bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic Review of Preventing Suicide in Old Age: 2005–2010
Authors: de Mendonça Lima C.A. , Rodrigues R.M.
Published: May 2011

Suicide is a typical phenomenon of the elderly and mainly among men. Besides the importance of suicide in terms of public health there is fewer interest to prevent suicide in old age. This can be explained by stigma, poor evaluation of the dimension of the problem and lack of politic will.

Suicide prevention and the care of survivors of suicide depend on the mental health network of care. Interventions to reduce suicide can be made at individual level and at level of the development of policies and strategies. The detection of the persons at risk of suicide and the management of the suicide attempt are two main strategies to prevent suicide. Both received recently an important support from WHO with its publication mhGAP Intervention Guide which was conceived to be used in non-specialized health-care settings by health-care providers working at first- and second-level facilities. It includes guidance on evidence-based interventions to make the diagnosis and manage a number of priority conditions, including suicide.

Our review of the literature pointed to the necessity to develop additional research to determine:

•

the role of somatic disorders as precipitant factor;

•

the role on suicide of the pre-morbid personality, cognitive functioning, social support and recent and chronic stressing events;

•

the participation of normal and pathological ageing on the expression of the suicide behavior;

•

the biological markers of suicide in old age;

•

the potential impact on suicide rates of educational interventions for the general public and for caregivers.
Risk for Suicide Among the Elderly: Is the Geriatric Depression Scale a Useful Screening Tool?
Authors: Wancata J. , Marquart B. , Friedrich F. , Cerny G.
Published: May 2011

Introduction

Depression is among the main risk factors for suicide. The Geriatric Depressions Scale (GDS-30, GDS-15) is depression screening instrument specifically developed for the elderly.

Objectives and aims

To provide a systematic review of the screening accuracy of both GDS versions.

Methods

An electronic search was performed using Medline, Embase, Cinahl, Psyndex and Cochrane library. The selection and examination of papers was done by two reviewers independently. The following studies were excluded: number of depression cases less than 10, no clear case criterion, phone version, psychiatric samples.

Results

Of 173 papers which were read and examined, only 42 papers were included. For both GDS versions similar mean validity indices were found (GDS-30: sensitivity 0.753, specificity 0.770; GDS-15: sensitivity 0.805, specificity 0.750). Using pooled samples we could not find significant differences between the two versions of the GDS. Using comparative studies based on identical samples, both GDS versions showed significantly better validity indices than the “Yale-1-question” screen, but did not differ from the CES-D. Frequently, essential information about research methods was not given. When methods were reported, the differing methods (e.g. concerning blinding, cut-off values, sampling procedures) limit the comparability of primary studies.

Conclusions

In general, the GDS seems to be sufficient for depression screening. While early recognition of depression is essential for identifying persons at risk for suicide, the GDS does not explicitly focus on this problem.
Treatment Resistance in Depression
Authors: Kasper S.
Published: May 2011

Due to the advancement of antidepressant medication, more patients receive treatment in everyday practice, and response/remission is not achieved in the majority of the patients. Several attempts to validate the definition of treatment resistance have been undertaken and the criteria usually encompased to treatment sequences are that two different classes of antidepressants given in a sufficient dosage for a sufficient time have to be administered. Clinically, it is evident that this defintion does not include the treatment refractory patients which could be defined as not responding to numerus trials including electroconvulsive therapy. The goal to improve treatment through the use of predicitve biomarkers has not as yet been obtained and will be the challenge for the future. The clinical variables predicting treatment resistance include comorbid anxiety disorders as well as melancholic features. Although there is a plethora of hints in textbooks that switching the mechanism of action should be obtained when a patient does not respond to one medication, the few controlled trials which have been undertaken to challenge this notion revealed that staying on the same antidepressant mechanism of action for a longer time is more beneficial. In previous times, the conjunctive use of agents such as lithium or thyroid augmentation have been proposed, however the new data achieved with atypical antipsychotics demonstrate a more rapid improvement. Techniques such as brain stimulation or vagus nerve stimulation have also shown promising early results. Treatment resistance continues to be a major barrier achieving remission in patients with major depressive disorder and a thorough re-evaluation of the condition and its treatment is needed.
Treatment resistance in borderline personality disorder
Authors: Pérez-Solá V.
Published: May 2011

Borderline Personality Disorder (BPD) is the most common personality disorder which afflicts an estimated 2% of the general population, 10% of individuals seen in outpatient mental health clinics and 15–20% of psychiatric inpatients. Patients with BPD present a large variety of symptoms, high rates of comorbid conditions, substantial use of healthcare resources and constitute a significant social and economic burden. This disorder often is resistant to psychotherapeutic and pharmacological interventions. These therapeutic difficulties lead to common psychotropic drug prescription for BPD patients in clinical practice and, according to our results, in Spain virtually all patients with BPD are prescribed drug treatment and polypharmacy is common. It is possible that polypharmacy may also be a reflection of the severe difficulties encountered during the management of these patients. Another explanation could be the psychiatrist's ‘desperation’ due to the patients’ deterioration or lack of improvement, so that polypharmacy may be used to compensate the lack of funded and sustained psychotherapy programmes which would be required to successfully treat these patients in the long term.
Treatment resistance in bipolar disorder
Authors: Rihmer Z.
Published: May 2011

