News and media, October 2008

Murder rates by the mentally ill have fallen steadily
The number of murders committed by people with a mental illness has been falling steadily since the late 1970s, according to an analysis of official Home Office figures. Matthew Large and his colleagues, who made the observation in the British Journal of Psychiatry, said they believe the trend is likely due to improvements in treatment (tinyurl.com/5tphtt).

The researchers identified overall homicide rates in the UK between 1946 to 2004 and compared these with rates of homicide with a verdict of diminished responsibility, not guilty by reason of insanity, unfit to plead and infanticide(all legal categories pertaining to mental disorder, used by the researchers as an indication that the person who committed the homicide was mentally ill). Rates of homicide due to mental disorder rose between 1957 and 1979, as did homicides in general. However, since 1979 homicides due to mental disorder have fallen consistently while other homicides have continued to rise.

The fall has occurred despite the fact that there have been no changes to the official definitions of the defences to murder since the mid-1950s. Moreover, one would expect the improved detection of mental illness in more modern times to have inflated the rates of murder attributed to mental illness, not reduced them.

'The introduction and increasing use of antipsychotic medication, the greater awareness of the treatment of psychosis by primary care providers after deinstitutionalisation, and the creation of regional health authorities with responsibility for defined populations, may all have contributed to the observed decline in abnormal homicide since the 1970s,' the researchers wrote.

Dr Large told The Psychologist that he was surprised by how little media coverage his paper had received. 'The British Journal of Psychiatry issued a press release and it was covered in the BMJ, New Scientist and BBC Online – but no newspapers,' he said [although now see tinyurl.com/6a3xcn]. 'And yet I was in the UK recently for a month and murders by the mentally ill came up quite often. It seems to me this is proof positive that the press are more interested in one murder than the lack of 50–70 per year. I believe the undue attention on very rare events can drive bad treatment and policy and is a serious issue.' 

 

Neuroscience for spooks
The National Research Council in America has published a guide for spooks on how developments in cognitive neuroscience are likely to affect national security. Many of the highlighted areas will come as no surprise to our readers: cognitive enhancers, lie detection via brain imaging, brain–machine interfaces and artificial intelligence are all predicted to play a role in the next two decades.

More refreshing perhaps is the report's attention to the 'cultural underpinnings of neuroscience'. The report explains: 'There is a growing need these days to understand hearts and minds at a strategic level because of their potential to exacerbate insurgencies and other problems.' Later on, the report continues: 'Crosscultural comparative research can be pursued to test whether the brain function and human behavior assumed by European and American psychological models are universal.'

Several esteemed American psychologists were involved in drafting the report, including Michael Gazzaniga, Elizabeth Loftus and James Blascovich. 'We were quitea diverse group,' Professor Loftus told The Psychologist. 'In addition to psychologists, there were experts in pharmacology, medicine, molecular biology, human–machine interactions, brain imaging, and more. We were trying to anticipate where the world might be in the next 20 years. What could an enemy be capable of doing to us that we have not yet thought about, and how can we prepare ourselves to respond for the safety of our society.' 

The full report, Emerging Cognitive Neuroscience and Related Technologies, is available at tinyurl.com/5eyr6y.

 

Partners protect
Living with a partner could help reduce the risk of Alzheimer's disease, according to new epidemiological research. Speaking at the Alzheimer's Association Conference in Chicago, Krister Håkansson of the Karolinska Institute presented Finnish data on 2000 people first assessed when they were aged around 50 years. Participants who were married or living with a partner when first assessed, were 50 per cent less likely to have Alzheimer's when re-assessed 21 years later, than were the participants originally living alone. Risk was greatest among those participants left widowed before mid-life: they were six times more likely to have Alzheimer's at follow-up than participants who were married in mid-life.

 

Removing the barriers
A new campaign report by Age Concern has highlighted the problem of depression in older people, and the innovative projects psychologists are running in order to tackle it.

The report, Undiagnosed, Untreated, At Risk (see tinyurl.com/67k5h7), says that one in four older people – two million over the age of 65 – have symptoms of depression that are severe enough to warrant intervention. Half of this group have symptoms of clinical depression, the majority of which is undiagnosed and untreated.

