Millions of people with mental illness are unable to do everyday things like going shopping, making new friends or applying for jobs, according to a survey conducted by the British mental health charity Rethink.

The survey of more than 3,000 people with mental disorders reveals that this includes people you expect to love you unconditionally, your family, (36%), closely followed by employers (35%), neighbors (31%), friends (25%) and family doctors (23%).

At the other end of the discriminators' league table, children (5%), teachers (8%), retailers (10%), and public transport workers (10%) are revealed as the groups who are most accepting of people with mental health problems.

The findings, which will shape a high-profile £18 million mental health anti-stigma campaign, reveal that:

• Nearly nine out of 10 people with mental health problems have been affected by stigma and discrimination, with two thirds saying they have stopped doing things because of the stigma they face. Stigma stops people with mental health problems from doing everyday things such as applying for jobs, making new friends, and going out to pubs and shops. It can even prevent people from reporting a crime.



• People with mental health problems want the anti-stigma campaign to target schools and the media to change attitudes and reduce prejudice.



• Carers of people with mental health problems also stop doing things because of the stigma and discrimination that they face.

Paul Corry, Rethink's director of public affairs, says: "Our research clearly shows that stigma and discrimination are ruining people's lives. People with mental health problems have enough on their plates without facing additional pressure caused by other people's archaic and bigoted opinions.

Janey Antoniou, who has schizophrenia, recalls one example of the stigma she encountered: "I had a neighbor who used to run inside when she saw me because she had once seen me taken to the hospital by the police in my dressing gown. The fact that I'd walked down the road with a briefcase thousands of times seemed irrelevant."

"The Moving People anti-stigma campaign will lay firm foundations for ending mental health discrimination in the UK, but long term it is essential that the government ploughs hefty resources into tackling the problem, as has been done in Scotland and New Zealand. As an employer, the government could also lead by example and employ more people with mental health problems within its departments, and encourage other public sector bodies to do the same," said Mr Corry.

The 'Moving People' anti-stigma campaign will be launched in January 2009 with funding from the Big Lottery Fund and Comic Relief and will be evaluated by the Institute of Psychiatry at King's College, London.

Full survey results/additional information... ()

Swedish and British researchers have found that the hormone oxytocin can inhibit feelings of anxiety in specific individuals. Their discovery might lead to a better understanding and the improved treatment of disorders in which people feel distressed when meeting others, such as autism and social phobia.

Oxytocin is a neuropeptide that is secreted by the body during massage, childbirth and breastfeeding to induce a calming, analgesic effect. Animal studies have also shown that oxytocin promotes social interaction, such as during the courting process. The hormone has a direct influence on the amygdala, a brain area that is important for social interaction and for identifying immediate emotional threats.

In this new study scientists at the Swedish medical university Karolinska Institutet and the Welcome Trust Functional Imaging Laboratory in London demonstrated that oxytocin has a more targeted effect than simply producing a general feeling of wellbeing.

Subjects were shown pictures of four different faces, two of which were combined with a tiny, harmless but uncomfortable electric shock. As expected, the researchers found that the faces associated with the shock were considered more unpleasant than the others. However, when half of the subjects were then given oxytocin spray and the other half a placebo spray, an interesting change was brought about.

"When we showed the oxytocin group the two faces again that had previously been associated with the shock, they no longer found them disagreeable, while those who had received the placebo still found them so," says Dr Predrag Petrovic from the Department of Clinical Neuroscience at Karolinska Institutet.

Using an fMRI scanner, the team also found that subjects who had developed shock-induced feelings of anxiety for certain faces exhibited, when shown these faces, higher levels of activity in two brain areas - the amygdalae and the 'fusiform face area' - that process unpleasant and threatening faces. These activity levels then dropped when they were given oxytocin, but not when given the placebo.

"This suggests that oxytocin can reduce anxiety and increase the chances of social contact for people with certain types of psychiatric disorder," says Dr Petrovic. "There are also previous studies to show that oxytocin can inhibit amygdala activity, which tells us that we should see this as an opportunity for new forms of treatment."

The study was conducted at the Welcome Trust Functional Imaging Laboratory in London and the data analysed in London and at Karolinska Institutet in Stockholm and was co-financed by the Swedish Research Council.

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Petrovic P, Kalisch R, Singer T, Dolan RJ. Oxytocin attenuates affective evaluations of conditioned faces and amygdala activity. J Neurosci. 2008 Jun 25;28(26):6607-15.   [Abstract]

The expectation that East-Asian people emphasize physical symptoms of depression (e.g. headaches, poor appetite or aches/pains in the body) is widely acknowledged, yet the few available empirical studies report mixed data on this issue. A new study from the Centre for Addiction and Mental Health (CAMH) debunks this cultural myth, and offers clinicians valuable insight to into cultural context when assessing a patient, leading to more accurate diagnosis.

Lead by CAMH Clinical Research Director Dr R. Michael Bagby, in collaboration with Dr Andrew Ryder, Concordia University, Steven Heine, University of British Columbia and a number of collaborators from Second Xiangya Hospital of Central South University, People's Republic of China, this study recruited more than 200 participants, half from an outpatient clinic in China, and half from a clinical research department outpatient clinic at CAMH, and tested two central hypotheses: 1. East-Asian participants will emphasize somatic or physical symptoms of depression more than North American participants, and 2. North American participants would emphasize psychological symptoms of depression (e.g. report feeling sad, crying spells, or a loss of self-confidence) more than East-Asian participants. Dr Bagby and his team also wanted to examine the role stigma and alexithymia (difficulty using words to describe emotions) play in how each culture presented and expressed depression symptoms.

This rigorous work is one of only a few studies to address these questions with a direct cross-cultural comparison of clinical patients. Also, it is the only study to use three assessment tools (spontaneous report of problems during unstructured discussion with doctor; clinician-rated symptoms in a structured clinical interview; and a symptom rating scale in questionnaire form) translated into both English and Chinese (Mandarin) and modified to address cross-cultural differences.

As Dr Bagby explains, "the onset of depression triggers a biological response that takes place within a specific social context, resulting in a cascade of somatic and psychological experiences that are interpreted through a particular cultural lens. Careful translation and adaptation of our assessment tools helped us clarify if different approaches lead to different symptom profiles and conclusions about patients."

Overall, the data demonstrate a consistently greater level of psychological symptom reporting in the North American sample, regardless of assessment tool. This suggests a tendency for Western cultures to emphasize psychological symptoms of depression (psychologization), rather than a tendency for those from East-Asian cultures to emphasize physical symptoms (somatization).

East-Asian participants did report a significantly higher level of somatic symptoms when reporting through the spontaneous interview and structured clinical interview. Also, these participants reported higher levels of stigma and alexithymia. A refined examination of this link revealed that the observed cross-cultural differences in somatic symptom scores relates, in part, to cultural differences in internally versus externally oriented thinking. This suggests that people who do not frequently focus on their internal emotional state are more likely to notice somatic symptoms.

While this data may help clinicians be more aware of how culture can impact how people talk about their illness, this data does not constitute a norm for depression worldwide. More work should be done to understand the interaction of biology, culture and individual differences in predicting variations in how people present symptoms of depression.

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Ryder AG, Yang J, Zhu X, et al. The cultural shaping of depression: somatic symptoms in China, psychological symptoms in North America? J Abnorm Psychol. 2008 May;117(2):300-13.   [Abstract]

By Kurt Ullman, Contributing Writer
Health Behavior News Service

People who suffer from severe depression following a heart attack might be more likely to experience cardiac complications while hospitalized, according to a new study.

"There is good evidence that if a person has depression after a heart attack, they are more likely to die from cardiac causes in the following months and years," said lead author Jeff Huffman, M.D., assistant professor of psychiatry at Harvard Medical School. "No one had yet studied whether depression impacts cardiac outcomes immediately after a heart attack-the time we see the most complications."

