bluuebunny/crossref_metadata_2025 huggingface dataset:
SS05-03 - Proven antidepressant efficacy of agomelatine against the full range of symptoms
Authors: Kasper S.
Published: May 2011

Most antidepressants acting through monoaminergic systems have limitations in efficacy and tolerability and this has led to other approaches to provide patients with adequate treatment.

Agomelatine is an innovative approach to depression as it resynchronizes circadian rhythms, which are disturbed in depressed patients, thanks to its action on the melatonergic MT1 and MT2 receptors, and the 5-HT2C receptors.

The efficacy of agomelatine in depressed patients has been shown in several multicenter, randomized, double-blind parallel-group studies either in comparison with placebo or in 4 head-to-head studies vs an SSRI (sertraline, escitalopram, or fluoxetine in patients with more severe depression) or vs an SNRI (venlafaxine) after 6-8 weeks of treatment.

Agomelatine produced a continuous improvement by significantly reducing all core symptoms of depression. Agomelatine significantly reduced the incidence of relapse in acute responders over a 6-month period (21.7% for agomelatine versus 46.6% for placebo, P = 0.0001), even in the severely depressed patients. Agomelatine was well tolerated in the short and long term.

The pooled analysis of 4 head-to-head comparison studies showed after 6-8 weeks a significant difference in favor of agomelatine vs SSRIs/SNRIs in the HAM-D total score 1.37 (P < 0.001) and for responders (7.21%, P = 0.005). In addition, fewer patients withdrew due to emergent adverse events with agomelatine (6.3%) than with SSRIs/SNRIs (10.5%, P = 0.0058).

Taken together these data indicate that agomelatine is an effective treatment of depression in the short and long term, with a distinctive efficacy and better tolerability than the main current treatments.
SS05-04 - Overcoming the challenges of the anxiety spectrum
Authors: Stein D.
Published: May 2011

Anxiety disorders are considered to be the most prevalent of the psychiatric disorders, with generalized anxiety disorder (GAD) being one of the most common in primary care practice. GAD is a chronic and disabling disorder, which is frequently underdiagnosed and undertreated. It is characterized by both psychic symptoms (particularly worry) and somatic symptoms, and often complicated by comorbid conditions such as depression.

Agomelatine, the first melatonergic antidepressant, has been shown to be effective and well tolerated, not only in treating major depressive disorder, but also in treating the anxiety symptoms of depression. These findings give impetus to investigation of its potential anxiolytic properties in GAD.

Two randomized, double-blind, placebo-controlled studies assessed the efficacy of agomelatine in GAD. The first, a 12-week study, used the HAM-A total score as the primary outcome measure. In the second, a relapse prevention study, the responders to a 16-week open treatment period with agomelatine were randomized to maintenance treatment with either agomelatine or placebo for a 26-week period.

In the short-term treatment of GAD,1 agomelatine was superior to placebo with a HAM-A total score difference of 3.28 (P = 0.04). In the maintenance treatment of GAD, the incidence of relapse was significantly lower with agomelatine than with placebo. Agomelatine was well tolerated in both trials.

In summary, these studies showed that the novel antidepressant agomelatine is also efficacious in the treatment of GAD.
Update on pharmacological treatment of anxiety disorders: Where is the greatest room for imrpovement?
Authors: Baldwin D. , Meron D. , Tiwari N.
Published: May 2011

The ideal anxiolytic drug would be effective in all anxiety disorders, with a rapid onset of action, across all symptom domains and the spectrum of severity, in achieving remission and minimising disability, in preventing relapse, and in treating comorbid depression. Ideally, the drug would be suitable for once-daily dosage, would have minimal adverse effects or cause minimal interference with everyday life, not lead to the development of tolerance, have no discontinuation symptoms, be suitable in physically ill patients and free from interactions, and be safe in overdose.

But there are no ideal anxiolytic drugs. Response rates to initial treatment can be disappointing, it is not possible to reliably predict likelihood of response; a substantial proportion of patients experience unwanted effects; many will relapse despite treatment adherence; comparatively little is known about further management after initial non-response; and discontinuation symptoms can be troublesome.

