Showing papers in "Acta Psychiatrica Scandinavica in 2006"

Public beliefs about and attitudes towards people with mental illness: a review of population studies

Abstract: Objective: To provide a review of population-based attitude research in psychiatry during the past 15 years. Method: An electronic search using PubMed, Medline, and Academic Search Premier plus a hand search of the literature was carried out for studies on public beliefs about mental illness and attitudes towards the mentally ill published between 1990 and 2004. Results: Thirty-three national studies and 29 local and regional studies were identified, mostly from Europe. Although the majority are of descriptive nature, more recent publications include studies testing theory-based models of the stigmatization of mentally ill people, analyses of time trends and cross-cultural comparisons, and evaluations of antistigma interventions. Conclusion: Attitude research in psychiatry made considerable progress over the past 15 years. However, there is still much to be done to provide an empirical basis for evidence-based interventions to reduce misconceptions about mental illness and improve attitudes towards persons with mental illness.

Prevalence and predictors of depression in populations of elderly: a review.

Abstract: Objective: To offer an update on prevalence and predictors of old age depression in populations of elderly Caucasians. Method: The databases MEDLINE and Psychinfo were searched and relevant literature from 1993 onwards was reviewed. Results: The prevalence of major depression ranges from 0.9% to 9.4% in private households, from 14% to 42% in institutional living, and from 1% to 16% among elderly living in private households or in institutions; and clinically relevant depressive symptom ‘cases’ in similar settings vary between 7.2% and 49%. The main predictors of depressive disorders and depressive symptom cases are: female gender, somatic illness, cognitive impairment, functional impairment, lack or loss of close social contacts, and a history of depression. Conclusion: Depression is frequent in populations of elderly. Methodological differences between the studies hinder consistent conclusions about geographical and cross-cultural variations in prevalence and predictors of depression. Improved comparability will provide a basis for consistent conclusions.

Prejudice and schizophrenia: a review of the 'mental illness is an illness like any other' approach.

Abstract: Objective: Many anti-stigma programmes use the ‘mental illness is an illness like any other’ approach. This review evaluates the effectiveness of this approach in relation to schizophrenia. Method: The academic literature was searched, via PsycINFO and MEDLINE, to identify peer-reviewed studies addressing whether public espousal of a biogenetic paradigm has increased over time, and whether biogenetic causal beliefs and diagnostic labelling are associated with less negative attitudes. Results: The public, internationally, continues to prefer psychosocial to biogenetic explanations and treatments for schizophrenia. Biogenetic causal theories and diagnostic labelling as ‘illness’, are both positively related to perceptions of dangerousness and unpredictability, and to fear and desire for social distance. Conclusion: An evidence-based approach to reducing discrimination would seek a range of alternatives to the ‘mental illness is an illness like any other’ approach, based on enhanced understanding, from multi-disciplinary research, of the causes of prejudice.

Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review.

Abstract: Objective: Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors. Method: We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures. Results: Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety. Conclusion: Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.

Validity and reliability of the CAPE: a self-report instrument for the measurement of psychotic experiences in the general population.

Abstract: Objective: General population longitudinal cohort studies have demonstrated the prognostic validity of self-reported psychotic experiences, but data on reliability and cross-validation with interview-based measures of these experiences are sparse. This study tested the reliability and validity of the Community Assessment of Psychic Experiences (CAPE42). Method: At baseline, the CAPE42 was used to measure the subclinical psychosis phenotype in a general population sample (n = 765). At follow-up (mean interval: 7.7 months), the Structured Interview for Schizotypy, Revised (SIS-R), the Brief Psychiatric Rating Scale (BPRS), and the CAPE42 were administered (n = 510). Results: Baseline self-reported dimensions of psychosis were specifically and independently associated with their equivalent interview-based dimension at follow-up (standardized effect sizes of 0.4–0.5) and with their equivalent self-reported measure (standardized effect sizes of 0.6–0.8). Conclusion: The results indicate that self-reported dimensions of psychotic experiences in general population samples appear to be stable, reliable and valid.

