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Autumn 2005, Vol 9 No 1

section identifier imagethe front cover of a crosscurrents magazine- the main image is a vase with bold coloured flowers

Research Update           

 

Pain medication addiction more likely among young people

Young people are more likely than older people to want to rapidly increase their dosage of opioid-based medications such as morphine, methadone and oxycodone, thus raising risk of abuse, according to research from the University of California, San Francisco. Researchers examined the medical records of 206 individuals who had been treated at a pain management centre for two years for non-cancer –related pain. Records of clients under age 50 were compared with those 60 or older. The study found that older clients, regardless of gender or type of pain, increased opioid use significantly less over two years than younger clients. The average peak dose for clients under age 50 was more than twice that of older clients – often more than half a gram per day of morphine or other drugs. Older clients also experienced long-term pain relief with opiate-based drugs, but younger clients did not. The authors indicate that younger clients may be better candidates for newer non-steroidal anti-inflammatories and poorer candidates for opioids, whereas older clients may benefit more from opioids.

 

Anesthesia and Analgesia, June 2005, v. 100: 1740–1745. Chante Buntin-Mushock et al., Department of Anesthesia and Perioperative Care and Department of Neurology, University of California, San Francisco.

 

Excessive Internet use linked with psychiatric disorders

Young people who use the Internet excessively experience more psychiatric symptoms than those who access it less often, according to researchers at Korea’s Dong-A University College and Harvard Medical School in Boston, Massachusetts. Participants were 328 male and female Korean students aged 15–19. They completed four questionnaires: Internet use patterns during the previous month, the Internet Addiction Test, the Symptom Checklist-90-R and the Sixteen Personality Factor Questionnaire. Participants were separated into four groups based on average Internet use: non-users, minimal users (0.8 hours per day), moderate users (1.5 hours per day) and excessive users (2.3 hours per day). Sixteen students were classified as excessive users, logging on an average of 19 hours per week. Fifty-nine students reported no Internet use. There were significantly more males than females in the moderate and excessive groups. Excessive users experienced more hostility, obsessive-compulsiveness, paranoia, depression, irritability, impulsiveness, anxiety, phobias, somatization and psychoticism than moderate and minimal Internet users. Excessive users also appeared to have a distinctive personality profile compared with other users and non-users. The authors indicate various study limitations, including small sample size and use of questionnaires rather than interviews. They suggest that excessive Internet users “may use the Internet to counteract psychological distress rooted in their personality.”

 

Canadian Journal of Psychiatry, June 2005, v. 50: 407–414. Chang-Kook Yang et al., Department of Psychiatry, Dong-A University College of Medicine, Busan, Korea.

 

Medication adherence linked to good therapeutic relationships

Good relationships with clinicians during admission to acute treatment may improve attitudes toward and adherence to anti-psychotic medication, according to UK researchers. The study examined various factors that may influence medication compliance, including psychiatric symptoms and lack of insight, as well as factors related to the therapeutic relationship, including the client’s perception of the degree of coercion during admission to hospital and the attitudes of inpatient staff. The study involved 228 clients in eight inpatient acute care wards in Wales and England who were diagnosed with schizophrenia or schizoaffective disorder. It was found that good insight, lack of coercion during admission, a positive relationship with the medication prescriber, involvement in treatment decisions and medications with fewer side-effects increased medication adherence. The researchers mention limitations to the study, including the focus on the acute phase of treatment, indicating that different stages of illness and different social contexts may yield different results. They propose measures for client-centred care, including involving clients in treatment decisions, respecting clients’ health beliefs and adjusting treatment to minimize negative side-effects.

 

Archives of General Psychiatry, June 2005, v. 62: 717–724. Jennifer C. Day et al., Pharmacy Department, Mersey Care NHS Trust, Merseyside, United Kingdom.

 

Children born to mothers who drink during pregnancy are more likely to contract infections as newborns, according to a study at Emory University in Atlanta, Georgia. Researchers examined data from 872 women who delivered single infants at 36 weeks or more of gestation. Following delivery, mothers were asked about alcohol and tobacco use in the three months prior to conception, and during the first, second and third trimester. Information about gender, gestational age and size was also collected. Fifty-one infants were diagnosed with newborn infections. Mothers who reported alcohol use, excessive drinking (seven or more drinks per week) or smoking during pregnancy were more likely to have a newborn diagnosed with an infection than were mothers who reported abstaining. After controlling for low maternal income, smoking and low birth weight, excessive alcohol use, especially during the second trimester, increased the risk of newborn infection more than three-fold. The authors recommend further research to determine whether drinking during the second trimester is particularly damaging. Maternal smoking at any time point before and during pregnancy also increased infection risk. The authors call for further research on the effects of maternal alcohol consumption on developing organ systems, as well as on the combined effects of alcohol consumption and smoking on the newborn.

 

Alcoholism: Clinical and Experimental Research, June 2005, v. 29: 1035–1043. Theresa W. Gauthier et al., Children’s Center Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, Georgia.