The study included 129 patients at Massachusetts General Hospital. Within 72 hours of having a heart attack, each participant underwent an interview to determine if he or she suffered from depression or anxiety. Seventeen of the original group members had a diagnosis of major depression lasting for at least two weeks.

The presence of major depression was a significant predictor of heart rhythm problems, congestive heart failure or a second heart attack.

Anxiety did not affect the risk for any in-hospital complication.

"The results suggest that physicians should be especially mindful of treating depression in patients with cardiac risk factors," Huffman said. "They also suggest close in-hospital monitoring of heart attack patients with major depression given this increased risk for complications."

Huffman noted that the study, which appears in the July-August issue of the journal Psychosomatics, is a small, preliminary study. Most of the participants were white males, so its findings might not apply to other groups.

"What is surprising is that differences in outcomes were seen in a relatively short time. The new observation is that risk for these bad outcomes start while patients are still in the hospital," said David Bush, M.D., associate professor at The Johns Hopkins University School of Medicine and Heart Institute.

"The separation between heart disease, typically managed by cardiologists and internists, and mental disease, typically managed by psychiatrists, is not as great as many seem to think." Bush said. "Physicians and patients should be sensitive to this and work on treating depression in addition to controlling diabetes, lowering blood pressure and lowering cholesterol."

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Huffman JC, Smith FA, Blais MA, et al. Pre-Existing Major Depression Predicts In-Hospital Cardiac Complications After Acute Myocardial Infarction. Psychosomatics 2008 Jul;49:309-316   [Abstract]

In addition to helping protect us from heart disease and cancer, a balanced diet and regular exercise can also protect the brain and ward off mental disorders.

"Food is like a pharmaceutical compound that affects the brain," said Fernando Gómez-Pinilla, a UCLA professor of neurosurgery and physiological science who has spent years studying the effects of food, exercise and sleep on the brain. "Diet, exercise and sleep have the potential to alter our brain health and mental function. This raises the exciting possibility that changes in diet are a viable strategy for enhancing cognitive abilities, protecting the brain from damage and counteracting the effects of aging."

Gómez-Pinilla analyzed more than 160 studies about food's affect on the brain; the results of his analysis appear in the July issue of the journal Nature Reviews Neuroscience.

Omega-3 fatty acids - found in salmon, walnuts and kiwi fruit - provide many benefits, including improving learning and memory and helping to fight against such mental disorders as depression and mood disorders, schizophrenia, and dementia, said Gómez-Pinilla, a member of UCLA's Brain Research Institute and Brain Injury Research Center.

Synapses in the brain connect neurons and provide critical functions; much learning and memory occurs at the synapses, Gómez-Pinilla said.

"Omega-3 fatty acids support synaptic plasticity and seem to positively affect the expression of several molecules related to learning and memory that are found on synapses," Gómez-Pinilla said. "Omega-3 fatty acids are essential for normal brain function.

"Dietary deficiency of omega-3 fatty acids in humans has been associated with increased risk of several mental disorders, including attention-deficit disorder, dyslexia, dementia, depression, bipolar disorder and schizophrenia," he said. "A deficiency of omega-3 fatty acids in rodents results in impaired learning and memory."

Children who had increased amounts of omega-3 fatty acids performed better in school, in reading and in spelling and had fewer behavioral problems, he said.

Preliminary results from a study in England show that school performance improved among a group of students receiving omega-3 fatty acids. In an Australian study, 396 children between the ages 6 and 12 who were given a drink with omega-3 fatty acids and other nutrients (iron, zinc, folic acid and vitamins A, B6, B12 and C) showed higher scores on tests measuring verbal intelligence and learning and memory after six months and one year than a control group of students who did not receive the nutritional drink. This study was also conducted with 394 children in Indonesia. The results showed higher test scores for boys and girls in Australia, but only for girls in Indonesia.

Getting omega-3 fatty acids from food rather than from capsule supplements can be more beneficial, providing additional nutrients, Gómez-Pinilla said.

Scientists are learning which omega-3 fatty acids seem to be especially important. One is docosahexaenoic acid, or DHA, which is abundant in salmon. DHA, which reduces oxidative stress and enhances synaptic plasticity and learning and memory, is the most abundant omega-3 fatty acid in cell membranes in the brain.

"The brain and the body are deficient in the machinery to make DHA; it has to come through our diet," said Gómez-Pinilla, who was born and raised in salmon-rich Chile and eats salmon three times a week, along with a balanced diet. "Omega-3 fatty acids are essential."

A healthy diet and exercise can also reduce the effect of brain injury and lead to a better recovery, he said.

Recent research also supports the hypothesis that health can be passed down through generations, and a number of innovative studies point to the possibility that the effects of diet on mental health can be transmitted across generations, Gómez-Pinilla said.

A long-term study that included more than 100 years of birth, death, health and genealogical records for 300 Swedish families in an isolated village showed that an individual's risk for diabetes and early death increased if his or her paternal grandparents grew up in times of food abundance rather than food shortage.

"Evidence indicates that what you eat can affect your grandchildren's brain molecules and synapses," Gómez-Pinilla said. "We are trying to find the molecular basis to explain this."

Controlled meal-skipping or intermittent caloric restriction might provide health benefits, he said.

Excess calories can reduce the flexibility of synapses and increase the vulnerability of cells to damage by causing the formation of free radicals. Moderate caloric restriction could protect the brain by reducing oxidative damage to cellular proteins, lipids and nucleic acids, Gómez-Pinilla said.

The brain is highly susceptible to oxidative damage. Blueberries have been shown to have a strong antioxidant capacity, he noted.

In contrast to the healthy effects of diets that are rich in omega-3 fatty acids, diets high in trans fats and saturated fats adversely affect cognition, studies indicate.

Junk food and fast food negatively affect the brain's synapses, said Gómez-Pinilla, who eats fast food less often since conducting this research. Brain synapses and several molecules related to learning and memory are adversely affected by unhealthy diets, he said.

Emerging research indicates that the effects of diet on the brain, combined with the effects of exercise and a good night's sleep, can strengthen synapses and provide other cognitive benefits, he added.

In Okinawa, an island in Japan where people frequently eat fish and exercise, the lifespan is one of the world's longest, and the population has a very low rate of mental disorders, Gómez-Pinilla noted.

Folic acid is found in various foods, including spinach, orange juice and yeast. Adequate levels of folic acid are essential for brain function, and folate deficiency can lead to neurological disorders such as depression and cognitive impairment. Folate supplementation, either by itself or in conjunction with other B vitamins, has been shown to be effective in preventing cognitive decline and dementia during aging and enhancing the effects of antidepressants. The results of a recent randomized clinical trial indicate that a three-year folic acid supplementation can help reduce the age-related decline in cognitive function.

In patients with major depression and schizophrenia, levels of a signaling molecule known as brain-derived neurotrophic factor, or BDNF, are reduced. Antidepressants elevate BDNF levels, and most treatments for depression and schizophrenia stimulate BDNF. Here, too, omega-3 fatty acids are beneficial, as is the curry spice curcumin (turmeric), which has been shown to reduce memory deficits in animal models of Alzheimer's disease and brain trauma. BDNF is most abundant in the hippocampus and the hypothalamus - brain areas associated with cognitive and metabolic regulation.

The high consumption of curcumin in India may contribute to the low prevalence of Alzheimer's disease on the subcontinent.

In humans, a mutation in a BDNF receptor has been linked to obesity and impairments in learning and memory.

"BDNF is reduced in the hippocampus, in various cortical areas and in the serum of patients with schizophrenia," Gómez-Pinilla said. "BDNF levels are reduced in the plasma of patients with major depression."

Smaller food portions with the appropriate nutrients seem to be beneficial for the brain's molecules, such as BDNF, he said.

Gómez-Pinilla demonstrated in 1995 that exercise can have an effect on the brain by elevating levels of BDNF.

He noted that while some people have extremely good genes, most of us are not so lucky and need a balanced diet, regular exercise and a good night's sleep.

