Gender differences in psychiatric illness and treatments: a critical review

Controversy exists about the causation of gender differences long observed in the prevalence of mental disorders. Recent epidemiological, biochemical, and genetic research has shed further light upon both their etiologies and treatments. Both controversies and research are reviewed and critically examined.     

Family functioning and mental illness: a comparison of psychiatric and nonclinical families

The primary objective of the present investigation was to examine adaptive functioning in the families of patients with a wide range of psychiatric disorders. Seven dimensions of family functioning, as measured by the Family Assessment Device (FAD), were compared across families of patients with a schizophrenia spectrum disorder (n = 61), bipolar disorder (n = 60), major depression (n = 111), anxiety disorder (n = 15), eating disorder (n = 26), substance abuse disorder (n = 48), and adjustment disorder (n = 46). Families in each psychiatric group were also compared to a control group of nonclinical families (N = 353). Results indicated that regardless of specific diagnosis, having a family member in an acute phase of a psychiatric illness was a risk factor for poor family functioning compared to the functioning of control families. However, with few exceptions, the type of the patient's psychiatric illness did not predict significant differences in family functioning. Thus, having a family member with a psychiatric illness is a general stressor for families, and family interventions should be considered for most patients who require a psychiatric hospitalization for either the onset of, or an acute exacerbation of, any psychiatric disorder.     

Beliefs about mental illness as a functon of psychiatric status and psychiatric hospitalization.

Beliefs about mental illness were assessed among psychiatric inpatients at a VA hospital, the mental health staff responsible for their treatment, and a group of medical and surgical (control) patients. Results indicated that: (a) Psychiatric and nonpsychiatric patients generally hold similar opinions regarding mental illness. Severely disturbed psychiatric patients, however, view mental illness in more moralistic terms than do "normals." (b) Psychiatric hospitalization is generally accompanied by a change in the patient's beliefs concerning mental illness, toward those held by the staff. (c) Psychiatric patients whose beliefs about mental illness are most strikingly influenced by the staff tend to respond most favorably to treatment, as measured by length of hospital stay and gains in self-esteem during the 1st month of treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facing chronic illness: the family support model and its benefits

With the aging of the population and the evolving health care system, it is more important than ever before that individuals be actively involved in selfcare activities and that individuals and families receive education and support to help them cope with chronic illness. This article describes a model family support program which operates within a hospital setting to provide information, education, support, and respite services. This model is based on an extensive research base which underscores the value of this model both for the individuals and families involved and for the health care system.     

The effects of independent living on persons with chronic mental illness: an assessment of the Section 8 certificate program

The feasibility of the Section 8 certificate program for individuals with chronic mental illness (CMI) and the outcomes associated with independent housing are examined. The analysis is based on data from a longitudinal survey of Section 8 certificate users in Baltimore and Hamilton County (Cincinnati) and on information from Section 8 application forms in each site. A pre-post research design was used to examine changes in hospitalization, residential stability, and mental health service outcomes. Four key dimensions of the CMI certificate program are examined: affordability, housing conditions, neighborhood conditions, and service gaps. Results suggest that the certificate program has a positive effect on independent living, that certificate use is associated with positive mental health outcomes, and that there is no evidence of "creaming" among program applicants.     

Reconstructing a sense of self in patients with chronic mental illness

Acute massive pulmonary embolism was induced in 94 random-bred dogs. There were 3 groups of the time control (0, 1 and 6 hrs) and 4 experimental groups (1- and 6-hrs compensated, 1- and 6-hrs decompensated). Favorable signs of the vascular adaptation: moderate arterial plasmorrhagia; lack of blood stasis, heterogeneity of metabolic profiles of arteries; prevalence of anaerobic glycolysis; some prevalence of catabolic reactions over anabolic reactions. Non-favorable signs: considerable plasmorrhagia; perivascular edema; multiple stases and hemorrhages; venous thrombosis; a dramatic decrease of the enzymatic activity in the arterial wall.     

Social support and undermining in close relationships: Their independent effects on the mental health of unemployed persons.