Cognitive training in Alzheimer's disease: a meta-analysis of the literature

Abstract: Objective: To systematically review the literature and summarize the effect of cognitive training (CT) for Alzheimer's disease (AD) patients on multiple functional domains. Method: Effect sizes (Cohen's d) were calculated for 17 controlled studies identified through a comprehensive literature review. Results: An overall effect size of 0.47 was observed for all CT strategies across all measured outcomes. Mean effect sizes were higher for restorative (0.54) than for compensatory (0.36) strategies. Domain-specific effect sizes ranged from 2.16 (verbal and visual learning) to −0.38 (visuospatial functioning). Data are also presented on the relative impact of restorative and compensatory strategies for each domain of functioning. Conclusion: CT evidenced promise in the treatment of AD, with primarily medium effect sizes for learning, memory, executive functioning, activities of daily living, general cognitive problems, depression, and self-rated general functioning. Restorative strategies demonstrated the greatest overall effect on functioning. Several limitations of the published literature are discussed.

The criterion validity of the Geriatric Depression Scale: a systematic review.

Abstract: Objective: The objective was to provide a systematic review of the screening accuracy of both versions of the Geriatric Depressions Scale (GDS-30, GDS-15). Method: An electronic search was performed by using Medline, Embase, Cinahl, Psyndex and the Cochrane library. The selection and examination of papers were performed by two reviewers independently. Results: Among the 42 papers included, important methodological aspects such as sampling methods or blinding of research workers often were not reported. For both GDS versions, similar validity indices were found (GDS-30: sensitivity 0.753, specificity 0.770; GDS-15: sensitivity 0.805, specificity 0.750). Using comparative studies based on the identical samples, both GDS versions showed significantly better validity indices than the ‘Yale-1-question’ screen, but were similar to the ‘Center for Epidemiological Studies Depression scale’ (CES-D). Conclusion: The GDS does not show a better criterion validity than the CES-D, but methodological limitations of primary studies hamper the generalizability of pooled analyses.

Do mental health professionals stigmatize their patients

Abstract: Objective: Assessing stereotypes towards people with mental illness among mental health professionals, comparing their view to the Swiss general population and analysing the influence of demographic factors, profession and work place variables (type of ward, employment time and professional experience). Method: Conducting a representative telephone survey (n = 1073). Factor analysis was used to achieve one-dimensional scales, which were analysed by regression analysis. Results: Most positive depictions were regarded as less characterizing people with mental illness, whereas most negative descriptions were viewed as more typifying these people. Compared with the Swiss general population, mental health professionals have not consistently less negative or more positive stereotypes against mentally ill people. Of the 22 stereotypes five factors were detected: ‘social disturbance’, ‘dangerousness’, ‘normal healthy’, ‘skills’ and ‘sympathy’. Stereotypes about people with mental illness are influenced by the professional background and if at all only slightly affected by gender, age, ward type, participation rate of the hospital, weekly working hours or years of professional experience. Conclusion: Mental health professionals must improve their attitudes towards people with mental illness. Different ways, e.g. improving their professional education or their quality of professional contacts by regular supervision to prevent burn-out, are discussed.

Standardized remission criteria in schizophrenia

Abstract: Objective: Recent work has focussed on schizophrenia as a ‘deficit’ state but little attention has been paid to defining illness plasticity in terms of symptomatic remission. Method: A qualitative review of a recently proposed concept of remission [N.C. Andreasen, W.T. Carpenter Jr, J.M. Kane, R.A. Lasser, S.R. Marder, D.R. Weinberger (2005) Am J Psychiatry 162: 441] is presented. Results: The proposed definition of remission is conceptually viable, and can be easily implemented in clinical trials and clinical practice. Its increasing acceptance may reset expectations of treatment to a higher level, improve documentation of clinical status and facilitate dialogue on treatment expectations. The availability of validated outcome measures based on remission will enhance the conduct and reporting of clinical investigations, and could facilitate the design and interpretation of new studies on cognition and functional outcomes. While useful as a concept, it is important to consider that remission is distinct from recovery. Conclusion: The introduction of standardized remission criteria may offer significant opportunities for clinical practice, health services research and clinical trials.

Prospective studies of suicidal behavior in major depressive and bipolar disorders: what is the evidence for predictive risk factors?

Abstract: OBJECTIVE: Prospective studies over the past 30 years have identified an array of predictive indicators for suicidal acts in mood disorders. However, prediction of suicidal behavior remains an elusive goal. This paper reviewed evidence from prospective studies for clinical factors that elevate risk of suicidal acts in that group. METHOD: English language prospective studies of suicidal behavior in major depressive and bipolar disorders were examined. RESULTS: The predictors with the best support were a past history of suicidal behavior and the presence of refractory or recurrent depressions. For other risk factors, there was either not enough data to consider them robust or findings were contradictory. CONCLUSION: Future studies must not only be comprehensive in their inclusion of potentially contributing factors, but must also address their relative importance towards the goal of developing predictive models and enhance suicide prevention efforts. Language: en

Shared decision making for in-patients with schizophrenia.