The research was funded by the National Institutes of Health's National Institute of Neurological Disorders and Stroke.

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Gómez-Pinilla F. Brain foods: the effects of nutrients on brain function. Nat Rev Neurosci. 2008 Jul;9:568-578   [Abstract]

People in most countries around the world are happier these days, according to newly released data from the World Values Survey based at the University of Michigan (U-M) Institute for Social Research.

Data from representative national surveys conducted from 1981 to 2007 show the happiness index rose in an overwhelming majority of nations studied.

"It's a surprising finding," said U-M political scientist Ronald Inglehart, who directs the World Values Surveys and is the lead author of an article on the topic published in the July 2008 issue of the journal Perspectives on Psychological Science. "It's widely believed that it's almost impossible to raise an entire country's happiness level."

The 2007 wave of the surveys also provides a ranking of 97 nations containing 90 percent of the world's population. The results indicate that Denmark is the happiest nation in the world and Zimbabwe the unhappiest. The United States ranks 16th on the list, immediately after New Zealand.

During the past 26 years, the World Values Surveys have asked more than 350,000 people how happy they are, using the same two questions.

"Taking all things together, would you say you are very happy, rather happy, not very happy, not at all happy?" And, "All things considered, how satisfied are you with your life as a whole these days?"

Combining responses to these two questions, Inglehart and colleagues constructed an index of subjective well-being that reflects both happiness and general life satisfaction.

In the 52 countries for which a substantial time series is available (covering 17 years on average), this index rose in 40 countries and fell in only 12. The average percentage of people who said they were "very happy" increased by almost seven points.

"Most earlier research has suggested that happiness levels are stable," Inglehart said. "Important events like winning the lottery or learning you have cancer can lead to short-term changes, but in the long run most previous research suggests that people and nations are stuck on a 'hedonic treadmill.' The belief has been that no matter what happens or what we do, basic happiness levels are stable and don't really change."

The new findings from the World Values Surveys not only show that during the past 25 years, happiness has in fact risen substantially in most countries. Fully as important as the fact that happiness rose is the reason why. In recent decades, low-income countries such as India and China have experienced unprecedented rates of economic growth, dozens of medium-income countries have democratized and there has been a sharp rise of gender equality and tolerance of ethnic minorities and gays and lesbians in developed societies.

Economic growth, democratization and rising social tolerance have all contributed to rising happiness, with democratization and rising tolerance having even more impact than economic growth. All of these changes have contributed to providing people with a wider range of choice in how to live their lives-which is a key factor in happiness.

The people of rich countries tend to be happier than those of poor countries, but even controlling for economic factors, certain types of societies are much happier than others.

"The results clearly show that the happiest societies are those that allow people the freedom to choose how to live their lives," Inglehart said.

As an example, Inglehart points to the tolerant social norms and democratic political systems in Denmark, Iceland, Switzerland, the Netherlands and Canada all of which rank among the 10 happiest countries in the world.

"The events of the past 25 years have brought a growing sense of freedom that seems to be even more important than economic development in contributing to rising happiness," Inglehart said. "Moreover, the most effective way to maximize happiness seems to change with rising levels of economic development. In subsistence-level societies, happiness is closely linked with in-group solidarity, religiosity and national pride. At higher levels of economic security, free choice has the largest impact on happiness."

He also notes that the largest recent increases on the subjective well-being index, measuring both happiness and life-satisfaction, occurred in the Ukraine, followed by Moldova, Slovenia, Nigeria, Turkey and Russia.

"While most ex-communist countries show low levels of happiness, many of them show large recent increases in subjective well-being," Inglehart said. "The collapse of communism was generally followed by a sharp decline in well-being, which tended to rise again with economic recovery."

Comparing World Values Survey data from 1981 to 2007 with earlier data from 1946 from the World Database of Happiness, Inglehart and colleagues found that 19 of 24 countries show rising happiness and several countries - India, Ireland, Mexico, Puerto Rico and South Korea - show steeply rising trends. Only four countries show downward trends - Austria, Belgium, the United Kingdom and West Germany. For more information on happiness trends in more than 20 nations, visit: http://www.worldvaluessurvey.org/happinesstrends.

The World Values Surveys in the United States and in several other countries are funded by the National Science Foundation. Additional funding for the surveys comes from a variety of agencies and foundations around the world, including the Swedish and Netherlands Foreign Ministries.

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Inglehart R, Foa R, Peterson C, Welzel C. Development, Freedom, and Rising Happiness: A Global Perspective (1981-2007). Perspect Psychol Sci. 2008 Jul;3(4):264-285   [Abstract]

Mothers and fathers of twins conceived either spontaneously or with assisted reproductive technology (ART) suffer more mental health symptoms after delivery and one year later than do parents of singleton babies, according to research presented to the 24th annual meeting of the European Society of Human Reproduction and Embryology in Barcelona on Monday.

However, the mothers of ART twins had fewer symptoms of depression before the birth than did mothers of twins conceived spontaneously. "This may be due to better counseling and preparation of infertile couples for twins," Dr Leila Unkila Kallio told the conference. "The good mental health during pregnancy may also reflect the couples' satisfaction with successful treatment and fulfilment of hopes for parenthood," she added. After birth, fathers of twins in both groups showed more depression, anxiety, social dysfunction and sleeping problems than did fathers of singletons.

The study is the first to investigate the mental health of both mothers and fathers of twins conceived either spontaneously or through ART using their own sperm and eggs, covering the transitional period to parenthood from pre-birth through to one year afterwards. Dr Unkila Kallio said that it showed that psychological well-being of prospective parents should be taken into account when deciding how many embryos to implant during ART - as well as the health risks of twin pregnancies to both mothers and babies.

"We believe it is important to reduce multiple pregnancies worldwide by introducing single embryo transfers. Our results on parental mental health of twin parents provide further evidence to support this policy," said Dr Unkila Kallio, who is a senior consultant in gynaecology and obstetrics at Helsinki University Central Hospital, Helsinki , Finland.

Dr Unkila Kallio and her colleagues studied ART parents of 91 twins and 367 singletons and control parents of 20 twins and 379 singletons (conceived spontaneously) at three time points: in the second trimester of pregnancy, when the children were two months old and when they were one year old. Depressive symptoms, anxiety, sleeping difficulties and social dysfunction were measured using the General Health Questionnaire (GHQ36). Mothers and fathers separately had to indicate how much their present state was like or unlike their normal state for a range of symptoms on a scale of 1 to 4 (1 = not at all; 2 = same as usual; 3 = rather more than usual; 4 = much more than usual). The researchers measured differences in the way the symptoms varied between the groups.

During pregnancy, they found that ART mothers of twins had lower mean averages of depressive symptoms than the control mothers of twins (1.18 versus 1.34) but similar levels to the ART and control mothers of singletons (1.14 and 1.26, respectively). Fathers in all groups had similar mental health during the pregnancies.

After delivery and at one year, mothers of twins in both the ART and control group had more symptoms of depression (1.30 and 1.34) and anxiety (1.60 and 1.67) than did the mothers of singletons in both groups (1.19 and 1.23 for depression in ART and control mothers, and 1.45 and 1.47 for anxiety).

ART fathers of two-month old twins, had higher mean averages of depressive symptoms than ART fathers of singletons (1.26 vs 1.22) but their scores were comparable to those of control fathers, which were 1.37 for twins and 1.26 for singletons. "Furthermore, fathers of two-month old twins in both ART and control groups reported significantly more impaired social dysfunction than fathers of singletons," said Dr Unkila Kallio. At one year, the ART and control fathers of twins also had higher levels of depressive and anxiety symptoms and sleeping difficulties than did the fathers of singletons.

"Mental health of mothers, irrespective of ART, seemed to be resilient to the effects of parity, prematurity or health problems of the newborns," said Dr Unkila Kallio. "Concerning fathers, the control fathers of premature babies (usually twins) had more impaired social dysfunction than ART fathers. Similarly, problematic health of the newborns induced higher levels of anxiety symptoms and sleeping problems in control fathers of twins. Thus, fathers of ART twins seemed to cope better with child-related problems than did the controls.

