Do Video Games Cause Violent Behavior? More Then 200 Academics Think Not

The APA recently released findings that stated there while there was not a “single” cause for aggression; violent video games can play a role. The APA set up a team to go over studies and papers that were published on the subject between 2005 and 2013.

The paper reports, “The research demonstrates a consistent relation between violent video game use and increases in aggressive behaviour, aggressive cognitions and aggressive affect, and decreases in pro-social behaviour, empathy and sensitivity to aggression.”

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The research for the paper was done primariliy though meta-analysis. It looked at the results of a number, hundreds, of studies and tried to find patterns and parallels. “While there is some variation among the individual studies, a strong and consistent general pattern has emerged from many years of research that provides confidence in our general conclusions,” said task force chairman Mark Appelbaum.

However, the research team’s findings have not been met with open arms. A group of more than 200 academics made up of “media scholars, psychologists and criminologists” have released an open letter to the APA opposing the findings. They suggest that the methodology of the study is inherently unsound. Much of the surveyed papers and studies that the APA used have not been peer reviewed, the open letter criticizes the methodology of the taskforce’s study and findings.

The notion that violent video games may cause aggression is a strongly contested one. It has historically been a scapegoat for violent behavior particularly in adolescents and teens. And while people don’t deny an effect of games, many deny the correlation between violent video games and outright violence:

“I fully acknowledge that exposure to repeated violence may have short-term effects – you would be a fool to deny that – but the long-term consequences of crime and actual violent behaviour, there is just no evidence linking violent video games with that,” says Dr Mark Coulson, one of the signatories of the letter told BBC. “If you play three hours of Call of Duty you might feel a little bit pumped, but you are not going to go out and mug someone.”

The rating system for video games can also be tricky. The US goes by the Entertainment Software Rating Board (ESRB) and begins with “eC” (Early Childhood) and progresses to “AO” (Adults 18+ Only). The rating system however has been controversial from the beginning with critics saying that the ESRB has gotten more lax on their “M” (Mature) rating and the games have gotten progressively more violent without receiving an AO rating.

In the letter to the APA the writers acknowledged that youth violence is currently “at a 40-year low” and that the “statistical data are simply not bearing out this concern and should not be ignored.”

The letter ends with a striking call for better data and research, “Policy statements based on inconsistent and weak evidence are bad policy and over the long run do more harm than good, hurting the credibility of the science of psychology.” With an overwhelming number of signatories, their message should not be ignored.

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Victims of childhood bullying at higher risk of cardiovascular disease in later life « King’s College London

bullying

People who experienced bullying in childhood are more likely to be overweight and show higher levels of blood inflammation in later life, finds new research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London. This puts them at higher risk of heart attack and various age-related conditions, including type-2 diabetes, according to the study authors. 

The findings are based on data from the British National Child Development Study (NCDS), a long-term study of all children born in England, Scotland and Wales during one week in 1958. The study, published today in Psychological Medicine, includes 7,102 children whose parents provided information on their child’s exposure to bullying when they were aged 7 and 11. Measures of blood inflammation and obesity were obtained from information and samples collected when participants were aged 45.


Professor Louise Arseneault
, senior author from the IoPPN at King’s College London, said: ‘Our research has already shown a link between childhood bullying and risk of mental health disorders in children, adolescents and adults, but this study is the first to widen the spectrum of adverse outcomes to include risks for cardiovascular disease at mid-life. Evidently, being bullied in childhood does get under your skin.’

Researchers found that 26 per cent of women who had been occasionally or frequently bullied in childhood were obese at the age of 45, compared to 19 per cent of those who had never been bullied. A second measure of abdominal fat was calculated by dividing waist measurements by hip size (waist-hip ratio). Both men and women who suffered childhood bullying showed greater waist-hip ratio at 45 years old than non-bullied participants. Findings remained significant when controlling for childhood risk factors including parental social class, participants’ BMI and psychopathology and also key adult variables such as social class, smoking, diet and exercise.

Frequent bullying in childhood also led to higher levels of inflammation at mid-life in men and women. Researchers found that 20 per cent of those who had been frequently bullied, compared to 16 per cent of those who had never been bullied, had C-reactive protein (CRP) levels of more than 3mg/L. High CRP levels increase risk of heart disease by promoting atherosclerosis, a condition where arteries become clogged up by fatty substances. Those who were frequently bullied in childhood also had raised levels of fibrinogen, a protein which promotes the formation of blood clots.

