Psychiatrists and community partners examine religion and spirituality

ABSTRACT

The commentary reflects on the definition of spirituality and religion and further implications for the practice of psychiatry. These include the possibilities to partner with spiritual and religious practitioners to support education and research, provide access to care for people with or at risk of mental ill health, and also consider how to the reduce the risks to the well-being of vulnerable people and families from some practices and settings. The World Psychiatric Association sees the possibilities for collaborating with its member societies and community partners including service users and family carers to develop resources on working with faith groups and spiritual healers in high- and low-income countries.     

Memory consolidation effects on memory stabilization and item integration in older adults

This study examined the differential effects of aging on consolidation processes that strengthen newly acquired memory traces in veridical form (memory stabilization) versus consolidation processes that are responsible for integrating these memory traces into an existing body of knowledge (item integration). Older adults learned 13 nonwords and were tested on their memory for the nonwords, and on whether these nonwords impacted upon processing of similar-sounding English words immediately and 24 hours later. Participants accurately recognized the nonwords immediately, but showed significant decreases in delayed recognition and recall. In comparison, the nonwords impacted upon processing of similar-sounding words only in the delayed test. Together, these findings suggest that memory consolidation processes may be more evident in item integration than memory stabilization processes for new declarative memories in older adults.     

Crying wolf? Australian adolescents’ perceptions of the ambiguity of visible indicators of mental health and authenticity of mental illness

Young people’s perspectives about mental health concepts shape both their interactions with sufferers of mental illness and their actions related to their own mental health. The current study employed a cross-sectional qualitative design to explore how adolescents (aged 12–18 years) speak about mental health and illness in order to gain insight into young people’s perceptions and experiences and contribute to shaping approaches to policy and practice. When discussing mental health concepts and appropriate behaviours toward sufferers of mental illness, adolescents conveyed a sense of acceptance and understanding of the potential complexity and severity of mental health problems. In contrast, when discussing mental health in the context of their own lives, a stronger sense of scepticism was conveyed, with students expressing difficulty with the lack of visible markers of mental health and confusion determining authenticity in the mental health states conveyed by their peers. Interestingly, adolescents interviewed commonly conveyed the notion that young people may exaggerate or “fake” a mental illness for personal gain. Adolescent perceptions of mental health and illness hold practical implications for policy and school-based programs aimed at improving mental health knowledge, attitudes and behaviours among youth.     

The Longitudinal Relationship Between Media Violence and Empathy: Was It Sympathy All Along?

Previous research with adolescents has reported a negative relationship between media violence and empathy. There are, however, two important conceptual issues in this earlier literature that deserve further research attention. First, studies often treat empathy as a one-dimensional construct while it consists of both an affective and cognitive component. Second, while aiming to measure empathy, several studies have measured sympathy instead. Driven by these concerns, this study was designed to investigate the longitudinal relationship between media violence, affective empathy, cognitive empathy, and sympathy. Using data from a two-wave panel study with 943 adolescents (10–14 years old), a cross-lagged model tested whether media violence exposure negatively influences empathy and sympathy (desensitization) or whether empathy and sympathy negatively influence media violence exposure (selection). Results were in line with desensitization. However, rather than showing that media violence leads to a decrease in empathy (which previous studies have shown), results indicate a decrease in sympathy instead. These findings provide clarification to existing work as well as offer methodological and practical implications.     

Object naming induces reliance on orientation-independent representations during longer-term, but not short-term, visual remembering

Naming novel objects with novel count nouns changes how the objects are drawn from memory, revealing that object categorisation induces reliance on orientation-independent visual representations during longer-term remembering, but not during short-term remembering. Serial position effects integrate this finding with a more established conceptualisation of short-term and longer-term visual remembering in which the former is identified as keeping an item in mind. Adults were shown a series of four novel objects in orientations in which they would not normally be drawn from memory. When not named ("Look at this object"), the objects were drawn in the orientations in which they had been seen. When named with a novel count noun (e.g., "Look at this dax"), the final object continued to be depicted in the orientation in which it had been seen, but all other objects were depicted in an unseen but preferred (canonical) orientation, even though participants could still remember the orientations in which they had been seen. Although orientation-dependent exemplar representations appear to be more accessible than orientation-independent generic representations during short-term remembering, the reverse is the case during longer-term remembering. How the theoretical framework emerging from these observations accommodates a broader body of evidence is discussed.     