"It may be that counseling for the option of a twin pregnancy, as well as its medical and psychosocial risks before attending for ART, may have a decisive importance for a couple's ability to realize the consequences of a twin birth and, in the case of a twin pregnancy, to help the couple to adapt to twin parenthood, thus explaining the findings in ART couples. It is possible that many fathers of spontaneous twin pregnancies may lack this knowledge, although mothers do participate in maternity clinics services and so may be better counseled and supported," said Dr Unkila Kallio.

"During pregnancy, the fathers had similar mental health in all groups. Being the father of newborn and one-year old twins, irrespective of ART, was associated first with higher averages of depressive symptoms and social dysfunction, later also to sleeping difficulties and anxiety symptoms when compared to singletons. Becoming a father means a big change in man's internal world and in relations to others. Transition to parenthood may be demanding for fathers and especially so for fathers of twins. They often have to bear economical responsibility for the family, as well as responsibility to be more available and to participate in infant care. Fathers usually experience less social support than mothers, and may have difficulties in coping with these increasing demands."

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Unkila Kallio L. Mothers and fathers of twins report more mental health symptoms than parents of singletons: single pregnancies should be the aim of ART. Presentation ESHRE 24th Annual Meeting Barcelona 2008 Jun 7.

Meditation sessions are proving a hit for members of the Royal College of Psychiatrists at their Annual Meeting at Imperial College, London - with a growing number claiming they are turning to the spiritual discipline to combat anxiety and burnout.

Meditation workshops, run by the College's 2,000-strong Spirituality Special Interest Group, are overbooked. "It seems to be an indication of the need for spiritual nourishment, something that College members are not finding easily in the outside world," says Dr Sarah Eagger, chair of the Spirituality Group.

Dr Eagger, consultant psychiatrist at St Charles Hospital, London, said her daily meditation practice was as important in her everyday work as her medical training. "A strong spiritual practice really comes into its own when you are faced with a very distressed patient, while also coping with the pressures of working in teams under immense stress, and then having to spend hours filling in forms that make you feel that you are not trusted. I am stressed enough as it is. Without meditation practice to keep a still space inside, I would be suffering burn-out."

Dr Andrew Powell, the founding chair of the Spirituality Group, said: "There is a level of concern within the profession about being trapped in a culture of measurement and box-ticking. The result is that it's becoming ever more difficult to practice psychiatry, to contain the anxiety and concerns of our patients, to maintain a common humanity and avoid getting caught up in an 'us and them' mentality."

However, many mental health practitioners struggle to understand the relevance of spirituality to their work, the meeting was told. Julia Head, specialist chaplain at the Maudsley Hospital in London, told the conference that spirituality is increasingly recognized as a vital part of good mental health care.

"The National Institute for Mental Health in England is just the latest body to acknowledge the limitations of modern medicine by recommending that practitioners provide spiritual support alongside physical treatments, including medication," said Dr Head who coordinates 'recovery' training programs for 300 mental health practitioners in the London boroughs of Southwark and Lambeth.

"Practitioners should be encouraging hope, and fostering a desire for change and the possibility of recovery. Yet this idea of healing, as opposed to clinical treatment, is something that is foreign to many practitioners," she said. 'They feel trapped in a culture where measuring clinical activity is the priority. It takes them time to understand that in order to support their patients' recovery, they need to feel valued themselves and to take time for their own nurture.'

The meeting was also told that the evidence-base for the therapeutic value of meditation for a wide range of health problems was significantly stronger than most pharmaceutical products. A new meta-analysis of 823 randomly controlled trials of meditation, conducted by the US National Institute of Alternative and Complementary Medicine, showed the clinical benefits of meditation across a wide range of physical and emotional disorders.

"Meditation is a way of life rather than quick fix achieved by paying for eight sessions or using gimmicks such as incense, music and light," Dr Avdesh Sharma, past president of the Indian Psychiatric Association, said. "It doesn't work immediately. You need to practice it for several weeks before the effects begin to be felt."

Dr Sharma added: "If meditation was a drug, we'd all want shares in it. It has a beneficial effect on most physical health problems and is very effective for mental health problems significantly reducing levels of depression and anxiety by improving relaxation, oxygenation of the brain, insomnia and energy levels."

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Eagger S. (Chair) Soul Matters: The role of Spirituality in the treatment of mental illness. Symposium S20, RCPsych Annual Meeting, London 2008 Jul 3.

Rod Santa Ana

A cold slice of watermelon has long been a Fourth of July holiday staple. But according to recent studies, the juicy fruit may be better suited for Valentine's Day.

That's because scientists say watermelon has ingredients that deliver Viagra-like effects to the body's blood vessels and may even increase libido.

"The more we study watermelons, the more we realize just how amazing a fruit it is in providing natural enhancers to the human body," said Dr Bhimu Patil, director of Texas A&M's Fruit and Vegetable Improvement Center in College Station.

"We've always known that watermelon is good for you, but the list of its very important healthful benefits grows longer with each study."

Beneficial ingredients in watermelon and other fruits and vegetables are known as phyto-nutrients, naturally occurring compounds that are bioactive, or able to react with the human body to trigger healthy reactions, Patil said.

In watermelons, these include lycopene, beta carotene and the rising star among its phyto-nutrients - citrulline - whose beneficial functions are now being unraveled. Among them is the ability to relax blood vessels, much like Viagra^® does.

Scientists know that when watermelon is consumed, citrulline is converted to arginine through certain enzymes. Arginine is an amino acid that works wonders on the heart and circulation system and maintains a good immune system, Patil said.

"The citrulline-arginine relationship helps heart health, the immune system and may prove to be very helpful for those who suffer from obesity and type 2 diabetes," said Patil. "Arginine boosts nitric oxide, which relaxes blood vessels, the same basic effect that Viagra has, to treat erectile dysfunction and maybe even prevent it."

While there are many psychological and physiological problems that can cause impotence, extra nitric oxide could help those who need increased blood flow, which would also help treat angina, high blood pressure and other cardiovascular problems.

"Watermelon may not be as organ specific as Viagra," Patil said, "but it's a great way to relax blood vessels without any drug side-effects."

The benefits of watermelon don't end there, he said. Arginine also helps the urea cycle by removing ammonia and other toxic compounds from our bodies.

Citrulline is found in higher concentrations in the rind of watermelons than the flesh. As the rind is not commonly eaten, two of Patil's fellow scientists, Drs Steve King and Hae Jeen Bang, are working to breed new varieties with higher concentrations in the flesh.

In addition to the research by Texas A&M, watermelon's phyto-nutrients are being studied by the U.S. Department of Agriculture's Agricultural Research Service in Lane, Oklahoma.

As an added bonus, these studies have also shown that deep red varieties of watermelon have displaced the tomato as the lycopene king, Patil said. Almost 92 percent of watermelon is water, but the remaining 8 percent is loaded with lycopene, an anti-oxidant that protects the human heart, prostate and skin health.

"Lycopene, which is also found in red grapefruit, was historically thought to exist only in tomatoes," he said. "But now we know that it's found in higher concentrations in red watermelon varieties."

Lycopene, however, is fat-soluble, meaning that it needs certain fats in the blood for better absorption by the body, Patil said.

"Previous tests have shown that lycopene is much better absorbed from tomatoes when mixed in a salad with oily vegetables like avocado or spinach," Patil said. "That would also apply to the lycopene from watermelon, but I realize mixing watermelon with spinach or avocadoes is a very hard sell."

No studies have been conducted to determine the timing of the consumption of oily vegetables to improve lycopene absorption, he said.

"One final bit of advice for those Fourth of July watermelons you buy," Patil said. "They store much better uncut if you leave them at room temperature. Lycopene levels can be maintained even as it sits on your kitchen floor. But once you cut it, refrigerate. And enjoy."

