̽��ֱ�� of Cambridge - Ian Goodyer

Mental health disorders: risks and resilience in adolescence

lw355 — Wed, 10 Oct 2018 08:25:17 +0000

When Charly Cox was diagnosed in her teenage years with depression and other mental health disorders, what lay ahead for her was “a long and painful ordeal of trial and error, guesswork and delay. I felt loss and frustration more times than I was ever gifted hope, knowledge or effective treatment.”

For Flo Sharman, who suffered from mental illness from the age of eight: “I lost my childhood to the stigma surrounding mental health.”

James Downs recovered from disordered eating and extreme emotions, but he describes the process as being “like an experimental DIY project rather than something with clear oversight and a plan.”

One in four of us experience the debilitating, isolating and traumatic effects of mental health disorders. Around 75% of adult mental health problems begin before the age of 18, disrupting education and social interactions, affecting relationships with family and friends and future job opportunities, and in some cases, costing lives.

Charly, Flo and James are among those who have lent their support – and their stories – to the mental health charity MQ to help work towards a future in which adolescents no longer face the life-altering challenge of living with these disorders.

Dr Anne-Laura van Harmelen from Cambridge’s Department of Psychiatry leads a project funded by MQ, called HOPES, and shares this vision: “Our brains undergo complex neural development during the teenage years to prepare us to take care of ourselves. However, some of these changes may be linked to a vulnerability to mental health disorders. If we can better understand what these vulnerabilities are, we can identify those at risk and treat them early, before the disorders emerge.”

But, until recently, remarkably little has been known about what’s going on inside a teenager’s head. Unravelling some of the complexity has required the combined input of psychiatrists, neuroscientists, psychologists, social scientists, computational biologists and statisticians – and the brains of hundreds of healthy teenage volunteers. ̽��ֱ��teenagers were scanned as part of the NeuroScience in Psychiatry Network (NSPN), set up in 2012 by Professor Ian Goodyer from the Department of Psychiatry with funding from the Wellcome Trust.

So far, 2,300 healthy volunteers aged 14 to 24 years have been recruited by the ̽��ֱ�� of Cambridge and ̽��ֱ�� College London for analysis through behavioural questionnaires, cognitive tests, and medical and socio-economic history. Some 300 adolescents have also had their brain anatomy and activity scanned millimetre by millimetre using MRI, a method that can reveal connections between brain activity centres.

̽��ֱ��result is one of the most comprehensive ‘circuit diagrams’ of the teenage brain ever attempted. “ ̽��ֱ��project has been a big step forward in looking inside the black box of the teenage brain,” explains Professor Ed Bullmore, who leads the NSPN. “We found that there were distinctive patterns of developmental change in brain structure and function during adolescence that could help to explain why mental health disorders often arise during late adolescence.”

For instance, Bullmore’s colleagues Dr Kirstie Whitaker and Dr Petra Vértes discovered that the outer region of the brain, known as cortical grey matter, shrinks, becoming thinner during adolescence. As this happens, the levels of myelin – the sheath that ‘insulates’ nerve fibres, allowing the fibres to communicate efficiently in the white matter – increase.

In a separate study, Dr František Váša designed a method to combine all of the scans of the structural changes in the brain through a ‘sliding window’ – as if viewing the changes in the brain network of an ‘average’ adolescent as they mature from 14 to 24 years of age. It sounds simple enough but this innovation was so complex that it took several years of statistical and computational analysis to perfect.

“We saw that the changes are greatest in the most connected ‘hub’ parts of the brain. Our interpretation is that when the brain develops it builds too many connections; then, during the teenage years, those that are used frequently are strengthened and others are ‘pruned’,” says Váša, whose PhD studies were funded by the Gates Cambridge Trust.

What makes this especially interesting is that Vértes and Whitaker also discovered that the brain areas undergoing the greatest structural changes during adolescence are those in which genes linked to risk of mental health disorders are most strongly expressed.

One of the disorders is schizophrenia, which affects 1% of the population and often starts in adolescence or early adult life. Vértes has recently been funded by MQ to search for unique patterns of brain connectivity among those who develop symptoms of schizophrenia, and to cross-reference them with patterns of gene expression across the brain. “Not only is this knowledge important for identifying new treatments that are more effective for a greater number of patients at an earlier stage, but it could also help in predicting those who are at risk,” she explains.

Another area where there has been little improvement in predicting behaviours is that of suicide – the second leading cause of death among the young.

“Around 16% of teens think about suicide and 8% report making an attempt, yet there has been little improvement in our ability to predict suicidal behaviours in 50 years,” says van Harmelen, who is a Royal Society Dorothy Hodgkin fellow. ̽��ֱ��HOPES project she leads aims to develop a model to predict who is at risk of suicide by analysing brain scans and data on suicidal behaviour of young people from across the world to identify specific, universal risk factors.