Abstract: Objective: Patients’ participation in treatment planning is being increasingly advocated in mental health. The model of ‘Shared Decision Making’ (SDM) is proposed as a promising method of engaging patients in medical decisions and improving health-related outcomes. In the present study, the feasibility and effects of SDM for in-patients with schizophrenia should be evaluated. Method: Randomized controlled trial comparing a SDM program with routine care (n = 107). Results: The intervention studied was feasible for most of the patients and did not take up more of the doctors’ time. Patients in the intervention group had a better knowledge about their disease (P = 0.01) and a higher perceived involvement in medical decisions (P = 0.03). The intervention increased the uptake of psychoeducation (P = 0.003). Conclusion: Sharing medical decisions with acutely ill in-patients with schizophrenia is in many cases possible and improves important treatment patterns. This might help in destigmatizing this group of patients and improving schizophrenia-related health outcomes.

Alcoholism and suicidal behavior: a clinical overview.

Abstract: Objective: The purpose of this paper was to provide a clinical review of the literature on the relation of alcoholism to suicidal behavior. Method: Studies of alcoholism and suicidal behavior available in MEDLINE, Institute for Scientific Information Databases (Science Citation Index Expanded, Social Sciences Citation Index, and Arts & Humanities Citation Index), EMBASE, and Cochrane Library were identified and reviewed. Results: Alcoholism is associated with a considerable risk of suicidal behavior. Individuals with alcoholism who attempt or complete suicide are characterized by major depressive episodes, stressful life events, particularly interpersonal difficulties, poor social support, living alone, high aggression/impulsivity, negative affect, hopelessness, severe alcoholism, comorbid substance, especially cocaine abuse, serious medical illness, suicidal communication, and prior suicidal behavior. Partner-relationship disruptions are strongly associated with suicidal behavior in individuals with alcoholism. Conclusion: All individuals with alcoholism should receive a suicide risk assessment based on known risk factors.

Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse

Abstract: Objective: To examine the evidence that discontinuation of long-term antipsychotic medication, including clozapine, may provoke a psychotic episode.Method:Databases were searched and citations scrutinised.Results: Evidence for a rapid onset psychosis (supersensitivity psychosis) following clozapine withdrawal was found and weaker evidence that this might occur with some other antipsychotic drugs. Some cases were reported in people without a psychiatric history. It appears that the psychosis may be a feature of drug withdrawal rather than the re-emergence of an underlying illness, at least in some patients. Meta-analyses of withdrawal studies have suggested that antipsychotic discontinuation may also increase the risk of relapse over and above the risk because of the underlying disorder, but not all individual studies show this effect. Mechanisms may relate to brain adaptations to long-term drug use but data are sparse.Conclusion: These effects require further urgent research. Interventions to reduce morbidity after drug withdrawal need to be developed.

Randomized dose-ranging pilot trial of omega-3 fatty acids for postpartum depression.

Abstract: Objective: Postpartum depression (PPD) affects 10–15% of mothers. Omega-3 fatty acids are an intriguing potential treatment for PPD. Method: The efficacy of omega-3 fatty acids for PPD was assessed in an 8-week dose-ranging trial. Subjects were randomized to 0.5 g/day (n = 6), 1.4 g/day (n = 3), or 2.8 g/day (n = 7). Results: Across groups, pretreatment Edinburgh Postnatal Depression Scale (EPDS) and Hamilton Rating Scale for Depression (HRSD) mean scores were 18.1 and 19.1 respectively; post-treatment mean scores were 9.3 and 10.0. Percent decreases on the EPDS and HRSD were 51.5% and 48.8%, respectively; changes from baseline were significant within each group and when combining groups. Groups did not significantly differ in pre- or post-test scores, or change in scores. The treatment was well tolerated. Conclusion: This study was limited by small sample size and lack of placebo group. However, these results support further study of omega-3 fatty acids as a treatment for PPD.

Outcomes of involuntary hospital admission--a review.