Hence there is much room for improvement in identifying those patients who are most likely to benefit from treatment; in choosing between drug and psychological treatments; in choosing the right drug for the right patient groups; in optimising medication dosage to achieve maximum effectiveness whilst minimising adverse effects; in combining drug treatments to enhance efficacy; and in treating over the long term to prevent relapse and recurrence.
Depression
Authors: Kasper S.
Published: May 2011

Depression is one of the thoroughly evaluated diseases in psychiatry with regard to diagnosis as well as treatment variables. Like in other medical conditions, early treatment should be aimed and watchful waiting which is for instance also not done in the treatment of high blood pressure or diabetes, has not been proven to be a sophisticated approach based on neurobiological considerations. Like in other diseases, it is apparent that days of untreated depression may result in brain damage like reduced volume size of the hypocampus. The course of illness of depression shows that life events are less important in later stages of the illness than in earlier. The introduction of the group of selective serotonin reuptake inhibitors (SSRI) marked a revolution in the treatment of depression, since it was possible to treat patient for the first time effectively with a more minor side effect profile with this approach. Substantially more patients could be reached and the association with this phenomenon and the reduction of the suicide rates in different countries like Sweden, Austria and Hungary has been discussed. Dual reuptake inhibitors effecting both the serotonergic as well as the noradrenergic pathways and the dopaminergic noradrenergic medication bupropion have been introduced in the filed with specific angles of treatment goals like pain or somatic symptoms. With the introduction of agomelatine, a unique mechanism of action with the combination of melatonergic agonistic as well as serotonergic antagonistic activities has been achieved. With this approach a more potent influence on the circadian rhythm has been shown compared to other, previously used antidepressant properties. Deep brain stimulation and vagus nerve stimulation for treatment refractory depressed patients yield promising results. More thorough characterisation of the underlying pathophysiology of depression including brain imaging results as well as molecular biological variables will yield further inside of the understanding and treatment of depression.
Schizophrenia treatment guidelines - an international perspective
Authors: Gaebel W.
Published: May 2011

One of the recent initiatives inaugurated by the EPA European Platform of Psychiatrists aims at improving quality of mental health care in Europe by providing and implementing evidence-based information and advice and thereby minimizing mental health care gaps. To provide such guidance for schizophrenia, an overview will be given of existing treatment guidelines. This overview will focus firstly on methodological quality, since according to survey from 2005 the methodological quality of most guidelines was at best moderate (Gaebel et al. 2005). Secondly, the focus will be on treatment recommendations regarding core clinical questions like early recognition and intervention, acute and long-term treatment. Accordingly, respective recommendations from well established international guidelines will be presented. In addition, participants hopefully from all over Europe are encouraged to engage in the discussion and to provide information from their national/regional treatment guidelines, especially if not available in English language.
A systematic evaluation and comparison of the guidelines for screening and monitoring of cardiometabolic risk in people with schizophrenia
Authors: De Hert M. , Vancampfort D. , Correll C. , Peuskens J. , van Winkel R. , Mitchell A.
Published: May 2011

Metabolic and cardiovascular health problems have become a major focus for clinical care and research in schizophrenia. To evaluate the content and quality of screening guidelines for cardiovascular risk in schizophrenia we performed a systematic review and quality assessment of guidelines/recommendations published between 2000–2010, using the Appraisal of Guidelines for Research and Evaluation (AGREE). AGREE domain scores varied between 18 identified guidelines. Most guidelines scored best on the domains ‘Scope and Purpose’ and ‘Clarity of Presentation’. The domain ‘Rigour of Development’ was problematic in most guidelines, while the domains ‘Stakeholder Involvement’ and ‘Editorial Independence’ scored the lowest. The following parameters were recommended, in order of frequency: fasting glucose, BMI, fasting triglycerides, fasting cholesterol, waist, HDL/LDL, blood pressure, symptoms of diabetes. In terms of interventions most guidelines recommended advise on physical activity, advise on diet psycho-education of the patent, treatment of lipid abnormalities, treatment of diabetes, referral for advise and treatment, psycho-education of family and smoking cessation advice. Compared across all domains and content, 4 European guidelines could be recommended. Four of the evaluated guidelines are of good quality and should guide clinicians’ screening and monitoring practices. Future guideline development could be improved by increasing its rigour and assuring user and patient involvement. Although good guidelines are available research shows that the implementation in daily clinical practice remains poor.
Sociodemographic and clinical characteristics of depressive disorder in Kirkuk county
Authors: Al-Jiboori S.D.A.
Published: May 2011

Background

Depression has been recognized as a major public health evidenced by its ranking of fourth position among the global burden of diseases. Many believe it will occupy second position by the year 2020. Studies have been done in Iraq and neighboring countries in the Arabic area. This is the first study in Kirkuk.

