'Our relationship is different': exploring mothers' early experiences of bonding to their twins.

Objective: The aim of this research was to explore mothers' lived experience of early bonding with their twins.Background: Research has suggested that the process of bonding with twins may differ from that of bonding with singletons. However, there is limited research exploring this experience from the mother's perspective.Method: An IPA study involved six participants in semi-structured interviews.Results: Two superordinate themes emerged; 'Twin guilt and shame' and 'I missed out … they miss out'. Results suggested the experience of bonding with two infants simultaneously generated guilt for the mothers, who at points felt that they and their infants had missed out and had had to adapt.Conclusion: The experience of bonding with twins can be complex and take longer than anticipated, with mothers reporting the experience as being different from their expectations. Having a greater understanding and information about the complexities of bonding with twins would be beneficial for both mothers and professionals working with them.

Male professional footballers' experiences of mental health difficulties and help-seeking.

OBJECTIVES: Male professional footballers (soccer) represent an at-risk population of developing mental health difficulties and not accessing professional support. One in four current footballers report mental health difficulties. Higher prevalence is reported after retirement. This qualitative study aimed to provide in-depth insight into male professional footballers' lived experiences of mental health difficulties and help-seeking. METHODS: Seven participants were interviewed. Data were analysed using interpretative phenomenological analysis. RESULTS: One superordinate theme emerged; 'Survival'. This related to survival in the professional football world, of mental health difficulties and after transition into the 'real world'. Six subordinate themes are explored alongside literature pertaining to male mental health, identity, injury, transition, and emotional development. Shame, stigma, fear and level of mental health literacy (knowledge of mental health and support) were barriers to help-seeking. CONCLUSION: Support for professional footballers' mental wellbeing requires improvement. Recommendations are made for future research, mental health education and support.

Neuropsychological performance over time in people at high risk of developing schizophrenia and controls.

BACKGROUND: Neuropsychological assessments of relatives of schizophrenics have shown subtle impairments in verbal memory, executive and intellectual function, which are stable in those beyond the age of maximum risk for the disorder. We sought to: (1) determine baseline neurocognitive predictors of psychosis, and (2) compare performance over time between relatives within the age of maximum risk, and controls. METHODS: (1) and (2) were examined in 118 individuals at familial high risk of schizophrenia (HR) and 30 controls (C), using one-way analyses of variance (ANOVAs) and repeated measures analyses of covariance (ANCOVAs), controlling for intelligence quotient, time between and number of assessments, and correcting for multiple comparisons. RESULTS: HR who became ill (n = 13) performed nonsignificantly less well at baseline than HR who did not (n = 105) on a test of verbal learning (t(109) = 2.1, p = .03). Across assessments, C performed significantly better than the entire HR group on immediate (F(3,133) = 5.11, p = .002) and delayed (F(3,133) = 5.02, p = .002) story recall. There were no significant interactions of time by group. CONCLUSIONS: Results suggest greater verbal memory impairment in HR who go on to develop schizophrenia. Stable differences between groups over time suggest a trait deficit, which is relatively unaffected by the presence of psychotic symptoms and psychosis onset. Alternatively, small numbers may have precluded detection of group by time interactions.

Genetic liability to schizophrenia or bipolar disorder and its relationship to brain structure.

Bipolar disorder and schizophrenia are highly heritable conditions that are associated with structural brain abnormalities. Although brain abnormalities are found in the well relatives of people with schizophrenia, the extent to which genetic liability relates to brain structure in either disorder is still unclear. This study sought to ascertain the effects of genetic liability to schizophrenia and bipolar disorder on white and grey matter volume in patients with these diagnoses and their well relatives. Seventy-one patients and 72 unaffected relatives were recruited for the study. Patients included those with schizophrenia from families affected by schizophrenia alone, those with bipolar disorder from families affected by bipolar disorder alone and those with bipolar disorder from families affected by both bipolar disorder and schizophrenia. Samples of unaffected relatives of each patient group were also recruited. Subjects underwent an MRI scan of the brain, which was analysed using optimised voxel-based morphometry (VBM). Grey and white matter volume was then related to a continuous measure of genetic liability based on a threshold-liability model. Genetic liability to schizophrenia was associated with decreased grey matter volume in dorso- (DLPFC) and ventrolateral prefrontal (VLPFC) cortices. The relationship remained after diagnostic status had been taken into account. Complementary white matter changes were also demonstrated. No relationship was demonstrated between a genetic liability to bipolar disorder and either white or grey matter volume. Genes that raise the likelihood of developing schizophrenia may exert their effects by diminishing grey matter volume in the DLPFC and VLPFC and their associated white matter connections. Genes for bipolar illness might have subtle effects on brain structure, which may need particularly large samples to detect.

Effects of competition, exercise, and mental stress on secretory immunity.

