The role of attachment anxiety in the relationship between childhood trauma and schizophrenia-spectrum psychosis.

Childhood trauma (CT) is a comprehensive concept encompassing experiences of sexual, physical, and emotional abuse, and neglect during childhood and adolescence. Patients with schizophrenia-spectrum psychosis (SSP) display higher rates of CT than healthy controls. Among the potential mediators of this association, insecure attachment has gained attention and empirical validation. The present study aimed to extend existing knowledge on this field by exploring the role of the two attachment dimensions, attachment anxiety and attachment avoidance, in the CT-SSP association. A clinical sample of 63 SSP inpatients was compared to a healthy control group on CT and attachment style measures. Correlations between CT, attachment dimensions and psychopathology were sought. Mediation analyses were also performed to examine whether attachment anxiety and/or attachment avoidance mediated the CT-SSP association. Patients displayed higher rates of CT and insecure attachment than controls. Attachment anxiety and severity of Mother Antipathy were linked to severity of hallucinations. Attachment anxiety was recognized as the sole mediator of the CT-SSP association. Our findings suggest that individuals with severe CT and increased attachment anxiety represent a risk population warranting early clinical attention, regular monitoring and tailored therapeutic interventions aimed at reducing the psychological impact of trauma.

How shrinks think: decision making in psychiatry.

OBJECTIVES: Psychiatrists use biopsychosocial models in identifying aetiological factors in assessing their patients and similar approaches in planning management. Models in decision making will be influenced by previous experience, training, age and gender, among other factors. Critical thinking and evidence base are both important components in the process of reaching clinical decisions. Expected outcome of treatment may be another factor. The way we think influences our decision making, clinical or otherwise. With patients expecting and taking larger roles in their own management, there needs to be a shift towards patient-centred care in decision making. CONCLUSIONS: Further exploration in how clinical decisions are made by psychiatrists is necessary. An understanding of the manner in which therapeutic alliances are formed between the clinician and the patient is necessary to understand decision making.

Relationship among latitude, climate, season and self-reported mood in bipolar disorder.

OBJECTIVE: Many researchers have analyzed seasonal variation in hospital admissions for bipolar disorder with inconsistent results. We investigated if a seasonal pattern was present in daily self-reported daily mood ratings from patients living in five climate zones in the northern and southern hemispheres. We also investigated the influence of latitude and seasonal climate variables on mood. METHOD: 360 patients who were receiving treatment as usual recorded mood daily (59,422 total days of data). Both the percentage of days depressed and hypomanic/manic, and the episodes of depression and mania were determined. The observations were provided by patients from different geographic locations in North and South America, Europe and Australia. These data were analyzed for seasonality by climate zone using both a sinusoidal regression and the Gini index. Additionally, the influence of latitude and climate variables on mood was estimated using generalized linear models for each season and month. RESULTS: No seasonality was found in any climate zone by either method. In spite of vastly different weather, neither latitude nor climate variables were associated with mood by season or month. CONCLUSION: Daily self-reported mood ratings of most patients with bipolar disorder did not show a seasonal pattern. Neither climate nor latitude has a primary influence on the daily mood changes of most patients receiving medication for bipolar disorder.

Rumination-focused cognitive behaviour therapy for residual depression: a case series.

The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been identified as a key factor in the onset and maintenance of depression, which is found to remain elevated following remission from depression. Fourteen consecutively recruited participants meeting criteria for medication--refractory residual depression [Paykel, E.S., Scott, J., Teasdale, J.D., Johnson, A.L., Garland, A., Moore, R. et al., 1999. Prevention of relapse in residual depression by cognitive therapy--a controlled trial. Archives of General Psychiatry 56, 829-835] were treated individually for up to 12 weekly 60-min sessions. Treatment specifically focused on switching patients from less helpful to more helpful styles of thinking through the use of functional analysis, experiential/imagery exercises and behavioural experiments. Treatment produced significant improvements in depressive symptoms, rumination and co-morbid disorders: 71% responded (50% reduction on Hamilton Depression Rating Scale) and 50% achieved full remission. Treating depressive rumination appears to yield generalised improvement in depression and co-morbidity. This study provides preliminary evidence that rumination-focused CBT may be an efficacious treatment for medication--refractory residual depression.

Burden and marital and sexual satisfaction in the partners of bipolar patients.

OBJECTIVES: Bipolar disorder can be traumatic for both patients and patients' partners. Hence, partners' stress, burden, marital and sexual satisfactions are important areas to investigate. However, there have been problems with past attempts to identify the determinants of marital satisfaction in bipolar patients and their partners. The present study aimed to address these issues and provide an accurate description of relationship functioning in these couples. METHODS: The sample involved 37 partners of bipolar patients. A semi-structured interview assessed the impact of bipolar disorder on aspects of everyday functioning and partners' attributions for patients' disturbing behaviour. Standardized instruments assessed partners' sexual and marital satisfaction across the different affective states. RESULTS: Despite couples staying together, significant numbers of partners reported strain as a result of socioeconomic and household changes. More male partners reported premature ejaculation and female partners reported sexual infrequency when patients were depressed. Overall, partners were less sexually satisfied when the patient was ill. Marital disharmony was greater when patients were ill and worse during manic than depressed phases. Marital disharmony was also more likely when partners believed the patient could control their illness; they had increased domestic responsibilities; or were sexually dissatisfied. CONCLUSION: Reductions in sexual satisfaction during affective episodes may be the result of illness-related changes in sexual interest, responsiveness and affection. Partners who attribute control for the illness to the patient may use strategies to influence behaviour that disrupt marital harmony. Interventions involving education, problem-solving strategies and sex therapy components may help to reduce marital dissatisfaction.