Antidepressants show only limited activity in children and adolescents, with some indication of increasing benefit with older age, and possibly greater effect with fluoxetine (Prozac^®), according to the results of a meta-analysis.

The authors note that the use of antidepressants in children and adolescents is receiving considerable attention, particularly due to a claimed increase in suicidal thoughts associated with SSRI treatment. The primary aim of the meta-analysis was to evaluate the efficacy of all antidepressants in this age group; other aims were to compare effect in younger children and adolescents, to compare SSRI with other agents, and identify factors affecting efficacy.

The researchers conducted a comprehensive literature search for randomized placebo-controlled trials of antidepressant drugs in people aged under 20 with depressive illness, where responder rates were reported as participant counts (not as average change in symptom scores). Data from reports was extracted to give responder rates for the primary outcome of each included study. Doses were compared by using standardized imipramine (Tofranil^®) equivalent dose, derived from manufacturer's recommended doses, textbook summaries, and clinical practice.

Initial searches located 304 potentially eligible studies for screening, of which 29 were eligible for inclusion. One study included three arms (tricyclic, SSRI, and placebo), to yield 30 comparisons for analysis with a total of 3,069 participants. Mean age was 13.5 years (range 6 to 20) and only four studies (all involving tricyclics) reported results for children and adolescents separately. There were 14 comparisons with placebo for tricyclics, 12 for SSRI, and 4 for others (moclobemide (Manerix^®), mirtazapine (Remeron^®), and nefazodone (Serzone^®)). Symptom scores indicated that participants generally had moderate to severe depression.

The analysis found a modest pooled response rate (RR 1.22; 95% CI, 1.15 to 1.31). Overall response rate difference was 10.9% (60.1% drug vs. 49.2% placebo; Number Needed to Treat (NNT)=9). When analysed by drug, the response rates differed: Tricyclics - NNT=14 > SSRI - NNT=9 > others - NNT=8; however ranges overlapped considerably and overall did not show significant superiority for any group. There was some indication that adolescents were more likely to respond than younger children (NNT =8 vs. NNT =21). Pooled efficacy for fluoxetine was somewhat higher than for other drugs.

The authors conclude that antidepressants have only modest efficacy in children. There is some indication that fluoxetine may be more effective, and adolescents seem to respond better than younger children. There is an urgent need for more research on treatments for depression in this age group.

Limitations include the short duration of some of the studies included in the analysis with a mean of 8.7 weeks (median 8, range 1 to 12) and the relatively high placebo response of 49.2 percent.

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Tsapakis EM, Soldani F, Tondo L, Baldessarini RJ. Efficacy of antidepressants in juvenile depression: meta-analysis. Br J Psychiatry. 2008 Jul;193:10-17   [Abstract]

Studies exploring potential predictors of post-traumatic stress disorder (PSTD) following major trauma have resulted in varied conclusions. While a number of risk factors such as injury severity, demographic factors and compensation-related factors have been identified, none is strong enough to reliably predict which patient will develop the disorder.

PTSD is characterized by flashbacks of the event, anxiety, and social withdrawal. Victims of major trauma are at significant risk of developing PTSD, with about 15% developing the disorder within a year of the injury.

A study in the July issue of ANZ Journal of Surgery - Predictors of Post-Traumatic Stress Disorder following Major Trauma - by Professor Ian Harris and colleagues argues that the lack of consistency of previous PTSD studies is a result of methodological flaws such as selection bias, and poorly defined diagnostic criteria.

The authors investigated the association between injury severity, demographic and compensation-related factors with the development of PTSD and found that the disorder was also independently associated with having an unsettled compensation claim, their use of lawyer services and the placement of blame on others for the injury.

However, another study in the same issue finds that there is no existing risk factor model that enables an accurate prediction of how patients will be psychologically affected in the aftermath of the injury.

The author, Professor Alexander Cowell McFarlane says, "The inconsistencies in PTSD predictors suggest the pivotal role of health-care professionals in the identification of patients at risk of developing psychiatric disorders."

"While risk factors should be considered, the traumatic events are sufficient to elicit symptoms in the individuals. Ultimately, it is the surgeons' skill in the management of the psychological recovery that will play a critical role in the patients' rehabilitation," he adds.

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Harris IA, Young JM, Rae H, et al. Predictors of Post-Traumatic Stress Disorder Following Major Trauma. ANZ J Surg. 2008 Jul;78(7):583-587.   [Abstract]

McFarlane AC. Predictors of Post-Traumatic Stress Disorder After Major Injury. ANZ J Surg. 2008 Jul;78(7):533-534. [No Abstract]

Not all dietary supplements and "alternative" products are harmless though. German Institute urges consumers to be more critical of health claims

Many people use "alternative" or complementary products because they see them as a more gentle form of medicine. The German Institute for Quality and Efficiency in Health Care has now analyzed the latest research on several products and released the results along with a guide for consumers.

St John's wort (hypericum), for example, could help ease mild depression, but it does not help with severe depression.

According to the Institute, conflicting research results in recent years have caused confusion and controversy about St. John's wort. It concluded this is partly because the effects vary from product to product, and the effect depends too on how severe depression is. The controversy highlights the importance of looking at all clinical trial results to gain a better picture of health care treatments.

"Consumers need to be more critical of all health claims," according to the Institute's Director, Professor Peter Sawicki. "This is as true of dietary supplements and complementary medicines as it is of prescription medicine. Just because a product is made from a plant or vitamins, it does not mean it is necessarily safe in very high doses or for frequent use. And not all medicinal products can provide as much relief as patients expect." The growing evidence that high doses of some vitamins and antioxidants can cause cancer or earlier death is an important reminder that dietary supplements are not necessarily harmless.

Patients need to consider several questions before choosing any treatment, including a dietary supplement. Professor Sawicki said, "Doctors and patients need to know whether treatments have been proven to work in enough good clinical trials that measured benefits large enough to matter to the patient. Whether a medicine is made from a plant or manufactured in a laboratory, the same scientific standards apply if you want to know which treatment might be the best for you."

To help consumers, the Institute also published a new guide for consumers considering using dietary supplements or complementary medicine products. The fact sheet lists key questions that could help people make decisions for or against a particular treatment.

Fact sheet: Using dietary supplements and complementary medicines

Mobile (cell) phones and the internet will soon be used to help up to two million Australians manage their mental health problems.

The innovative approach is designed to help people monitor their wellbeing on a day-to-day basis in areas including mood, sleep, activities, medication, physical activity as well as drug and alcohol abuse.

The target groups are adolescents and adults at risk of developing anxiety, depression, or stress, as well as those with existing conditions.

A $1.88 million Federal Government grant has been awarded to the Black Dog Institute and the University of New South Wales (UNSW) to undertake the program between 2008-2011.

Senior Research Fellow at the Black Dog Institute and the School of Psychiatry at the University of New South Wales, Dr Judy Proudfoot, said the first stage in the program would be delivered via the internet followed by use of the mobile phone platform.

"Information is fed back to the users on how they are going and alerts are sent when things aren't going well, along with links to appropriate self-help tools," says Dr Proudfoot.

Most mental health programs, whether they are delivered face-to-face, by phone or via the web, rely on people monitoring their symptoms or activities. Dr Proudfoot said quite often an individual's recall of symptoms, mood or behaviour over several days or weeks can be poor which not only affects the accuracy of their reporting but the medical response.

"The Black Dog Institute Tracker System is an important initiative that allows 'just-in-time'' monitoring. If a patient reports that he or she has been feeling anxious and not sleeping well, they would receive an alert pointing to tools for managing anxiety and giving tips for sleeping better.

"The alert may also recommend discussing the issues with a GP or clinician.

"In fact, research indicates the number of people consulting a doctor is as low as 35 percent in cases of mental illness," says Dr Proudfoot. "At the same time, many people report they do not see the need to consult a doctor, preferring instead to manage the condition themselves. Self-monitoring is a critical component of selfmanagement."

