Acta Neuropsychiatrica

To provide a comprehensive review and evaluation of the psychological and neurophysiological literature pertaining to mindfulness meditation.

A search for papers in English was undertaken using PsycINFO (from 1804 onward), MedLine (from 1966 onward) and the Cochrane Library with the following search terms: Vipassana, Mindfulness, Meditation, Zen, Insight, EEG, ERP, fMRI, neuroimaging and intervention. In addition, retrieved papers and reports known to the authors were also reviewed for additional relevant literature.

Mindfulness-based therapeutic interventions appear to be effective in the treatment of depression, anxiety, psychosis, borderline personality disorder and suicidal/self-harm behaviour. Mindfulness meditation per se is effective in reducing substance use and recidivism rates in incarcerated populations but has not been specifically investigated in populations with psychiatric disorders. Electroencephalography research suggests increased alpha, theta and beta activity in frontal and posterior regions, some gamma band effects, with theta activity strongly related to level of experience of meditation; however, these findings have not been consistent. The few neuroimaging studies that have been conducted suggest volumetric and functional change in key brain regions.

Preliminary findings from treatment outcome studies provide support for the application of mindfulness-based interventions in the treatment of affective, anxiety and personality disorders. However, direct evidence for the effectiveness of mindfulness meditation per se in the treatment of psychiatric disorders is needed. Current neurophysiological and imaging research findings have identified neural changes in association with meditation and provide a potentially promising avenue for future research.

Long chain omega-3 polyunsaturated fatty acids (LCn-3PUFA) are in increasing use in the general population to treat health problems. The objective of the current article is to review the evidence for the rationale and benefit of LCn-3PUFA in the treatment of common psychiatric disorders in children and adolescents.

A search of Psychlit, PubMed and Cochrane Databases was conducted using the terms child, adolescent, bipolar, depression, psychosis, first-episode psychosis, schizophrenia, attention deficit hyperactivity disorder (ADHD), autism, psychiatric, omega-3, n-3, docosahexaenoic acid and eicosapentaenoic acid. Further studies were identified from the bibliographies of published reviews.

One small randomized controlled trial with LCn-3PUFA supplementation in depression in children found a small beneficial effect over placebo. Four placebo-controlled trials showed uncertain benefit of LCn-3PUFA for ADHD. Single placebo-controlled trials showed no benefit in autism or bipolar disorder. There is an absence of studies examining benefit for first-episode psychosis or schizophrenia in children and adolescents.

While children and adolescents are receiving LCn-3PUFA for a range of psychiatric indications, there is only evidence of likely benefit for unipolar depression.

In professional literature, mainly anecdotic descriptions can be found of striking, sometimes even bizarre manipulations of the appearance by psychiatric patients.

In this study, it was examined whether the inclination to (drastically) change the appearance is related to (pre)psychotic symptoms.

By means of a questionnaire, the frequency and nature of changing the appearance was studied among a sample of healthy volunteers (n = 38) and psychiatric patients (n = 61). The psychiatric group consisted of 1) patients with schizophrenia (n = 22), 2) patients with a borderline personality disorder (n = 20) and 3) patients with a depressive disorder (n = 19).

In accordance with previous findings, self-reports of drastic changes of appearance were associated with scores on various schizotypy scales. Psychiatric patients reported more changes of appearance, compared with healthy volunteers. Patients with schizophrenia reported most changes, followed by the group of patients with borderline personality disordered.

Perhaps, drastic changes of the appearance are a visible expression of the loss of ego boundaries and/or of the sense of reality.

There has been fairly consistent empirical support for the association between major depressive disorder and marital dissatisfaction. However, this evidence is limited mostly to out-patient and population-based samples. Further, the role of possible mediating factors such as attachment style and conflict communication are less well investigated in major depression.

The present study aims to investigate whether couples with a depressed partner and nonclinical couples differ in marital satisfaction, attachment style, psychological distress and conflict communication. Gender differences are also investigated.

Seventy-seven couples, who participated in a family intervention trial, were compared with 77 age- and gender-matched nonclinical couples.

The depressed patients reported more psychological distress and attachment difficulties and less marital satisfaction than their partners and the nonclinical couples. Partners perceived their relationship as more satisfying than the nonclinical couples. The clinical couples reported less mutual constructive and more mutual avoidant communication in their relationship compared with the nonclinical couples. Finally, female depressed patients reported higher levels of psychological symptoms and were more avoidant attached than male patients.

This study shows important differences in several individual and relational characteristics between couples with a depressed partner and nonclinical couples. Further research will be necessary to clarify whether the investigated psychosocial variables play a causal and/or a maintaining role in depression.

There are considerable data on the possible association between streptococcal infection and obsessive compulsive disorder (OCD), particularly the relation between Sydenham’s chorea (SC) and OCD. However, neuropsychiatric sequelae related to streptococcal infection are mainly reported in children. In this preliminary study, we examined prevalence of OCD in a group of adult subjects with established rheumatic heart disease (RHD). We hypothesized that the rate of OCD would be higher than the known general population rates.

One hundred adult subjects with RHD were evaluated for OCD and other comorbid psychiatric disorders using well-known psychiatric assessment tools. A qualified psychiatrist conducted the assessments. The diagnoses were made according to DSM-IV criteria.

The rate of clinical OCD and subclinical OCD was 10% and 3%, respectively (n = 13), a rate much higher than the 1–3% rate reported in general population. Of the 13 subjects, only three had a history of SC (23%).

OCD could be a long-term sequel in adults with a history of rheumatic fever in childhood, even in the absence of frank chorea. The findings call for systematic research in this little explored area.

Hallervorden-Spatz syndrome is characterized by pyramidal and extrapyramidal signs, and dysarthria and dementia. Psychiatric symptomatology can emerge in the course of the disorder. Mutations in the pantothenate kinase 2 gene have been found in many cases. We report a case with psychosis as sole presenting symptom.

A 41-year-old man presented with change in behavior and paranoid delusional ideation. Six months later, spasticity, extrapyramidal rigidity and dysarthria were added to the picture. Eventually, the patient became mute and wheel-chair bound. The brain magnetic resonance imaging (MRI) was consistent with iron depositions in the globus pallidus and substantia nigra.

In this case, the combination of clinical and MRI findings was consistent with Hallervorden-Spatz syndrome. The combination of psychiatric and MRI findings should lead to further neurological investigation.