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Autumn 2009, Vol 13 No 1

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Research Update


Mark de la Hey


Social phobia affects interpretation of social cues

People with generalized social phobia tend to rate happy faces as less approachable than do people without the phobia, according to a new study from the University of Manitoba in Winnipeg. The study involved 12 individuals with generalized social phobia and 28 participants without the phobia. Participants were asked to view 24 emotional faces on a laptop computer and label their expressions as happy, disgusted or angry. They were then asked how likely they would be to approach the person depicted and engage them in a social interaction. Both groups rated happy faces as more approachable than disgusted or angry faces. However, participants with social phobia rated the happy faces as less approachable than did the controls. Depression scores did not affect an individual’s rating of the approachability of happy faces, so it could not be argued that depressive symptoms were responsible for the tendency among those with social phobia to see happy faces as less approachable. These results are consistent with the idea that people with social phobia lack the positive interpretation bias found among individuals without phoba. Instead, they show a more negative interpretation bias that may result from their interpreting happy faces as reflecting mockery, social dominance or raised social expectations. The study’s authors indicate that their results point to the need for treatment that addresses interpretational biases toward positive social signals in people with social phobia, not just biases towards negative social signals.

Depression and Anxiety, May 2009, v. 26: 419–424. D.W. Campbell et al., Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba.


Shared vulnerability to opioid abuse and psychiatric disorders

According to a new study from Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, people with psychiatric disorders are more likely to engage in non-medical opioid use and, conversely, those who use opioids for non-medical purposes are more likely to develop psychiatric disorders. Opioids are drugs with morphine-like effects that are primarily used as painkillers. Researchers looked at data about 43,093 participants from the National Epidemiologic Survey on Alcohol and Related Conditions. There were 1,815 individuals in this sample who had used opioids for non-medical purposes in their lifetimes, and 131 of these were considered opioid dependent. Those who had pre-existing psychiatric disorders (including mood disorders, major depressive disorder, bipolar I disorder, anxiety disorders, panic disorder and generalized anxiety disorder) were more likely than healthy individuals to use opioids for non-medical purposes, with hazard ratios ranging from 2.2 times as likely in the presence of an anxiety disorder to 3.1 times as likely in the presence of bipolar I disorder. Pre-existing psychiatric disorders also made the development of dependence more likely among nonmedical opioid users, particularly in the presence of generalized anxiety disorder (hazard ratio of 10.8) and bipolar I disorder (hazard ratio of 9.7). On the other hand, those who were non-medical opioid users increased their risk of developing subsequent psychiatric disorders relative to non-users, with hazard ratios ranging from 2.8 for generalized anxiety disorder to 3.6 for bipolar I disorder. Those opioid users who could be considered dependent had an even higher risk of developing psychiatric disorders, with hazard ratios ranging from 4.9 for mood disorders to 8.5 for panic disorder. The researchers see these results as pointing to an underlying general vulnerability to opioid use and mood and anxiety disorders, as well as providing support for the idea that some opioid users are self-medicating pre-existing psychiatric disorders.

Drug and Alcohol Dependence, July 2009, 103: 16–24. Silvia S. Martins et al., Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.


Stigma resistance helps consumers lead fulfilling lives

Research from the Medical University of Vienna indicates that developing the ability to counteract the stigma of mental illness, known as stigma resistance, can help people with mental illness recover and lead fulfilling lives. Researchers asked 157 individuals with a diagnosis of either schizophrenia or schizoaffective disorder to fill out questionnaires rating their subjective experience of stigma on the Internalized Stigma of Mental Illness (ISMI) Scale. The ISMI measures stigma resistance as well as four measures of stigma itself: alienation, stereotype endorsement, discrimination experience and social withdrawal. Almost two thirds of participants showed high levels of stigma resistance: 44 per cent for alienation, 38 per cent for discrimination, 34 per cent for social withdrawal and 15 per cent for stereotype endorsement. Stigma resistance correlated positively with self-esteem, empowerment and quality of life. It was negatively correlated with depression and all measures of stigma except discrimination experience. Higher levels of stigma resistance were seen in those who had social networks with a sufficient number of friends, those who were single or married rather than separated, and among those who received outpatient treatment rather than inpatient treatment or treatment in a clinic. The researchers suggest that therapy might be more successful in reducing the effects of stigma if it were to focus on the development of stigma resistance and only secondarily on fighting the stigmatizing beliefs themselves.

Schizophrenia Bulletin, June 1, 2009, doi: 10.1093/schbul/sbp048. Ingrid Sibitz et al., Department of Psychiatry and Psychotherapy,
Medical University of Vienna, Vienna, Austria.