Antidepressant-resistant major depression (AD-RD) is a great challenge for the treating clinician. The most widely accepted definition of AD-RD refers that the depressed patient does not show a clinically significant response after at least two adequate trials of different classes of antidepressants. In spite of the fact that there are several causes of AD-RD in general, there is increasing evidence that one of the most common sources of it is the unrecognized bipolar nature of the “unipolar” major depressive episode, when the patients receive antidepressant monotherapy - unprotected by mood stabilizers/atypical antipsychotics. While it is well documented that the optimal clinical response to antidepressants is much rare in bipolar I and II than in unipolar major depression, only the most recent clinical studies have focused on the boundaries between treatment-resistant unipolar major depressive disorder and bipolar disorder. The most widely noted conclusion of the prior studies on AD-RD is that if noncompliance, hypothyreosis, use of “depressiogenic” drugs and pharmacokinetic causes etc, can be excluded, antidepressant-resistance reflects the heterogeneity of depressive disorders and different subgroups of depressed patients respond (or do not respond) to different drugs. However, current psychopathological research on the complex relationship between unipolar depression and bipolar disorders show that the most common source of antidepressant-resistance in DSM-IV diagnosed unipolar major depression is the result of the subthreshold or unrecognized bipolar nature of the depressive episode and antidepressant-induced (hypo)manic switches, antidepressant-resistance and “suicide-inducing” potential of antidepressants seem to be related to the underlying bipolarity of the major depressive episode.
Monotherapy vs combination therapy in bipolar disorder: What does the evidence say?
Authors: Fountoulakis K.
Published: May 2011

The treatment of bipolar disorder is complex and the overall results of monotherapy are not satisfactory. Combination and add-on studies suggest that in acutely manic patients who are partial responders to lithium, valproate or carbamazepine, a good strategy would be to add haloperidol, risperidone, olanzapine, quetiapine or aripiprazole. Adding oxcarbazepine to lithium is also a choice. For patients with refractory bipolar depression the only positive data concern adding lamotrigine to lithium. During the maintenance phase the combination of quetiapine plus mood stabilizer is superior to monotherapy in the prevention of manic and depressive recurrences in either manic, depressive, or mixed index episode over a period of 2-years. These combination studies appear to be the first to report prevention on both depression and mania regardless of the type of index episode.

Discontinuation studies suggest that patients stabilized on combination therapy (olanzapine plus lithium/valproate or mood stabilizer plus ziprasidone) do worse when the antipsychotic is discontinued. The recently published BALANCE could neither reliably confirm nor refute a benefit of combination therapy compared with lithium monotherapy. Add on studies suggest that at least some strategies could be useful in patients with inadequate response to monotherapy. Overall, although there is no compelling data that combination treatment does better than monotherapy, the data suggest that those patients stabilized on combination treatment might do worse if shifted from combination, and patients refractory to monotherapy could benefit with add on treatment with olanzapine, valproate, an antidepressant or lamotrigine, depending on the index acute phase.
Bipolar treatment in everyday practice - the European perspective; data from the international AMSP program
Authors: Konstantinidis A. , Grohmann R. , Friedrich M.E. , Greil W. , Kasper S.
Published: May 2011

In the last decade new psychotropic agents have been licensed for the treatment of bipolar depression and mania. We wanted to evaluate if this led to changes in psychotropic prescriptions for bipolar-inpatients over the time-period from 2000 to 2007.

On two reference-days per hospital and per year, the following data are recorded for all patients on the wards under AMSP surveillance: all drugs applied on that day with the daily dosage for psychotropic drugs, ICD-diagnosis, age, and sex. In our analysis we evaluated data from 2000 (N = 210) and 2007 (N = 383).

We found a decrease of psychotropic monotherapy from 13.8% in 2000 to 4.7% in 2007. The percentage of inpatients receiving 5 or more psychotropics increased significantly from 10.95% in 2000 to 22.19% in 2007 (chi2: 11.199, df:1, p < 0.001). Furthermore we found a significant decrease of prescriptions for one or two psychotropics (38.89% to 16.38%) in bipolar-depressed-inpatients, but not in bipolar-hypo/manic-inpatients (chi2: 17.929, df:1, p < 0.001). The most frequently prescribed psychotropic in bipolar depression in 2000 was lithium-carbonate (median-dosage: 675 mg/day) and in 2007 valproic-acid (median-dosage: 1000 mg/day). In bipolar hypo-/mania the most commonly prescribed psychotropic in 2000 was again lithium-carbonate (median-dosage: 675 mg/day) and in 2007 valproic-acid (median-dosage: 1500 mg/day). The most frequently prescribed combinations were those of cbamazepine with lithium-carbonate (4.76%) in 2000 and of valproic-acid with quetiapine (8.88%) in 2007.

