Simple tool may help evaluate risk for violence among patients with mental illnessopen original article

Sun Sep 16, 2012 23:21 from RSS 2.0 by University of California at San Francisco

Mental health professionals, who often are tasked with evaluating and managing the risk of violence by their patients, may benefit from a simple tool to more accurately make a risk assessment, according to a recent study conducted at the University of California, San Francisco.

The research, led by psychiatrist Alan Teo, MD, when he was a UCSF medical resident, examined how accurate psychiatrists were at evaluating risk of violence by acutely ill patients admitted to psychiatric units.

The first part of the study showed that inexperienced psychiatric residents performed no better than they would have by chance, whereas veteran psychiatrists were moderately successful in evaluating their patients’ risk of violence.

However, the second part of the study showed that when researchers applied the information from the “Historical, Clinical, Risk Management–Clinical” (HRC-20-C) scale – a brief, structured risk assessment tool – to the patients evaluated by residents, accuracy in identifying their potential for violence increased to a level nearly as high as the faculty psychiatrists’, who had an average of 15 years more experience.

“Similar to a checklist a pilot might use before takeoff, the HRC-20-C has just five items that any trained mental health professional can use to assess their patients,” Teo said. “To improve the safety for staff and patients in high-risk settings, it is critical to teach budding psychiatrists and other mental health professionals how to use a practical tool such as this one.”

The study was published Aug. 31 in the journal Psychiatric Services.

The HCR-20-C was developed several years ago by researchers in Canada, where it is used in a number of settings such as prisons and hospitals. However, in the United States, structured tools such as the HCR-20-C are only beginning to be used in hospitals.

“This is the first study to compare the accuracy of risk assessments by senior psychiatrists to those completed by psychiatric residents,” said senior author Dale McNiel, PhD, UCSF professor of clinical psychology. “It shows that clinicians with limited training and experience tend to be inaccurate in their risk assessments, and that structured methods such as HCR-20-C hold promise for improving training in risk assessment for violence.”

“The UCSF study was unusual,” Teo added, “in applying a shorter version of the tool that could be more easily incorporated into clinical practice.”

Teo and his team assessed the doctors’ accuracy by comparing the risk assessments that they made at the time patients were admitted to the hospital, to whether or not patients later became physically aggressive toward hospital staff members, such as by hitting, kicking or biting. The study included 151 patients who became violent and 150 patients who did not become violent.

The patients in the study had severe mental illnesses, often schizophrenia, and had been involuntarily admitted to the hospital.

http://www.camh.ca/en/hospital/Pages/home.aspx

http://www.camh.ca/en/hospital/Pages/home.aspx

Researchers illuminate roles of novel epigenetic chemical in the brainopen original article

Mon Sep 17, 2012 18:03 from RSS 2.0 by Centre for Addiction and Mental Health

Researchers from the Centre for Addiction and Mental Health (CAMH) have identified a new role of a chemical involved in controlling the genes underlying memory and learning.

“The brain is a plastic tissue, and we know that learning and memory require various genes to be expressed,” says CAMH Senior Scientist Dr. Art Petronis, who is a senior author on the new study. “Our research has identified how the chemical 5-hmC may be involved in the epigenetic processes allowing this plasticity.” Dr. Petronis is head of the Krembil Family Epigenetics Laboratory in CAMH’s Campbell Family Mental Health Research Institute.

5-hmC is an epigenetic modification of DNA, and was discovered in humans and mice in 2009. DNA modifications are chemical changes to DNA. They flag genes to be turned “on” – signalling the genome to make a protein – or turned “off.” As the overwhelming majority of cells in an individual contain the same genetic code, this pattern of flags is what allows a neuron to use the same genome as a blood or liver cell, but create a completely different and specialized cellular environment.

The research, published online in Nature Structural & Molecular Biology, sheds light on the role of 5-hmC. Intriguingly, it is more abundant in the brain than in other tissues in the body, for reasons not clear to date.