It has been suggested that the psychological stress associated with competitive sports events may help to explain the increased susceptibility to respiratory infections due to reductions in secretory immunity. In the current study, we investigated the influence of competitive exercise and psychological stress on secretory immunoglobulin A (s-IgA). Salivary s-IgA and heart rate were measured in 62 healthy young recreationally active men at rest and, in a between-subjects design, following one of four 8-min tasks: mental arithmetic, cycling at workloads of 60 to 180 W (mean = 146 W), mental arithmetic while cycling, or competitive cycling. Mental arithmetic was associated with significant increases in s-IgA concentration (mean = 49 microg.min(-1)) and s-IgA secretion rate (mean = 25 microg.ml(-1)) compared with rest, while mental arithmetic combined with exercise was associated with a significant increase in s-IgA concentration only (mean = 124 microg.min(-1)). In contrast, competitive exercise and exercise alone did not influence s-IgA concentration or secretion rate. Heart rate increased modestly to mental arithmetic (mean = 7 beats.min(-1)) and substantially, and similarly, to the three exercise tasks (mean = 56(62 beats.min(-1)). The hypothesis that the psychological stress of competitive exercise contributes to increased susceptibility to infection via reductions in s-IgA requires further investigation.

White matter density in patients with schizophrenia, bipolar disorder and their unaffected relatives.

BACKGROUND: This study sought to assess white matter density in patients and relatives with histories of bipolar disorder and/or schizophrenia. METHODS: Subjects included those with schizophrenia from families affected by schizophrenia alone, those with bipolar disorder from families affected by bipolar disorder alone and those with bipolar disorder from families affected by both bipolar disorder and schizophrenia. Unaffected relatives of the three patient groups were also recruited. Subjects underwent an MRI brain scan which was analyzed using a white-matter optimized technique. RESULTS: Subjects with schizophrenia and bipolar disorder showed reduced white matter density in the anterior limb of the internal capsule which was not found in unaffected relatives. Reductions were found in frontal subgyral white matter density in affected subjects with a family history of schizophrenia only. CONCLUSIONS: Abnormal anterior internal capsule white matter may provide a structural substrate for both disorders.

Neuropsychological impairments in people with schizophrenia or bipolar disorder and their unaffected relatives.

BACKGROUND: Neuropsychological abnormalities in schizophrenia are well replicated and are present in unaffected relatives. Cognitive findings in bipolar disorder are less clearly established. AIMS: To examine the possibility that these abnormalities may provide a means by which the disorders might be separated and to clarify the associations of phenotypic expression and genetic liability. METHOD: A neuropsychological test battery was administered to 50 control participants, 74 patients and 76 unaffected relatives recruited for the study. Patients included those with schizophrenia from families affected by schizophrenia alone, those with bipolar disorder from families affected by bipolar disorder alone and those with bipolar disorder from families affected by both disorders. Unaffected relatives were also recruited. RESULTS: Current, verbal and premorbid IQ were impaired in people with schizophrenia and in their close relatives. Memory was impaired in all patient and relative groups. Psychomotor performance and performance IQ were impaired in patients, regardless of diagnosis. CONCLUSIONS: This study finds evidence that intellectual abnormalities are related to a genetic liability to schizophrenia. Abnormalities of memory appear to be related to an increased liability to psychosis in general. No impairment was specific to bipolar disorder.

Voxel-based morphometry of patients with schizophrenia or bipolar disorder and their unaffected relatives.

BACKGROUND: Structural brain abnormalities in schizophrenia are well replicated; many emerge before the onset of illness and are present in relatives who remain well. Structural changes in bipolar disorder are less clearly established. The possibility that structural abnormalities might provide a means by which the disorders might be separated is one that has attracted limited research effort. This study sought to examine these issues and clarify the associations of phenotypic expression and genetic liability. METHODS: Forty-nine control subjects, 71 patients, and 72 unaffected relatives were recruited for the study. Patients included those with schizophrenia from families affected by schizophrenia alone, those with bipolar disorder from families affected by bipolar disorder alone, and those with bipolar disorder from families affected by both bipolar disorder and schizophrenia. Unaffected relatives were recruited from the families of the three patient groups. Subjects underwent a magnetic resonance imaging scan of the brain, which was analyzed with a grey-matter-optimized, voxel-based morphometry technique. RESULTS: Compared with control subjects, all patient and relative groups showed evidence of reduced anterior thalamic gray matter. Reductions in middle prefrontal gyrus and dorsomedial thalamus were specific to participants with schizophrenia. CONCLUSIONS: Whereas prefrontal and dorsomedial thalamic gray matter reductions seem to be specific to schizophrenia, anterior thalamic reductions seem to be a marker of liability to psychosis in general. These results are discussed in the context of their functional role and in terms of their connections with other cortical and subcortical structures.

