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Spring 2010, Vol 13, No 3

Research Update


by Mark de la Hey


Health and appearance motivate adolescents who don't smoke

Adolescents who choose not to smoke appear to be motivated primarily by concerns about health and physical appearance, rather than by restrictions and smoking bans, according to a study from Heidelberg University in Germany. A total of 707 non-smoking students aged 12 to 15 were interviewed as part of the German SToP (“Sources of Tobacco for Pupils”) Study. Participants were asked to write down their motives for not smoking, yielding 1,324 statements that were categorized and evaluated by researchers. Health-related concerns were most frequently mentioned as a motivation for not smoking, appearing in 78 per cent of all statements. Fear of cancer and a desire to maintain physical fitness were the most common health-related concerns. No participants mentioned cardiovascular disease, cerebrovascular disease or chronic obstructive pulmonary disease as concerns, even though these are the most common health consequences of smoking. An aesthetic aversion to the effects of smoking tobacco, such as odour or yellowing teeth and nails, was mentioned in 39 per cent of statements. A lack of perceived benefits from smoking was cited 25 per cent of the time, and economic motives were cited 21 per cent of the time. Only nine per cent of statements indicated concern about possible economic, legal or social sanctions, such as parental and school smoking bans or legal age limits. This finding is surprising, given the known effectiveness of tobacco taxes and bans on the sale of tobacco to minors. The authors speculate that young non-smokers may simply be too young to have had any experience with such measures, or they may not perceive such external limitations as the true motive for their decision not to smoke.

Health Policy, 2009 online, doi: 10.1016/j.healthpol.2009.10.007. Sven Schneider et al., Mannheim Medical Faculty, Heidelberg University, Mannheim, Germany.


Drawing helps older children report emotional experiences

Drawing is known to facilitate young children’s reports about previous emotional experiences and is often used for clinical assessments and legal purposes. Now, a new study from the University of Otago in New Zealand has demonstrated that drawing can also be useful in facilitating reports from older children up to age 12. Researchers asked 90 children between age 5 and 12 to either tell or both draw and tell everything they could remember about a past event that made them feel happy, sad, scared or angry. Children reported more information when they were asked to draw during the interviews, and this was true for older children as well as younger children. Parents attested to the accuracy of the reports, indicating that only eight of 252 reported events never happened. Drawing had no effect on report accuracy. It turned out that interviewers asked more open-ended questions (e.g., “Can you tell me more about that?”) and gave more minimal responses (e.g., “Uh huh,” ‘Really,” “Wow”) when the children were asked to draw. The number of minimal responses, in particular, was highly correlated with the amount of information provided by children in all age groups. These findings indicate that drawing can be useful in facilitating clinical and forensic interviews with children of all ages.

Applied Cognitive Psychology, November 24, 2009 online, doi: 10.1002/acp.1650. Tess Patterson and Harlene Hayne, Department of Psychological Medicine, University of Otago, New Zealand.


Ketamine harmful to cognition and mental health

Ketamine has become increasingly popular in recent years as a club drug. New research from University College London in the United Kingdom has found that heavy use of ketamine can harm cognitive function and psychological well-being. The study followed 150 participants over the course of one year, dividing them into five groups of 30: frequent users used ketamine more than four times a week; infrequent users used it at least once a month; abstinent users had not used the drug for at least a month; polydrug users used other drugs; and non-drug users did not use illicit drugs at all. Researchers found that cognitive deficits were largely confined to frequent ketamine users, among whom increased ketamine use over the year was correlated with declines in spatial working memory and pattern recognition memory. Former ketamine users showed no cognitive deficits, suggesting that although impairment from ketamine may be cumulative, cognitive function can recover after people stop using the drug. Frequent users also experienced more dissociative symptoms, and delusional symptoms increased in a dose-response relationship with the amount of ketamine used. Both frequent and abstinent users experienced increases in depression scores over the course of the year. The authors recommend that health education campaigns target ketamine users, who are still largely unaware of the dangers of using the drug and its potential for dependency.

Addiction, 2009 online, doi: 10.1111/j.1360-0443.2009.02761.x. Celia J.A. Morgan et al., Clinical Psychopharmacology Unit, University College London, London, United Kingdom.


Pharmacy-based interventions improve medication adherence

A pharmacy-based intervention can increase the likelihood that people with serious mental illness will take their medication as required, according to a new study from the Department of Veterans Affairs in Ann Arbor, Michigan. The study involved 118 Veterans Affairs patients who had schizophrenia, schizoaffective disorder or bipolar disorder. They were all being given long-term treatment with antipsychotic medication and had medication compliance rates under 80 per cent in the previous year. Sixty of the patients received usual care, which included visits with a psychiatrist, non-medical mental health visits and group visits. Another 58 per cent were assigned to a Meds-Help pharmacy-based intervention involving unit-of-use packaging of patients’ medications, a medication education session, refill reminders sent by mail and notification of clinicians when patients failed to fill prescriptions within 7 to 10 days. Compliance rates were reassessed at 6 and 12 months. At the beginning of the study, the average compliance rates were 54 per cent for the Meds-Help group and 55 per cent for the usual care group. At six months, the compliance rates had increased to 91 per cent for the Meds-Help group, compared with 64 per cent for the usual care group. At 12 months, Meds-Help patients still had 86 per cent compliance rates, while rates for the usual care group were only 62 per cent. Given that their results are comparable with those previously reported for people with diabetes and hypertension in a similar intervention, the authors conclude that a pharmacy-based intervention can be as effective in increasing compliance among people with serious mental illness as among people with other chronic medical conditions.

