Which psychosocial interventions in bipolar depression?

This review of psychosocial interventions in bipolar disorders demonstrates that some therapies, when combined with medication, are more efficacious at preventing or delaying depressive relapse, and can be more effective than medication alone in reducing time to recovery from an acute bipolar depressive episode. However, apparent benefits diminish over time, suggesting that maintenance or ? booster ? therapy sessions may be needed. Given the scarcity of trained therapists, further studies are needed to determine which bipolar depressed patients should be targeted and to establish more clearly the potential cost and benefits of such interventions.     

Dual diagnosis of dihydropyrimidine dehydrogenase deficiency and GM₁ gangliosidosis

An 8-month-old girl, born to consanguineous parents, presented with developmental delay, decreased muscle tone, disinterest in her surroundings, and sleepiness. Tests revealed a marked excretion of thymine with significantly increased uracil excretion in the urine, indicating a pyrimidine catabolic disorder, i.e., dihydropyrimidine dehydrogenase deficiency. Plasma endogenous purines confirmed elevated plasma thymine (21 μmol/L) and uracil (29 μmol/L), also consistent with dihydropyrimidine dehydrogenase deficiency. Purine mutation analysis confirmed complete dihydropyrimidine dehydrogenase deficiency with a 16 [ corrected] base pair homozygous deletion in exon 16, corresponding to DPYD c.2043-2058del. Cranial magnetic resonance imaging at 14 months indicated severe hypomyelination with gliosis. Her basal ganglia were also involved. At age 15 months, she was hospitalized for aspiration pneumonia and seizures, and also manifested hepatosplenomegaly. White cell enzymes revealed a marked deficiency of β-galactosidase activity (4 μmol/g/hour) in white cells and an elevated chitotriosidase activity (443 μmol/L/hour) in plasma indicating GM(1) gangliosidosis. Mutation analysis confirmed c.841C>T (p.His281Tyr) homozygosity for GM(1) gangliosidosis. She died at age 19 months.     

Preventive interventions in families with parental depression: children’s psychosocial symptoms and prosocial behaviour

The aim is to document the effectiveness of a preventive family intervention (Family Talk Intervention, FTI) and a brief psychoeducational discussion with parents (Let’s Talk about the Children, LT) on children’s psychosocial symptoms and prosocial behaviour in families with parental mood disorder, when the interventions are practiced in psychiatric services for adults in the finnish national health service. Patients with mood disorder were invited to participate with their families. Consenting families were randomized to the two intervention groups. The initial sample comprised 119 families and their children aged 8–16. Of these, 109 completed the interventions and the baseline evaluation. Mothers and fathers filled out questionnaires including standardized rating scales for children’s symptoms and prosocial behaviour at baseline and at 4, 10 and 18 months post-intervention. The final sample consisted of parental reports on 149 children with 83 complete data sets. Both interventions were effective in decreasing children’s emotional symptoms, anxiety, and marginally hyperactivity and in improving children’s prosocial behaviour. The FTI was more effective than the LT on emotional symptoms particularly immediately after the intervention, while the effect of the LT emerged after a longer interval. The study supports the effectiveness of both interventions in families with depressed parents. The FTI is applicable in cultural settings other than the USA. Our findings provide support for including preventive child mental health measures as part of psychiatric services for mentally ill parents.     

Who participates in psychosocial interventions for caregivers of patients with dementia?

OBJECTIVE: The purpose of the present study is to evaluate if the participants in psychosocial interventions for dementia caregivers are representative of the whole population of dementia patients or if some socioeconomic groups are over- or underrepresented. DESIGN: The demographic and socioeconomic characteristics of the 128 participants of a randomized controlled study on the effects of caregiver education were compared with those of all the elderly residents of the City of Zurich (n = 64,856, elderly group), of all demented patients entering a City of Zurich nursing home in a 6-month period (n = 218, NH entry group) and of all demented inhabitants evaluated during a 20-month follow-up at a community memory clinic (n = 187, memory group). METHODS: Data on income and wealth were derived from official tax records. The characteristics of the different groups were compared by chi2 or t tests. RESULTS: As expected in a study on caregiver education, the demented patients were younger, more often male and married than all other study groups (p < 0.01). The participants in the psychosocial intervention had significantly (p < 0.01) higher education than all other groups; this effect is caused in part by the higher proportion of males. The NH entry group was less well educated than the elderly group (p < 0.05). The intervention group had a higher income and was wealthier than the three other groups (p < 0.01), but there was no significant difference with respect to the wealth of the memory group. The 25% poorest of the elderly group made up only about 10% of the participants in the intervention group. However, the 25% richest of the elderly group made up 42% of the intervention group. The method of recruitment for the psychosocial intervention (by media, referral of physicians and by a memory clinic) was not significantly related to any of the demographic or socioeconomic parameters. CONCLUSION: The lower socioeconomic strata are clearly underrepresented in psychosocial interventions.     