Abstract: Introduction: This paper reviews studies on outcomes of involuntary hospital admissions in general adult psychiatry, and predictors of outcomes. Method: Studies assessing observer-rated clinical change and self-rated outcomes were identified. Relevant databases were searched and authors were contacted. Studies were classified according to quality criteria. Results: Eighteen studies fulfilled the inclusion criteria. Most involuntarily admitted patients show substantial clinical improvement over time. Retrospectively, between 33% and 81% of patients regard the admission as justified and/or the treatment as beneficial. Data on predictors of outcomes is limited and inconsistent. Patients with more marked clinical improvement tend to have more positive retrospective judgements. Conclusion: A substantial number of involuntary patients do retrospectively not feel that their admission was justified and beneficial. At least for this group, new approaches might have to be considered. Larger studies are required to identify predictors on which patients are likely to fall into this group.

Obesity among individuals with serious mental illness

Abstract: Objective: To study the distribution and correlates of body mass index (BMI) among individuals with serious mental illness. Method: A total of 169 participants were recruited from randomly selected out-patients receiving community-based psychiatric care and were interviewed with items from the National Health and Nutrition Examination Survey (NHANES) III. Their BMI was compared with that of 2404 matched individuals from the NHANES data set. Results: The distribution of BMI in the psychiatric sample significantly differed from that of the comparison group; 50% of women and 41% of men were obese compared with 27% and 20% in the comparison group. Within the psychiatric sample, higher BMI was associated with current hypertension and diabetes, a wish to weigh less, and reduced health-related functioning. Conclusion: Obesity is more prevalent among individuals with serious mental illness than in demographically matched individuals from the US general population. Among persons with mental illness, obesity is associated with co-occurring health problems.

Symptom dimensions in obsessive-compulsive disorder: prediction of cognitive-behavior therapy outcome.

Abstract: Objective: A significant number of patients with obsessive–compulsive disorder (OCD) fail to benefit sufficiently from treatments. This study aimed to evaluate whether certain OCD symptom dimensions were associated with cognitive-behavioral therapy (CBT) outcome. Method: Symptoms of 104 CBT-treated in-patients with OCD were assessed with the clinician-rated Yale-Brown Obsessive–Compulsive Scale symptom checklist. Logistic regression analyses examined outcome predictors. Results: The most frequent OCD symptoms were aggressive and contamination obsessions, and compulsive checking and cleaning. Patients with hoarding symptoms at baseline (n = 19) were significantly less likely to become treatment responders as compared to patients without these symptoms. Patients with sexual and religious obsessions tended to respond less frequently, although this failed to reach statistical significance (P = 0.07). Regression analyses revealed that higher scores on the hoarding dimension were predictive of non-response, even after controlling for possible confounding variables. Conclusion: Our results strongly indicate that in-patients with obsessive–compulsive hoarding respond poorly to CBT.

Perinatal risk factors and infantile autism

Abstract: Objective: Suboptimal conditions during pregnancy and birth have been suggested as a cause of infantile autism. We have studied the association between obstetric factors and infantile autism. Method: A population-based, matched case–control study of infantile autism. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI). Results: The risk of infantile autism was increased for mothers aged >35 years, with foreign citizenship, and mothers who used medicine during pregnancy. A higher risk of infantile autism was seen among children with low birth weight and with congenital malformations. Birth interventions, pathological cardiotocography, green amnion fluid and acidosis during delivery were not associated with increased risk for infantile autism. Conclusion: Our findings suggest that suboptimal birth conditions are not an independent risk factor for infantile autism. A high prevalence of low birth weight and birth defects among autism cases seems to explain the suboptimal birth outcome.

Determinants of quality of life in people with severe mental illness.

Abstract: Objective: The objective of this article was to review some methodological issues in this field and give an overview of empirical research findings with a special focus on factors associated with or affecting subjective quality of life in people with a severe mental illness. Method: A selective review of relevant scientific literature on quality of life in severe mental illness was conducted. Results: Subjective quality of life in people with a severe mental illness is only to a lesser extent related to external life conditions. Major determinants are psychopathology, especially symptoms of depression and anxiety, and aspects of the social network. Personality related factors such as self-esteem are also influential. Comparative studies have further shown that patients in community care settings have a better subjective quality of life than patients in hospital settings. Conclusion: Efforts to improve subjective quality of life in people with severe mental illness should include a careful monitoring of depressive of and anxiety symptoms, and pay particular attention to assessment. and interventions against unmet needs. Further, such interventions should stress a strengthening of the social support of the clients. It is also important to pay attention to mediators of changes in subjective quality of life such as self-esteem, mastery, autonomy, and self-efficacy. (Less)

Prospective investigations of the prodromal state of schizophrenia: review of studies.