“These risk factors may be connected with traumatic and stressful events early in their lives,” she adds. “In fact, we know that about a third of all mental health problems are attributable to events such as bullying, abuse and neglect. Much of my work has been to understand the impact of these factors on the developing brain.”

She discovered that childhood adversity is related to an altering of the structure and function of parts of the brain, and that this increases vulnerability to mental health problems. Intriguingly, some adolescents with traumatic early life experiences fared a lot better than would be predicted. This ‘resilience’ was enhanced by receiving the right kind of support at the right time. She calls this ‘social buffering’ and finds that for 14-year-olds it most often comes from family members, and for 19-year-olds from friendships.

With funding from the Royal Society, she is now starting to look for biological factors that underpin resilient functioning – for instance, how does the immune system interact with the brain during periods of psychosocial stress in resilient adolescents? Are there biomarkers that can be used to predict resilience after childhood adversity?

“We are diving deeper into the factors and mechanisms that might help,” says van Harmelen. “We know there are lots of social, emotional and behavioural factors that help to build resilience, and that these factors are amenable to intervention by therapists – but which are the most important, or is it a specific combination of these factors?

“If you speak to anyone who has had a mental health problem, you will know the effect it’s had on them and their families,” she adds. “Even a minor contribution to lowering this effect through early diagnosis and treatment is worth a lot of effort.”

Video: In this video you can see the regions of the brain coloured by how much they change between 14 and 24 years of age. ̽��ֱ��darker the colour the more the myelin changes. ̽��ֱ��size of the 'nodes' of the network represents how well connected they are and halfway through the movie the smallest nodes are removed and only the hubs remain. ̽��ֱ��edges that are added in are the strongest connections between these hub regions and represent the brain's 'rich club'. Data taken from 'Adolescence is associated with genomically patterned consolidation of the hubs of the human brain connectome' by Whitaker, Vertes et al. published in PNAS in July 2016. DOI: 10.1073/pnas.1601745113 Link: http://dx.doi.org/10.1073/pnas.160174.

Read a profile of Dr František Váša on the Gates Cambridge website.

Deeper understanding of the wiring and rewiring of the adolescent brain is helping scientists pinpoint why young people are especially vulnerable to mental health problems – and why some are resilient.

If you speak to anyone who has had a mental health problem, you will know the effect it’s had on them and their families. Even a minor contribution to lowering this effect through early diagnosis and treatment is worth a lot of effort

Anne-Laura van Harmelen

Photo by Jon Tyson on Unsplash

̽��ֱ��text in this work is licensed under a Creative Commons Attribution 4.0 International License. Images, including our videos, are Copyright © ̽��ֱ�� of Cambridge and licensors/contributors as identified. All rights reserved. We make our image and video content available in a number of ways – as here, on our main website under its Terms and conditions, and on a range of channels including social media that permit your use and sharing of our content under their respective Terms.

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Cuts to mental health services putting young people at risk, say experts

cjb250 — Fri, 15 Sep 2017 12:18:05 +0000

In an article published today in the Journal of Public Mental Health, the team discuss the policy implications of their study published earlier in the year, which found that young people who have contact with mental health services in the community and in clinics are significantly less likely to suffer from clinical depression later in their adolescence than those with equivalent difficulties who do not receive treatment.

Young people’s mental health problems are associated with an increased risk of problems later on in adulthood, including poor mental health, lower income, unemployment, inability to maintain a stable cohabiting relationship, and greater contact with the criminal justice system. However, the team’s previous study suggested that access for adolescents with mental health problems to intervention in schools and clinics reduces mental health problems up to three years later and would therefore yield personal, economic, and societal benefits over an individual’s lifespan.

In the study, Sharon Neufeld and colleagues from the Department of Psychiatry at the ̽��ֱ�� of Cambridge used data obtained between 2005-2010 – prior to funding cuts to Child and Adolescent Mental Health Services in the community and in NHS clinics. Between 2008 and 2013, funding for the services dropped by 5.4 per cent in real terms so that in 2012/2013, only 6 per cent of the NHS’ total mental health budget was spent on these services. ̽��ֱ��knock-on effect of this was that while in 2005/2006, 38% of 14-year olds with a mental disorder had made contact with mental health provision for young people in the past year, in 2014/2015 only 25% of all children and young people with a mental disorder had made such service contact.

One consequence of this has been that the number of young people attending A&E due to a psychiatric condition had doubled by 2014/2015, compared with 2010/2011.

“It’s important to improve young people’s mental health services in schools and strengthen the care pathway to specialist Child and Adolescent Mental Health Services, in order to meet the NHS target of returning contact back up to 35% by 2020/2021,” says Mrs Neufeld.

