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Neuropsychology

Mental health issues ‘may stem from childhood cognitive problems’

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Children who experience cognitive problems including low attention, poor memory or lack of inhibition may later have mental health issues as teenagers and young adults, new research has found.

Analysing data from 13,988 individuals born in the UK between April 1991 and December 1992, the study discovered a number of key and specific links between childhood cognitive problems and mental health issues in later life, such as:

  • Deficits in sustained attention in eight-year-olds precede development of borderline personality disorder (BPD) symptoms at 11-12 years and depression at 17-18 years;
  • Difficulties with inhibition in eight-year-olds were associated with psychotic experiences at 17-18 years; 
  • Working memory deficits in 10-year-olds were related to hypomania at 22-23 years.

Mental disorders cause a significant disease burden globally and at least 10 per cent of children and adolescents worldwide have a mental disorder. Around 75 per cent of mental disorders diagnosed in adults have their onset in childhood and adolescence.

Targeting specific markers in childhood for early treatment may help to minimise the risk of children developing such problems in adolescence and adult life, the research found, which was led by the University of Birmingham. 

“Our study highlights the potential impact of childhood cognitive deficits on young people’s mental health, suggesting specific associations with certain conditions,” says lead author Dr Isabel Morales-Muñoz, from the University of Birmingham’s Institute for Mental Health and the Finnish Institute for Mental Health, in Helsinki.

“Prevention strategies focussed on easing these specific cognitive issues could help to reduce the likelihood of such children developing linked mental health problems in adolescence and early adulthood.”

The study was the first analysis to follow subjects over a significant period of time, to explore specific associations between cognitive deficits in childhood and several psychopathological issues in young people.

Deficits in sustained attention at eight years being associated with BPD symptoms at 11-12 years is consistent with similar deficits in adult BPD patients linked to difficulties in sticking to therapy programmes. 

Previous evidence also suggests a significant link between adult BPD and childhood Attention Deficit Hyperactivity Disorder (ADHD) symptoms -indicating that ADHD could represent a risk factor for BPD.

The study also supports the theory that lack of inhibition in childhood precedes later psychotic experiences, with a lack of inhibitory control common in psychotic disorders such as schizophrenia.

Researchers found that working memory deficits in childhood were linked to hypomania in young adults, but when they checked for co-existing psychopathological conditions this association disappeared – indicating that further investigation is needed.

Bipolar disorder, depression and psychosis commonly emerge during adolescence and continue in young adulthood – potentially related to anomalies in the way adolescents mature caused by psychosocial, biological or environmental factors.

“It’s crucial to study the onset of mental disorders at these early stages and evaluate which risk factors predate these conditions and in what way. These factors are core features of mental disorders such as psychosis and mood disorders,” adds co-author Professor Matthew Broome.

Neuropsychology

Supporting survivors, families and professionals to understand brain injury

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Two neuropsychologists have joined forces to create an education programme for brain injury survivors, their loved ones and medical professionals alike, to help them better understand how to move forward with life after such traumatic events. 

The Brain Place has been created by Dr Kim Fletcher and Dr Amanda Mobley, who are building on the therapy they deliver through their NHS roles with the hope of offering group-based sessions geared around the needs of the participants. 

The venture, established in 2018, aims to work with professionals, survivors and families. A number of successful seminar sessions for professionals were held before the pandemic and further sessions are planned for after lockdown restrictions are lifted, with a range of innovative survivor workshops set to launch in the autumn. 

With over 20 years’ combined clinical experience working with people after brain injury and with rehabilitation teams, Kim and Amanda are committed to delivering an open and engaging forum for discussion of a range of topics, from sexual experiences after brain injury to sleep problems and memory loss. 

The small group approach is a central component in what The Brain Place does, which Kim and Amanda believe fills a gap in existing neuropsychology provision. 

“Our workshops are not just about delivering information, We are using the group context to bring people together in every sense. We want to deliver what is important to the participants in the workshop and we’ll go on a collaborative journey through that,” says Amanda.  

“We aim to create a holistic feel, and the whole environment is multi-sensory and we use interactive activities which engage the senses. 