Schizophrenia Bulletin, November 21, 2009 online, doi: 10.1093/schbul/sbp121. Marcia Valenstein et al., Department of Veterans Affairs Serious Mental Illness Treatment, Research, and Evaluation Center, Ann Arbor, Michigan.


Women and men misuse painkillers for different reasons

The reasons for misuse of opioid painkillers appear to differ along gender lines, according to research from Harvard Medical School in Boston, Massachusetts. Working with pain management centres in five U.S. states, researchers recruited 335 females and 275 males prescribed opioid painkillers for chronic non-cancer pain. Participants were followed for five months, answering a series of questionnaires and providing urine samples at the end of the study for toxicology assessment. The participants’ physicians also completed substance misuse behaviour checklists. At the five-month follow-up, women were more likely to self-report misuse on a drug use questionnaire, while men were more likely to be flagged for misuse by their physicians. There were no gender differences in actual opioid misuse as measured using urine toxicology screens and either self-report or physician report – about one-third of both women and men were found to have misused their medication. On questionnaires examining risk for substance misuse, women were more likely to mention risk factors such as psychiatric diagnoses and a history of physical and sexual abuse, while men were more likely to report legal and behavioural problems and a history of alcohol or other drug problems. The authors suggest that efforts to reduce opioid misuse should emphasize educating women about avoiding painkillers to deal with anxiety and sleep disturbances and more closely monitoring men’s behaviour. Women may also benefit from antidepressant medication and cognitive-behavioural therapy.

The Journal of Pain, 2009 online, doi: 10.1016/j.pain.2009.07.016. Robert N. Jamison et al., Departments of Anesthesia and Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.


Young male binge drinkers expect to be unhappy later in life

Young men who believe that happiness declines with age are more likely to binge drink, according to research from Queen’s University Belfast in Northern Ireland. Researchers used data from a 2007 survey of 1,036 citizens of Northern Ireland over age 15. Participants were questioned about the frequency of binge drinking and a range of other health-related issues. Researchers asked participants how happy they currently were and how happy they expected to be at the ages of 30 and 70. They were also asked how happy they estimated the average person is and how happy that person would be at 30 and 70. No differences were found between the self-reported happiness levels of young people and older people. However, young people tended to believe that happiness declines with age. Just more than half of participants were classified as binge drinkers – 59 per cent of males and 45 per cent of females. Young men who expected lower levels of happiness in old age were more likely to binge drink. There was no such correlation for females. The authors suggest that young men’s underestimation of happiness later in life increases the likelihood that cultural ideals of masculinity (toughness, strength, invulnerability, risk-taking, competitiveness and living for the moment) will be expressed through binge drinking. The authors conclude that it may be worthwhile to remind young men of the benefits of reducing alcohol consumption, as well as informing them about the reality that happiness is common in old age.

Journal of Happiness Studies, November 12, 2009 online, doi: 10.1007/s10902-009-9174-1. John Garry and Maria Lohan, School of Politics, International Studies and Philosophy, Queen’s University Belfast, Belfast, Northern Ireland, United Kingdom.


Therapeutic alliance improves supportive psychotherapy outcome

The development of a therapeutic alliance between therapist and client over the course of psychotherapy can lead to significant improvements in the client’s level of social, occupational and psychological functioning, according to research from the Hôpital Purpan in Toulouse, France. Using data from a previously published study, researchers studied 74 individuals who received 10 weeks of acute outpatient treatment for major depression. Thirty-nine participants were given the antidepressant clomipramine, combined with supportive psychotherapy, and 35 received clomipramine and psychodynamic psychotherapy. Supportive therapy “focused on empathic listening, guidance, support and alliance, while psychodynamic therapy emphasized the development of an empathic relationship between patient and therapist who, together, investigate interpersonal difficulties in relation to past life-events.” The researchers found that therapeutic alliance increased over time in both treatment groups. Among participants who received supportive therapy, this increase in therapeutic alliance translated into improved social, occupational and psychological functioning. However, the benefit from the therapeutic alliance appeared to be related more to the perception of collaboration between client and therapist toward a common therapeutic goal, rather than to the perception of the therapist as a provider of help. Among those who received psychodynamic therapy, there was a significant relationship between the therapeutic alliance and improvements in functioning at two weeks, but this relationship was no longer evident after the full 10 weeks of treatment. The authors conclude that the therapeutic alliance may not be the main active therapeutic factor in psychodynamic therapy, but that it is more active in supportive therapy.

Psychiatry Research, December 30, 2009, v. 170 (2–3): 229–233. Lionel Cailhol et al., INSERM, Hôpital Purpan, Toulouse, France.