smoking habits, alcohol consumption, body mass index, and hypertension. Participants who reported regularly watching television for more than 4 hours per day throughout the study also had worse midlife cognition than those who reported less television viewing. Those who reported a history of long-term low physical activity and high television viewing were almost two times more likely to have poor cognitive function in midlife.

The researchers said that because global data suggests that levels of physical inactivity and sedentary behavior are increasing, understanding the relationship between physical activity in early adulthood and cognitive decline later in life may be of importance. They concluded that because research indicates that Alzheimer's disease and other dementias develop over several decades, increasing physical activity and reducing sedentary behavior beginning in early adulthood may have a significant public health impact.

An overview of the study by Yaffe is available here.

For more information about the role of physical activity in reducing the onset Alzheimer's disease or other dementias, see the Psychiatric News article "Exercise Found to Reduce Amyloid Plaques in Brain."

Friday, July 24, 2015

Attention-Control Training Found to Improve PTSD Symptoms

Attention-control training is more effective than attention-bias modification at reducing the symptoms of posttraumatic stress disorder (PTSD), according to a study published today in American Journal of Psychiatry in Advance.

Attention-bias modification is designed to shift attention away from perceived threat, whereas attention-control training aims to balance attention between threat and neutral stimuli.

This study compared these two attention strategies in two groups of veterans: one in Israeli Defense Forces veterans and the other in U.S. military veterans. The protocol involved computerized tests focusing the participants’ attention on either neutral or aggressive words.

In both groups, the attention-control training was far more effective in reducing both self-reported and clinician-reported PTSD symptoms in the participants. Attention control, but not attention-bias modification, also reduced the participants’ variability in their attention bias, which is how much they shifted their attention toward or away from threat within a training session.

When the results of both training sessions were combined, the analysis showed that this normalization of attention variability was at least partially responsible for the related improvements in PTSD symptoms. Thus, the authors suggested that balancing these moment-to-moment attention shifts from threat vigilance to threat avoidance may be a preferred treatment strategy.

To learn about another potential approach to treating PTSD, see the Psychiatric News article “Trial of Interpersonal Therapy May Open New Door to Treat PTSD.”

(Image: Shutterstock.com/Feng Yu)

Thursday, July 23, 2015

Many Vietnam Vets Still Have Current PTSD, Study Shows

More than a quarter-million Vietnam War veterans appear to still have current PTSD related to their experience, according to an analysis of survey data appearing in JAMA Psychiatry.

Researchers led by Charles R. Marmar, M.D., from the Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury at the New York University Langone Medical Center, New York, and other institutions analyzed data from the National Vietnam Veterans Readjustment Study (NVVRS). That survey consisted of a self-report health questionnaire (n=1,409), a computer-assisted telephone survey health interview (n=1,279), and a telephone clinical interview (n=400) in a representative national sample of veterans who served in the Vietnam theater of operations. A total of 1,839 veterans participated in at least one NVVRS study phase.

Study instruments included the Mississippi Scale for Combat-Related PTSD, PTSD Checklist for DSM-IV supplemented with PTSD Checklist for DSM-5 items (PCL-5+), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and Structured Clinical Interview for DSM-IV, Nonpatient Version.

They found that among male theater veterans, the prevalence of current PTSD ranged from 4.5% based on CAPS-5 criteria to 11.2% using PCL-5+ criteria. Among female veterans, estimates were between 6.1% and 8.7%. Comorbid major depression occurred in 36.7% of veterans with current war-zone PTSD. With regard to the course of PTSD, 16% of theater veterans reported an increase and 7.6% reported a decrease of greater than 20 points in Mississippi Scale for Combat-Related PTSD symptoms.

“Approximately 271,000 Vietnam theater veterans have current full PTSD plus subthreshold war-zone PTSD, one-third of whom have current major depressive disorder, 40 or more years after the war,” the researchers stated. “These findings underscore the need for mental health services for many decades for veterans with PTSD symptoms.”

In an editorial accompanying the study in JAMA Psychiatry, Charles W. Hoge, M.D., of the Center for Psychiatry and Neuroscience at the Walter Reed Army Institute of Research, said, “The study is of vital importance to subsequent generations of war veterans and underscores medical service needs for PTSD and related comorbidities extending decades after service. The study also highlights a need to reconsider changes to the PTSD definition, a definition intimately connected with the Vietnam generation and the foundation for the past 25
years of epidemiologic, neurobiological, and clinical knowledge and evidence-based treatment practices."

For more information see the Psychiatric News article, "Serious Heart Disease Found in Vietnam Vets With PTSD."

(Image: Straight 8 Photography/shutterstock.com)


Wednesday, July 22, 2015

Novel Twist on Fear Extinction Opens New Doors for Research

Something’s better than nothing, at least when using extinction as a means of overcoming fear conditioning, according to Joseph Dunsmoor, Ph.D., Elizabeth A. Phelps, Ph.D., and colleagues from the Psychology Department and Center for Neural Sciences at New York University, writing in the August 1 issue of the journal Biological Psychiatry.