"On the other hand, many people do consult a clinician, and self-monitoring is an important part of their treatment. The system will allow people to print off reports so they can take them to their clinician."

Dr Proudfoot said the mood tracking system was designed to suit people of differing ages and levels of electronic literacy.

"As we know, Australia's mobile phone penetration has surpassed natural saturation, with every Australian who can using one. Mobile phones are typically carried on the person and are usually turned on, which facilitates the collection of self-monitoring information as people go about their everyday activities," Dr Proudfoot said.

"Such applications are easy to deliver to large numbers of people, they can include time-sensitive prompts via SMS for users to input their information and they are location independent.

"At the same time mobile phone use is not restricted by socio-economic status and is the preferred means of communication among adolescents (18 to 24 years) who represent 27 percent of people affected by mental illness," Dr Proudfoot said.

Scientists have been aware for many years that if cancer patients are not able to deal with the stress associated with being sick, the cancer will progress faster than in calmer patients. To counteract this phenomenon, physicians encourage treatments that help cancer patients handle their psychological stress. Scientists theorized that the stress relief may have come as a result of increased beta-endorphin peptide (BEP), the "feel good" hormones in the brain that are released during exercise, a good conversation, and many other aspects of life that give humans pleasure.

Researchers at Rutgers hypothesized that BEP producing neurons do not just make us feel good, but also play roles in regulating the stress response and immune functions to control tumor growth and progression. In a paper published in the Proceedings of the National Academy of Science, Dr Dipak K. Sarkar and his colleagues demonstrate the physical mechanisms that support their hypothesis.

"Our findings show promise for future therapeutic treatments for bolstering the immune function," said Sarkar, professor of animal sciences and director of the Endocrinology Program at the Rutgers School of Environmental and Biological Sciences, and principal investigator of the research project.

Previous research has shown that too few, or inactive, BEP neurons are associated with various diseases. For example, low numbers of BEP neurons have been identified in the brains of patients with depression and schizophrenia. Neurons that produce too little BEP are found in many obese patients. In both these cases the patients also had higher levels of infection and more incidence of cancer.

To test their hypothesis about the role of BEP in controlling tumor growth and progression, the Rutgers scientists took neural stem cells, transformed them into BEP neurons by treating them with particular chemicals, and then transplanted them into brains of live rats. The authors studied tumor growth in the rats that had been given carcinogens to induce prostate tumors. The authors noted that the BEP neurons boosted the immune system by increasing the activity of particular immune cell types and decreasing inflammation.

The neurons also protected the rats against prostate cancer 90 percent of the time. The researchers discovered that the "natural killer," or NK cells that typically attack cancer cells in the body, are activated by the inserted BEP neurons. The NK cells reduced inflammation around the cancer cells, which slowed down caner cell growth and killed many of these cells.

"We are optimistic that this research can be applied to human medicine," said Sarkar. "Instead of transplanting cells, we will investigate whether we can increase BEP using a chemical approach."

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Sarkar DK, Boyadjieva NI, Chen CP, et al. Cyclic adenosine monophosphate differentiated ß-endorphin neurons promote immune function and prevent prostate cancer growth PNAS 2008 Jun 17;doi:10.1073/pnas.0800289105   [Abstract]

Employees who work overtime are at increased risk of anxiety and depression, suggests a study in the June Journal of Occupational and Environmental Medicine.

Elisabeth Kleppa and colleagues of the University of Bergen, Norway, analyzed data on work hours from a larger study of Norwegian men and women. Symptoms of anxiety and depression were assessed using a standard screening questionnaire. Anxiety and depression scores were compared for 1,350 workers who worked overtime, 41 to 100 hours per week; and approximately 9,000 workers who worked normal hours, 40 hours or less.

Working overtime was associated with higher anxiety and depression scores among both men and women. The rate of questionnaire scores indicating "possible" depression increased from about nine percent for men with normal work hours to 12.5 percent for those who worked overtime.

For women, the rate of possible depression increased from seven to eleven percent. In both sexes, rates of possible anxiety and depression were higher among workers with lower incomes and for less-skilled workers.

The relationship between overtime and anxiety/depression was strongest among men who worked the most overtime - 49 to 100 hours per week. Men working such very long hours also had higher rates of heavy manual labor and shift work and lower levels of work skills and education.

Previous studies have raised possible health and safety concerns of working long hours. However, most studies of this issue have focused on the health effects of shift work, rather than overtime. Under European Union work rules, employees have the right to refuse to work more than 48 hours per week.

The new results support this directive by showing increased rates of anxiety and depression among overtime workers. Men working more than 48 hours per week are at highest risk, although the authors note that working even moderate overtime hours seems to increase the risk of "mental distress."

The study permits no conclusions about how working long hours leads to increased anxiety and depression. It could be that working overtime leads to increased "wear and tear," or that individuals with characteristics predisposing to anxiety and depression (such as low education and job skills) are more likely to take jobs requiring long work hours.

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Kleppa E, Sanne B, Tell GS. Working Overtime is Associated With Anxiety and Depression: The Hordaland Health Study. J Occup Environ Med. 2008 Jun;50(6):658-666   [Abstract]

Bill Hathaway

Yale psychologist Rajita Sinha started with a simple question posed to a diverse group of academic colleagues at Yale and two other universities.

"What is the role that stress plays in the loss of self-control leading to overconsumption of tobacco, alcohol and foods?"

The question led to a collaborative $23 million effort of social scientists, neuroscientists, radiologists, psychiatrists, molecular biologists and health economists to find new ways to understand and treat addictive behaviors. Six months later, the interdisciplinary quest is enabling scientists to better tackle a complex set of health, behavioral and social problems, providing a model for other cooperative scientific efforts at Yale and laboratories across the country, and yielding surprising insights into the human condition.

"This effort will have implications far beyond the targeted focus of these studies," predicts Sinha, professor of psychiatry.

Smoking, drinking and overeating are the top three causes of preventable death and disease in the United States. In order to tackle this huge social issue, the Yale Stress Center headed by Sinha proposed a sort of Manhattan project to study the relationship of psychological stress to the abuse of tobacco, alcohol and food. The center recruited 16 researchers from Yale, Florida State and the University of California-Irvine, and applied for funding from the National Institutes of Health (NIH) under its Roadmap initiative, which is designed to foster interdisciplinary research. The NIH received more than 100 such proposals, but the Yale led-proposal was one of only nine to receive funding.

The focus on a simple question - the impact of stress on self control - immediately opened up a host of research opportunities. For instance, many of the researchers share an interest in the study of compulsion, which drives addicts to smoke, drink or eat regardless of consequence.

Jane Taylor, associate professor of psychiatry at Yale, has studied the neurobiology of compulsive habits for many years. She has found that a brain region called the nucleus accumbens is key for the creation of emotional habits and compulsive behaviors. The prefrontal cortex can regulate the nucleus accumbens, and thus inhibit compulsive behaviors.

"The flip side of compulsion is a loss of control," Sinha notes.

And that territory of the brain is fertile intellectual ground for Yale neurobiologist Amy Arnsten.

Arnsten is a one of the world's experts on the prefrontal cortex, the seat of higher cognitive function and also the area of the brain that plays a key role in impulse control. Several labs have now shown that chronic stress exposure can actually lead to structural changes in the brain. Stress unleashes a biochemical cascade that short-circuits the prefrontal cortex's ability to moderate impulses. With sustained stress, scientists have learned, the brain actually loses gray matter in the prefrontal cortex, a finding that suggests chronically stressed individuals would find it very difficult to rein in their impulses and, say, turn down a cigarette or a drink.

While it may be difficult, it is possible for addicts to learn to control those impulses, theorizes consortium member Roy Baumeister, the Francis Eppes Eminent Scholar and professor of psychology at Florida State University. Baumeister has long been interested in addictive behaviors in adolescents and is now studying whether the damaging effects of stress can be repaired by mental exercise. His experiments are testing whether college students can actually learn to improve self-control - a skill sorely needed by those seeking to quit or limit smoking, drinking and eating of rich, fatty foods.