 

Friendships help us live longer

Strong friendships may lead to longer life, according to researchers at Flinders University in Adelaide, Australia. Researchers used data from the Australian Longitudinal Study of Ageing, which assesses how economic, social, behavioural and environmental factors affect people over age 70. Beginning in 1992, researchers monitored 1,477 people living in the community and residential care facilities. Participants were asked how much personal and phone contact they have with their spouses, children, other relatives, friends and confidants. They were monitored every year for the first four years and then every three years. The study found that participants over age 70 with a strong network of friends were 22 per cent less likely to die compared to those with the weakest network. A smaller positive effect was found for confidants. Networks with children and other relatives had little effect on survival. The correlation held after controlling for socio-economic status, health and lifestyle. The researchers suggest that friends may discourage risky behaviours, while lifting mood, self-esteem and coping ability.

 

Journal of Epidemiology and Community Health, June 2005, v. 59: 574–579. Lynne C. Giles et al., Department of Rehabilitation and Aged Care, Flinders University, Adelaide, Australia.

 

Antipsychotic drugs show quick effect

Antipsychotic medications begin to reduce psychosis within the first 24 hours of treatment, suggests research from the Centre for Addiction and Mental Health and University of Toronto. In this multi-centre double-blind study, 311 individuals with schizophrenia were randomly assigned to either a placebo group or a group that received the antipsychotics olanzapine or halperidol. Participants were monitored for changes in their behaviour at baseline and two hours and 24 hours after the drugs were administered, using the Positive and Negative Syndrome Scale and the Clinical Global Impressions rating scale. Analysis of clinical data showed that change in psychosis (which included conceptual disorganization, hallucinatory behaviour and unusual thought content) appeared within 24 hours for both drugs and showed greater change than the placebo group. The authors indicate that this result is contrary to the prevailing assumption that it takes at least two weeks for antipsychotics to affect symptoms. They suggest that this finding has important clinical implications because it raises the possibility that physicians may be able to look for effects earlier, and thereby develop more efficient strategies for the medical management of psychosis.

 

American Journal of Psychiatry, May 2005, v. 162: 939–946. Shitij Kapur et al., Centre for Addiction and Mental Health, Toronto, Ontario.

 

Successful anti-stigma campaigns target violence stereotype

Campaigns aimed at reducing stigma and discrimination toward people with schizophrenia would be most effective if they addressed perceptions of unpredictability and dangerousness, according to researchers at the University of Leipzig in Germany. A fictional case scenario was presented to 5,025 people, describing an individual who met DSM-III-R criteria for schizophrenia or major depressive disorder. Participants were asked to describe the problem presented. Responses were grouped into four categories: correct psychiatric diagnosis, other psychiatric illness, personal problem or other. Participants then indicated whether the individual was unpredictable or dangerous, whether lack of willpower was responsible for the illness and what the prognosis would be given optimal treatment. They were also asked whether they had personal experience with mental illness. Finally, participants were given a list of social relationships such as tenant or in-law and indicated whether they would accept the individual from the case scenario in such roles.

The study found that regardless of familiarity with mental illness, mental illness labels increased the likelihood that participants would consider the individual unpredictable and dangerous. Perceived unpredictability and dangerousness increased negative responses to accepting the individual in a social role. Labelling the problem as a mental illness lowered the tendency to attribute the disorder to lack of willpower. The authors caution that the findings may be limited by the study’s focus on schizophrenia. They conclude that anti-stigma campaigns should address stereotypes of unpredictability and dangerousness because these are most likely to affect people’s willingness to engage in social relationships with individuals with schizophrenia.

 

Social Psychiatry and Psychiatric Evaluation, May 2005, v. 40: 391–395. Matthias C. Angermeyer and Herbert Matschinger, Department of Psychiatry, University of Leipzig, Leipzig, Germany.

 

Gambling and substance use issues share personality traits

Rebelliousness, anger and risk-taking are personality traits shared by compulsive gamblers and people with substance use issues, according to researchers at the University of Missouri-Columbia. Researchers performed personality assessments on 939 18-year-old males and females in New Zealand and administered structured interview-based diagnoses of past-year problem gambling and alcohol, cannabis and nicotine problems at age 21. They examined the association between problem gambling and each of the three substance use problems. They then compared 10 basic personality traits of individuals in each disorder group to individuals who did not develop gambling or substance use problems. The study found similar personality profiles for people with a gambling problem and those with substance use problems. Those with problem gambling in the past year were three times more likely to have a substance use problem. Those with gambling problems were more likely to score higher on personality measures of negative emotions, including nervousness, anger and feeling victimized, and impulsive or risk-taking behaviour. The authors indicate that the findings may help to explain the relationship between problem gambling and other addictions and may lead to better treatments.

 

Archives of General Psychiatry, July 2005, v. 62: 769–775. Wendy S. Slutske et al., University of Missouri-Columbia, Columbia, Missouri.