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Winter 2009-10, Vol 13 No 2

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Research Update

 

By Mark de la Hey

 

Risk-taking teens show surprisingly mature brain structure

New research indicates that, contrary to what might be expected, teens who engage in dangerous behaviours, including drinking, smoking, taking drugs and drinking and driving, have brains that are in some respects more adult in form than those of their risk-averse peers. Researchers at the Emory University School of Medicine in Atlanta, Georgia, used diffusion tensor imaging to measure white matter organization in the brains of 91 adolescents. They assessed dangerous behaviour using the Adolescent Risk Questionnaire (ARQ), which measures thrill-seeking, rebellious, reckless and antisocial behaviours. Compared to more cautious adolescents, those who engaged in risky behaviour had increased fractional anisotropy (FA) and decreased transverse diffusivity (TD) in their frontal white matter, both indicators of a more mature brain structure. The researchers found that much of the correlation between risk scores and FA and TD resulted from correlations with what they termed rebellious behaviour (drinking, smoking, taking drugs). However, they note that white matter correlations accounted for no more than 25 per cent of the variation in ARQ scores, indicating that other unknown factors also play a role in determining an individual’s propensity for dangerous behaviour. The association of risky behaviour with more mature brain structure may reflect the fact that these behaviours provide adolescents with more “life experience,” or it may be that precocious development of the brain leads them to engage in behaviours considered more appropriate for adults than adolescents.

PLoS One, August 2009, v. 4(8), doi:10.1371/journal.pone.0006773. Gregory S. Berns et al., Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.

 

Heroin maintenance therapy more effective than methadone

Prescription heroin appears to be more effective than methadone in maintenance therapy for people with heroin addiction, according to research from the University of British Columbia in Vancouver. The study involved 251 long-term heroin users in Vancouver and Montreal, 111 of whom were randomly assigned to receive oral methadone, while 115 received injectable diacetylmorphine (the active ingredient in heroin). In addition, 25 participants were assigned injectable hydromorphone for the purpose of validating self-reported use of street heroin. The injectable medications were self-administered under supervision at treatment clinics. After one year, 88 per cent of participants who received heroin remained in treatment, compared with 54 per cent of those who received methadone. Rates of illicit drug use and other illegal activity were reduced by 67 per cent in the heroin maintenance group, while the methadone group saw a 48 per cent reduction. The heroin maintenance group also showed greater improvement in physical and mental health, economic well-being, employment and family and social relationships. However, those given heroin experienced more serious adverse events (51 in total), including 11 overdoses and seven seizures, which resulted from the study drug. Methadone treatment resulted in only 18 adverse events, none resulting from the study drug. The authors recommend that heroin maintenance therapy be provided in settings where medical personnel are available for prompt intervention. Although the authors conclude that methadone should remain the treatment of choice for most people with heroin dependence, they assert that prescription heroin is a “safe and effective adjunct treatment” for people who do not benefit from methadone treatment.

New England Journal of Medicine, August 20, 2009, 361: 777–786. Eugenia Oviedo-Joekes et al., School of Population and Public Health, University of British Columbia, Vancouver, British Columbia.

 

Mental health and / or addiction treatment more common among sexual minorities

Men and women who are lesbian, gay or bisexual are significantly more likely than heterosexuals to receive treatment for mental health or substance use disorders, according to a study from the University of California, Los Angeles. The study was based on interviews with 2,074 California adults who were selected for sexual orientation minority status. Twenty-nine per cent of the sample had received treatment for mental health, alcohol or other substance abuse problems in the previous 12 months. However, lesbian and bisexual women were much more likely to receive such treatment, at 55 per cent, compared with 43 per cent of gay and bisexual men, 27 per cent of heterosexual women and 17 per cent of heterosexual men. Even among those who had no diagnosed disorder, 44 per cent of lesbian and bisexual women nonetheless received treatment, compared with 31 per cent of gay and bisexual men, 17 per cent of heterosexual women and 10 per cent of heterosexual men. The higher rates of treatment among sexual minorities may be due to cultural norms favouring help-seeking among sexual minorities, as well as to greater exposure to discrimination, violence and other stressful life events. The differences in treatment may also reflect cultural norms among gay and lesbian communities that see therapeutic services as “appropriate places for coping with the stresses associated with being a sexual minority.” Furthermore, they may reflect a persistent tendency to view homosexuality as a mental illness. Future research into the effects of treatment for sexual minorities who do not have diagnosable disorders could help determine whether such treatment can reduce the likelihood that an individual will progress to more severe levels of illness.

BMC Psychiatry, August 14, 2009, v. 9(52), doi:10.1186/1471-244X-9-52. Christine E. Grella et al., Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California.