In our bipolar sample polypharmacy increased over the years. Further studies evaluating the safety of this polypharmacy, as well as putative effects of psychotropic combination-treatment in bipolar disorder are needed.
Drug interactions in the treatment of Bipolar disorder
Authors: Baumann P.
Published: May 2011

Bipolar disorders are characterized by many different forms and episodes, which require specific pharmacological treatments. For the treatment or prevention of manic episodes, lithium salts, some atypical antipsychotic drugs and some anticonvulsants were introduced. Antidepressant drugs but also a very limited number of anticonvulsants (lamotrigine) and antipsychotic drugs (quetiapine) are recommended for the treatment of depressive episodes. In addition, benzodiazepines or related compounds may be useful as comedications for sleep problems or for their sedative properties. Polypharmacy is therefore rather common, also in case of insufficient response to a single drug, when the administration of a combination of active agents appears to be promising.

Most of these drugs are substrates of cytochrome P-450, and many of them are also either inducers or inhibitors of some of its isozymes. Interactions may also occur at the level of conjugating enzymes. Increasingly, knowledge about the underlying mechanisms of drug transport from intestine to the blood, and from the blood to the brain helps to predict interactions at this level. Indeed, many drugs are transported by P-glycoprotein, and inhibitors and inducers, respectively, may modify the transport of psychotropic drugs. Therefore, it is recommended to consider the interaction profile of each drug before initiating a combined treatment and adapt medication. Sometimes, despite it is known that interactions may occur with pharmacodynamic consequences, some risky combined treatments may nevertheless be useful. In such situations, careful titration of the drug doses and therapeutic drug monitoring are recommended.
Chronotherapeutics: Fulfilling the unmet needs for faster, better, and longer-lasting antidepressant response
Authors: Wirz-Justice A.
Published: May 2011

Chronotherapeutics (light, darkness, sleep manipulations, melatonin) offer a new synthesis of non-pharmacologic interventions designed to accelerate remission in patients with depression and bipolar disorder. Combinations of light and wake therapy achieve fast results and, by reducing residual symptoms, also minimise relapse over many months. In addition, chronotherapeutics seem to be a major facilitator of drug response, and, in combination with antidepressants, a promising method to stabilise patients over the long term. The above treatments fulfil the unmet needs for a new antidepressant drug - short latency of action, fewer residual symptoms, lack of side effects, shorter hospital stays, and less relapse, as well as WHO criteria for interventions that are effective, affordable and sustainable. Yet, despite the growing evidence for their efficacy, and more than thirty years of implementation, it is surprising how limited their use still remains. Is it an image problem (alternative medicine, too simple) or a marketing problem (not patentable, therefore not profitable)? One important factor is lack of insurance reimbursement, because of not being a listed treatment (because they do not go through official clinical trial registration at federal regulatory agencies). Perhaps it is the patients who will spearhead the transition, together with a younger generation of psychiatrists curious to find biologically active alternatives to medication.

See: the nonprofit, multilingual patients’ website www.cet.org and clinicians’ website www.chronotherapeutics.org
Neuroimaging and genetics of antidepressant response to sleep deprivation: Implications for drug development
Authors: Benedetti F.
Published: May 2011

Despite confirmed evidences about some neurochemical effects of antidepressant treatments, there is still an high level of uncertainty about which biological changes are needed to recover from a major depressive episode. Changes of monoaminergic neurotransmission are paralleled by profound changes in brain metabolism, neural responses to stimuli, sleep architecture, biological rhythms, and, at the intracellular level, neuronal signaling pathways regulating gene expression, neuroplasticity, and neurotrophic mechanisms.

Sleep deprivation targets the biological mechanisms which are responsible of the possibility, unique to mood disorders, of rapid switching between depression, euthymia, and mania. The rapidity of action of sleep deprivation enables the study of the correlates of antidepressant response at close time points, providing a good model to study the biological basis of the antidepressant response and of the patophysiology of affective illness.

Current knowledge suggests that multiple neurobiological effects of sleep deprivation are responsible for the clinical mood amelioration, suggesting a multi-target mechanism of action. An impressive group of brain imaging studies using different brain imaging techniques (positron emission tomography, single photon emission tomography, functional magnetic resonance imaging, proton spectroscopy, arterial spin labeling) showed that clinical response is associated with changes in the functioning of specific brain areas. The combination of these new methodological acquisitions with the classical neurobiological and pharmacogenetic perspective provides an evolving knowledge about brain changes associated with antidepressant response, and will then help to identify the real targets of antidepressant treatment.
Wake therapy yields sustained response and remission. A rater-blind 9 weeks controlled study using a chronotherapeutic intervention compared to exercise
Authors: Martiny K. , Refsgaard E. , Lund V. , Lunde M. , Bech P.
Published: May 2011

Introduction

Wake therapy (sleep deprivation) is known to induce a rapid amelioration of depressive symptoms. Recently, techniques using bright light therapy and sleep time control have been developed to sustain the acute response of wake therapy.