Transcranial magnetic stimulation for auditory hallucinations in schizophrenia.

It has been suggested that low frequency transcranial magnetic stimulation (TMS) over left temporo-parietal cortex may reduce the frequency and intensity of auditory hallucinations in schizophrenia. Sixteen patients with hallucinations, treatment-resistant for at least 2 months, were randomised into a placebo-controlled crossover study of TMS at 1 Hz and 80% of motor threshold over left temporo-parietal cortex. Treatment periods lasted for 4 days, with daily duration escalating from 4 to 8, 12 and 16 min on subsequent days. Each minute of stimulation was followed by 15 s of rest to check coil position and allow the patient to move, if necessary. Both patients and symptom raters were unaware of the treatment condition. Patients' hallucination scores improved from baseline with both real and sham TMS, and there was no significant difference between real and sham treatments. There was a trend for second treatments, whether sham or real, to be more effective than first treatments. Other psychopathology scales (apart from positive symptoms) and verbal memory were not affected by real or sham TMS. Previous positive studies could not be replicated with these parameters. TMS is safe if applied within the protocol used.

Reductions in secretory immunoglobulin A to cold pressor stress are not influenced by timing of saliva sampling.

Acute psychological stress has been shown to alter secretory immunity, principally secretory immunoglobulin A (S-IgA). Most acute stress tasks result in increases in S-IgA, but decreases have been reported in response to the cold pressor. However, the evidence is mixed, with increases and no changes in S-IgA in response to the cold pressor also being reported. It was hypothesised that differences in the timing of saliva sampling may provide an explanation for these discrepant results. Participants completed two 4-min cold pressor tasks, each preceded by a rest period in which baseline S-IgA was measured. In one condition, S-IgA was assessed during the final 2 min of the cold pressor; in the other, it was measured immediately after completion of the task. S-IgA decreased from baseline to task, regardless of timing of saliva sampling. It was concluded that differences in timing of sampling do not account for the mixed reports in the literature.

Implicit memory bias and trait anxiety: a psychophysiological analysis.

The effect of threatening words and anxiety upon implicit memory performance was investigated. It was predicted that anxious individuals would show a bias to threat-related material. In addition, psychophysiological measures were obtained to assess the attentional and encoding processes that might underlie this cognitive bias. Forty participants were equally allocated to high and low trait anxious groups, according to pre-determined cut-offs. All participants were exposed to threat and non-threat words and following a filler task, were asked to complete primed and unprimed wordstems. Implicit memory performance was assessed in terms of accuracy and reaction time for completion. Heart rate and electrodermal responses were measured. Results demonstrated initial increased cardiac deceleration to threat stimuli, subsequent cardiac acceleration to non-threat stimuli, and an implicit memory bias to non-threat material by all participants. These findings are discussed in relation to the 'vigilance-avoidance' model of attention to threat stimuli.

Competitiveness and hemodynamic reactions to competition.

This study examines the effects of competition and competitiveness on hemodynamics. Cardiovascular activity was measured in 27 men at resting baseline and during a car racing game, which comprised a solo race against time and three races against an experimenter. To assess hematocrit, blood was collected at rest and after the final race. Trait competitiveness was assessed by questionnaire. Competition elicited increases in hematocrit, blood pressure, heart rate, and total peripheral resistance, as well as decreases in preejection period and heart rate variability. The final race was rated as more competitive than the solo race. Compared to intrapersonal solo racing, the final interpersonal race was associated with shorter preejection periods and faster heart rates, markers of beta-adrenergic activation. Although trait competitiveness was not associated with beta-adrenergic activation, variations in state competitiveness were.

Stress, coping, and hepatitis B antibody status.

OBJECTIVE: The present study investigated the association between exposure to stressful life events, coping style, and antibody status after hepatitis B vaccination. METHODS: Two hundred sixty medical school undergraduates, who had received the three-dose hepatitis B vaccine before recruitment to this study, completed questionnaires measuring exposure to stressful life events during the past year, customary coping strategies, and health behaviors. Antibodies against hepatitis B surface antigen were determined; levels <100 mIU/ml were deemed inadequate. RESULTS: Two participant cohorts were identified: those vaccinated within the last year and those vaccinated earlier. In the early vaccination cohort, participants with greater-than-average stress exposures had a more than two-fold increased risk of having an inadequate antibody titer. Coping by accepting the reality of stressful situations proved protective, whereas coping by substance use increased the risk of having an inadequate antibody count in this cohort. These associations remained significant after adjustment for possible mediators. Furthermore, the effects of stress and coping were largely independent of one another. Neither stress nor coping was significantly associated with antibody status in the recently vaccinated cohort. CONCLUSIONS: The present study confirms that the immune system is sensitive to variations in psychological factors. Stressful life events and coping strategy seem to have a continuing impact on hepatitis B antibody status.