Age Concern is proposing a three-point plan, which includes public awareness campaigns, working with GPs to raise awareness and challenge ageist attitudes, and pushing the government and NHS to 'remove the ageist barriers that prevent older people with depression from receiving effective treatment'.

The report also includes examples of good practice, including a project set up by Society member Dr Amanda Gatherer, Clinical Psychology Lead for North Warwickshire Primary Care Mental Health Team. The scheme uses peer support volunteers, who are in their fifties and sixties, to provide encouragement, support and hope of recovery to others.

Dr Gatherer told us: 'The project is particularly innovative in its use of older people as peer supporters. It is also an excellent example of partnership working between the voluntary sector and health:?volunteers have been recruited by Age Concern Warwickshire and the primary care mental health service has provided them with training in mental health first aid, awareness and in facilitating others to use self-help materials. The volunteers are attached to selected GP surgeries and primary care practitioners from whom they can receive referrals. Ongoing support, supervision and training is offered by both Age Concern and the Primary Care Mental Health Team.

'The project has recently gone live and the evaluation will focus on benefits to clients, peer supporters and to primary care staff. Once sufficient outcome data have been collated it is hoped that the service could be developed across the entire county, and could influence others in developing similar projects.'

 

Music to your ears
The simple act of listening to music can improve some aspects of our musical competence – formal tuition isn't needed. That's according to Henkjan Honing and colleagues at the University of Amsterdam who devised a web-based musical task (see tinyurl.com/5fh4en) that was completed by participants with a mixture of formal expertise levels and music listening habits. On each trial, participants had to say which of two performances of the same piece of jazz, rock or classical music was 'real', given that one of them had had its timing artificially altered to match the other. When it came to those judgments that the participants said they were 'sure' about, accuracy was related not to formal expertise, but rather to how often participants said they listened to that genre of music. 'It turns out that mere exposure makes an enormous contribution to how musical competence develops,' Honing said. The findings are in press at the Journal of Experimental Psychology: Human Performance and Perception.

 

Deep brain stimulation brings relief
Mention brain surgery in the same breath as mental illness and you evoke the shocking spectre of Moniz's lobotomies. And yet a new study suggests a modern-day neurosurgical intervention could offer a relatively safe treatment for the 10 to 20 per cent of depressed patients who don't benefit from conventional help.

Writing in the journal Biological Psychiatry (tinyurl.com/5gvygl), a team of Canadian neurosurgeons report how deep brain stimulation brought clinically significant relief to 20 patients diagnosed with major depression for whom psychotherapy, drugs and electroconvulsive therapy
had proven ineffective.

Andres Lozano at the University of Toronto and his colleagues inserted minute electrodes into the subcollosal cingulate gyrus of the patients. This brain region is typically overactive in depression andis known to have connections with many other depression-relevant areas, such as the amygdala, hippocampus and hypothalamus.

With echoes of Penfield, the precise location for deep brain stimulation was chosen by observing the effects of stimulation on patients during an initial operation, in terms of calmness and improved mood. Having identified the appropriate area, stimulation was applied constantly from then on, via an implanted generator, at a rate of 130hz.

A month after the electrodes had been transplanted, 35 per cent of the patients showed improvement, as judged by a 50 per cent reduction in their depression severity according to the Hamilton Depression Rating Scale. Bysix months, 60 per cent of patients showed this level of improvement, a benefit that was largely maintained at 12 months follow-up. There were some moderate medical complications in some patients, but no cognitive adverse effects whatever. 'These results, particularly in this treatment-resistant patient population, are striking,' the researchers said.

The precise mechanism by which the deep brain stimulation exerts its beneficial effects is unknown but is thought to involve a disruption of the pathological brain activity underlying depression. Brain imaging confirmed that the stimulation led to changes in neural activity downstream of the subcollosal cingulate gyrus.

As acknowledged by Lozano and his team, future work is now needed to establish the efficacy of this intervention using blind, controlled conditions. However, they point out that it's unlikely a placebo effect is responsible for the results. For example, the benefits were progressive over time (uncharacteristic for placebo). Moreover, in two patients for whom stimulation was, unbeknownst to them, temporarily discontinued (in one case this was planned, for the other it wasn't) depressive symptoms returned until stimulation was resumed.