Researchers are also looking to find new drugs to curtail addictive behavior, and Arnsten's lab is again playing a central role. Arnsten has identified multiple ways that stress leads to dysfunction of the prefrontal cortex. She has found that medications that inhibit stress pathways in the prefrontal cortex may help people have better control over their thoughts and actions. For example, the drug prazosin (Minipress^®) is currently being used to treat patients with post-traumatic stress disorder. Another drug, the alpha+beta-blocker carvedilol (Coreg^®), is being tested by Dr Sherry McKee, an associate professor of psychiatry at Yale. McKee is exploring whether carvedilol can help people resist the urge to smoke when they are stressed.

Another important brain pathway is being studied by Daniele Piomelli, the Louise Turner Arnold Chair of neuroscience and professor of pharmacology and biological chemistry at the University of California-Irvine. Piomelli is investigating whether stress early in life disrupts the endocannaboid system, the molecular pathway activated by marijuana that also seems to help animals deal with stress. The disruption of this system during adolescence may lead to problems handling stress as an adult, Piomelli theorizes.

Piomelli and Arnsten are collaborating to test his ideas about endocannaboids. The hope is that manipulating this pathway may not only lead to new therapies to help treat addiction, but create a new generation of non-addictive painkillers as well.

"The researchers in the consortium are engaged in genuine collaboration, learning about differing perspectives, and combining talents to facilitate discovery," Arnsten says.

For instance, Piomelli's research on early life stress dovetails with the investigations of Yale researchers.

Dr Linda C. Mayes, professor of pediatrics and psychology and the Arnold Gesell Professor of Child Development at the Yale Child Study Center has long been interested in why adolescents raised in stressful environments are more likely to engage in risky behaviors, such as alcohol and drug abuse. She and Dr Hilary Blumberg, associate professor of psychiatry and diagnostic radiology, have decided to use imaging technology to examine how stress alters brain development - and increases risk of addiction.

There is another side of the issue: What effects do addictive substances have on the brain? This question helps drive Sinha's own research.

"We have been studying whether and how alcohol, nicotine and maybe even rich, fatty foods may affect stress and compulsions," Sinha says. "They seem to weaken stress regulation pathways or our ability to 'de-stress' and simultaneously activate craving pathways."

In other words, the substances further batter systems already under assault by chronic stress. Scientists like Sinha have begun to provide an outline of a devastating feedback loop: Stress creates conditions in which compulsion to consume addictive substances can take root. The substances themselves further decrease an individual's ability to combat compulsion. Brain imaging experts like Dr Alexander Neumeister and Dr Marc Potenza, both associate professors of psychiatry and diagnostic radiology at Yale, are examining these processes in the brain using individuals suffering from addictive habits and healthy volunteers.

It is these types of insights that can change social attitudes and policies toward addictions, help individuals find better ways to manage stress, and create new treatments and drugs to curb addictive behavior, Sinha says.

The same collaborative approach could also lead to similar insights into other chronic disease states, cancer, heart disease or diabetes, she said.

"By linking investigators from different disciplines, we are creating the structures and organization to let investigators interact, learn from each other and push the process of science and discovery forward in a more efficient manner," she says. "Right now, they are often too busy in their own silos. This is another way to look at complex diseases."

A University of Alberta researcher in collaboration with researchers from Duke University has proven that wisdom really does come with age, at least when it comes to your emotions.

A study conducted by Dr Florin Dolcos, assistant professor of psychiatry and neuroscience in the Faculty of Medicine & Dentistry, identified brain patterns that help healthy older people regulate and control emotion better than their younger counterparts. The study identified two regions in the brain that showed increased activity when participants over the age of 60 were shown standardized pictures of emotionally challenging situations.

"Previous studies have provided evidence that healthy older individuals have a positivity bias - they can actually manage how much attention they give to negative situations so they're less upset by them," said Dr Dolcos, a member of the Alberta Cognitive Neuroscience Group, which brings together researchers from the University of Alberta to explore how the brain works in human thought, including issues like perception, attention, learning, memory, language, decision-making, emotion and development. "We didn't understand how the brain worked to give seniors this sense of perspective until now."

During the study, younger and older participants were asked to rate the emotional content of standardized images as positive, neutral or negative, while their brain activity was monitored with a functional magnetic resonance imaging (fMRI) machine, a high-tech device that uses a large magnet to take pictures inside the brain. The older participants rated the images as less negative than the younger participants. The fMRI scans helped researchers observe this reaction in the senior participants. The scans showed increased interactions between the amygdala, a brain region involved in emotion detection, and the anterior cingulate cortex, a brain region involved in emotion control.

According to Dr Dolcos, "These findings indicate that emotional control improves with aging, and that it's the increased interaction between these two brain regions that allows healthy seniors to control their emotional response so that they are less affected by upsetting situations."

This research may have clinical implications. "If we can better understand how the brain works to create a positivity bias in older people, then we can apply this knowledge to better understand and treat mental health issues with a negativity bias, such as depression and anxiety disorders, in which patients have difficulty coping with emotionally challenging situations," Dolcos said.

The research was funded by grants from the U.S.-based National Alliance for Research on Schizophrenia and Depression (NARSAD), the Canadian Psychiatric Research Foundation (CPRF), the University Hospital Foundation (UHF) in Edmonton and the University of Alberta.

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St. Jacques P, Dolcos F, Cabeza R. Effects of aging on functional connectivity of the amygdala during negative evaluation: A network analysis of fMRI data. Neurobiol Aging. 2008 May;doi:10.1016/j.neurobiolaging.2008.03.012   [Abstract]

Rhode Island Hospital and Brown University researchers are calling on clinicians to adopt a standardized measurement of outcomes when treating depression.

Researchers led by Mark Zimmerman, M.D., noted that quantified measurement of outcome is rarely done when treating depression, yet to determine the impact of treatment it is necessary to evaluate outcome. It provides the clinician with a concrete way to assess the degree and completeness of treatment success. However, studies among clinicians in both the United States and the United Kingdom confirm that the vast majority of psychiatrists did not routinely use scales to monitor outcome when treating depression, with less than 10 percent reporting that they always used scales to monitor outcome.

Zimmerman and the researchers determined that one issue serving as an obstacle to evaluating outcomes is a perception of the added burden, as clinicians are already overburdened with paperwork. Because of this, the Rhode Island Hospital team has suggested the use of a self-report questionnaire as a cost-effective option that highly correlates with clinician ratings. A self-report can be brief and will provide clinicians with useful information, improve the efficiency of conducting their clinical evaluation and therefore this measure has a practical value for the clinician.

In addition, the team developed a scale for clinical utility. Known as the Clinically Useful Depression Outcome Scale (CUDOS) [pdf], it contains 18 items that assess all of the DSM-IV inclusion criteria for major depressive disorder and dysthymic disorder as well as psychosocial impairment and quality of life. The 16 symptoms items are rated on a 5-point Likert scale in order to keep the scale brief. Studies by the research team found the CUDOS to be a reliable and valid measure of depressive symptoms that is sensitive to clinical change and can be used to determine whether depressed patients have remitted from treatment.

Zimmerman notes, "Unlike other areas of medical care that can measure outcomes on numerical values like body temperature, blood pressure and other quantifiable variables, psychiatry is the only medical discipline in which quantified measurements of outcome are not the standard of care. We believe that it is critical to do so, and that systematic outcome assessment will assume an increasing importance during the next decade, if for no other reason that payor mandates will require it."

Zimmerman concludes, "There may be only limited data suggesting that measurement might improve outcome when treating depression; however, there is no reason to wait until such studies are done to provide the benefit of measurement-based care in the treatment of depression. Frankly, there is little downside to adopting this approach as part of an overall treatment plan for the depressed patient."