“We need to acknowledge the mental health suffering in our young people that has only been increasingly apparent in recent years, and resolve to improve young people’s access to effective mental health services.”

She and her colleagues argue that as well as protecting funding for specialist Child and Adolescent Mental Health Services, funding for school-based counselling is also important as their study found that this was the second most used service for young people with a mental health disorder.

“ ̽��ֱ��current government has promised to provide funding for mental health first aid training for teachers in secondary schools, which should enable them to better identify those with mental health issues and connect students to the appropriate support services,” says Professor Peter Jones. “But this is against a backdrop of freezing school budgets, the very budgets that typically fund school-based counselling.

“Funding for school-based counselling must be ring-fenced, whether it be funded through the education sector or NHS, to ensure young people have adequate service access prior to specialist mental health services.”

̽��ֱ��researchers also argue that GPs could use more training in identifying mental disorder. ̽��ֱ��Royal College of General Practitioners reports that nine out of ten people with mental health problems are managed in primary care. However, even in the recent past, most GPs do not include a rotation in mental illness as part of their training. Such gaps in training, say the researchers, mean that GPs correctly identify less than a half (47%) of depression cases.

“This is a huge missed opportunity,” adds Professor Ian Goodyer. “GPs will encounter a large number of individuals with mental disorders, but have insufficient background knowledge to appropriately identify such cases.”

Reference
Sharon AS Neufeld, Peter B Jones and Ian M. Goodyer. Child and adolescent mental health services: longitudinal data sheds light on current policy for psychological interventions in the community. Journal of Public Mental Health; Date; DOI 10.1108/JPMH-03-2017-0013

Funding cuts and austerity measures are damaging young people’s access to mental health services, with potentially long-term consequences for their mental wellbeing, say researchers at the ̽��ֱ�� of Cambridge.

We need to acknowledge the mental health suffering in our young people that has only been increasingly apparent in recent years, and resolve to improve young people’s access to effective mental health services.

Sharon Neufeld

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Opinion: New ways to treat depression in teenagers

ljm67 — Wed, 08 Mar 2017 12:34:57 +0000

Around one in 20 teenagers suffers from depression. Episodes can last for several months. Unfortunately, about 50% of teenagers who have a depressive episode are at risk of falling ill again, increasing the likelihood of relationship difficulties, educational failure and poor employment prospects. It’s important that treatments have a lasting effect to reduce the risk of becoming ill a second time.

My research investigates the causes of and treatments for adolescent mental illnesses, with a particular focus on depression. One of our key projects is evaluating the importance of various psychological treatments that are effective in helping young people with depression.

Only one treatment – cognitive behavioural therapy (CBT) – is approved by the UK’s National Institute for Health and Care Excellence (NICE) for treating depression in teenagers. Unfortunately, there is a shortage of CBT therapists in the UK. This means that many young people with depression are placed on a waiting list, increasing their risk of worsening mental health.

With a growing rate of self-harm among depressed teenagers and no signs of the suicide rate going down, we have arguably reached a tipping point in services where we need to improve availability of therapies using existing mental health staff. With limited resources available for youth mental health in most countries, we need new therapeutic approaches that could be taught more easily than CBT but carry at least the same effectiveness for the depressed teenager.

Our “Improving mood with psychoanalytic and cognitive therapies” (IMPACT) study published in ̽��ֱ��Lancet Psychiatry considered three treatments: cognitive behavioural therapy (CBT), short-term psychoanalytic psychotherapy (STPP) and brief psycho-social intervention (BPI).

CBT in this trial was a 20-session treatment focused on correcting negative thinking about the self, the world and the future, together with efforts to alleviate low mood arising from negative thoughts. STPP is a 28-session psychoanalytic treatment that aims to improve the ability to regulate mood and make and maintain positive relationships. BPI, in contrast, is a 12-session intervention that aims to provide information and explanations about depression, advising on immediate problems including keeping safe at this time of vulnerability, together with caring and support in making decisions about family school and friends.

There is good evidence that CBT works in adolescents. There is evidence that STPP is as good as CBT in adults, but, at the start of the trial we did not know if it worked for adolescents. We used BPI as a reference treatment, likely to be less effective than CBT or STPP because it uses fewer sessions and there is no evidence for or against its effectiveness.

We carried out a randomised controlled trial of 465 teenagers, referred to 15 NHS clinics across England. Each participant had a diagnosis of depression. We wanted to know if STPP is as effective as CBT. We also expected that both of these more intensive and specialist therapies would be more effective than BPI.

Our main goal was to find out which of these therapies showed the most enduring effects a year after the end of treatment. If we could show such a long-term effect we may have revealed a therapy that is not only a useful treatment but, importantly, also reduces the chances of a second episode occurring – something which is very common in teenage years.