Bullying is characterised by repeated hurtful actions by other children, where the victim finds it difficult to defend themselves. In the NCDS, 28 per cent of participants were bullied occasionally in childhood and 15 per cent were bullied frequently. These figures are consistent with prevalence rates of childhood bullying victimisation today.

Professor Louise Arseneault said: ‘Bullying is a part of growing up for many children from all social groups. While many important school programmes focus on preventing bullying behaviours, we tend to neglect the victims and their suffering. Our study implies that early interventions in support of the bullied children could not only limit psychological distress but also reduce physical health problems in adulthood.’

Dr Andrea Danese, a co-author from the IoPPN at King’s, said: ‘Taking steps to tackle obesity and high blood inflammation is important because both can lead to serious and potentially life-threatening conditions, such as type-2 diabetes and cardiovascular disease.

‘The effects of being bullied in childhood on the risk for developing poor health later in life are relatively small compared to other factors. However, because obesity and bullying are quite common these days, tackling these effects may have a real impact.’

He added: ‘The main focus of prevention for age-related disease has traditionally been on unhealthy adult behaviours, such as smoking, physical inactivity, and poor diet. These are clearly important but our research highlights the need to trace the roots of these lifelong risk trajectories back to psychosocial experiences in childhood.’

This research was funded by the British Academy and the Royal Society.

via King’s College London –Victims of childhood bullying at higher risk of cardiovascular disease in later life

The full paper, published in Psychological Medicine, “Bullying victimization in childhood predicts inflammation and obesity at mid-life: a five-decade birth cohort study” by  R. Takizawa, A. Danese, B. Maughan and L. Arseneault is can be viewed here free of charge until 15th July 2015 .

 

Cardiovascular risk factors extremely high in people with psychosis « King’s College London

Extremely high levels of cardiovascular risk factors have been found in people with established psychosis, with central obesity evident in over 80 per cent of participants, in a study by researchers from the NIHR Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust (SLaM) and King’s College London.

In the largest study of its kind in the UK, drawing on a sample of more than 400 outpatients with psychosis, it was discovered that nearly half of the sample were obese (48 per cent), with a body mass index (BMI) of 30 or more. Additionally, nearly all women and most men had a waist circumference above the International Diabetes Federation’s (IDF) threshold for central obesity. According to this measure 83 per cent of patients were centrally obese: 95 per cent of females and 74 per cent of males. Central obesity refers to excessive fat around the stomach and abdomen, to the extent that it is likely to have a negative impact on health.

The majority of participants tested (57 per cent) met the IDF’s criteria for metabolic syndrome, which is a cluster of biochemical and physiological abnormalities associated with the development of heart disease, stroke and type-2 diabetes. A fifth met the criteria for diabetes and 30 per cent showed a higher risk of going on to develop diabetes.

Although cardiovascular risk factors are common in psychosis, this UK study reports some of the highest rates worldwide, reinforcing the need to incorporate weight and cardiovascular risk assessment and management into the routine care of people with psychosis.

Data was collected as part of the NIHR-funded IMPaCT trial and the study took place within community mental health teams in five mental health NHS Trusts in urban and rural locations across England.

The study, published in Psychological Medicine, also identified lifestyle choices likely to add to cardiovascular risk, with 62 per cent of the sample reported to be smokers, greatly in excess of the general UK population smoking rates of 20 per cent. Lack of exercise was also commonplace, with only 12 per cent of participants engaging in high intensity physical activity.

Dr Fiona Gaughran, senior author from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, and the National Psychosis Unit at SLaM, said: ‘We already know that diagnosis of a psychotic illness such as schizophrenia or bipolar disorder is associated with a reduced life expectancy of between 10 to 25 years. This mortality gap is largely due to natural causes, including cardiac disease. The worryingly high levels of cardiovascular risk shown in our study indicate that a much greater emphasis on physical activity is needed for those with severe mental illnesses, as well as a more significant focus on supporting attempts to quit smoking.

‘While previous research has demonstrated that people gain weight on starting anti-psychotics, our study of people who have had psychosis for nearly 16 years on average found no difference in the rates of cardiovascular risk between the various different anti-psychotic medications. Research is urgently needed into the best ways to reduce existing cardiovascular risk in people with psychosis, prevent weight gain and promote healthy lifestyles in the early stages of the illness.’