Aims of the study

To determine the clinical and sociodemographic characteristic of depressive disorders in Kirkuk county. To compare it with previous studies in Iraq and other countries. To try to draw some inferences from the study, in order to develop psychiatric services to meet the demand of this challenging disorder.

Methods

231 depressed patients were included, 78 men, 153 women. Outpatients attendees were included after they consented to participate. DSM IV TR criteria were used to identify cases.

Results

Women outnumbered men (66%), unemployed were a majority (61%), rural areas were over represented (61.5%). Widowed came at the top (30%) followed by divorced (28%). The lowest rate was in Married (17%). Major depression was the most common subtype (61%) followed by dysthymia(15%), while the lowest subtype is bipolar depression 14(6%). Loss of energy or fatigue was the most frequent symptom (77%), while the lowest was suicidal idea (25%). The highest comorbidity was anxiety disorders (male14%, female46%). Alcohol and drug abuse were nonexistent in women and very low in men (3%, 5%).

Conclusion

The frequency of depression subtypes among patients were as follows, major depression 61%, dysthymia 15%, psychotic depression 9.5%, postpartum depression 8.6%, bipolar depression 6%. The sociodemographic characteristic factors are consistent with some previous findings. The high comorbidity of anxiety disorders among depressed patients may be due to situational factors nowadays.
Sociodemographic and clinical features of patients with depressive disorder in Khartoum, Sudan
Authors: Omer A.
Published: May 2011

Introduction and objective

It's known worldwide that depression is becoming a major health problem and its prevalence is increasing. Unfortunately very few studies were done in our country to verify this. The main objective of this study is to find out the prevalence of depression among patients attending a general psychiatric clinic, and demonstrate their Sociodemographic and clinical features.

Type of study

This is a descriptive retrospective study carried in Khartoum, Sudan.

Method

Files of patients attending a private psychiatric clinical in Khartoum in the period June 2005- June 2010 was reviewed. Only those with diagnosis of depression were chosen, socio demographic date and clinical features were documented, results were shown below.

Result and discussion

Total numbers of patients with depression were 137 (11.4%) those with schizophrenia are (13%), meaning that patients with schizophrenia are brought with relatives more than patients with depression. Females are more than males (56.2%), the majority are between ages 41---60 (40.9%), married (65%), (14.9%) has got family history of psychiatric disorders, (52%) has previous history of psychiatric treatment. Regarding clinical features, depressed mood is the commonest symptom (98.5%), loss of interest (91.9%), reduced energy (57%), guilt feelings (17.9%) and (35.8%) of our samples expressed suicidal ideations. The commonest type of somatic symptoms is generalized aches and pain (30.7%). (8%) presented with nihilistic delusions. The most common prescribed antidepressants are SSRI.
Sociodemographic and clinical characteristics of depressive disorder in Saada in Yemen
Authors: Shuwail A.Y.
Published: May 2011

Background

Depression has been recognized as a major public health evidenced by its ranking of fourth position among the global burden of diseases. Many believe it will occupy second position by the year 2020. This is the first study in Saada and Yemen.

Aims of the study

To determine the clinical and sociodemographic characteristic of depressive disorders in Saada country.

Methods

Patients who attended the medical OPD in general hospital during six month and consented to participate in this were screened with Hospital Anxiety and Depressive Scale (HAD). Identified depressed patients were studied and results were analysis.

Results

714 patients attended, 20 refused to participate. 694 patients were screened by HAD Scale. 438(63%) were men. 21% were borderline and only 16% fulfilled the score for depression.72.3 suffer from loss of appetite, 50% from fatigue, 50% from loss of interest, 21% from suicidal ideas, 41% sleep disturbance and 12% of guilt feeling. 28% suffered from dizziness, 23% of gasterointestinal symptoms, and 16% from aches and pains. There was statistically significant difference between major depressive disorder and mixed anxiety and depressive disorder in that women were more. There was a trend towards statistical significance (P = 0.054) between delusions and qat chewing. There was no statistical significance with hallucination and qat chewing. Results were analysed and compared with other local and international studies.