There is no sign of the suicide rate going down. SpeedKingz/Shutterstock.com

More to choose from

We found that two-thirds of the depressed teenagers from each of the three treatments (CBT, STPP, BPI) showed improvements. Participants who responded continued to do so up to a year after their treatment ended.

Treatment effects (defined as a drop in depression symptoms of 50% or more, 12 months after the end of treatment) were obtained with between six to eleven sessions of therapy delivered over a three to six-month period for each category. These improvements were had using about half of the sessions planned for each treatment. We believe that many teenagers do not remain in longer-term treatments once they are confident they are functioning reasonably normally again or because they believe there is little likelihood therapy will do them any good.

We are currently analysing detailed information from the patients to understand their experience of treatment and confirm our speculations about the preference for shorter than planned therapy.

̽��ֱ��total costs of treatment, including the subsequent use of health and social services after the end of treatment, were no different across the three therapies. ̽��ֱ��results are important as there is a limited choice of talking therapies. ̽��ֱ��fact that all three therapies are equally effective, and cost about the same to implement, means that we can now offer alternatives to depressed young people.

̽��ֱ��next step is to see how we can target these treatments more precisely to patients’ needs as we suspect that there are important individual differences in determining which psychological treatment suits each type of depressed young person. We believe that each of these psychological treatments may have advantages for distinct groups of adolescent depression. Targeting the treatments in a more personalised manner may deliver more efficient and effective therapy and further reduce time to remission as well as lower the risk of further episodes.

Ian Michael Goodyer, , ̽��ֱ�� of Cambridge

This article was originally published on ̽��ֱ��Conversation. Read the original article.

Prime Minister Theresa May recently announced measures to improve mental health support at every stage of a person’s life, with an emphasis on early intervention for children and young people. Writing in ̽��ֱ��Conversation, Professor Ian Goodyer from the Department of Psychiatry looks at the options for helping teenagers.

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Teenagers who access mental health services see significant improvements, study shows

cjb250 — Wed, 18 Jan 2017 10:00:46 +0000

̽��ֱ��study, published in Lancet Psychiatry, found that 14-year-old adolescents who had contact with mental health services had a greater decrease in depressive symptoms than those with similar difficulties but without contact. By the age of 17, the odds of reporting clinical depression were more than seven times higher in individuals without contact than in service users who had been similarly depressed at baseline.

Researchers from the Department of Psychiatry recruited 1,238 14-year-old adolescents and their primary caregivers from secondary schools in Cambridgeshire, and followed them up at the age of 17. Their mental state and behaviour was assessed by trained researchers, while the teenagers self-reported their depressive symptoms. Of the participants, 126 (11%) had a current mental illness at start of the study – and only 48 (38%) of these had had contact with mental health services in the year prior to recruitment.

Contact with mental health services appeared to be of such value that after three years the levels of depressive symptoms of service users with a mental disorder were similar to those of 996 unaffected individuals.

“Mental illness can be a terrible burden on individuals, but our study shows clearly that if we intervene at an early stage, we can see potentially dramatic improvements in adolescents’ symptoms of depression and reduce the risk that they go on to develop severe depressive illness,” says Sharon Neufeld, first author of the study and a research associate at in the Department of Psychiatry.

̽��ֱ��Cambridge study is believed to be the first study in adolescents to support the role of contact with mental health services in improving mental health by late adolescence. Previous studies have reported that mental health service use has provided little or no benefit to adolescents, but the researchers argue that this may be because the design of those studies did not consider whether service users had a mental disorder or not. ̽��ֱ��approach taken on this new study enabled it to compare as closely as possible to present study statistically-balanced treated versus untreated individuals with a mental disorder a randomised control trial.

̽��ֱ��researchers say their study highlights the need to improve access to mental health services for children and adolescents. Figures published in 2015 show that NHS spending on children’s mental health services in the UK has fallen by 5.4% in real terms since 2010 to £41 million, despite an increase in demand. This has led to an increase in referrals and waiting times and an increase in severe cases that require longer stays in inpatient facilities.

On 9 January this year, the Prime Minister announced plans to transform the way we deal with mental illness in the UK at every stage of a person’s life – not just in our hospitals, but in our classrooms, at work and in our communities – adding: “This starts with ensuring that children and young people get the help and support they need and deserve – because we know that mental illness too often starts in childhood and that when left untreated, can blight lives, and become entrenched.”

Professor Ian Goodyer, who led the study, has cautiously welcomed the commitment from the Prime Minister and her Government. “ ̽��ֱ��emphasis going forward should be on early detection and intervention to help mentally-ill teens in schools, where there is now an evidence base for psychosocial intervention,” he says. “We need to ensure, however, that there is a clear pathway for training and supervision of school-based psychological workers and strong connections to NHS child and adolescent mental health services for those teens who will need additional help.