 

Abortion and mental health
So long as it is her first abortion, a woman with an unwanted pregnancy who opts to have a first-trimester abortion is no more likely to experience mental health problems than other women who in similar circumstances decide to go through with the birth. That's one of the conclusions of the American Psychological Association Task Force report on abortion and mental health, published in August (tinyurl.com/6e9qfw).

The report's authors, led by Brenda Major of the University of California, said the evidence was more equivocal for women who have multiple abortions. However, in this case, it is likely that the same factors that led to the need for multiple abortions also increase the risk of mental health problems.

The task force came to its conclusions after reviewing all 50 English-language articles since 1989 that compared mental health outcomes for women having an abortion with similar women who went through with their births. The report also considered 23 articles that looked at factors affecting whether a woman having an abortion is likely to experience mental health problems. These factors were not unique to abortion, with a history of mental health problems being the most significant.

A small number of studies lookedat the case of women who abort a pregnancy that is unwanted due to fetal abnormalities. These found an increase risk of mental health problems on a par with the psychological impact of miscarrying a wanted pregnancy.

The report notes how few high-quality studies there are in this area and calls on more rigorously controlled studies to be conducted. It is a difficult area to research because there are multiple reasons why a woman might choose to have an abortion. Moreover, the same factors influencing her decision to have an abortion are also likely to play a causal role in any subsequent mental health problems.

However, even with better research, the report concludes: '[T]here is unlikely to be a single definitive research study that will determine the mental health implications of abortion "once and for all" as there is no "all", given the diversity and complexity of women and their circumstances.'

 

The sound of movement
Psychologists in California have documented a new form of synaesthesia – the neurological condition that leads people to experience a crossing over of the senses (tinyurl.com/69gddd). Whereas most synaesthetes experience colour associations with letters or pieces of music, Melissa Saenz and Christof Koch at Caltech have described four people who experience sounds – beeping, tapping or whirring – when they see movement or flashes.

Saenz and Koch didn't just take these synaesthetes' word for it. They compared their performance on a rhythmic comparison task (see tinyurl.com/6kt9zk) with that of 10 age-matched control subjects. The participants were presented with a stream of either visual flashes or auditory beeps and had to say whether a second stream, delivered via the same modality, was identical or not.

Both the synaesthetes and controls performed similarly when judging beeps, but the synaesthetes dramatically outperformed the controls when it came to the more difficult visual version of the task. This result is consistent with the idea that the synaesthetes were able to use the sounds they experienced during the flashes to help them with the task.

Writing in the journal Current Biology, the researchers said 'Further study could reveal whether hearing-motion synaesthesia represents an exaggerated form of normal interactions between auditory and visual systems and whether synaesthetic sound perception is associated with activation of the auditory cortex.' 

 

Eye movement at cross purposes
Psychologists testing an explanation for why eye movements can aid memory have found the technique could actually be detrimental to people who aren't strongly right-handed (tinyurl.com/66n5ka).

Previous studies have shown that moving the eyes from side to side before a memory test can aid free recall and recognition memory. A popular explanation is that the eye movements increase communication between the hemispheres.

Keith Lyle at the University of Louisville and colleagues reasoned that if this explanation is true, the eye-movement benefit should be larger among people whose baseline inter-hemispheric communication is lower. As past research has shown that right-handed people have less inter-hemispheric communication than left-handers, then it follows that they should benefit more from the eye-movement technique.

In two studies involving nearly 300 students, the researchers replicated the memory benefits of 30 seconds of eye movements for strong right-handers but found the technique was actually detrimental to left-handers and those not strongly right-handed, leading these participants to generate more false memories.

Writing in the journal Psychonomic Bulletin and Review, the researchers speculated that in the case of people who aren't strongly right-handed, and who therefore already have more inter-hemispheric communication, too much hemispheric cross-talk actually ends up being a bad thing, triggering activation of related but inappropriate information.

'For now we caution that, although eye movements may hold promise as a simple memory-enhancement technique for some individuals, they may prove detrimental for others,' they said.