Objectives

The aim of this study was to establish the efficacy of these new methods and to control for the placebo response by incorporating an active control group.

Methods

Patients with an actual diagnosis of unipolar or bipolar major depression were randomized to either a wake group or an exercise group and followed for 9 weeks. All patient were treated with duloxetine 60 mg daily. After a one week medication run-in phase, all patient were admitted to an open ward for six days: The wake group had 3 wake nights during their stay in combination with daily bright light treatment and sleep time control and the exercise-group started their exercise program. Bright light and exercise were continued for the whole study period.

Results

Patients in the wake group had a statistically significant larger improvement from immediately after wake therapy and maintained for the rest of the study period. At end of study the Wake group achieved a response / remission rate of 70.2 % and 45.6 %. The exercise group had a response/remission rate of 42.2 % and 23.1 %

Conclusion

The chronotherapeutic intervention induced a rapid and sustained response superior to the response seen in the exercise group.
Relationship between fast-acting antidepressant properties of total sleep deprivation and serum BDNF levels
Authors: Caliyurt O.
Published: May 2011

Sleep deprivation therapy is a treatment option for major depressive disorder. Total sleep deprivation for one night improves depressive symptoms in 40–60% of treatments. Recent reports have suggested that brain-derived neurotrophic factor (BDNF) levels are reduced in individuals suffering major depressive disorder and these levels normalize following antidepressant treatment.

In a recent study we have shown that the effects of total sleep deprivation therapy on BDNF levels in major depression. Results were compared between depressive patients that were treated with sertraline and healthy volunteers who experienced single total sleep deprivation. The baseline BDNF levels were significantly lower in both patient groups than the controls. Single sleep deprivation therapy was shown to decrease HAM-D scores and increase BDNF levels significantly in depressive patients. Effects of single sleep deprivation therapy on HAM-D scores was correlated with changes in BDNF levels. A series of three sleep deprivation therapies in a week accelerated the treatment response and increased the BDNF levels rapidly compared to the patients treated with sertraline alone. Better treatment response in the TSD group was also correlated with the statistically significant increase of BDNF levels in the 7th day compared to the sertraline group.

In conclusion, our results support the BDNF reduction in major depression. Rapid antidepressant effects of sleep deprivation therapy appear to relate to the rapid BDNF increase in major depressive patients. These results give an opportunity to explore the relationship between fast antidepressant response and BDNF changes in major depression.
Sexual disorders in DSM V, ICD 11 - patient focused approach to diagnosis
Authors: Segraves R.T.
Published: May 2011

Both ICD asnd DSM are in process of revision. DSM V should be implemented by 2013 and ICD 11 by 2015. These systems must be compatible by treaty obligation. In this presentation, i will summarize current proposals for changes in the DSM V for the sexual disorders. These proposals are the result of extensive literature reviews, commentaries by advisors, feedback on a publically available website. critiques received after publication and presentation of proposals, and field trials. Initial proposals include having specific duration and severity criteria. Another proposed change will be the listing of co-morbid conditions and the requirement of clinically significant distress or impairment prior to diagnosis. Specific proposals for changes in each diagnosis will be summarized in this presentation.
Neurobiology of premature ejaculation - from animal experiments to evidence- based treatment in humans
Authors: Waldinger M.D.
Published: May 2011

In the last two decades an increasing number of sexual behavioral studies in laboratory animals has contributed to a better understanding of the neural basis of ejaculatory functioning. In addition, these studies, which mainly involved male and female Wistar rats, elucidated basic mechanisms that underly the psychopharmacology of SSRI-induced ejaculation delay. Notably, a new animal model for premature and retarded ejaculation has been developed. This model has been shown to be of eminent importance for the investigation of ejaculatory disorders. Moreover, it has been proven useful into the investigation of female rat sexual motivation. Translational research translates findings of animal research into human application. Indeed, objective and systematic psychopharmacological research in men with lifelong premature ejaculation yields a remarkable similarity with data that have been found in animals. Sofar, animal research of premature ejaculation remarkably predicts data in men with lifelong PE, on the condition that clinical human research was performed according to evidence based research principles.
Pharmacotherapy of male sexual dysfunction: From serendipidity to rational approach to treatment
Authors: Balon R.
Published: May 2011