Abstract: Objective: The paper presents a comprehensive overview of prospective studies monitoring or intervening in the pre-onset phase of first episode psychosis. Method: A systematic literature search was conducted and supplemented by a manual search. All relevant studies were ordered and intensively reviewed according to specified criteria. Methodological and conceptual issues are discussed. Results: Reports of 23 prospective studies were found, some describing subsamples of larger samples. Major methodological and conceptual divergences exist. Conclusion: Applied criteria detect individuals with a significantly increased risk of psychosis within the schizophrenia spectrum, but these criteria are only validated on clinical populations. The significance of differences in sample-characteristics is unclear. Most study samples are small. Results are preliminary and in need of further research before they constitute a realistic knowledge base. Methodological and conceptual issues should not be underestimated.

Antidepressants and sexual dysfunction.

Abstract: Objective: Many patients with depression suffer from sexual dysfunction and sexual dysfunction is a recognized side-effect of antidepressants. The aim of this review was to examine the prevalence of psychosexual dysfunction associated with antidepressants, and to review treatment options which are specific to the affected component of sexual functioning and antidepressants. Method: Comprehensive literature review using Medline and Cochrane databases. Results: Up to 70% of patients with depression may have sexual dysfunction. Tricyclic antidepressants, selective-serotonin reuptake inhibitors and venlafaxine are most and the non-serotonergic antidepressants and duloxetine least likely to produce sexual dysfunction. Pharmacological treatment options include antidepressants less likely associated or ‘antidotes’ to reverse sexual dysfunction. Conclusion: Sexual dysfunction may be a preventable or treatable side-effect of antidepressants. Patients need routinely to be asked about sexual function to identify problems early. If sexual dysfunction is ignored it may maintain the depression, compromise treatment outcome and lead to non-compliance.

Functional disability of mental disorders and comparison with physical disorders: a study among the general population of six European countries

Abstract: Objective: To examine the association of mental and physical disorders with multiple domains of functioning and compare the two. Method: Data were derived from the European Study of the Epidemiology of Mental Disorders, a general population study in which adults (n > 21 000) from Belgium, France, Germany, Italy, the Netherlands and Spain were assessed using the Composite International Diagnostic Interview (mental disorders), World Health Organization Disability Assessment Schedule second edition (functional disability) and self-report (physical disorders). Means in different groups were compared using the Mann-Whitney U-test and multiple regression analyses. Results: Mental disorders were related to disability in all domains of functioning: anxiety disorders the most, followed by mood disorders, and finally alcohol disorders. The findings suggest that mental disorders are associated with similar or higher levels of disability in all domains, except getting around, than arthritis and heart disease. Conclusion: Mental disorders are associated with a similar or higher negative impact on daily functioning than arthritis and heart disease.

Understanding suicidal ideation in psychosis: findings from the Psychological Prevention of Relapse in Psychosis (PRP) trial

Abstract: Objective: To examine the clinically important phenomenon of suicidal ideation in psychosis in relation to affective processes and the multidimensional nature of hallucinations and delusions.Method: In a cross-sectional study of 290 individuals with psychosis, the associations between level of suicidal ideation, affective processes, positive symptoms, clinical and demographic variables were examined.Results: Forty-one per cent of participants expressed current suicidal ideation. Suicidal ideation was associated with depressed mood, anxiety, low self-esteem, negative illness perceptions, negative evaluative beliefs about the self and others and daily alcohol consumption. Frequency of auditory hallucinations and preoccupation with delusions were not associated with suicidal ideation; however, positive symptom distress did relate to suicidal thoughts.Conclusion: Affective dysfunction, including distress in response to hallucinations and delusions, was a key factor associated with suicidal ideation in individuals with psychotic relapse. Suicidal ideation in psychosis appears to be an understandable, mood-driven process, rather than being of irrational or 'psychotic' origin.

Clinical correlates of DHEA associated with post-traumatic stress disorder.

Abstract: Objective: Increased plasma dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEAS) have been demonstrated in post-traumatic stress disorder (PTSD), but the documented beneficial effects of these steroids in enhancing mood and cognition, as well as neuroprotection, suggest their presence in PTSD may be associated with defensive rather than maladaptive effects. Method: We, therefore, examined plasma DHEA, DHEAS, cortisol, and the DHEA/cortisol ratio in 40 male veterans with or without PTSD, and determined their relationships to PTSD symptom severity and symptom improvement. Results: The PTSD group showed significantly higher plasma DHEA and non-significantly higher DHEAS levels as well as a significantly lower cortisol/DHEA ratio, controlling for age. Regression analyses demonstrated that DHEA and DHEAS levels could be predicted by symptom improvement and coping, whereas the cortisol/DHEA ratio was predicted by severity of childhood trauma and current symptom severity. Conclusion: That greater symptom improvement was related to DHEA levels may suggest for a role for these hormones in modulating recovery from PTSD.