 
Scanning the unexpected
If, after participating in a brain-imaging experiment, the researchers made no mention to you of any medical abnormalities in your scan, what would you conclude? It would be understandable if you got on with life, reassured that you'd been given a clean bill of cerebral health. This 'No news is good news' reaction seems sensible, and yet without a clear set of national guidelines on what brain researchers should do about so-called 'incidental findings', it could well  be the case that you weren't told the full story about your scan.

Let's be clear: it's almost certain you'd be told about any life-threatening anomalies for which there is a clear course of treatment. But for non-fatal cerebral peculiarities or even dangerous signs for which no treatment is available, it could be your local research institution's protocol to leave you in the dark.

Concern about incidental findings in scientific research – in the fields of genomics, as well as brain imaging – recently prompted the National Institutes of Health (NIH) in America to fund a multidisciplinary team of experts to study the ethics and practicalities of the issue. Led by Susan Wolf, McKnight Presidential Professor of Law, Medicine and Public Policy at the University of Minnesota, who describes the problem
of incidental findings as a 'ferocious tangle of science, medicine, and ethics', the panel convened a public conference in May last year. Now they've published their findings and recommendations in a special issue of the Journal of Law, Medicine and Ethics (tinyurl.com/5tnhzz).

The panel's literature review found widely varying occurrences of incidental findings in brain-imaging studies: from 13 per cent to 84 per cent depending on the study population, scanning protocol, and definition of incidental finding. However, rates of around 20 per cent are not uncommon in typical, asymptomatic populations (see, for example, tinyurl.com/6dxvnl and tinyurl.com/6a2d2t), and the report found that immediate referral is required up to 1.2 per cent of the time. As for how to deal with these cases when they arise, the panel have proposed a three-tiered decision-making process based on the likely net benefit to a participant of hearing about the incidental finding:
I    Abnormal findings that are unlikely to affect a participants' health should not be disclosed ('unlikely net benefit').
I    Non-fatal, yet serious, abnormalities should be disclosed, even if no health intervention would be possible, but not if the participant elected not to know ('possible net benefit').
I    Life-threatening and grave conditions should definitely be disclosed, unless the participant elected not to know ('strong net benefit').

Wolf and her colleagues further propose that:
I    research participants should be given examples of the kind of incidental findings that could be uncovered;
I    any such findings should go straight to the participant, not their GP;
I    ethics boards and funding councils need to address incidental findings in their protocols; and
I    more research be conducted on what impact the news of incidental findings has on research participants.

These recommendations are 'not unreasonable', according to Glyn Humphreys, Professor of Psychology and Scientific Director of Birmingham University Imaging Centre. 'I think people running research centres involved in work like ours that could turn up something like this should be aware of it as a possibility' Humphreys told us. 'It's a pretty rare event – I think we've had two in three years, during which we've run several thousand scans – but if something did come up, if we saw a tumor, for example, then we have to be geared up to respond.'

Birmingham's current protocol is to consult with the resident radiologist if anything suspicious is seen on a participant's scan. Based on a threshold similar to the 'strong net benefit' category of the new NIH recommendations, the radiologist then decides whether to contact the participant in an advisory capacity.

Dr Sarah-Jayne Blakemore, a psychologist at UCL's Institute of Cognitive Neuroscience, has spent 12 years conducting brain-imaging research with a particular focus on infants and adolescents. 'Whenever we complete a brain scan, there's always that moment of tension before we find out that the baby or adolescent is completely normal,' she said.

Blakemore further explained that it can be extremely difficult for the untrained eye to spot whether a structural brain abnormality is a cause for concern. 'You do see a lot of individual variance', she said. 'In other words, you see things that look abnormal but actually they're just in the normal range. I've only ever encountered one actual "incidental finding". That was several years ago and the man in question was told.'

'If we suspect something, the first thing we do is get a couple of clinicians– a radiologist and a neurologist – to have a look and then if they believe it is appropriate, we either tell the person they should contact their GP, or one of the clinicians would write to the GP,' Blakemore said.