“The activities are chosen to help facilitate the information being delivered making it an experience, something tactile and practical. We hope that this makes the information easier to consolidate and share with family members and colleagues. 

“From the choice of venue – we may use an art gallery, theatre or outdoor venue – to the choice of activity which the workshop is focused around, we want to show there are many different ways of having a conversation.”

And that conversation is critical, particularly around some of the more ‘taboo’ topics which may not be readily discussed

“Through exploring topics like sex after brain injury, we can connect people with shared experiences,” says Kim. 

“There is information out there on these topics, but it’s not always brought up as part of the rehab journey. It’s so important that we give people the space to express their feelings on these subjects and to remove this ‘taboo’. 

“We have an eagerness to turn towards these topics in our workshops, and show that these are things we really need to talk about.” 

The choice of venue is also an important component of The Brain Place’s workshops, to help participants connect with each other and their community. 

“The whole context of what we aim to do relies on us creating the right environment. By using community spaces, people can feel engaged in where they live and grow their confidence in being part of this community and using these venues,” says Kim. 

“For example we have been working to develop links with a local theatre venue, where the participants would be  able to go onto the stage and explore the set-up in a safe and comfortable way.  And as well as what they take from our workshop, they can find out how to book tickets at the theatre, they can see the disabled seats, look in the cafe – it can give them the courage to go there themselves, if they haven’t done so previously. 

“Our whole ethos is that we want to find venues which are caring and secure, which will then set the context for open and honest workshops.” 

While the vast majority of businesses which held workshops transferred them online with the onset of the pandemic, The Brain Place took a different approach and chose to pause their plans  

“We set up The Brain Place to create that multi-sensory and community experience around what are usually very complex topics, so it’s a real challenge to take that online,” says Amanda. 

“We do appreciate that online sessions can bring people together, which can work well for some of what we do and we may try this for our professional training sessions, but we love our face to face interactions and we would like that to be the staple of our workshops going forward.” 

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Neuropsychology

‘Game changing’ avatar trial to launch

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A groundbreaking trial is to be launched today which uses digital avatars to represent the auditory hallucinations experienced by people with psychosis.

The AVATAR 2 trial uses the unique therapy to help those with psychosis increase power and control over the voices they hear and reduce their distress.

The trial – led by the University of Glasgow and developed by King’s College London, UCL and UCL Business – is being launched in Glasgow with an online event which will celebrate the first full quarter of running the AVATAR2 trial in Scotland.

The therapy trial is also being extended to sites across the country including University of Manchester, as well as King’s College London and University College London.

The AVATAR2 trial has two clear aims:

  • To test two different forms of AVATAR therapy comparing each with a treatment as usual control and to find out which might be most helpful for people. People will be offered either six sessions (brief AVATAR therapy) or twelve sessions (extended AVATAR therapy), delivered weekly
  • To learn more about how AVATAR therapy may work, how it can be tailored to the individual and how best to deliver the therapy in clinical services.

The University of Glasgow’s psychosis research group, led by Professor Andrew Gumley, has been at the forefront of developing new therapies for people with experiences such as distressing voices, or auditory hallucinations.

Professor Gumley says: “AVATAR therapy is a new digital therapy that can help people change their relationship with distressing auditory hallucinations. 

“People with distressing voices have had poor access to talking therapies in Scotland. If this trial is successful, it could be a game changer in terms of enabling access to psychological therapies for people with distressing voices.

“The University of Glasgow’s psychosis research group has been at the forefront of developing new therapies for people with distressing voices. This includes digital therapies to promote recovery, wellbeing and empowerment in people who have a diagnosis of schizophrenia.”

This trial builds on a previous clinical trial, led by King’s and hosted by South London and Maudsley NHS Trust, which showed in 2018 that the therapy resulted in a rapid and substantial fall in frequency and associated distress of voices, when compared with supportive counselling alone at 12 weeks.

Jane, a participant in AVATAR1, said of her experience of receiving AVATAR therapy: “I would like to say since I’ve been unwell, I have had many psychological therapies. I can honestly say that AVATAR therapy has helped me the most. 

“Listening back to the Mp3 is like having therapy in my pocket. It has helped me gain back control of the voices.