The research paper summarises independent research funded by the National Institute for Health Research (NIHR) under its IMPaCT Programme Grant (Reference Number RP-PG-0606-1049).

via King’s College London –Cardiovascular risk factors extremely high in people with psychosis

 

The full paper, published in Psychological Medicine, “Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial” by P. Gardner-Sood, J. Lally, S. Smith et al. is published open access and can be viewed here.

Psychotic symptoms in frontotemporal dementia: a diagnostic dilemma?

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The April International Psychogeriatrics Article of the Month is entitled “Psychotic symptoms in frontotemporal dementia: a diagnostic dilemma?” by Maria Landqvist Waldö, Lars Gustafson, Ulla Passant and Elisabet Englund.

Despite all attempts to develop clinical diagnostic criteria with high specificity and sensitivity early diagnosis in FTD remains a challenge, even for the experienced clinician. The patients may present with a wide range of symptoms that often mimic other psychiatric disorders and initial psychiatric diagnoses are common. Psychotic symptoms are known to be prominent symptoms in several neurodegenerative diseases including AD and DLB, and have previously been thought to be quite rare in FTD. There are indications that a high prevalence of psychotic symptoms seems to be associated with specific molecular and genetic subgroups of FTD, but as this has not been adequately studied we examined prevalence of psychotic symptoms and possible correlations to brain pathology in FTD. Furthermore we evaluated clinical diagnostic accuracy as well as family history in our cohort of 97 neuropathologically diagnosed FTD cases.

We found that psychotic symptoms were present at some time during the course of dementia in 32% of our cases. There were no significant differences in gender, age at onset or disease duration between patients with and without psychotic symptoms. The most common type of psychotic symptoms was paranoid ideas (20.6%) followed by hallucinations and delusions (17.5%) in equal measure. There was a strong significant correlation between psychotic symptoms and predominantly right-sided brain degeneration.

We could see a trend with more frequent psychotic symptoms in tau-negative cases, however not statistically significant. Psychotic symptoms were particularly common in the cases with FUS pathology and in those without identified brain protein pathology.

The majority of patients received other first diagnoses than FTD, often psychiatric diagnoses. The patients with an initial psychiatric diagnosis were significantly younger than patients with other first diagnoses. About 80% patients where subsequently diagnosed with FTD and among these the median time from symptom onset until diagnosis was 4 years with median disease duration of 7.5 years, however with large variations. A clinical diagnosis of psychosis was almost exclusively given to tau-negative cases.

This is one of the largest studies aimed at assessing the prevalence of psychotic symptoms in FTD and relating them to neuropathology. Compared to many other studies we found a higher prevalence of psychotic symptoms. A correlation between psychotic symptoms and right-sided predominant pathology has been suggested earlier, but to our knowledge never shown in such a large neuropathological study. Although previous studies have found differences in the prevalence of psychotic symptoms between tau-positive and tau-negative cases, we did not find any significant differences between the groups. We identified two groups with particular high prevalence of psychotic symptoms: the FUS pathology cases and those with no identified protein pathology. Our FUS cases share many features with previous reports of this specific group such as young age at onset, no heredity for dementia and prominent neuropsychiatric symptoms. Interestingly, the cases from the group without specific protein pathology also display prominent psychiatric symptoms.

Read the full paper “Psychotic symptoms in frontotemporal dementia: a diagnostic dilemma” by Maria Landqvist Waldö, Lars Gustafson, Ulla Passant and Elisabet Englund

Read the commentary paper “Commentary on:  in frontotemporal dementia: a diagnostic dilemma?” by John T. O’Brien

Dodo bird verdict given new life by psychosis therapy study | The University of Manchester

alice and the dodo- shutterstock_75202624
A study by researchers at The University of Manchester and the University of Liverpool has examined the psychological treatment of more than 300 people suffering from psychosis, showing that, whatever the therapy, it is the relationship between the patient and therapist which either improves or damages wellbeing.

The research relates to one of the more controversial ideas in psychotherapy research – the Dodo bird conjecture.  Named after a bird in Alice’s Adventures in Wonderland which sent several characters on a race and then declared them all winners, this conjecture states that all types of psychotherapy, even though often appearing to be very different from each other, are equally beneficial to patients.

In this case, the research showed that it is the quality of the relationship between the therapist and patient which causes improvement and not the different techniques employed in the two therapies that were compared.

Many studies have looked at types of talking treatment which can help people recover from psychotic episodes.  These include cognitive behavioural therapy (CBT) and family therapy. High quality research uses a comparison group which also receives some kind of less structured treatment, for example supportive counselling or befriending.