“As always, the devil is in the detail. ̽��ֱ��funding of services and how the effectiveness of intervention is monitored will be critical if we are to reduce mental illness risks over the adolescent years. With the right measures and school-based community infrastructure, I believe this can be achieved.”

̽��ֱ��research was funded by Wellcome and the National Institute for Health Research.

Reference
Neufeld, S et al. Reduction in adolescent depression after contact with mental health services: a longitudinal cohort study in the UK. Lancet Psychiatry; 10 Jan 2017; DOI: 10.1016/S2215-0366(17)30002-0

Young people with mental health problems who have contact with mental health services are significantly less likely to suffer from clinical depression later in their adolescence than those with equivalent difficulties who do not receive treatment, according to new research from the ̽��ֱ�� of Cambridge. This comes as Prime Minister Theresa May announced measures to improve mental health support at every stage of a person’s life, with an emphasis on early intervention for children and young people.

If we intervene at an early stage, we can see potentially dramatic improvements in adolescents’ symptoms of depression and reduce the risk that they go on to develop severe depressive illness

Sharon Neufeld

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Teenagers could see long-term benefits from new treatments for depression

cjb250 — Thu, 01 Dec 2016 11:30:34 +0000

Depression affects around one in twenty adolescents, causing considerable suffering and potentially affecting relationships and educational performance. Unfortunately, recurrence is likely in a half of all cases through into adult life and is associated with increasing personal difficulties and lower educational and employment prospects. However, it may be possible to reduce the risk of recurrence if a treatment for the condition shows enduring effects a year after the end of therapy.

Good evidence exists that psychological treatments are effective – around 70% of adolescents who receive treatment go into clinical remission – but there is very little evidence about whether these effects last. Currently, only cognitive behaviour therapy (CBT) has a sufficient evidence base to be offered on the NHS; CBT focuses on identifying the thoughts, feelings and actions that maintain depression, and then working collaboratively with the patient to change unhelpful thoughts and behaviours and thereby improve social functions.

“Depression can seriously impair people’s lives, and in many cases begins during their teenage years,” explains Professor Ian Goodyer from the Department of Psychiatry at the ̽��ֱ�� of Cambridge. “If we can tackle it early on, evidence suggests we can reduce the chances of severe depression returning. In our study, we wanted to see if in routine NHS clinical settings two new treatments would be as effective as CBT, and, importantly, if their effects of any would last beyond end of treatment.”

Professor Goodyer is part of the ‘Improving mood with psychoanalytic and cognitive therapies’ (IMPACT) research team, which carried out a randomised controlled trial of 465 adolescents referred to 15 NHS clinics across England who received a diagnosis of major depression. ̽��ֱ��team randomised the patients to receive one of three treatments: CBT, short term psychoanalytic therapy, or a brief psychosocial intervention. ̽��ֱ��therapies tended to last between six and 11 sessions, delivered over a 25-28 week period.

Brief Psychosocial Intervention is a brief active problem solving intervention for depression that focuses on improving and maintaining mental and physical hygiene, engaging in pleasurable activities, maintaining schoolwork and peer relations, and reducing loneliness.

Short term psychoanalytic therapy, on the other hand, focuses on the patient’s preoccupations, memories, day-dreams, nocturnal dreams and subconscious drivers. ̽��ֱ��therapy aims to tackle these at an unconscious level and through the therapist-patient relationship.

̽��ֱ��researchers found that 70% of the adolescents in the study improved substantially in each of the therapy groups by end of treatment. Follow up over the next 12 months confirmed a continuing decline in depression symptoms – a 50% reduction by the end of the study, confirming non-clinical levels were sustained. Furthermore, for all three, the total cost of therapy and subsequent health service use was around the same amount.

Although it was not possible through this particular study to determine the extent to which improvement can be directly attributed to the treatments, the researchers say it demonstrates that these three different psychological therapies may each be employed in NHS child and adolescent mental health services with equal confidence. Furthermore all three can be delivered in 6-11 sessions over a seven month period and be expected to show sustained effects up to a year later. Importantly, although around 40% of the patients in each treatment arm received an antidepressant, this did not influence the effects of each psychological treatment when compared with each other.

“This is very promising and shows that at least two-thirds of teenagers may benefit from these psychiatric treatments, which in theory reduce the risk of recurrence,” says co-author Professor Peter Fonagy of the Anne Freud Centre and UCL. “Of course, this means that there are still a substantial proportion of teenagers who do not benefit and we need to understand why this should be the case and find appropriate treatments to help them, too.”