Re-emergence of extinguished auditory-cued conditioned fear following a sub-conditioning procedure: effects of hippocampal and prefrontal tetanic stimulations

Post-extinction exposure of rats to a sub-conditioning procedure can evoke conditioned fear, which may correspond to fear return and/or fear learning potentiation. The aim of the present study was to clarify this issue and examine the effects of tetanic stimulation of the hippocampus (HPC) and medial prefrontal cortex (mPFC), two brain regions implicated in post-extinction modulation of conditioned fear. Rats were initially submitted to five tone-shock pairings with either a 0.7-mA or 0.1-mA shock. Tone-evoked freezing was observed only with the higher shock intensity, indicating that the 0.1-mA shock corresponded to a sub-conditioning procedure. All conditioned rats underwent fear extinction with 20 tone-alone trials. When retrained with the sub-conditioning procedure, they displayed again tone-evoked freezing, except when the initial tone was unpaired or a new tone was paired with the 0.1-mA shock, demonstrating fear return rather than fear learning potentiation. We also found that HPC and mPFC tetanic stimulations, applied 24h after the sub-conditioning procedure, similarly reduced this fear return. However, mPFC inactivation abolished temporary HPC tetanus effect, whereas HPC inactivation did not interfere with mPFC tetanus effect. These data confirm our previous findings and reveal the nature of HPC-mPFC interactions in post-extinction modulation of conditioned fear.     

Cardiac morbidity risk and depression and anxiety: a disorder, symptom and trait analysis among cardiac surgery patients

The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.     

Sibling relationship quality in early adolescence: child and maternal perceptions and daily interactions

Correspondence between child and maternal perceptions of sibling relationship quality (standards, actual ratings, problems) and children's reports of daily interactions were assessed in 40 early adolescent children (M age=11.5 yrs) and their mothers (n=32). Children completed the Sibling Relationship Questionnaire (Furman & Buhrmester, 1985. Child Development, 56, 448–461) and Daily Checklist ratings of sibling interactions for 14 days. Mothers completed the Parental Expectations and Perceptions of Children's Sibling Relationship Questionnaire (Kramer & Baron, 1995. Family Relations, 44, 95–103). Overall, findings revealed correspondence between child perceptions of sibling warmth and maternal ratings of standards, actual ratings, and problems in sibling warmth but not conflict and rivalry. Maternal and child perceptions of sibling relationship qualities were positively associated with children's reports of ongoing interactions. Finally, regression analyses identified unique maternal and child correlates for both happy and prosocial daily interactions. Findings are discussed in light of recent research and theory on family dynamics. Copyright © 2010 John Wiley & Sons, Ltd.     

Should We Treat Depression with drugs or psychological interventions? A Reply to Ioannidis

We reply to the Ioannidis's paper "Effectiveness of antidepressants; an evidence based myth constructed from a thousand controlled trials." We disagree that antidepressants have no greater efficacy than placebo. We present the efficacy from hundreds of trials in terms of the percentage of patients with a substantial clinical response (a 50% improvement or more symptomatic reduction). This meta-analysis finds that 42-70% of depressed patients improve with drug and 21%-39% improve with placebo. The response benefit of antidepressant treatment is 33%-11% greater than placebo. Ioannidis argues that it would be vanishingly smaller because systematic biasing in these clinical trials would reduce the drug-placebo difference to zero. Ioannidis' argument that antidepressants have no benefit is eroded by his failures of logic because he does not present any evidence that there are a large number of studies where placebo is substantially more effective than drug. (To reduce to zero, one would also have to show that some of the unpublished studies find placebo better than drug and have substantial systematic or methodological bias). We also present the empirical evidence showing that these methodological concerns generally have the opposite effect of what Ioannidis argues, supporting our contention that the measured efficacy of antidepressants likely underestimates true efficacy. Our most important criticism is Ioannidis’ basic underlying argument about antidepressants that if the existing evidence is imperfect and methods can be criticized, then this proves that antidepressant are not efficacious. He presents no credible evidence that antidepressants have zero effect size. Valid arguments can point out difficulties with the data but do not prove that a given drug had no efficacy. Indeed better evidence might prove it was more efficacious that originally found. We find no empirical or ethical reason why psychiatrists should not try to help depressed patients with drugs and/or with psychotherapeutic/behavioral treatments given evidence of efficacy even though our treatment knowledge has limitations. The immense suffering of patients with major depression leads to ethical, moral, professional and legal obligations to treat patients with the best available tools at our disposal, while diligently and actively monitoring for adverse effects and actively revising treatment components as necessary.