The role of psychosocial interventions in bipolar II disorder: what do we know?

The tendency for patients with bipolar II disorder to present with depressive symptoms rather than hypomanic symptoms can lead to a misdiagnosis of unipolar depression. These patients are often treated with antidepressants, which may be inappropriate for patients with bipolar II disorder due to the risk of inducing manic switching or rapid cycling. Misdiagnosis and mistreatment or nontreatment can lead to substantial psychosocial dysfunction, which may be best addressed in the context of psychotherapy. Psychotherapy in conjunction with pharmacotherapy has been shown to be an effective treatment for patients with bipolar II disorder, but more research is needed to better understand how treatment interventions should be used to optimize symptomatic and functional outcomes.     

Infection–associated encephalopathies—their investigation, diagnosis, and treatment

Reduced level of consciousness is a common clinical finding in acutely sick patients. In the majority of cases a cause for the encephalopathy is readily identifiable,whilst in a minority the aetiology is more difficult to ascertain. Frequently the onset of encephalopathy is associated with, or follows, infection. The mechanisms through which infection leads to encephalopathy are diverse. They range from direct microbial invasion of the brain or its supporting structures, to remote, infectiontriggered mechanisms such as acute disseminated encephalomyelitis. Most common however, is the encephalopathy caused through a remote effect of systemic sepsis—septic encephalopathy. This article discusses the clinical presentation and underlying pathogeneses of the acute encephalopathies associated with infection, aiming to aid both their recognition and treatment.     

Ten years psychosocial outcomes among adolescents following suicide attempts – early recurrence and psychosocial outcomes

ObjectivesA suicide attempt (SA) is a major risk factor of recurrent SA in adolescence and may be associated with psychological or social problems in the future. REPEATERS is a longitudinal study which examines the long-term psychosocial outcome of adolescents following attempted suicide. It focuses on the impact of early recurrence (i.e., within the first year of the index SA) – data which is, in fact, poorly documented.MethodsTen years after the index SA, a self-reporting questionnaire was sent to all adolescents who had attempted suicide and were followed up by the CHRU (Regional University Hospital Centre) de Nancy, France, between 1994 and 2003 and their parents. The purpose of this questionnaire was to assess psychosocial outcomes. Data concerning SA were collected retrospectively.ResultsAfter ten years, 146 of the 309 adolescents who had attempted suicide and were participating in the study had responded: 90% lived with a partner and 41% had children. The mean (SD) current emotional life of suicide attempt survivors scored 7.3 (2.3) on a scale of 0 to 10. Compared to the general population of the same age, responders felt more depressed than their peers (29% vs. less than 8% of males and 20% of females), had more suicidal thoughts (14% vs. 5%), and had more SAs (27% vs. 0.3%). Moreover, the risk of recurrence over the ten year period was associated with suicide recurrence in the first year after the index SA (odds ratio [OR] = 2.3; 95% confidence interval [CI] = 1.1–4.9) and with a lower level of education at ten years (OR = 0.37; 95% CI = 0.19–0.45).ConclusionsAlthough a favorable outcome was reported ten years after the event for the majority of adolescents who had attempted suicide, some with a lower level of education were nevertheless at increased risk of recurrence and depression. Post-intervention strategies are therefore essential in order to evaluate risk factors which may persist if not taken into consideration.     