The CAMH team of scientists examined DNA from a variety of tissues, including the mouse and human brain, and looked at where 5-hmC was found in the genome. They detected that 5-hmC had a unique distribution in the brain: it was highly enriched in genes related to the synapse, the dynamic tips of brain cells. Growth and change in the synapse allow different brain cells to “wire” together, which enables learning and memory.

“This enrichment of 5-hmC in synapse-related genes suggests a role for this epigenetic modification in learning and memory,” says Dr. Petronis.

The team further showed that 5-hmC had a special distribution even within the gene. The code for one gene can be edited and “spliced” to create several different proteins. Dr. Petronis found that 5-hmC is located at “splice junctions,” the points where the gene is cut before splicing.

“5-hmC may signal the cell’s splicing machinery to generate the diverse proteins that, in turn, give rise to the unprecedented complexity of the brain,” he says.

The research team is continuing to investigate the role of 5-hmC in more detail, and to determine whether 5-hmC function is different in people with bipolar disorder and schizophrenia compared to people without these diagnoses.

Self Control

Self-control may not be a limited resource after allopen original article

Wed Sep 12, 2012 19:05 from RSS 2.0 by Association for Psychological Science

So many acts in our daily lives – refusing that second slice of cake, walking past the store with the latest gadgets, working on your tax forms when you’d rather watch TV – seem to boil down to one essential ingredient: self-control. Self-control is what enables us to maintain healthy habits, save for a rainy day, and get important things done.

But what is self-control, really? And how does it work?

In a new article in the September 2012 issue of Perspectives on Psychological Science, a journal of the Association for Psychological Science, researchers Michael Inzlicht of the University of Toronto and Brandon Schmeichel of Texas A&M University argue that the prevailing model of self-control may not be as precise as researchers once thought. Rather than being a limited resource, self-control may actually be more like a motivation- and attention-driven process.

Research on self-control has surged in the last decade and much of it has centered on the resource model of self-control. According to this model, originally proposed by Roy Baumeister and colleagues, self-control is a limited resource – if we exercise a lot of self-control by refusing a second slice of cake, we may not have enough self-control later in the day to resist the urge to shop or watch TV.

Over 100 papers have produced findings that support this model. Research has found, for example, that people who are required to manage their emotions show impaired performance on later tasks, such as solving a difficult puzzle, squeezing a handgrip exerciser, and keeping items in working memory.

But Inzlicht and Schmeichel point out that a newer crop of studies are yielding results that don’t fit with this idea of self-control as a depletable resource. Recent studies have shown that incentives, individual perceptions of task difficulty, personal beliefs about willpower, feedback on task performance, and changes in mood all seem to influence our ability to exercise self-control. These results suggest that self-control may not rely on a limited resource after all.

To accommodate these new findings and get at the mechanisms that underlie self-control, Inzlicht and Schmeichel propose an alternative model that describes self-control as a process involving motivation and attention.

“Engaging in self-control by definition, is hard work; it involves deliberation, attention, and vigilance,” the authors write. If we resist that second slice of cake, we may experience a shift in motivation so that we feel justified in indulging ourselves later on. It’s not necessarily the case that we can’t control ourselves because we’re “out” of self-control but rather that we choose not to control ourselves any longer.

At the same time, our attention shifts so that we’re less likely to notice cues that signal the need for self-control (cake = empty calories) and we pay more attention to cues that signal some kind of reward (cake = delicious treat).

In laying out the basic components of this process model, Inzlicht and Schmeichel want to motivate researchers to ask critical questions about how self-control really works. “The idea that self-control is a resource is one possibility, but there are alternative possibilities that can accommodate more of the accumulated data,” Inzlicht says.

Identifying the mechanisms that underlie self-control can help us to understand behaviors related to a wide range of important problems, including obesity, impulsive spending, gambling, and drug abuse. Inzlicht and Schmeichel hope that researchers will ultimately be able to use this knowledge to design effective methods for improving self-control.