Pharmacotherapy of male sexual dysfunction(s) has developed similar to pharmacotherapy of depression. Some of the treatments for male sexual dysfunctions have been used based on old observations or myths (e.g., so called aphrodisiacs), some based on intuition (e.g. hormones for hypoactive sexual desire disorder), and some were discovered serendipitously (e.g., PDE-5 inhibitors). New, “me-too” PDE-5 inhibitors (e.g., avanafil, mirodenafil, udenafil) are being developed, similar to the development of new antidepressants. A rational approach to pharmacotherapy of hypoactive sexual desire disorder, male erectile disorder and premature ejaculation is being conceptualized (no pharmacotherapy for delayed orgasm is available at present). For instance, the approach to treatment of erectile dysfunction has been frequently staged into three levels (Level I: psychotherapy, oral preparations including hormones, vacuum erectile devices; Level II: intraurethral and intracorporeal application of various preparations; Level III: microsurgery, prosthesis). The management of pharmacotherapy failures, as well as combination of approaches to sexual dysfunctions, (e.g., PDE-5 and hormones for erectile dysfunction) have not been systematically studied. This presentation discusses a rational approach to staging pharmacotherapy of male sexual dysfunction and will also discuss potential combination of therapeutic modalities, especially for treatment resistant cases.
Advances in male and female sex therapy: Expectations and disappointments
Authors: Zemishlany Z.
Published: May 2011

The introduction of the PDE-5 inhibitors for male erectile dysfunction (ED) evolved expectations for 70–80% of efficacy as has been shown in short term studies. Ten years later, we are aware of their limitation: PDE-5 inhibitors are not efficient when desire is lacking, as well as in severe ED. Also, long term studies showed a lesser degree of efficacy.

The new pharmacological treatment for premature ejaculation, Dapoxetine, has been developed as a short acting SSRI. It has been shown to increase the time for ejaculation by three folds but has some adverse effects including nausea and fainting (due to hypotension).

Low desire is the most common sexual complaint in females. New pharmacological treatments include Bupropion 150 mg/day and Flibanserin 150 mg/day, although the evidence for efficacy is not conclusive. Their proposed mechanism is an increase in dopamine and norepinephrine activity. Flibanserin is an antagonist at the serotonin 2A receptor and an agonist of the serotonin 1A and dopamine D4 receptors.

Estrogen and/or testosterone replacement may be beneficial in appropriate cases.

There is a growing awareness in the last decade that low sexual desire in women is associated with age, relationship duration, relationship distress and complaints of anxiety and depression. Those psycho-social factors might limit the role of pharmacological agents.

Sex therapy should always consider and relate to these key issues
Course of psychopathology in the at-risk mental state - outcomes beyond transition to psychosis
Authors: Ruhrmann S. , Schultze-Lutter F. , Salokangas R.K.R. , Linszen D. , Birchwood M. , Juckel G. , Heinz A. , Lewis S. , Klosterkötter J. ,   EPOS Group
Published: May 2011

Introduction

Research on at-risk states of psychosis has mainly aimed to predict conversion. Yet as a considerable number of patients does not to progress to this outcome during the investigated observation periods, the course of these non-converters (NC) is of major interest, particularly with regard to preventive interventions and treatment.

Aims

To analyze the psychopathological and functional in 18-month non-converters.

Methods

Data were derived from the prospective multicenter European Prediction of Psychosis Study with an 18-month follow-up period. Participants had to fulfill ultra-high risk criteria and/or the COGDIS criterion, which is based on a set of cognitive basic symptoms. Psychopathology was assessed with the Structure Interview for Prodromal Syndromes (SIPS), including the Global Assessment of Functioning Scale (GAF) and a short version of the Schizophrenia Proneness Instrument (SPI-A).

Results

All total and subscale scores improved significantly during follow-up. However, a more detailed analysis revealed that a considerable part of the patients showed no improvement or even a worsening of psychopathology and function.

Conclusions

Our first analysis of course on non-converters shows that a high proportion of patients improved. In the light of results from retrospective studies, however, this improvement has to be interpreted with caution, as the observation period does not allow to determine the proportion of outpost syndromes, i.e. precursors of a later prodrome. Furthermore, a considerable portion of our sample worsened functionally and/or symptomatically. With regard to retrospective schizophrenia related results, very long observation periods may be needed to characterize the patterns of course in subpsychotic syndromes.
Discharge planning, an intervention study - and where to go next?
Authors: Becker T. , Steffen S. , Puschner B. ,   NODPAM
Published: May 2011

Background

Process evaluation should be an integral part of randomised controlled trials (RCTs), and this is important in examining complex interventions with a number of active ingredients.

Objective

To analyse effectiveness and effect moderators in a multi-centre RCT of needs-oriented discharge planning vs. treatment as usual (TAU) for high utilisers of mental health care.

Method

From April 2006 to July 2007, 491 adults with high utilisation of mental health care for psychotic disorders gave informed consent to participate in a multi-site RCT at five German psychiatric inpatient services. Subjects allocated to the intervention group were offered a manualised needs-led discharge planning intervention of two 45 minute sessions delivered by a trained study worker. Outcomes (service use, needs, psychopathology, depression, quality of life, direct costs) were assessed at four measurement points during 18-month follow-up. Latent class modelling was used to scrutinise differential effectiveness. Characteristics of subgroups of participants showing variable treatment response will be described.

Results

There was improvement both in the intervention and (TAU) control group but no differential effectiveness of the discharge planning intervention. Only few variables significantly moderated effects. Effect moderators pertained to quality of delivery and intervention dose.