Structural equation analyses were used to examine the impact of social support vs social undermining (conflict) on mental health in longitudinal data from 1,087 recently unemployed respondents. The results demonstrated that social support and social undermining were not the opposite poles of the same factor, each having some impact independent of the other. Social undermining had statistically significant and strong adverse impact at each concurrent level of mental health. It also predicted improvement (but not a high level) in mental health in subsequent time waves. In contrast, social support had a significant beneficial impact on mental health only at Time 1. Compared with the volatile and extreme effects of social undermining, those of social support appear weaker but more stable. These findings are consistent with literature on the impact of life events (S. E. Taylor, 1991) and on marital interactions and satisfaction (J. M. Gottman and L. J. Krokoff, 1989). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detection and treatment of psychiatric illness in a general medical ward: a modified cost-benefit analysis

This article describes a prospective, randomized, controlled trial of screening and treatment for psychiatric disorder in medical in-patients. The study has assessed whether increased recognition of psychiatric disorder among medical in-patients improves clinical outcome and reduces the costs of care, and whether routine involvement of a psychiatrist in the assessment and care of medical in-patients with probable psychiatric disorder is superior to the efforts of the physicians alone. A total of 218 medical in-patients who scored over the screening threshold for psychiatric disorder on the General Health Questionnaire were randomly allocated to one of two intervention groups or a control group. Six months later their mental health, subjective health status, quality of life, and costs of care was reassessed. Mental health and quality of life at 6 months were similar in the two intervention groups and the control group. Patients whose physicians were told the results of the screening test had lower costs for subsequent admissions, but this was probably due to differences between the groups in terms of employment status. Treatments recommended by psychiatrists broke down when patients were discharged home, leading to inadequate treatment of psychiatric disorders. We have not been able to show that routine screening for psychiatric disorder produces any benefit, either in better outcome for patients or reduced costs for the NHS. Further research should: consider examining a more homogeneous group in terms of costs of care; screen only for disorders likely to respond to a specific treatment; and ensure that treatment recommendations are carried out.     

Dual diagnosis: a treatment model for substance abuse and major mental illness

The treatment of "dual diagnosis", co-occurring substance abuse and mental illness, calls for addressing two serious and often confounding problems. The authors introduce an expanded version of the transtheoretical model of change as formulated by J.O. Prochaska and C.C. DiClemente, and suggest that this new version offers a pragmatic approach to the conceptualization and treatment of dual diagnosis. The potential utility of the treatment model is presented through the authors' experiences in working with inner-city, chronic mentally ill individuals with substance abuse problems. Practical guidelines for dual diagnosis group therapy are discussed.     

The effects of sound films on opinions about mental illness in community discussion groups.

One or more sound films on mental illness were shown to adult community groups with or without group discussion, and before-and-after attitude tests were administered to evaluate opinion changes. "… a single mental health film did not produce significant changes in opinions toward mental illness in groups," with or without group discussion. "A series of three films, however, induced significant shifts of opinion in the directions intended by the film content. Degree of… change was no greater in groups which had discussed the films than in groups which had not held discussions." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of corticotropin releasing factor in depressive illness: a critical review

Corticotropin-releasing factor (CRF) is the principal neuropeptide involved in regulating the stress response. When centrally administered to animals it produces somatic changes analogous to those seen in both depression and anxiety. In humans, it is capable of reproducing the hormonal changes which are characteristically seen in depressed patients. A literature search using Medline, Embase Psychiatry, PsycLIT and BIDS from 1996-1997 revealed 25 studies that have examined CRF concentrations in patients with affective disorder. The methodology of these studies varies and they can be criticised, in particular, for failing to consider the stress response of the lumbar puncture. Recently, post-mortem immunocytochemical techniques have been employed to help clarify the nature of these abnormalities in depression. On balance, evidence from CSF sampling, post-mortem findings and dynamic endocrine studies suggests that both hypothalamic and extra-hypothalamic concentrations of CRF are moderately elevated in a proportion of currently antidepressant treatment, high CRF concentrations tend to normalise. The causes of increased CRF output in depression are also unknown but may involve an integration of remote vulnerability factors and recent stressors perhaps mediated through impaired function of glucocorticoid receptors. Ultimately, the careful manipulation of CRF may hold therapeutic promise for sufferers of mood disorders.     