Surprisingly, patients in these comparison groups often benefit from the comparison treatment as much as those receiving the specific, targeted therapies (CBT or family therapy). Both groups who receive a psychosocial treatment fare much better than those offered only medication and usual care.

The researchers explored in depth the causative effect of the ‘therapeutic alliance’ or relationship of trust between patient and psychologist when schizophrenia patients were treated during a trial of this kind.

Lucy Goldsmith, a PhD candidate from The University of Manchester’s Institute of Brain, Behaviour and Mental Health, carried out the research in collaboration with the researchers who had carried out the original trial: Manchester professors Shôn Lewis and Graham Dunn, and Liverpool professor Richard Bentall. She said: “The quality of the therapeutic relationship has been linked to outcomes before, but we wanted to see whether the it really causes the changes in wellbeing occurring during therapy.

“Does successful treatment make patients feel well disposed towards their therapist or is the relationship actually at the heart of whether therapy succeeds?”

By using already established rating systems of these relationships and taking data from the earlier study of 308 patients, the researchers found that a good level of therapeutic alliance had a beneficial impact on wellbeing, but where the relationship was poor, the treatment could actually be damaging.

“The implications are that trying to keep patients in therapy when the relationship is poor is not appropriate,” Lucy said.  “More effort should be made to build strong, trusting and respectful relationships, but if this isn’t working, then the therapy can be detrimental to the patient and should be discontinued.

“The study clearly shows that the two types of therapy are equally beneficial to the patient – as long as the trust, shared goals and mutual respect between client and psychologist are in place.”

The paper, ‘Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis,’ was published in the journal, Psychological Medicine.

via Dodo bird verdict given new life by psychosis therapy study | The University of Manchester.

The paper, “Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis” has been published gold Open Access, and can be found using this link. 

 

A positive attitude to ageing

 

Lothian cohort corrected

The September International Psychogeriatrics Article of the Month is entitled ‘Life course influences of physical and cognitive function and personality on attitudes to aging in the Lothian Birth Cohort 1936’ by Susan D. Shenkin, Ken Laidlaw, Mike Allerhand, Gillian E. Mead, John M. Star and Ian J. Deary.

 

The population is ageing, with the proportion of people worldwide aged over 60 rising from 8% in 1950, to 10% in 2000 and 21% in 2050 1. This has led to widespread concern about the negative impact this may have on society. We were interested in exploring whether older people themselves share this negative view of ageing, or whether they might have a more positive outlook. We were also interested to explore what factors throughout their life predicted their attitudes to ageing.

We were able to do this using a group of people who have had detailed information collected about them throughout their life, and asking them to complete (another!) questionnaire. This freely available questionnaire 2 has been widely used to assess the experience and attitudes of older people themselves to ageing. It includes questions in three main areas called Psychosocial Loss (e.g. “Old age is a time of loneliness”), Physical Change (e.g. “I don’t feel old”), and Psychological Growth (e.g. “Wisdom comes with age”), which people scored from ‘strongly disagree’ to ‘strongly agree’.

The group of people who completed the questionnaire were the Lothian Birth Cohort 1936 3. These are people born in 1936 who sat a nationwide test of intelligence when they were aged 11, and have gone on to provide very detailed information about their life, including their health and cognition now they are older.

We found that these people (aged around 75, 51.4% male) were generally positive about the three aspects of ageing. When we explored what predicted these attitudes, we were surprised to find that their social background, IQ test scores and physical health didn’t relate very much to their attitudes. In general, the strongest predictors of their attitudes to ageing was their personality. Personality type is determined by a questionnaire 4.

Psychosocial loss (e.g. “I feel excluded from things” was more common in people with personalities stronger on Neuroticism, and lower on Extraversion, Openness, Agreeableness and Conscientiousness, but also people with higher scores on a questionnaire assessing anxiety and depression, and people with more physical disability.

Physical Change (e.g. “My health is better than I expected”) was predicted by people with personality types of Extraversion, Openness, Agreeableness and Conscientiousness, but also females, social class and less physical disability.

Psychological growth (e.g. “I am more accepting of myself”) was associated with similar personality types, but surprisingly a less affluent environment, living alone, lower prior cognitive ability and slower walking speed.

In general, in this group of relatively healthy volunteers in Scotland aged around 75 we found a positive attitude to ageing. These attitudes were mostly associated with personality type, but social circumstances, physical health and mood also played a role. It will be interesting to explore whether attitudes are similar or different in other groups e.g. in people with poorer physical or mental health, in different countries etc. An intriguing possibility is whether influencing people’s attitudes is possible, and might result in changes to mood or physical health. However, it is clear that we should all share a more positive view of our ageing society.