Conclusions

Study results could help to tailor interventions to local conditions and guide future implementation of discharge planning in routine care. Further research should focus on scrutinising study process, ensuring ecological suitability of interventions and on head-to-head comparison studies.
Feasibility barriers and effectiveness of specific treatments for early psychosis in routine mental health care
Authors: Ruggeri M.
Published: May 2011

Introduction

Issues of organisational structure and commitment, resource development, and clarity of roles and responsibilities must be addressed before proceeding with any attempt to implement evidence based interventions in a specific service.

Evidence suggests that the management of most mental disorders and especially of psychoses is frequently suboptimal. This trend might reflect instances of inadequate resource allocation, but might also reflect the effects of stigma, discrimination, and social exclusion that people with psychosis often experience. It might also indicate poor management of available resources or deficiencies in knowledge or practice.

Aims

Multi-element psychosocial interventions in the first 5 years from psychosis onset have proved to facilitating recovery and reducing long-term disability. However, most studies often do not test efficacy against a control group and have been conducted in non-epidemiologically representative samples. The presentation will be focussed on process of assessment of acceptability and discrepancies between evidence and clinical practice in the treatment of schizophrenia in community care.

Methods and Results

Trials - such as the GET UP Trial (National Coordinator: Mirella Ruggeri) that is part of the Strategic Research Programs of the Italian Government - that are being conducted in the routine practice and that aim to test the feasibility and cost-effectiveness of evidence-based psychosocial interventions will be presented and discussed.

Conclusions

Verify the barriers to application and situations when evidence-based interventions practice might be ineffective or inappropriate, understanding their advantages and limitations is a crucial challenge in the area of early psychosis treatment.
Vocational rehabilitation in people with severe mental illness
Authors: Lauber C.
Published: May 2011

Vocational rehabilitation is an important topic in people with severe mental illness as only about 10–15% have a regular job. This paper will present results of a European multicentre study on a specific intervention of supported employment designed for people with mental illness. This new method is called Individual Placement and Support (IPS). The study found that IPS is much more effective than the traditional vocational rehabilitation. This paper will additionally describe approaches to further develop vocational rehabilitation in people with severe and enduring mental illness.
Needs of fathers and mothers of schizophrenia patients
Authors: Wancata J. , Matschnig T. , Freidl M. , Unger A. , Friedrich F.
Published: May 2011

Introduction

Most studies investigating the problems and needs of schizophrenia patients’ carers include only one care-giving relative - mostly the patients’ mothers.

Purpose

The compare needs of mothers and fathers of patients with schizophrenia.

Methods

101 sets of parents of patients suffering from schizophrenia were included in this study. They were assessed by means of the “Carers’ Needs Assessment for Schizophrenia”.

Results

Compared to fathers, mothers reported significantly more often problems concerning stress due to earlier life events and burn-out. Mothers required some interventions such as individual psychoeducation or family counselling more than twice as often than fathers. Overall, mothers reported more problems and needs than fathers. The number of mothers’ problems was predicted by not living with a partner and a shorter duration of the patients’ illness (DUPI). The number of mothers’ needs was predicted by patients’ psychiatric symptoms, not living with a partner and a shorter DUPI. Among fathers we could not identify any predictors, neither for problems nor for needs.

Conclusions

Parents of schizophrenic patients have various problems handling their child's illness and therefore need professional support. Overall, mothers reported more problems and needs for interventions than fathers. The differences between mothers’ and fathers’ problems and needs indicate the importance of considering the carer's gender in clinical work.
Early learning experience and adolescent anxiety: A cross-cultural comparison between Japan and England
Authors: Essau C.A. , Ishikawa S.-I. , Sasagawa S.
Published: May 2011

Anxiety disorders are among the most common psychiatric conditions in children and adolescents. One of the most consistent findings across studies is that anxiety disorders tend to run in families. While these high prevalence rates suggest that anxiety may be “transmitted” within the family, the exact mechanism involved in this transmission is still unclear. An area that has been suggested in the transmission of anxiety from parents to children is the role of learning experiences (i.e., through modeling and information transfer). While these studies have enhanced our knowledge on the association between learning experience and anxiety symptoms, it is not known whether these findings which were based on studies conducted in Western culture could be replicated in Eastern culture.

The present study compared the frequency of anxiety symptoms among adolescents in Japan and England, and examined the association between early learning experiences and anxiety symptoms. 299 adolescents (147 from England and 152 from Japan) were investigated. Adolescents in England reported significantly higher levels of anxiety symptoms than adolescents in Japan. No significant differences emerged between the two countries for parent punishment/reinforcement of anxious behavior. However, for non-anxiety symptoms, adolescents in England scored significantly higher in parent punishment and the Japanese sample scored higher in parent reinforcement. Parent verbal transmission about the danger of anxiety and cold symptoms was more common in Japan than in England. The impact of learning experience on adolescent's anxiety seemed to differ across cultures, which underscore the importance of cultural factors on adolescent's anxiety.
Self-injurious behavior and suicidal behavior in adolescents: Results from population based studies in Germany
Authors: Brunner R. , Kaess M. , Parzer P. , Haffner J. , Resch F.
Published: May 2011

Introduction

Self-harming and suicidal behaviour are both well-recognized problems during adolescence. While prevalence rates are very high and still rising in most western countries, there is an extensive need for understanding childhood developmental aspects, personality factors and psychological correlates of self-harm and suicidality. Additionally, specific and effective prevention should be established regarding self-harming and suicidal behaviour as one of the largest concerns of public health during this period of life.