“Being face to face with the avatar was very hard for me at first, especially the first session, but after a while I became more confident. 

“It was easier for me to talk back to the avatar. At times it was very challenging but I was very well supported during all of my sessions. I think it’s hard for people like me to try new therapies, but it has helped me so much in my recovery.”

An online launch event is being held tomorrow, which will introduce the AVATAR2 trial and demonstrate the therapy software used by the team at the University of Glasgow. There will also be a panel Q&A session.

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Neuropsychology

Gender differences persist in veterans accessing mental health support

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Gender differences are clear when it comes to military veterans seeking and accessing mental health support due to stigma around seeking such help, new research has revealed. 

Although only a minority of both male and female veterans are accessing support, females appear to have additional barriers to overcome when seeking help, such as negative gender stereotypes and a lack of recognition of their veteran status.

Barriers to accessing mental health services among veterans are well researched in the UK, and examples include a lack of military specialist healthcare professionals and anticipated mental health-related stigma.

However, these studies have included predominantly male participants, meaning the understanding of barriers to access experienced by female veterans is limited.

Although small, the number of female military veterans in the UK is increasing, with over 1,000 women leaving military service each year.

Researchers from Anglia Ruskin University in the UK set out to explore and understand any gender differences in barriers that may discourage female veterans from accessing mental healthcare support.

For the study, 100 participants – 43 female and 57 male – completed an open online survey of UK armed forces veterans who identified as having experienced post-military mental health problems.

The participants completed a 30-item ‘Barriers to Access to Care Evaluation’ scale and were asked to elaborate with more detail.

All participants were over the age of 31, all UK nationals, and most were white British. Both women and men had most commonly served in the Army, were non-commissioned on discharge and had left service over 10 years ago.

The results showed that overall, a minority of both female and male veterans had received mental health support/treatment during service (30 per cent of female and 26 per cent of male), but most had received support/treatment since discharge (79 per cent and 72 per cent respectively).

Of the 75 people who had received support/ treatment since discharge, around a fifth of both female and male veterans had taken more than 15 years to seek help following discharge.

The type of treatment varied between the sexes with women being significantly more likely to report accessing NHS mainstream services compared with men.

Results showed that of those who had received support/treatment since discharge, the majority of female veterans reported accessing mainstream NHS services that were non-veteran specific (61 per cent) while only 19 per cent accessed specialist veteran charities/third-sector organisations.

Male veterans most commonly reported accessing either mainstream NHS services (33 per cent) or specialist veteran charities/third-sector organisations (32 per cent).

The researchers said this could be due to the fact that mainstream NHS services had recognised the need for gender-sensitive services, so could be considered to better meet women’s needs than veteran-specific mental health services.

Additionally, it was also possible that female veterans did not identify with the term ‘veteran’ and as a result did not engage with veteran-specific services.

Putting gender to one side, only a small proportion of both genders had accessed NHS veteran-specific mental health services (women 21 per cent and men 14 per cent) which suggested, said the authors, that further research was needed to determine whether or not NHS veteran-specific services were effectively engaging and meeting the mental health needs of veterans.

Analysis of the comments made about barriers to care showed a distinction between male and female responses.

Male veterans described the impact of “male psychology”, with perceived masculinity at odds with help-seeking and accepting mental health needs, while female veterans reported a lack of understanding and negative stereotypes around women’s mental health, leading them to feel their care needs were not taken seriously.

In addition, women noted some gender-specific barriers to help-seeking related to their military service with some speaking of the increased desire to prove their strength due to disparagements around gender and weakness in the Armed Forces and others reporting misconceptions and a lack of recognition of women as Armed Forces personnel.

The authors acknowledge that this pilot study had only involved a relatively small sample of people and was not representative of the wider veteran population.

However, they conclude: “While efforts are being made by the UK Ministry of Defence to reduce barriers to mental healthcare for those still serving in the Armed Forces, it has been more difficult to provide a similar level of support to the veteran population.”

They add: “With little veteran research focusing on the specific experiences of women, this study suggests that female veterans encounter specific access barriers and issues related to their gender. Further research is therefore needed to ensure these findings are addressed.”

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