̽��ֱ��researchers believe it is possible that the different psychological treatments have advantages for specific types of adolescent depression, and targeting the treatments more precisely may deliver more efficient therapy and reduce time to remission.

“We currently have a limited arsenal of treatments, but the fact that all three therapies are equally effective – and cost the same to implement – means that we might now be able to offer alternatives,” adds Professor Goodyer. “These therapies are also relatively short, usually involving less than a dozen sessions. Together, these factors could be particularly helpful given that there are often long waiting times for referrals for CBT in the NHS.”

̽��ֱ��research was funded by the National Institute for Health Research (NIHR).

Reference
Goodyer, IM et al. Cognitive behavioural therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled superiority trial; Lancet Psychiatry; 30 Nov 2016; DOI: 10.1016/S2215-0366(16)30378-9

More than two-thirds of adolescents who suffer from depression could see long-term benefits from receiving one of three psychological treatments – of which only one is currently recommended on the NHS – according to research published today in ̽��ֱ��Lancet Psychiatry.

We currently have a limited arsenal of treatments, but the fact that all three therapies are equally effective – and cost the same to implement – means that we might now be able to offer alternatives

Ian Goodyer

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‘Map’ of teenage brain provides strong evidence of link between serious antisocial behaviour and brain development

cjb250 — Wed, 15 Jun 2016 23:01:00 +0000

In a study published today in the Journal of Child Psychology and Psychiatry, researchers used magnetic resonance imaging (MRI) methods to look at the brain structure of male adolescents and young adults who had been diagnosed with conduct disorder – persistent behavioural problems including aggressive and destructive behaviour, lying and stealing, and for older children, weapon use or staying out all night.

In particular, the researchers looked at the coordinated development of different brain regions by studying whether they were similar or different in terms of thickness. Regions that develop at similar rates would be expected to show similar patterns of cortical thickness, for example.

“There’s evidence already of differences in the brains of individuals with serious behavioural problems, but this is often simplistic and only focused on regions such as the amygdala, which we know is important for emotional behaviour,” explains Dr Luca Passamonti from the Department of Clinical Neurosciences at the ̽��ֱ�� of Cambridge. “But conduct disorder is a complex behavioural disorder, so likewise we would expect the changes to be more complex in nature and to potentially involve other brain regions.”

In a study funded by the Wellcome Trust and the Medical Research Council, researchers at the ̽��ֱ�� of Cambridge recruited 58 male adolescents and young adults with conduct disorder and 25 typically-developing controls, all aged between 16 and 21 years. ̽��ֱ��researchers divided the individuals with conduct disorder according to whether they displayed childhood-onset conduct disorder or adolescent-onset conduct disorder.

̽��ֱ��team found that youths with childhood-onset conduct disorder (sometimes termed ‘early-starters’) showed a strikingly higher number of significant correlations in thickness between regions relative to the controls. They believe this may reflect disruptions in the normal pattern of brain development in childhood or adolescence.

On the other hand, youths with adolescent-onset conduct disorder (‘late starters’) displayed fewer such correlations than the healthy individuals. ̽��ֱ��researchers believe this may reflect specific disruptions in the development of the brain during adolescence, for example to the ‘pruning’ of nerve cells or the connections (synapses) between them.

As the findings were particularly striking, the researchers sought to replicate their findings in an independent sample of 37 individuals with conduct disorder and 32 healthy controls, all male and aged 13-18 years, recruited at the ̽��ֱ�� of Southampton; they were able to confirm their findings, adding to the robustness of the study.

“ ̽��ֱ��differences that we see between healthy teenagers and those with both forms of conduct disorders show that most of the brain is involved, but particularly the frontal and temporal regions of the brain,” says Dr Graeme Fairchild, who is an Associate Professor in the Department of Psychology at the ̽��ֱ�� of Southampton. “This provides extremely compelling evidence that conduct disorder is a real psychiatric disorder and not, as some experts maintain, just an exaggerated form of teenage rebellion.

“These findings also show that there are important differences in the brain between those who develop problems early in childhood compared with those who only show behavioural problems in their teenage years. More research is now needed to investigate how to use these results to help these young people clinically and to examine the factors leading to this abnormal pattern of brain development, such as exposure to early adversity.”

“There’s never been any doubt that conditions such as Alzheimer’s disease are diseases of the brain because imaging allows us to see clearly how it eats away at the brain,” adds Professor Nicola Toschi from the ̽��ֱ�� “Tor Vergata” of Rome, “but until now we haven’t been able to see the clear – and widespread – structural differences in the brains of youths with conduct disorder.”