Neuroendocrinology of prolonged critical illness: effects of exogenous thyrotropin-releasing hormone and its combination with growth hormone secretagogues

CENP-B is a constitutive centromere DNA-binding protein that is conserved in a number of mammalian species and in yeast. Despite this conservation, earlier cytological and indirect experimental studies have provided conflicting evidence concerning the role of this protein in mitosis. The requirement of this protein in meiosis has also not previously been described. To resolve these uncertainties, we used targeted disruption of the Cenpb gene in mouse to study the functional significance of this protein in mitosis and meiosis. Male and female Cenpb null mice have normal body weights at birth and at weaning, but these subsequently lag behind those of the heterozygous and wild-type animals. The weight and sperm content of the testes of Cenpb null mice are also significantly decreased. Otherwise, the animals appear developmentally and reproductively normal. Cytogenetic fluorescence-activated cell sorting and histological analyses of somatic and germline tissues revealed no abnormality. These results indicate that Cenpb is not essential for mitosis or meiosis, although the observed weight reduction raises the possibility that Cenpb deficiency may subtly affect some aspects of centromere assembly and function, and result in reduced rate of cell cycle progression, efficiency of microtubule capture, and/or chromosome movement. A model for a functional redundancy of this protein is presented.     

Work and nonvocational domains of functioning in persons with severe mental illness: a longitudinal analysis

In this study we sought to understand the relationship between obtaining competitive employment and changes in nonvocational domains of functioning (symptoms, substance abuse, hospitalizations, self-esteem, quality of life) in persons with severe mental illness. A group of 143 unemployed patients participating in a study of vocational rehabilitation programs were assessed in nonvocational areas of functioning at baseline and 6, 12, and 18 months later. Statistical analyses examined the relationship between work status at the follow-up assessments and nonvocational functioning, controlling for baseline levels of nonvocational variables. Patients who were working at follow-up tended to have lower symptoms (particularly thought disorder and affect on the Brief Psychiatric Rating Scale), higher Global Assessment Scores, better self-esteem, and more satisfaction with their finances and vocational services than unemployed patients. Employment is associated with better functioning in a range of different nonvocational domains, even after controlling for baseline levels of functioning.     

Postdoctoral training in severe mental illness: A model for trainee development.

The development of postdoctoral training in professional psychology has been gaining increased attention. This article presents a model of trainee development based on the processes of change that are deemed essential for the transition from an intern to a fully functioning professional psychologist. The model focuses on work with the severely mentally disordered, an area that currently lacks strong leadership within the mental health community. The program, which is highly integrated within the existing service-delivery system and teaching/research community of a medical center, emphasizes continuity with the internship experience, the integration of multiple treatment approaches, training in the provision of supervision, and scholarly contributions. The development of required, 1-yr, American Psychological Association-accredited postdoctoral training programs that provide the opportunity for specialization is recommended as the final stage in the professional initiation process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The stigma of mental illness in Asian cultures

OBJECTIVE: This article reviews the attitudes towards mental illness and psychiatric stigma in Asian cultures. METHOD: Relevant literature published in English was reviewed. RESULTS: Psychiatric stigmas in Asian cultures share some common features. However, response to mental illness has many variations across cultures. Psychiatric stigma is prevalent and severe in some but not all Asian cultures. CONCLUSIONS: The stigma of mental illness needs to be studied within its sociocultural context in order to understand its origins, meanings and consequences. It may be relevant to examine the indigenous concepts, experience and implications of psychological problems to address problems in mental health care relating to stigma.     