 

Motivational interviews improve effectiveness of CBT for anxiety

Research at York University in Toronto has found that people with generalized anxiety disorder (GAD) respond much better to cognitive-behavioural therapy (CBT) when they are given motivational interviews prior to therapy. The researchers recruited 76 people with GAD, 38 of whom were assigned to receive CBT preceded by four weekly motivational interview sessions, while another 38 received CBT alone after a four-week waiting period. The motivational interviews were designed to increase participants’ motivation by reducing their ambivalence about changing their patterns of worrying. Six participants dropped out of treatment with CBT alone, while only four dropped out when given pre-treatment with motivational interviews. At the end of treatment, those given motivational interviews showed significantly lower scores on the Penn State Worry Questionnaire than those who received CBT alone. Ninety-two per cent of those who received pre-treatment had normal worry scores after completing the therapy, compared with 71 per cent of those given CBT alone. Not only did those given pre-treatment benefit more from the CBT, but the motivational interviews alone provided some reduction in their worry scores even before they began CBT. Those with high levels of worry showed the greatest benefit from motivational interviews. Among this subgroup, 81 per cent of those who received pre-treatment no longer met diagnostic criteria for GAD after completing CBT, compared with 56 per cent of those who received CBT alone. The authors conclude that further research into augmenting CBT with motivational interviewing is warranted for people with severe levels of anxiety.

Journal of Anxiety Disorders, 2009, doi:10.1016/j.janxdis.2009.07.014. Henny A Westra et al., Department of Psychology, York University, Toronto, Ontario.

 

Collaborative care boosts return to work

Collaborative mental health care improves the chances that employees receiving short-term disability benefits due to mental health problems will return to work, while also resulting in cost savings for the employer, according to a study from the Centre for Addiction and Mental Health in Toronto. The study followed 124 employees diagnosed with psychiatric disorders who worked at a large financial insurance company that had set up a collaborative mental health care (CMHC) program. Most of the employees had either major depressive disorder or adjustment disorder. Seventy-three were referred to the CMHC program in addition to receiving short-term disability benefits, while 51 control participants received only disability benefits. Eighty-five per cent of those in the CMHC group ended up returning to work, and seven per cent went on to long-term disability. In the comparison group, only 63 per cent returned to work and 31 per cent went on long-term disability. Those in the CMHC group averaged 62 days on short-term disability, compared with 76 days for the controls. The employer benefited from the CMHC program as well, with an average cost of $2,023 for each employee in the program, while the comparison group averaged $2,378. The authors conclude that the CMHC model of disability management is a worthwhile investment because it is less costly and more effective in helping employees get adequate treatment for their psychiatric disorders.

Canadian Journal of Psychiatry, June 2009, v. 54: 379–388. Carolyn S. Dewa et al., Work and Well-Being Research and Evaluation Program, Centre for Addiction and Mental Health, Toronto, Ontario.

 

People with psychiatric disorders more likely to use psychoactive herbal medication

Users of herbal medication and dietary supplements (HMDS) are more likely than non-users to be seeking help for mental health problems and to be dissatisfied with their health care, according to a study from the Desert Pacific Mental Illness Research, Education and Clinical Center in Los Angeles. Using data on 9,585 individuals from the Healthcare for Communities national household telephone survey, researchers looked at respondents’ use of HMDS and psychiatric medication, psychiatric diagnoses and use of mental health services. They found that HMDS users did not have significantly higher rates of psychiatric disorders, alcohol and substance use disorders, or psychiatric medication use. However, HMDS use was strongly associated with a perceived need for mental health services and dissatisfaction with health care. HMDS users were also more likely to have seen a mental health provider or a primary care physician in the previous year. Although individuals with psychiatric disorders were not more likely to use HMDS in general, they were more likely than those without such disorders to use psychoactive HMDS such as St. John’s wort or melatonin. Given that 14 per cent of those who use HMDS also use psychiatric medications, the authors see a need for health care providers to talk to their clients about HMDS and to “familiarize themselves with the risks, side effects, and contraindications of more commonly used HMDS.”

Community Mental Health Journal, August 18, 2009, doi:10.1007/s10597-009-9235-2. Noosha Niv et al., Desert Pacific Mental Illness Research, Education and Clinical Center, Los Angeles, California.

 

Suicide risk among older adults related to personality

Older adults who are considered strong-willed, obstinate and controlling, and who are reluctant to share their feelings appear to have an elevated risk of suicide, according to new research from the Oslo University Hospital in Norway. Researchers conducted qualitative interviews with 63 informants (relatives, family doctors and home care nurses) regarding 23 people over age 65 who had committed suicide. Many of them could be characterized as “survivors,” with more than half experiencing illness, poverty or loss of close relatives in childhood or adolescence, and many also had to cope with similar hardships later in life. These older adults tended to be action-oriented achievers whose lives revolved around their work. Most informants characterized them as strong-willed and obstinate individuals who were very controlling in their relationships with others. They were generally reluctant to share their feelings and kept a distance in their relationships. Their need to control their surroundings, as well as their inability to accept their own limitations and need for help, may have left these older adults unable to adapt to changing circumstances later in life and to develop new coping skills. In light of their findings, the authors conclude that therapy for older adults at risk for suicide should aim to “ensure that elderly people are given confirmation of their personal value when their functional capacities and ability to take action diminish.”

International Psychogeriatrics, October 2009, v. 21: 903–912. Ildri Kjølseth et al., RVTS, Oslo University Hospital, Oslo, Norway.