Although the findings point to the importance of the brain in explaining the development of conduct disorder, it is not clear how the structural differences arise and whether, for example, it is a mixture of an individual’s genetic make-up and the environment in which they are raised that causes the changes. However, the researchers say their findings may make it possible to monitor objectively the effectiveness of interventions.

“Now that we have a way of imaging the whole brain and providing a ‘map’ of conduct disorder, we may in future be able to see whether the changes we have observed in this study are reversible if early interventions or psychological therapies are provided,” says Professor Ian Goodyer from the Department of Psychiatry at the ̽��ֱ�� of Cambridge.

Reference
Fairchild, G et al. Mapping the structural organization of the brain in conduct disorder: replication of findings in two independent samples. Journal of Child Psychology and Psychiatry; 16 June 2016 DOI: 10.1111/jcpp.12581

̽��ֱ��brains of teenagers with serious antisocial behaviour problems differ significantly in structure to those of their peers, providing the clearest evidence to date that their behaviour stems from changes in brain development in early life, according to new research led by the ̽��ֱ�� of Cambridge and the ̽��ֱ�� of Southampton, in collaboration with the ̽��ֱ�� of Rome “Tor Vergata” in Italy.

Conduct disorder is a complex behavioural disorder, so we would expect the changes to be more complex in nature and to potentially involve other brain regions.

Luca Passamonti

Nicola Toschi

̽��ֱ��orbitofrontal cortex (blue) and medial temporal cortex (red) were more similar in terms of thickness in youths with Conduct Disorder than in typically-developing youths, suggesting that the normal pattern of brain development is disrupted.

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Support from family and friends important to help prevent depression in teenagers

cjb250 — Fri, 20 May 2016 07:19:46 +0000

Adolescence is a key time in an individual’s development, and is a period where some teenagers begin to show signs of major depression. One of the major risk factors for depression in adolescence is childhood family adversity, such as poor parenting and lack of affection, emotional, physical or sexual abuse, family financial problems or the loss of a family member. Another major risk factor for depression is bullying by peers – and the combined experience of childhood family adversity and peer bullying is associated with increased severity of depression symptoms.

Studies suggest that friendships and supportive family environments may help protect adolescents from depression if they have experienced peer bullying and childhood family adversity. However, no study has simultaneously examined the complex interplay of early life adversity, bullying, family support and friendships on later adolescent depression.

Researchers at the Department of Psychiatry at the ̽��ֱ�� of Cambridge studied almost 800 teenagers (322 boys and 449 girls), and used mathematical modelling to examine the impact of friendships and family support at age 14 on depressive symptoms at age 17 in adolescents who had previously experienced childhood family adversity and primary school bullying.

“Teenage years can be difficult for everyone, but we found that this is particularly the case for those teens who have had a difficult family environment,” explains Dr Anne-Laura van Harmelen, the study’s first author. “Adolescents who had experienced negative family environments are more likely to be bullied at school, and less likely to receive family support in adolescence. We also found that children who were bullied in primary school were less likely to have supportive friendships in adolescence.

“In fact, we found a strong relationship between having a negative family environment and being bullied at primary school. This puts teens at a double disadvantage and means they are more likely to experience more severe symptoms of depression in their late teens.”

Boys who had been bullied were less likely than girls to develop strong friendships in adolescence, which the researchers suggest may be because boys experienced more severe bullying or were more sensitive to bullying.

Crucially, the researchers also found that supportive family or friends in early adolescence could help reduce depressive symptoms in later teenage years. It is not clear from the results how social support influences later life mental health. However, the researchers suggest several possibilities, including that supportive friends and family environments may help enhance children’s ability to cope with adverse situations by improving their self-esteem and offering stress-relief and through helping them develop effective interpersonal skills.

“Our work really shows how important it is that children and teenagers have strong support from their family and friends, particularly if their childhood has been a difficult one,” adds Professor Ian Goodyer, senior author. “It also suggests a role for interventions such as helping parents in at-risk families develop their parenting and support skills or helping bullied teens build their confidence and social skills to help find and maintain friendships.”

̽��ֱ��research was funded primarily by the Wellcome Trust and the Netherlands Organization for Scientific Research.

Reference
Van Harmelen, AL et al. Friendships and Family Support Reduce Subsequent Depressive Symptoms in At-Risk Adolescents. PLOS ONE; 4 May 2016; DOI: 10.1371/journal.pone.0153715

̽��ֱ��importance of friendships and family support in helping prevent depression among teenagers has been highlighted in research from the ̽��ֱ�� of Cambridge. ̽��ֱ��study, published in the open access journal PLOS ONE, also found that teenagers who had grown up in a difficult family environment were more likely than their peers to be bullied at school.