 

The full paper “Life course influences of physical and cognitive function and personality on attitudes to aging in the Lothian Birth Cohort 1936” is available free of charge for a limited time here.

The commentary on the paper, “Positive attitudes on aging: a life course view” is also available free of charge for a limited time here.

 

References

1) http://www.un.org/esa/population/publications/worldageing19502050/

2) Attitudes to Ageing Questionnaire – AAQ (Laidlaw, K., Power, M. J. and Schmidt, S. (2007). The Attitudes to Ageing Questionnaire (AAQ): development and psychometric properties. International Journal of Geriatric Psychiatry, 22, 367–379

3) http://www.lothianbirthcohort.ed.ac.uk/index.php?option=com_content&view=article&id=7&Itemid=2 and Deary, I. J., Gow, A. J., Pattie, A., & Starr, J. M. (2011). Cohort Profile: The Lothian Birth Cohorts of 1921 and 1936. International Journal of Epidemiology. doi: 10.1093/ije/dyr197

4) (NEO-FFI: Costa, P. T. and McCrae, R. R. (1992). NEO PI-R and Professional Manual (Revised NEO Personality Inventory and NEO Five-Factor Inventory). Odessa, FL: Psychological Assessment Resources).

 

Image: ““Lothian Birth Cohort 1936 at a reunion in Edinburgh, 2007.  Credit: Douglas Robertson/Age UK”

www.lothianbirthcohort.ed.ac.uk

Photographers website: www.douglasinscotland.co.uk

 

Good days and bad days in dementia

Jul14 blog pic - Hiscox

The August International Psychogeriatrics Article of the Month is entitled ‘Good days and bad days in dementia: a qualitative chart review of variable symptom expression’ by Kenneth Rockwood, Sherri Fay, Laura Hamilton, Elyse Ross and Paige Moorhouse.

Anyone who works with people with dementia is bound to experience poignant moments. Especially striking is hearing that a person seemingly lost to permanent unknowing – even near muteness – suddenly spoke a full sentence, or sometimes more. Much more common, but still compelling, are reports of people with dementia having remarkably good or bad days.

In what does daily variability consist? For some years, that question has motivated our group. In a paper in this month’s issue, we report the findings of a clinical chart review spanning 30 months, to understand how patients and families experienced variability living with dementia from day to day. This line of inquiry was born from the realization that, for many patients and families, variability was a source of expectations – and often disappointments. Families asked questions that I couldn’t answer: “why can he be so helpful some days, and other days can’t even do for himself?” Often, they had answers as good as anything I could muster: “it’s best if he has a good night’s sleep”, or “I can tell if he’s missed his medications”.

The challenge is to understand the mechanisms of variability. To get there, we need to know just what is happening, and for that we need careful qualitative studies. The area is tricky, because variability threatens reliability, and that undermines measurement, which undermines understanding. Or so the argument goes. Progress however, obliges investigating the variability itself – as is being done in Lewy body dementia – and not just seeking ways to reduce it for testing purposes.

Our study offers some clues. For an important proportion of patients, variability occurs within the same symptom set: a good day is when the symptom is seen less, and a bad day when it occurs more. This makes fluctuation in specific neurochemical transmission seem likely. That some are implicated more than others is suggested by the patterns: most of these symptoms involve social conduct and engagement; other descriptions sound like attentional problems. For a second group of dementia symptoms, a bad day is marked by even a single occurrence of a bad problem: not being struck does not constitute a good day, even if being struck means a bad one.

Our group also gives thought to the mathematics of variable disease expression in dementia. On scales of months and years, a comprehensible, stochastic process can be modeled with high precision. Is what we see clinically another face of that, or does it signal instability that so often heralds more rapid decline, or is it a variation of the fluctuating attention seen in delirium and in Lewy Body dementia?

However it works, we should aim for treatment. Many families believe that some part is modifiable. Are they correct? Aiming for therapies might seem obvious, but against the thankfully fading fashion of rubbishing symptomatic treatments, it’s good to be reminded of how big is the gap between what we offer and what people need. And that is poignant.

Kenneth Rockwood, Dalhousie University, Halifax, Canada

 

The full paper “Good days and bad days in dementia: a qualitative chart review of variable symptom expression” is available free of charge for a limited time here.

The commentary on the paper, “Symptom variability in dementia” is also available free of charge for one month here.

 

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