Who decides what evidence is? Developing a multiple perspectives paradigm in mental health.

Abstract: Objective: To compare different perspectives on evidence in relation to mental health care. Method: The method and materials constitute a selective literature review comparing key elements of evidence-based medicine and evidence-based policy with perspectives on evidence from users, carers and professionals. The aim was to develop an argument concerning these comparisons. Results: What constitutes evidence from the perspectives of different stakeholders is a field of contestation. Conclusion: It is timely for a multiple perspective paradigm on evidence in science to be developed and this paper initiates this process in relation to mental health care.

Randomized controlled trial of a cannabis-focused intervention for young people with first-episode psychosis.

Abstract: Objective: To evaluate a cannabis-focused intervention (cannabis and psychosis therapy: CAP) for patients continuing to use cannabis following initial treatment for first-episode psychosis (FEP). Method: Consecutive admissions to an early psychosis program were screened and consenting individuals using cannabis in the 4 weeks prior to assessment participated. A single-blind randomized controlled trial compared CAP (n = 23) with a clinical control condition (psychoeducation, PE; n = 24). Results: There were no significant differences between the CAP and PE groups on cannabis use at end of treatment and 6 months post-intervention. There were no significant group differences on psychopathology and functional ratings at follow-up. A significant reduction in cannabis use was observed for both groups over time. Conclusion: PE and specific cannabis-focused intervention are associated with similar reductions in cannabis use in an FEP cohort. Simple interventions may therefore be worth considering prior to intensive psychotherapeutic efforts with this population.

The cardiovascular and respiratory health of people with schizophrenia

Abstract: Objective: To examine the cardiovascular and respiratory health of people with severe mental illness (SMI) and compare findings with the Health Surveys for England. Method: A prospective, multi-centre observational prevalence study of 602 patients with schizophrenia-related psychoses carried out in six locations across the UK over 24 months. Results: Compared with general population subjects, people with SMI reported higher rates of angina and respiratory symptoms and had poor lung function. Much of this increased risk could be explained by lifestyle risk factors; there were increased levels of obesity among younger people with SMI. Conclusion: Key indicators of the cardiovascular and respiratory health of people with SMI are poor compared with those of the general population. Care plans should prioritize interventions to attenuate lifestyle risk factors. Evidence of increasing obesity in younger patients is of particular concern, predicting even greater health needs in the future.

Is paternal postpartum depression associated with maternal postpartum depression? Population-based study in Brazil.

Abstract: Objective: To describe the prevalence of paternal postpartum depression (PPD) as well as its association with maternal PPD. Method: A population-based random sample of 386 couples was assessed from the sixth to the 12th week postpartum for demographic characteristics, alcohol misuse (AUDIT) and depressive symptoms [Beck Depression Inventory (BDI)]. Logistic regression was employed to control for potential confounders. Results: In the BDI, 26.3% of mothers and 11.9% of fathers scored above the selected threshold of 10. Mild maternal depression [odds ratio (OR) 3.31, 95% CI 1.52–7.20] and moderate to severe maternal depression (OR 8.44, 95% CI 3.53–20.21) were associated with paternal PPD. Conclusion: Paternal PPD is a clinically meaningful phenomenon. Fathers should be evaluated for mood disorders in the postpartum, especially when their partner is depressed.

The gluten connection: the association between schizophrenia and celiac disease

Abstract: Objective: Schizophrenia affects roughly 1% of the population and is considered one of the top 10 causes of disability worldwide Given the immense cost to society, successful treatment options are imperative Based on initial findings, gluten withdrawal may serve as a safe and economical alternative for the reduction of symptoms in a subset of patients Method: A review of the literature relevant to the association between schizophrenia and celiac disease (gluten intolerance) was conducted Results: A drastic reduction, if not full remission, of schizophrenic symptoms after initiation of gluten withdrawal has been noted in a variety of studies However, this occurs only in a subset of schizophrenic patients Conclusion: Large-scale epidemiological studies and clinical trials are needed to confirm the association between gluten and schizophrenia, and address the underlying mechanisms by which this association occurs