Variation in psychosocial influences according to the dimensions and content of children’s unusual experiences: potential routes for the development of targeted interventions

The psychosocial processes implicated in the development and maintenance of psychosis differ according to both the dimensional attributes (conviction, frequency, associated distress, adverse life impact) and the content or type (e.g. grandiosity, hallucinations, paranoia) of the psychotic symptoms experienced. This has informed the development of ‘targeted’ cognitive behavioural therapy for psychosis (CBTp): interventions focusing on specific psychological processes in the context of particular symptom presentations. In adults, larger effect sizes for change in primary outcomes are typically reported in trials of targeted interventions, compared to those for trials of generic CBTp approaches with multiple therapeutic foci. We set out to test the theoretical basis for developing targeted CBTp interventions for young people with distressing psychotic-like, or unusual, experiences (UEs). We investigated variations in the psychosocial processes previously associated with self-reported UE severity (reasoning, negative life events, emotional problems) according to UE dimensional attributes and content/type (using an established five-factor model) in a clinically referred sample of 72 young people aged 8–14 years. Regression analyses revealed associations of conviction and grandiosity with reasoning; of frequency, and hallucinations and paranoia, with negative life events; and of distress/adverse life impact, and paranoia and hallucinations, with emotional problems. We conclude that psychological targets for intervention differ according to particular characteristics of childhood UEs in much the same way as for psychotic symptoms in adults. The development of targeted interventions is therefore indicated, and tailoring therapy according to presentation should further improve clinical outcomes for these young people.     

Specific dance movement therapy interventions—Which are successful? An intervention and correlation study

This intervention study examined the correlation between specific DMT interventions and the improvement in quality of life, stress management, and stress reduction. Dance therapists (N = 11) completed 970 Intervention Checklist 1 (specific interventions at the individual level) and 120 Intervention Checklist 2 (specific interventions at the group level) reports during the course of 10 treatment sessions. The scores denoted by each therapist on the Intervention Checklists were compared with the scores of each client in the treatment group (N = 97) on standardized questionnaires. The successful therapists applied a self-selected approach and combined in-depth DMT approaches with specific interventions. These findings demonstrated the relationship between clients’ improvement in quality of life, coping, reduction of stress and the use of psychodynamic-oriented DMT, the Chace approach, the combination of directive and non-directive leadership styles, and interpersonal closure. The clients who performed dance improvisation, spatial synchrony, synchrony in effort and who received focused treatment sessions exhibited improved daily life and decreased somatization symptoms. These results indicate that specific DMT interventions were associated with an improvement in well-being, whereas other DMT interventions should be used cautiously until further research demonstrates their effectiveness. Additional successful DMT interventions must be identified in future studies.     

Editors’ Introduction and Review: Sociolinguistic Variation and Cognitive Science

Sociolinguists study the interaction between language and society. Variationist sociolinguistics — the subfield of sociolinguistics which is the focus of this issue — uses empirical and quantitative methods to study the production and perception of linguistic variation. Linguistic variation refers to how speakers choose between linguistic forms that say the same thing in different ways, with the variants differing in their social meaning. For example, how frequently someone says fishin’ or fishing depends on a number of factors, such as the speaker's regional and social background and the formality of the speech event. Likewise, if listeners are asked to use a rating scale make judgements about speakers who say fishin’ or fishing, their ratings depend on what other social characteristics are attributed to the speaker. This issue aims to reflect the growing number of interactions that bring variationist sociolinguistics into contact of different branches of cognitive science. After presenting current trends in sociolinguistics, we identify five areas of contact between the two fields: cognitive sociolinguistics, sociolinguistic cognition, acquisition of variation, computational modeling, and a comparative approach of variation in animal communication. We then explain the benefits of interdisciplinary work: fostering the study of variability and cultural diversity in cognition; bringing together data and modeling; understanding the cognitive mechanisms through which sociolinguistic variation is processed; examining indexical meaning; exploring links between different levels of grammar; and improving methods of data collection and analysis. Finally we explain how the articles in this issue contribute to each of these benefits. We conclude by suggesting that sociolinguistics holds a strategic position for facing the challenge of building theories of language through integrating its linguistic, cognitive, and social aspects at the collective and individual levels.