The commentary and the ensuing recommendations are from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, for which Zimmerman is the principal investigator. Zimmerman said, "The MIDAS project is unique in its integration of research quality diagnostic methods into a community-based outpatient practice affiliated with an academic medical center."

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Zimmerman M, McGlinchey JB, Chelminski I. An Inadequate Community Standard of Care: Lack of Measurement of Outcome When Treating Depression in Clinical Practice. Primary Psychiatry. 2008;15(6):67-75   [Full text]

One of the great scientific challenges is to understand the design principles and origins of the human brain. New research has shed light on the evolutionary origins of the brain and how it evolved into the remarkably complex structure found in humans.

The research suggests that it is not size alone that gives more brain power, but that, during evolution, increasingly sophisticated molecular processing of nerve impulses allowed development of animals with more complex behaviors.

The study shows that two waves of increased sophistication in the structure of nerve junctions could have been the force that allowed complex brains - including our own - to evolve. The big building blocks evolved before big brains.

Current thinking suggests that the protein components of nerve connections - called synapses - are similar in most animals from humble worms to humans and that it is increase in the number of synapses in larger animals that allows more sophisticated thought.

"Our simple view that 'more nerves' is sufficient to explain 'more brain power' is simply not supported by our study," explained Professor Seth Grant, Head of the Genes to Cognition Programme at the Wellcome Trust Sanger Institute and leader of the project. "Although many studies have looked at the number of neurons, none has looked at the molecular composition of neuron connections. We found dramatic differences in the numbers of proteins in the neuron connections between different species."

"We studied around 600 proteins that are found in mammalian synapses and were surprised to find that only 50 percent of these are also found in invertebrate synapses, and about 25 percent are in single-cell animals, which obviously don't have a brain."

Synapses are the junctions between nerves where electrical signals from one cell are transferred through a series of biochemical switches to the next. However, synapses are not simply soldered joints, but mini-processors that give the nervous systems the property of learning and memory.

Remarkably, the study shows that some of the proteins involved in synapse signalling and learning and memory are found in yeast, where they act to respond to signals from their environment, such as stress due to limited food or temperature change.

"The set of proteins found in single-cell animals represents the ancient or 'protosynapse' involved with simple behaviors," continues Professor Grant. "This set of proteins was embellished by addition of new proteins with the evolution of invertebrates and vertebrates and this has contributed to the more complex behaviors of these animals.

"The number and complexity of proteins in the synapse first exploded when muticellular animals emerged, some billion years ago. A second wave occurred with the appearance of vertebrates, perhaps 500 million years ago"

One of the team's major achievements was to isolate, for the first time, the synapse proteins from brains of flies, which confirmed that invertebrates have a simpler set of proteins than vertebrates.

Most important for understanding of human thought, they found the expansion in proteins that occurred in vertebrates provided a pool of proteins that were used for making different parts of the brain into the specialized regions such as cortex, cerebellum and spinal cord.

Since the evolution of molecularly complex, 'big' synapses occurred before the emergence of large brains, it may be that these molecular evolutionary events were necessary to allow evolution of big brains found in humans, primates and other vertebrates.

Behavioral studies in animals in which mutations have disrupted synapse genes support the conclusion that the synapse proteins that evolved in vertebrates give rise to a wider range of behaviors including those involved with the highest mental functions. For example, one of the 'vertebrate innovation' genes called SAP102 is necessary for a mouse to use the correct learning strategy when solving mazes, and when this gene is defective in human it results in a form of mental disability.

"The molecular evolution of the synapse is like the evolution of computer chips - the increasing complexity has given them more power and those animals with the most powerful chips can do the most," continues Professor Grant.

Simple invertebrate species have a set of simple forms of learning powered by molecularly simple synapses, and the complex mammalian species show a wider range of types of learning powered by molecularly very complex synapses.

"It is amazing how a process of Darwinian evolution by tinkering and improvement has generated, from a collection of sensory proteins in yeast, the complex synapse of mammals associated with learning and cognition," said Dr Richard Emes, Lecturer in Bioinformatics at Keele University, and joint first author on the paper.

The new findings will be important in understanding normal functioning of the human brain and will be directly relevant to disease studies. Professor Grant's team have identified recently evolved genes involved in impaired human cognition and modelled those deficits in the mouse.

"This work leads to a new and simple model for understanding the origins and diversity of brains and behavior in all species," says Professor Grant, adding that "we are one step closer to understanding the logic behind the complexity of human brains,"

This research was a collaboration between scientists in the Wellcome Trust Sanger Institute, Edinburgh University and Keele University.

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Emes RD, Pocklington AJ, Anderson CNG, et al. Evolutionary expansion and anatomical specialization of synapse proteome complexity. Nat Neurosci. 2008 Jun 8;doi:10.1038/nn.2135   [Abstract]

The modern workplace is often blamed for increased rates of depression and stress. However, new research published in the journal Occupational Medicine, shows that resuming work can actually aid recovery and help depressed employees.

But the British Society of Occupational Medicine warns that employers need to be sensitive and consider a range of interventions including changing an employee's tasks and reducing hours to help people when they return to work. Managers also play a key role as an early return to work is aided by managers keeping in touch at least once every two weeks.

The study followed more than 500 people who were unable to work with depression from a variety of industries over the course of a year. A return to employment significantly promoted recovery. Importantly, it was the approach and flexibility of their employers that proved vital.

The study echoes the findings of Dame Carol Black's Review 'Working for a healthier tomorrow' which recognized that for most people work is good both for their long-term health and for their family's well-being. The review found that 40 percent of the national cost of ill health was related to mental health.

"Better access to occupational health services and psychological support are essential if employees with depression and anxiety are to get back to work quickly" said Dr Gordon Parker, President of the Society of Occupational Medicine. "Employers are often frightened of contacting an employee whose sick note says 'depression' for fear of being accused of harassment, but sympathetic contact with the employee and early help through occupational health can identify the most appropriate support. Occupational health services are ideally placed to advise managers and employees on the best return to work plan and should be involved early in the management of the employee's absence."

In any one year about 1 in 4 employees will have a mental health problem, and depression is one of the most common. It is not just distressing for the person involved. It makes them less productive at work and is responsible for high rates of sick-leave, accidents and staff turnover. Work often plays one of the largest roles in shaping people's identity and if employees are absent for some time due to anxiety or depression, this can add to feelings of a lack of self-worth. This study shows that going back to work is often one of the most important factors in speeding up a return to full health. It provides an opportunity to regain a sense of self-esteem and puts routine and stability back into people's lives.

A good occupational health team can help senior management develop programs to educate managers and the workforce about depression so that the problem is recognized, appropriate early intervention given and employees are helped to return to work. Occupational Health staff will know about the particular stresses and strains of the work environment and have experience of sensitive issues such as workplace confidentiality, job security and the timing of the return to part-time or full-time working. They are also well placed to work closely with family doctors or other specialist health services.

British telco BT's 'Positive Mentality' program is an example of how a company can be proactive in this area. Their innovative approach supports not only those who have mental health problems but also those staff who are ostensibly well. By encouraging and promoting small changes in lifestyle, significant improvements have been made in how staff cope with stress and the pressures of work and feel about their mental well-being.

Richard Craig, a 54 year old BT employee, suffered from depression which resulted in 6 months off work. On returning to work his hours were reduced for the first two weeks and then increased each week until he was back full time. His manager at the time was in contact with him each week either by phone or one to one. He believes that going back to work and the attitude of his employer was crucial to his recovery.

"Whilst I was ill my manager kept coming to see me and was really supportive. When it was time to go back to work my Occupational Health doctor organized a phased return so that I started back part time." said Mr Craig "Going back to work gave me a structure and took my mind off things."

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Brenninkmeijer V, Houtman I, Blonk R. Depressed and absent from work: predicting prolonged depressive symptomatology among employees. Occup Med (Lond) 2008 Jun;58(4):295-301.   [Abstract]