Objectives

To investigate the prevalence and the associated psychological and social factors of self-harming behaviour in adolescents. To evaluate a school-based intervention aimed at reducing self-harming behaviour in adolescents.

Methods

In the years 2005 and 2010 we performed one population-based, cross-sectional study including a sample of 5,759 ninth-grade students and one randomized-controlled, school-based prevention study within the large EU-consortium (SEYLE) comprising a sample-size of 1,387 students on self-harming and suicidal behaviour in Heidelberg.

Results

The data suggest that there is a strong link between social factors and occasional self-injurious behavior and, especially in repetitive self-injurious behaviour, that there is a strong association between self-injurious behaviour and suicidal behaviour as well as self-injurious behaviour and emotional and behavioural problems. Preliminary results of the randomized-controlled prevention study could reveal a decrease of self-harming behaviour in adolescents in the short-term as well as long-term-follow-up.

Conclusions

The results support a need to investigate the possible neurobiological underpinnings as well as social factors of self-harming behaviour within a longitudinal model.
Evidence-based training in treatment treatments: The case of pediatric psychopharmacology
Authors: Jensen P.S.
Published: May 2011

Introduction

Despite major research advances in pediatric psychopharmacology and psychotherapy over the last 20 years, the lack of well-trained specialists has posed almost insurmountable barriers to many children and families from receiving high-quality, evidence-based assessment and treatments. The REACH Institute, an international non-profit organization dedicated to disseminating evidence-based treatments, has developed portable, effective methods to train primary care and specialty health providers in pediatric psychopharmacology and psychotherapies.

Objectives

To develop effective, scientifically-proven methods for teaching and disseminating evidence-based treatments.

Aims

To develop, disseminate, and evaluate high quality approaches for teaching primary care and specialty mental health practitioners in pediatric psychopharmacology.

Methods

Using novel approaches grounded in scientific behavioral change technologies, over 700 health care providers have been trained in evidence-based pediatric psychopharmacology in sites across multiple countries, including the US, Canada, and Norway. All trainings are rigorously evaluated for changes in health care practitioners' behaviors and clinical practices, including within an NIH-funded randomized controlled trial (RCT).

Results

Trainings have been very well-received across multiple countries, requiring only minor adaptations. These trainings have been effective in yielding changes in health care practitioners abilities and actual clinical practices, enabling more children to access appropriate pediatric psychopharmacology.

Conclusions

Effective and disseminable methods for changing health care practitioners behaviors in applying pediatric psychopharmacology treatments are possible, and can be adapted to different countries, languages, and cultural contexts.
Is there a biological basis to the Bipolar spectrum?
Authors: Agius M. , Lee J. , Wotherspoon D.
Published: May 2011

Background

The Bipolar Spectrum is usually presented as a Clinical Spectrum. We attempt to demonstrate that there is a neurobiological basis to this spectrum.

Method

We carried out a review of the literature.

Results

There is evidence, at a neuroimaging level, at a genetic level, and also at an intracellular level for a biological basis to the bipolar spectrum.

Discussion

What arises from this review is that the bipolar spectrum may be wider than previously thought. It is of interest that similar neuroimaging findings may be found in PTSD, Unipolar Depression, Bipolar Illness, and Borderline Personality Disorder.

Conclusion

The key biological issue regarding the bipolar spectrum is the mechanism by which unipolar depression evolves over time into bipolar illness. At present we can only speculate about this mechanism, but its elucidation will clarify how these illnesses are related in the bipolar spectrum.
Do neurons have mood and how can it be stabilised?
Authors: Hranov L.G.
Published: May 2011

Polarity of affective tone has taken the role of the core defining feature of bipolar affective disorder (BAD) eclipsing Falret's and Kraepelin's emphasis on cyclicity and recurrence. Yet in many clinical cases polarity is lost in the course of time while cyclic recurrence persists for decades, completely disrupting patients’ lives. That's why true “mood stabilisation” aims not as much at reducing episode severity as at reducing episode number to a minimum.