Conclusion

Mild depressive illness is more common in women, there was no impact of qat on depression, loss of appetite was the most common symptom. These finding are consistent with other local studies.
Telemental health in treatment of ethnic minorities in EU
Authors: Mucic D.
Published: May 2011

Access to adequate mental health care services is one of the identified problems within EU mental health services. Increased migration into and within EU cause the increased demands for clinicians with selected skills.

TeleMental Health applications could improve access to mental health care in rural, remote and under-served as well as in metropolitan areas all around EU. Telepsychiatry is the most common telemental health application. Furthermore, there are various internet based approaches to treatment of mental conditions on distance. Transcultural telepsychiatry model, developed in Denmark during last decade was aimed to treat ethnic minorities via their own mothertongue(s) by use of telepsychiatry. Patient satisfaction rapported within telepsychiatry service in Denmark is very high. The restricted physical contact and non-verbal communication of telepsychiatry compensates by the fact that the doctor and patient spoke the same language and had similar cultural and/or national references.

Ongoing international telepsychiatry collaboration established between Sweden and Denmark is a success that may be exported to other european countries. The experiences from this pioneer international transcultural telepsychiatry service may contribute to further development an European Telepsychiatry Network. However, this model may be used as an inspiration for conducting of larger international telepsychiatry service capable to provide mental health care toward diversity of patient populations underserved on their mother tongue within EU.
Depression and internet addiction: Correlation and treatment approaches
Authors: Stojakovic M.
Published: May 2011

Introduction

With increasing use of Internet in everyday life there is the risk of developing Internet dependency that can be correlated with depression. Is the internet an antidepressant or Internet addiction often causes mood-altering side effects?

Objectives

The focus is to examine correlation between depression and Internet addiction, as well as potential treatment approaches.

Aims

The aim of the study was to evaluate treatment approaches and the correlation between depression and Internet addiction(IA) by use of Telepsychiatric service.

Methods

A total of 100 Bosnian clients were studied. Internet Addiction Test (IAT), Beck Depression Inventory (BDI), and the Zung Depression Inventory (ZDI) was used, by Telepsychiatric service, to assess state measures of symptom severity. First, they were evaluated for their severity of Internet addiction with consideration of their behavioral characteristics and their primary purpose for computer use by IAT. Second, we investigated Depression by Telepsychiatry service with BDI and ZDI scale. Third, we investigated correlations between depression and Internet addiction.

Results

The symptoms of IA had been founded at 59% and 41% of patients had no IA. Symptoms of depression had been found at 45% patients. Internet addiction was significantly associated with depressive symptoms; IA and depression had been found at 41% patients (P < 0.01).

Conclusions

This study reveals a significant association between Internet addiction and depressive symptoms.
Treatment of opioid dependence using a Tele-Psychiatry Model
Authors: Schwager H.A. ,   TeleMental Health: From Research to Clinical Practice
Published: May 2011

Introduction

Opioid dependence has increased greater that 150% from 1965–2008. Almost 2 Million Americans are currnetly opioid depndent. Approxmately 4.4 million teenagers and adults have used opioid prescription painkillers for nonmedical purposes. Greater than 75% of opioid dependnet patients in the U.S. go untreated. Greater than 60% of opioid dependent patients don't seek reatment due to lack of accessibility of treatment centers or programs.

Method

100 opioid dependent patients (illicit street and iatrognenic) volunteered and entered a “TELE-PSYCIATRY MODEL” for treatment of their depencence (age range 19,- 61. 58 males,42 females). Utilizing the Bupernorphen protocol, all patients were intrviewed, examined, induced, and regularly followed, ALL utilizing SECURE VIDEOCONFERENCNG interactive treatment methodologies. No in-person contact was made with any patients.