Low response to alcohol increases risk of alcohol problems

People who have relatively little reaction to alcohol are more likely to develop alcohol use disorders (AUDs) later in life, according to research from the University of California, San Diego. Researchers studied 297 males from the San Diego Prospective Study who drank but who were not alcohol dependent when they were recruited. All participants were given an alcohol challenge at the time of recruitment to determine their responsiveness to alcohol. The men were between age 18 and 25 at time of recruitment and were followed for 25 years. One third developed AUDs by the 25-year follow-up. Low responses to alcohol increased the likelihood of developing AUDs throughout adulthood. This result held up even when researchers controlled for other risk factors for developing AUDs, such as family history, age of drinking onset and drinking levels at recruitment. A family history of AUDs did not have a comparable effect, except among participants who were heavy drinkers when first recruited. Participants who were heavy drinkers at recruitment had a higher risk of developing AUDs throughout adulthood. The researchers conclude that their results provide evidence that a low response to alcohol “is a unique risk factor for AUDs across adulthood, and not simply a reflection of a broader range of risk factors.”

Alcoholism: Clinical and Experimental Research, September 2009, v. 33 (9): 1–9. Ryan S. Trim et al., Department of Psychiatry, University of California-San Diego, San Diego, California.


Suicide and self-harm linked to nicotine dependence in girls

New research from Oulu University Hospital in Oulu, Finland, has found that nicotine dependence is associated with an increased risk of suicide attempts and self-mutilation in adolescent girls. Researchers collected data from 508 individuals aged 12 to 17 (300 girls and 208 boys) who received inpatient psychiatric treatment at the hospital. Participants were interviewed using the Schedule for Affective Disorder and Schizophrenia for School-Age Children. Fifty-five participants (35 girls and 20 boys) had attempted suicide, 95 (74 girls and 21 boys) had engaged in self-mutilation, and 49 (43 girls and 6 boys) reported both suicide attempts and self-mutilation. Girls who had high levels of nicotine dependence were four times as likely as those who did not smoke to have attempted suicide, and almost five times as likely to have engaged in self-mutilation. While the risk for suicide attempts was increased only by high levels of nicotine dependence, risk for self-mutilation was elevated even among girls with mild nicotine dependence. Nicotine dependence had no effect on suicide attempts or self-mutilation among males. Given that this is the first study to report an association between nicotine dependence and suicide attempts and self-mutilation among adolescent girls but not adolescent boys, the authors call for further sex-specific studies. They also recommend that nicotine dependence be taken into account when assessing suicide risk among adolescents.

Comprehensive Psychiatry, July/August 2009, v. 50: 293–298. Kaisa Riala et al., Department of Psychiatry, Oulu University Hospital, Oulu, Finland.


Child abuse linked to future revictimization

Adolescent mothers have high rates of previous childhood physical abuse, subsequent revictimization as adults and impaired psychosocial functioning. Now, research from the University of Washington in Seattle has clarified the causal pathways linking these events, showing that the experience of childhood physical abuse first impairs psychosocial functioning, leading to revictimization (interpersonal violence) in adult life, which maintains or worsens the existing psychosocial impairment. Researchers recruited 229 unmarried pregnant adolescents who were periodically interviewed over the next 9.5 to 11.5 years. More than half had experienced at least one incident of childhood physical abuse. Between age 21 and 22, almost half of participants reported experiencing some form of interpersonal violence, and 10 per cent reported experiencing a sexual assault during that year. Rates of depression and anxiety for the entire sample did not differ from those in the general population. Alcohol use also reflected that in the general population, but participants had higher rates of marijuana use. Childhood physical abuse had an effect on levels of psychological distress in adolescence that was maintained into early adulthood, and it also influenced adult psychological distress and substance use through two mediated pathways: one through psychological distress and subsequent interpersonal violence and another directly through interpersonal violence. Childhood physical abuse did not significantly affect levels of substance use, and although marijuana use did affect interpersonal violence in adult life, the pathways leading through substance use were not as important as psychological distress in adult outcomes. The researchers conclude that their findings point to the need for “early intervention with adolescent mothers who come from abusive families and who display higher levels of psychological distress.”

American Journal of Orthopsychiatry, April 2009, v. 79: 181–190. Taryn Lindhorst et al., School of Social Work, University of Washington, Seattle, Washington.


Poor outcomes found for treatment-resistant depression

New research from King’s College London has found high rates of relapse for treatment-resistant depression. Using databases such as MEDLINE and PsycINFO, researchers identified nine outcome studies that focused on treatment-resistant depression. These studies included a total of 1,279 participants, most of whom were recruited from secondary and tertiary mental health services. Overall, rates of relapse (readmission or premature death) ranged from 28 per cent to 68 per cent. However, rates of relapse within a year of achieving remission were as high as 80 per cent for those requiring multiple treatments. Those whose illness was more protracted had an approximately 40 per cent likelihood of recovering within 10 years. Three studies reported on mortality and found rates that are comparable to those for depression in general. Treatment-resistant depression was also found to be associated with poorer quality of life. The predictors of outcome identified in these studies were similar to those for depression in general, indicating that treatment-resistant depression is “part of the continuum of depressive disorders rather than a separate or distinct illness.” Given that the available studies show considerable variability in recruitment procedures, definitions and outcome assessments, the authors recommend further study to improve understanding of treatment-resistant depression and to plan effective treatment interventions.

Journal of Affective Disorders, July 2009, v. 116: 4–11. Abebaw Fekadu et al., Institute of Psychiatry, King’s College London, London, United Kingdom.