On the neuronal level polarity could be envisaged as interplay between arousal and inhibition due to trans-membrane ion currents, either brief and adaptive or pathologically sustained. Cyclicity and recurrence could arise from permanent deficits in neuronal plasticity and resilience which are to a large extent under genetic control. The “mood stabilising” properties of different pharmacological agents are due to multi-level actions on the intracellular signal transduction pathways affecting the function of Gi and Go proteins, of some intracellular messengers (mioinositol, Bcl-2, ER stress proteins, MARKS, the complex calmodulin-synapsin1-synaptotagmin), and of some crucially important enzymes: adenilyl cyclase, various protein kinases (ά, ε, C, MAP, Akt), mitochondrial respiratory chain enzyme complexes, histone deacetylase and acetyltransferase, GSK-3. Thus, in the long run “mood-stabilising agents” exert blockade of excitotoxic/apoptotic pathways, phosphorilation of microtubular proteins, and regulation of the expression of genes implicated in processes involved in neuroplasticity, neuroprotection, even neurogenesis, and hamper the long-term neuronal (and by extension, mental) deterioration. Lithium displays the broadest spectrum of such actions and provides, by far, the best control over the chronic protean symptoms of BAD.
Genetics of schizophrenia and bipolar disorder
Authors: Pregelj P.
Published: May 2011

According to recent knowledge there are probably multiple susceptibility genes involved in patophysiology of schizophrenia and bipolar disorder, each of small effect, which act in conjunction with environmental factors. These genes could influence synaptic plasticity, neurodevelopment and neurotransmission. There are an estimated 4,000 genes involved in the complicated communication between brain cells. However, overlapping of candidate genes between both disorders was reported.

Recent studies revealed that random mutations not inherited from either parent play a role in schizophrenia. The relation between psychopathological events, the phenomenology of the trauma and neurobiological changes related to schizophrenia and bipolar disorder is not totally understood.

The symptoms of schizophrenia are believed to be triggered by stress-induced changes in neurobiological systems representing an inadequate adaptation of neurobiological systems to exposure to stressors. Recent studies suggest that epigenetic mechanisms may play an important role in the interplay between stress exposure and genetic vulnerability also in humans. In preclinical studies it was first suggested that epigenetic mechanisms may be involved in the modulation of gene expression in response to stressful stimuli. Recently, epigenetic differences in a neuron-specific glucocorticoid receptor (NR3C1) promoter between postmortem hippocampus obtained from suicide victims with a history of childhood abuse and those from either suicide victims with no childhood abuse or controls were found, indicating the involvement of these mechanisms in human adaptation to stress. Future research could lead to prenatal screening for both disorders, and for new, more personalized approaches to treating people depending upon their genetic profile.
Variation in oxytocin receptor gene and psychiatric illness
Authors: Brüne M.
Published: May 2011

Oxytocin (OT) is an evolutionarily conserved nonapeptide that is produced in the magnocellular neurons of hypothalamic paraventricular and supraoptic nuclei. The widespread intracerebral projections of OT-producing neurons subserve its role as a neurotransmitter and neuromodulator. OT is well known for its functions in reproduction, including parturition and lactation. In recent years, the effects of OT on social interaction have become a focus in both normal and abnormal psychology research. OT attenuates fear responses, improves empathy and also exerts major effects on pair-bonding and attachment.

Studies have revealed that polymorphic variation of the oxytocin receptor gene (OXTR) also influences stress reactivity and empathetic responses in humans, as well as temperament, and even amygdala volume. This clearly implies that OXTR variation interacts with environmental contingencies, such that it can be regarded an interesting target in psychopathology research.

OT has the potential to ameliorate symptom severity in psychiatric conditions such as social anxiety disorder, autism and schizophrenia. Accordingly, future research into the interaction between OXTR variation and environment may contribute to clarify the role of OT in psychopathology.
Gene environmental interaction in psychiatry: The 5-HTTLPR and COMT story from an evolutionary point of view
Authors: Sanjuan J. , Costas J. , Molto M.D.
Published: May 2011

The general medical model explains that there are genetic and environmental risks and protective factors in the aetiology of any complex disease. The main idea supported by this model is the existence of good and bad polymorphisms. We present a review of the literature and some examples of our own empirical studies about this issue in psychiatry; with special focus on the methodological problems of this medical model.

In relation with 5-HTTLPR we present the results of a longitudinal study of 1804 women. In this study the “LL” genotype seems to be a risk factor for post-partum depression, probably due to gene-hormone interaction after delivery. But the same genotype might be a protective factor of emotional disorder in other life-time and environmental condition.

In relation with COMT gene, we present a meta-analysis (including our own data) of 51 studies comprising 13,894 schizophrenic patients and 16,087. We found a small but significant protective effect for heterozygosis at rs4680 (pooled OR ¼ 0.947, P¼ 0.023; pooled OR ¼ 0.813, P¼ 0.0009). Thus, the COMT functional polymorphism rs4680 contributes to schizophrenia genetic susceptibility under an over-dominant model, indicating that both too high and too low levels of dopamine (DA) signalling maybe risk factors.

In summary, both examples suggested that there are no ‘bad’ or ‘good’ genotypes in relation to common variants. The controversial results of many genetics associations’ studies in psychiatry might become comprehensive under an evolutionary approach.