Extinction normally overcomes the association between a benign conditioned stimulus (like a sound or light) and a threatening unconditioned stimulus (like an electric shock) by overlaying a newly learned memory that couples the conditioned stimulus with the absence of threat.

However, that effect often wears off over time, so the researchers used both rats and humans to test another way to extinguish fear. Rather than simply leaving out the shock, they replaced it with a new, nonaversive tone. The goal was to eliminate any ambiguity about the safety or danger of the conditioned stimulus by using the element of surprise to generate “a mismatch between the predicted and received outcome, therefore signaling a clear change in the environment to promote the acquisition of new learning” and “providing a more substantive alternative association for the conditioned stimulus than no shock,” they wrote.

If used in exposure treatments for disorders like anxiety or PTSD, this “novelty-facilitated extinction” may neutralize negative beliefs “by experiencing an unexpectedly mundane event, rather than simply experiencing the absence of a negative event.”

For more in Psychiatric News about fear extinction research, see “Context Is Critical in PTSD Fear Learning.”

(Image: imagineerinx/Shutterstock.com)

Tuesday, July 21, 2015

Ultrabrief Pulse ECT Offers Similar Benefit to Standard ECT With Fewer Side Effects

Electroconvulsive therapy (ECT) is known to be a highly efficacious treatment for depression, but it has been associated with cognitive side effects in patients. A meta-analysis of studies published online today in the Journal of Clinical Psychiatry suggests that ultrabrief pulse stimulation is almost as effective as standard brief pulse ECT with fewer side effects.

ECT has historically been administered with brief pulses (1 ms in width). While some studies suggest ECT delivered with ultrabrief pulses (0.25-0.37 ms) may show similar rates of efficacy as the standard method, others have produced conflicting results.

Colleen Loo, M.D., a professor of psychiatry at the University of New South Wales, and colleagues conducted a systematic review of studies comparing brief pulse and ultrabrief pulse right unilateral ECT in patients that reported mood ratings for depression. They identified six studies involving 689 patients (261 receiving brief pulse right unilateral ECT and 428 receiving ultrabrief pulse right unilateral ECT) and used statistical analysis to examine the efficacy and cognitive side effects of brief pulse versus ultrabrief pulse right unilateral ECT.

The analysis revealed that while brief pulse ECT has a small efficacy advantage (reflected in both mean change in mood ratings, remission rates over the ECT course, and one fewer session in the treatment course) over ultrabrief pulse ECT, it was associated with significantly more cognitive side effects in all cognitive domains examined, including global cognition, anterograde learning and recall, and retrograde memory.

"The decision of whether to use BP [brief pulse] or UBP [ultrabrief pulse] RUL [right unilateral] ECT should be made on an individual patient basis and should be based on a careful weighing of the relative priorities of efficacy versus minimization of cognitive impairment," the study authors concluded.

For related information, see the Psychiatric News article “Psychiatrists Discuss Benefits, Risks of ECT.”

(Image: buffaloboy2513/Shutterstock.com)

Monday, July 20, 2015

Autoimmune Disorder May Be Linked With Some Cases of Postpartum Psychosis

Previous studies have found that some women who develop psychosis during the postpartum period undergo significant changes in their immune systems. A new study published in AJP in Advance now finds autoimmune encephalitis may underlie about 4% of postpartum psychosis cases and suggests that autoantibody screening should be considered as part of the diagnosis.

Antibody screenings were performed on 96 women who developed postpartum psychosis and 64 healthy postpartum women. Four of the patients with psychosis tested positive for neuronal cell surface antibodies suggestive for encephalitis—two of these patients were identified as having anti-NMDA receptor encephalitis; the other two patients did not test positive for any known brain antigen. In contrast, none of the 64 healthy controls tested positive for any autoimmune activity. This is important as false positives are a major concern when considering clinical screening.

The researchers also found that the women with postpartum psychosis and anti-NMDA receptor autoantibodies exhibited extrapyramidal symptoms with low-dose haloperidol—“a clinical response that is not particularly common among patients with postpartum psychosis,” they noted.

“In patients with acute psychosis during the postpartum period, systematic screening for anti-NMDA receptor autoantibodies should be considered,” the study authors concluded. “The acute onset of severe atypical psychiatric symptoms in young female patients should raise the index of suspicion for anti-NMDA receptor encephalitis, particularly in the setting of neurological symptoms, including extrapyramidal side effects of antipsychotic treatment.

To read more about the treatment of postpartum psychosis, see the recent AJP article “Treatment of Psychosis and Mania in the Postpartum Period.”

(Bergink et al., AJP in Advance, July 17, 2015)


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