Although Birmingham and UCL, and presumably other institutions around the UK, have their own local procedures for reporting incidental findings, both Humphreys and Blakemore told The Psychologist they would welcome a standardised set of guidelines, similar to those laid out by the NIH-funded panel.

'I do think it would be useful to have some clear, objective and universal guidelines' Blakemore said, 'because at the moment it's obvious that there's all sorts of arbitrariness.'

'I don't think it would do any harm to have a standard set of guidelines,' Humphreys agreed. 'At the moment itis done on a centre-by-centre basis, but I don't think there should be any problem setting it up nationally.'
 

Media

Decision time

Jon Sutton on the popular choice of psychology in the science press

During a short placement at New Scientist, I was once told that sales shot up every time they put the word 'quantum' on the cover: pretty much regardless of what word followed it. I would be interested to hear what happens now when they put something psychological on the cover:?there certainly seems to be a lot inside.

Take any issue, for example the 30 August one. There you will find autistic mice, how 'undecided' voters' true intentions could be revealed using the implicit association test, national happiness levels, the use of psychedelic drugs in PTSD treatment, a review of a book about mass hysteria and the dancing epidemic of 1518, and a fascinating article about decision making.
The latter piece, by Michael Bond, included plenty of colourful illustrations of the impact of emotional arousal on our decisions, from psychological research and 'real life'. For example, the number of people killed in road accidents in the US rose by around 1600 in the year following 9/11, as many unwisely chose to drive rather than take domestic flights.

As the article notes, 'statistics wither in the face of millennia of evolutionary adaptation.' So psychologist Paul Slovic says that we need to imbue statistics with more emotional significance. 'We learn how to deal with numbers from a young age as cold or abstract entities – to read them, add them, multiply them – but we don't learn to think about how they represent reality in a way that conveys feeling and meaning. We need to teach people to step away from their intuitive response, which is insensitive to magnitude, and think more carefully about what the numbers represent'.

The number of psychological items in such an important publication certainly add up to good news for psychology.  

 

The September issue of Prospect magazine features a freely available (see tinyurl.com/5rgxzs), hard-hitting debate on whether or not behavioural economics is all it's cracked up to be.

Standard economics sees peopleas selfish, rational decision makers. Traditional economic models predict that, provided people have the necessary information to hand, they will tend to choose those options that are in their own best interest. By contrast, behavioural economics is less psychologically naive, recognising that people are often far from rational, and are influenced by such human foibles as having a sense of fairness.

Behavioural economics is all the rage these days, not least because of the interest politicians like Barack Obama and David Cameron have started to show in the way its principles can be exploited to change people's behaviour – as advocated and explained in books like Nudge.

In this new Prospect debate, Pete Lunn (author of Basic Instincts: Human Nature and the New Economics) argues that behavioural economics will 'deliver a revolutionary new way of understanding the world.' In response Tim Harford (author of The Logic of Life) plays down the impact of behavioural economics, arguing that the field's lab studies rarely translate well into the messiness of the real world:

No doubt you are familiar with the laboratory work on how workers respond to wage offers. In one celebrated experiment, behavioural economists divided their subjects into 'employers' and 'workers'. They discovered that when the 'employers' paid unexpectedly generous 'wages', the 'workers' reciprocated by working unexpectedly hard.

It's a classic of the field. But the real world remains intractable. The economists John List and Uri Gneezy recently repeated the lab study in the field, advertising real jobs, hiring real workers and paying real hourly rates. They used a controlled trial to see what happened when workers were paid unexpectedly generous rates. And they discovered that the lab results were evanescent: after a couple of hours the gratitude evaporated and the workers slacked off, reverting to the rational self-interested behaviour described in those pesky textbooks. I would not advise personnel departments to rewrite salary scales on the basis of an effect that does not survive past lunch on day one.'

Behavioural economics and its advocates are so much the rage these days that I for one found Harford's scepticism refreshing. That said, he did seemly overly aggressive at times: 'You are too vague: arguing with you feels like trying to arm-wrestle a hologram' he tells Lunn, adding later: 'I realise it is tedious to be so specific, but your handwaving is getting us nowhere.' Still, if you like a lively debate, as I do, Harford's approach does juice things up nicely.