In trend: September 2015
Stress addiction—Stress has been shown to increase cravings and drug taking behaviour, so it would be logical to assume that the stress hormone cortisol might have a role to play in increasing cravings. According to a double blind, placebo controlled, cross over study in Translational Psychiatry, however, this may not be true (doi:10.1038/tp.2015.101). A study of 29 heroin dependent patients in a stable heroin assisted treatment setting found that patients with a low dose heroin addiction experienced fewer cravings after cortisol was administered compared with those who received placebo, both before and after heroin administration (P=0.0019; P=0.0074, respectively). A single oral dose of 20 mg cortisol or placebo was given 105 minutes before the participants took their daily dose of heroin. Participants were shown pictures of drug paraphernalia at various time points in the study and asked to rate their cravings. Interestingly, addicts who received a medium or high dose of heroin did not experience the same reduction in cravings after cortisol was given. The authors suggest that this might be because those who require a higher dose of heroin probably have a more severe substance misuse disorder, which means they are “generally less responsive to regular treatment interventions.” They conclude that their study might have important clinical implications for the treatment of addictions but call for further studies to look at the mechanism behind their findings.
Monkey see, monkey smoke—We like to think that our opinions are unique, but in the case of attitudes towards the use of e-cigarettes, it turns out that the actions of our peers have an influence. A prospective cohort study published in Pediatrics (doi:10.1542/peds.2015-0639) used a questionnaire to collect data from adolescents aged 16-18 who took part in the Southern California Children’s Health Study during the spring of 2014. The 2084 participants were asked about personal e-cigarette and cigarette use, as well as the use of and attitudes towards these products at home and among their peer groups. The study found that use of and positive attitudes towards e-cigarettes at home and within peer groups were positively associated with personal use. This effect was much less pronounced for cigarettes. For example, a “very friendly” attitude of a participant’s friends towards e-cigarettes resulted in a 37-fold increase in personal e-cigarette use (95% confidence interval 20.9 to 65.5); compared with only a ninefold increase in personal cigarette use (5.29 to 16.7). The authors thought that their results were a cause for concern because a large proportion of e-cigarette users in their study had not used cigarettes previously and the long term health impact of e-cigarettes is still unknown.
Sweet dreams—A good night’s sleep, your mother’s panacea for all number of ailments, might well be the best thing for your mental health. A Norwegian population based study published in the British Journal of Psychiatry (doi:10.1192/bjp.bp.114.146514) surveyed 10 220 people aged 16-19 about their sleep habits and their mental health, including self harm. Participants with sleep problems were significantly more likely to report self harm than those without sleep problems in a dose-response relation. Those who reported self harming behaviours got on average 5.33 hours sleep per night, compared with 6.29 hours among those who did not report self harming behaviours. This effect remained even after adjustment for depression, perfectionism, and symptoms of attention-deficient hyperactivity disorder. The authors call for further studies to determine whether sleep based interventions are effective in preventing and treating self harm in practice.
Preterm personality—When thinking about the determinants of personality, it might not occur to you to think back as far as birth. But according to a longitudinal prospective cohort study published in ADC Fetal and Neonatal Edition (doi:10.1136/archdischild-2014-308007), being born prematurely or having a low birth weight poses an important risk for withdrawn personality type. The study authors used the Bavarian Longitudinal Study which looked at neonatal at risk children born in 1985 and 1986 in Germany and identified 200 very preterm (gestational age at birth <32 weeks) and very low birth weight (<1500 g) participants and 197 controls. At the age of 26 years, participants completed screening questionnaires that measured broad autism phenotype, personality traits, and risk taking behaviours. When compared with the control group, the very preterm and low birthweight adults were more at risk of a withdrawn personality, as indicated by displaying significantly more autistic features, higher levels of introverted and neurotic personality traits, and reported lower risk taking (P<0.001). The authors suggest that their findings might be caused by changes in brain structure and function caused by impaired development as well as parental protectiveness and over involvement, and they recommend “early interventions that foster preterm-born children’s social skills.”
Social networks—It’s okay to prefer your own company, but women who have higher levels of social integration have a lower risk of suicide, according to a prospective cohort study published in JAMA Psychiatry (doi:10.1001/jamapsychiatry.2015.1002). The study authors used data from the Nurses’ Health Study, an ongoing nationwide US study that began in 1992 and has surveyed 72 607 nurses between the ages of 46 and 71 about their social relationships. Social integration was measured with a seven item index that included marital status, social network size, frequency of social contact, and participation in religious or other social groups. Over 18 years of follow-up there were 43 suicides in the patient population, the incidence of which significantly decreased with increased levels of social integration—which were independent of poor mental health and serious physical illness (P=0.001). The authors suggest that in clinical practice, “asking patients about the extent of their participation in a range of social relationships may yield information useful for risk assessment or in developing tailored interventions aimed at strengthening social relationships to be more functional and satisfying.”
Sweet tooth—You know sugar is the new bad guy on the scene. You’ve been dutifully avoiding the cake in an effort to eat less of it, but what effect does drinking sugary drinks have on the risk of developing type 2 diabetes? In a systematic review and meta-analysis published in The BMJ (doi:10.1136/bmj.h3576), researchers used national surveys from the US between 2009 and 2010 (n=4729 representing 189.1 million adults without diabetes), and the United Kingdom between 2008 and 2012 (n=1932 representing 44.7 million). They found that higher consumption of sugar sweetened beverages was associated with a 13% greater incidence of type 2 diabetes per serving per day (95% confidence interval 9 to 28), after adjustment for the body weight of each participant. Although the study did not establish causality, the authors conclude that it “informs the potential efficacy of reducing the consumption of sugar sweetened beverages in a contemporary population.”
In trend is compiled by Katy Bettany
Cite this as: Student BMJ 2015;23:h4343