Results

2 patients dropped out, 98 remain in treatment, and opioid free after a 7 month average. All patients found the Tele Psychiaty model to be acceptable, effective and prefeable.
EPA Guidance on Prevention of Mental Illness and Promotion of Mental Health
Authors: Bhugra D.
Published: May 2011

Prevention of mental illness and promotion of mental health are a significant component of any clinician's clinical work load. However, often this aspect is omitted from training and service delivery due to insufficient resources and the sheer volume of clinical load. Considerable evidence confirms that prevention can significantly reduce the onset of and subsequent related burdens to mental illness, and associated personal, social and economic costs. Often prevention and promotion get confused, and further mental illness and mental health are related but distinct dimensions. Acute mental illness usually prevents positive mental health or wellbeing, yet similarly someone without mental illness can have poor mental health and poor well being. Prevention of mental illness relates closely to and can result from promotion of mental health and associated resilience.

Prevention can be categorised in multiple ways and most clinicians regularly utilise secondary and tertiary prevention. Primary prevention addresses wider determinants across whole populations. Selective prevention targets groups at higher risk of developing disorder. Secondary prevention involves early detection and intervention and corresponds to indicated prevention. This lecture summarises these challenges and the impact of mental illness, and develops the case for prevention. The risk and protective factors for mental illness and various ages of onset are presented. Interventions at different life stages are also outlined. The lecture relies on the EPA Guidance on prevention of mental ill health and promotion of mental well being using the development of UK policy as structure. Future steps will be presented within European and global context.
Position Statement of the European Psychiatric Association (EPA) on the Value of Antidepressants in the Treatment of Unipolar Depression
Authors: Möller H.-J.
Published: May 2011

This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality, their place in a complex psychiatric treatment strategy including psychotherapy.

The efficacy of antidepressants is clinically relevant. The highest effect size was demonstrated for severe depression. Based on responder rates and based on double-blind placebo-controlled studies, the number needed to treat (NNT) is 5–7 for acute treatment and 4 for maintenance treatment. Monotherapy with one drug is often not sufficient but has to be followed by other antidepressants or by comedication/augmentation therapy approaches.

Generally antidepressants reduce suicidality, but under special conditions like young age or personality disorder, they can also increase suicidality. However, under the conditions of good clinical practice, the risk-benefit relationship of treatment with antidepressants can be judged as favourable also in this respect.

The capacity of psychiatrists to individualise and optimise treatment decisions in terms of ‘the right drug/treatment for the right patient’ is still restricted since currently there are no sufficient powerful clinical or biological predictors which could help to achieve this goal. There is hope that in future pharmacogenetics will contribute significantly to a personalised treatment. With regard to plasma concentration, therapeutic drug monitoring (TDM) is a useful tool to optimize plasma levels therapeutic outcome.

The ideal that all steps of clinical decision making can be based on evidence-based medicine is far away from reality. Clinical experience still has a great impact.
EPA Guidance on Conflicts of Interest
Authors: Hoschl C. , Fialova L.
Published: May 2011

Conflict of interest (COI) is a set of circumstances that creates a risk that professional judgments or actions regarding a primary interest will be unduly influenced and compromised by a secondary interest. It might arise in clinical practice, research, and education, and might include individuals and institutions.

Primary interests include the pursuit of well-being of patients, ensuring the independence of medical education, and protecting the objectivity and integrity of medical research.

Secondary interests might involve financial interests, pursuit of recognition and professional career advancement. COI might result from the multiple roles of physicians in patient care, research, administration, provision of expert opinion and policy advice, and consultancy to commercial organizations. The purpose of the COI policy is to protect the interests of the patients, strengthen the integrity of the profession, and preserve public trust in medicine and psychiatry. The aim of the guidance is to eventually prevent these conflicts from arising rather than remediate them ex post. It is desirable to identify factors that might lead to their occurrence, offer a framework for their recognition and assessment, introduce the principles and standards of their disclosure, and provide recommendations for their transparent resolution.
A Multi-Centre Pragmatic Trial of Antipsychotic Drug Treatment
Authors: Kilian R. , Steinert T. , Weiser P. , Bayer W. , Jaeger S. , Pfiffner C. , Frasch K. , Eschweiler G. , Messer T. , Croissant D. , Becker T. , Längle G.
Published: May 2011

The ELAN study is a prospective multi centre observational trial on the effectiveness and safety of long-term antipsychotic treatment of people with schizophrenia or schizoaffective disorders with quetiapine in comparison to olanzapine and risperidone under real world treatment conditions.