Teenage years can be difficult for everyone, but we found that this is particularly the case for those teens who have had a difficult family environment

Anne-Laura van Harmelen

Michael Coghlan

Zoe and Friend

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Use of TV, internet and computer games associated with poorer GCSE grades

cjb250 — Fri, 04 Sep 2015 07:00:21 +0000

In a study published today in the open access International Journal of Behavioral Nutrition and Physical Activity, researchers also found that pupils doing an extra hour of daily homework and reading performed significantly better than their peers. However, the level of physical activity had no effect on academic performance.

̽��ֱ��link between physical activity and health is well established, but its link with academic achievement is not yet well understood. Similarly, although greater levels of sedentary behaviour – for example, watching TV or reading – have been linked to poorer physical health, the connection to academic achievement is also unclear.

To look at the relationship between physical activity, sedentary behaviours and academic achievement, a team of researchers led by the Medical Research Council (MRC) Epidemiology Unit at the ̽��ֱ�� of Cambridge studied 845 pupils from secondary schools in Cambridgeshire and Suffolk, measuring levels of activity and sedentary behaviour at age 14.5 years and then comparing this to their performance in their GCSEs the following year. This data was from the ROOTS study, a large longitudinal study assessing health and wellbeing during adolescence led by Professor Ian Goodyer at the Developmental Psychiatry Section, Department of Psychiatry, ̽��ֱ�� of Cambridge.

̽��ֱ��researchers measured objective levels of activity and time spent sitting, through a combination of heart rate and movement sensing. Additionally the researchers used self-reported measures to assess screen time (the time spent watching TV, using the internet and playing computer games) and time spent doing homework, and reading for pleasure.

̽��ֱ��team found that screen time was associated with total GCSE points achieved. Each additional hour per day of time spent in front of the TV or online at age 14.5 years was associated with 9.3 fewer GCSE points at age 16 years – the equivalent to two grades in one subject (for example from a B to a D) or one grade in each of two subjects, for example. Two extra hours was associated with 18 fewer points at GCSE.

Screen time and time spent reading or doing homework were independently associated with academic performance, suggesting that even if participants do a lot of reading and homework, watching TV or online activity still damages their academic performance.

̽��ֱ��researchers found no significant association between moderate to vigorous physical activity and academic performance, though this contradicts a recent study which found a beneficial effect in some academic subjects. However, both studies conclude that engaging in physical activity does not damage a pupil’s academic performance. Given the wider health and social benefits of overall physical activity, the researchers argue that it remains a public health priority both in and out of school.

As well as looking at total screen time, the researchers analysed time spent in different screen activities. Although watching TV, playing computer games or being online were all associated with poorer grades, TV viewing was found to be the most detrimental.

As this was a prospective study – in other words, the researchers followed the pupils over time to determine how different behaviours affected their academic achievement – the researchers believe they can, with some caution, infer that increased screen time led to poorer academic performance.

“Spending more time in front of a screen appears to be linked to a poorer performance at GCSE,” says first author Dr Kirsten Corder from the Centre for Diet and Activity Research (CEDAR) in the MRC Epidemiology Unit at the ̽��ֱ�� of Cambridge. “We only measured this behaviour in Year 10, but this is likely to be a reliable snapshot of participants’ usual behaviour, so we can reasonably suggest that screen time may be damaging to a teenager’s grades. Further research is needed to confirm this effect conclusively, but parents who are concerned about their child’s GCSE grade might consider limiting his or her screen time.”

Unsurprisingly, the researchers found that teenagers who spent their sedentary time doing homework or reading scored better at GCSE: pupils doing an extra hour of daily homework and reading achieved on average 23.1 more GCSE points than their peers. However, pupils doing over four hours of reading or homework a day performed less well than their peers – the number of pupils in this category was relatively low (only 52 participants) and may include participants who are struggling at school, and therefore do a lot of homework but unfortunately perform badly in exams.

Dr Esther van Sluijs, also from CEDAR, adds: “We believe that programmes aimed at reducing screen time could have important benefits for teenagers’ exam grades, as well as their health. It is also encouraging that our results show that greater physical activity does not negatively affect exam results. As physical activity has many other benefits, efforts to promote physical activity throughout the day should still be a public health priority.”

̽��ֱ��research was mainly supported by the MRC and the UK Clinical Research Collaboration.

Reference
Corder, K et al. Revising on the run or studying on the sofa: Prospective associations between physical activity, sedentary behaviour, and exam results in British adolescents. International Journal of Behavioral Nutrition and Physical Activity; 4 Sept 2015.

Each extra hour per day spent watching TV, using the internet or playing computer games during Year 10 is associated with poorer grades at GCSE at age 16, according to research from the ̽��ֱ�� of Cambridge.

Parents who are concerned about their child’s GCSE grade might consider limiting his or her screen time

Kirsten Corder

Al Ibrahim

365.060 - Watching TV

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