Leptin levels in protracted critical illness: effects of growth hormone-secretagogues and thyrotropin-releasing hormone

Prolonged critical illness is characterized by feeding-resistant wasting of protein, whereas reesterification, instead of oxidation of fatty acids, allows fat stores to accrue and associate with a low-activity status of the somatotropic and thyrotropic axis, which seems to be partly of hypothalamic origin. To further unravel this paradoxical metabolic condition, and in search of potential therapeutic strategies, we measured serum concentrations of leptin; studied the relationship with body mass index, insulin, cortisol, thyroid hormones, and somatomedins; and documented the effects of hypothalamic releasing factors, in particular, GH-secretagogues and TRH. Twenty adults, critically ill for several weeks and supported with normocaloric, continuously administered parenteral and/or enteral feeding, were studied for 45 h. They had been randomized to receive one of three combinations of peptide infusions, in random order: TRH (one day) and placebo (other day); TRH + GH-releasing peptide (GHRP)-2 and GHRP-2; TRH + GHRH + GHRP-2 and GHRH + GHRP-2. Peptide infusions were started after a 1-microgram/kg bolus at 0900 h and infused (1 microgram/kg.h) until 0600 h the next morning. Serum concentrations of leptin, insulin, cortisol, T4, T3, insulin-like growth factor (IGF)-I, IGF-binding protein-3 and the acid-labile subunit (ALS) were measured at 0900 h, 2100 h, and 0600 h on each of the 2 study days. Baseline leptin levels (mean +/- SEM: 12.4 +/- 2.1 micrograms/L) were independent of body mass index (25 +/- 1 kg/m2), insulin (18.6 +/- 2.9 microIU/mL), cortisol (504 +/- 43 mmol/L), and thyroid hormones (T4: 63 +/- 5 nmol/L, T3: 0.72 +/- 0.08 nmol/L) but correlated positively with circulating levels of IGF-I [86 +/- 6 micrograms/L, determination coefficient (R2) = 0.25] and ALS (7.2 +/- 0.6 mg/L, R2 = 0.32). Infusion of placebo or TRH had no effect on leptin. In contrast, GH-secretagogues elevated leptin levels within 12 h. Infusion of GHRP-2 alone induced a maximal leptin increase of +87% after 24 h, whereas GHRH + GHRP-2 elevated leptin by up to +157% after 24 h. The increase in leptin within 12 h was related (R2 = 0.58) to the substantial rise in insulin. After 45 h, and having reached a plateau, leptin was related to the increased IGF-I (R2 = 0.37). In conclusion, circulating leptin levels during protracted critical illness were linked to the activity state of the GH/IGF-I axis. Stimulating the GH/IGF-I axis with GH-secretagogues increased leptin levels within 12 h. Because leptin may stimulate oxidation of fatty acids, and because GH, IGF-I, and insulin have a protein-sparing effect, GH-secretagogue administration may be expected to result in increased utilization of fat as preferential substrate and to restore protein content in vital tissues and, consequently, has potential as a strategy to reverse the paradoxical metabolic condition of protracted critical illness.     

The Ludloff osteotomy: a critical analysis

Fourteen Ludloff (oblique shaft) osteotomies were performed to reduce the first intermetatarsal angle on 12 female patients whose average age was 47 years. Average reduction of the first intermetatarsal angle was 6.5 degrees (postoperative average, 9.4 degrees). Average hallux abductus angle reduction was 16.7 degrees (postoperative average, 13.4 degrees). These reductions were statistically significant (P < or = 0.05). Average first metatarsal shortening was 1.4 mm. No transfer lesions nor lesser metatarsal stress fractures were noted. One patient (a 30+ pack/year smoker) sustained a delayed union. The average American Orthopedic Foot and Ankle rating score was 92.3 out of 100. Average follow-up was 48 months. This procedure is a viable alternative to closing base wedge osteotomies.     

Parkinson's disease: The psychological aspects of a chronic illness.

In a review of the literature on the psychological and social aspects of Parkinson's disease, it is noted that since the discovery of the underlying neuropathology of parkinsonism, research on its psychological aspects has had a biomedical orientation and has focused almost exclusively on the depression and cognitive impairment observed in a substantial proportion of Parkinson's patients. Present evidence does not permit firm conclusions about the relative contributions of neurological and psychosocial factors to these symptoms. Methodological problems, reliance on indirect evidence, and the paucity of psychosocial data all contribute to the inconclusiveness of the findings. It is argued that a comprehensive understanding of the psychological aspects of Parkinson's disease depends on combining the investigation of how individual patients experience and adapt to their illness with the prevailing biomedical approach to research. (117 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)