Laxatives, memory and depression

Too busy to read all the journals? Let Dr Nicolette Price keep you up to date with the research.

Research of the week

Genetics versus peer pressure in alcohol use
Addiction 2007; 102: 894-903

This paper examined genetic and environmental influences on adolescent alcohol use and that of their friends. The study involved 862 twin pairs, both mono- and dizygotic, and included analysis of influences such as friend sharing, sibling interaction, parental genes and genetic tendency to seek out particular peers. It was noted that peers are considered an important environmental influence.

The authors comment that genetic factors can influence the choice of friends and to what extent the chosen friends use alcohol.

It seems that persuading my offspring to get 'in with the right crowd' is even more complicated than I thought. 

Memory and well-being in older adults
AGING MENT HEALTH 2007; 11: 291-300

When I began reading this, I hoped to discover a conclusion that chatting with our elderly relatives about their past experiences could improve their mental well-being.

In effect the paper does this, in that simple reminiscence in which pleasant memories are brought to mind and exchanged is found to be moderately effective; it also suggests that a far more effective way of improving psychological well-being is in the form of life-review, in which a therapist encourages evaluation and discussion of both positive and negative life events. Simple reminiscence was found to be more effective for those living in the community than for those living in residential care or nursing homes.

Laxative use after obstetric anal sphincter injury
BR J OBSTET GYNAECOL 2007; 114: 736-40

Anal sphincter injury during delivery occurs in around 3 per cent of women and, in this study, the authors assessed whether a stool softener (lactulose) should be used alone in the postpartum period or,in line with Royal College of Gynaecologists guidelines, in combination with a bulking agent (ispaghula husk).

The study findings were that combined usage of the two preparations did not lead to greater patient satisfaction or reduced pain and was associated with higher incidence of faecal incontinence. There was also less compliance with ispaghula husk.

The conclusion was that routine use of ispaghula husk in the immediate postpartum period is not justified.

Psychosocial risk factors and neck problems
PAIN 2007; 129: 311-20

Over 330 female office workers completed a questionnaire for this study, which assessed workplace psychosocial factors such as job demands, decision authority and support from peers and supervisors. The study excluded call centre workers, had no male comparison group, and a response rate of only 30 per cent.

However, the findings were interesting in that as job demands increased, low supervisor support became a significant risk factor for neck symptoms.

I would be interested to know if these findings would be replicated in a group of male subjects.

Treatments for diabetic neuropathy
BMJ 2007 DOI:10.1136/bmj.39213.565972

Neuropathic pain is a common symptom of diabetic neuropathy, thought to be caused primarily by hyperglycaemia. This systematic review aimed to identify the most effective pain-relieving treatments by meta-analysis of randomised trials from 1996 to 2006. These compared both topical and non-topical medications - including tricyclic antidepressants, anticonvulsants, SSRIs, serotonin noradrenalin reuptake inhibitors and opioids - with placebo.

Oral tricyclic antidepressants and traditional anticonvulsants were found to be better for pain relief in the short term.

CBT for depressed adolescents
BMJ 2007;doi:10.1136/bmj.39224.494340.55

Adolescents with severe major depression, treated in specialist clinic settings in the UK, were randomised to receive treatment with an SSRI and usual clinical care, or SSRI, usual care and cognitive behavioural therapy (CBT). In contrast to other similar trials, adolescents with suicidality, depressive psychosis or conduct disorder were included.

Results at 28 weeks suggested that the addition of CBT adds little to specialist clinical care plus an SSRI in subjects with severe depression.

The authors recommend that longer-term outcomes should be considered in future studies.

- Dr Price is a medical examiner for the Department for Work and Pensions, a former GP in Hampshire, and a member of our team who regularly reviews the journals

The quick study

  • Older patients' mental well-being can be helped by recalling pleasant events.
  • Anal sphincter pain from postpartum injury is not reduced by adding a bulking agent to the laxative regimen.
  • Neck pain is more prevalent in women office workers with little supervision.
  • Tricyclic antidepressants are the best option for diabetic neuropathic pain.
  • CBT in teenagers on SSRIs does little to improve outcomes.

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