374 adult persons with schizophrenia or schizoaffective disorder prescribed antipsychotic maintenance therapy with quetiapine, olanzapine or risperidone were included at discharge from inpatient treatment. Psychotropic regimen, psychopathological symptoms, general and cognitive functioning, negative side-effects and quality of life were assessed before discharge and at 6, 12, 18 and 24 month follow-up assessments. Intention-to-treat analyses and crossover analyses were conducted by mixed-effects regression models including random linear time effects and time x treatment effects, controlling for baseline differences and additional psychotropic medication and using propensity scores to control for selection bias.

As indicated by significant linear time effects the patients improved with regard to psychopathological symptoms, general functioning, subjective quality of life and cognitive processing speed. No change of extrapyramidal motor side-effects, body mass index or waist circumference was obtained. The lack of any significant time x treatment interaction effects indicated no differences in the safety or effectiveness between the three antipsychotics. Nevertheless, the average hospital admission rate of patients receiving olanzapine was lower in comparison to patients receiving quetiapine or risperidone.
Which Outcome Indices Would Clinicians Like to See in Schizophrenia Clinical Trials?
Authors: Galderisi S.
Published: May 2011

Outcome measurement tools were almost exclusively used, so far, in research studies, while in routine clinical practice gross descriptive evaluation was generally provided. Discrepancies among studies and among stakeholders as to the effectiveness of one or the other treatment, study designs based on strict inclusion and exclusion criteria unlikely to generalize to clinical practice, the choice of outcome measures not always clinically meaningful, difficulties in the interpretation of clinical trials results and the relatively short trial duration have contributed to clinicians’ skeptical attitude toward clinical trials findings. Researchers designing future clinical trials are confronted with the need of providing clinically meaningful outcome measures, without undermining the statistical power of the study. However, integrative measures, such as "time to discontinuation for any reason", thought to convey information about efficacy, tolerability and safety, can be influenced by several nonspecific variables likely to vary from site to site and from doctor to doctor. Simple and global measurements, such as CGI-SCH, while preferred by many clinicians, might not capture the non unitary nature of the schizophrenia outcome constructs. Remission criteria are still limited to symptoms and clinicians would certainly like to see criteria for functional remission implemented as well. Clinical trials based on simple designs and on more comprehensive outcome measures will probably contribute to reduce the gap between research findings and clinical practice.
The online discussion forum depression: Chances and risks
Authors: Hegerl U. , Blume A. , Rummel-Kluge C.
Published: May 2011

Introduction

We evaluated participation effects and motives of people participating in an online discussion forum for depressive patients.

Objectives/Aims

Characteristics of participants, diagnoses and treatment status were analysed. In addition, the effects of participation in the forum on the individual handling of the illness and their motivation to use the online forum were examined.

Methods

55 active users were interviewed by telephone using a computer-assisted version of a fully structured psychiatric interview (DIA-X) and online with the Beck Depression Inventory (BDI).

Results

52 study participants (94.5%) received the diagnosis depression. Currently, 36.5% of the respondents suffer from a depressive episode. 90.2% received outpatient treatment before, 64.7% inpatient treatment. The respondents stated that their trust in medical treatment was raised (63.3%) and that they were encouraged to seek professional help (61.2%).

Conclusion

The forum reaches its targets, namely to provide an information platform for depressive patients and their relatives to encourage patients to seek professional help and the users do not see it as an alternative, but rather as a supplement to professional and psychological care. By participating in the forum, aspects of self-help, especially a strengthened sense of community and acceptance of coping with the own illness-related situation can be accomplished.

The results of this study as well as first results of a current research project, an evaluation of the content by analyzing word counts in psychological and linguistic categories, will be presented in the context of chances and risks of this E-mental health tool.
Internet-Based Self-Help for Young Females with Bulimia Nervosa — an Innovative Effective Treatment Method
Authors: Wagner G. , Wanner C. , Imgart H. , Karwautz A.
Published: May 2011

Bulimia nervosa (BN) is a highly disabling disorder with severe health consequences. In a stepped care approach the NICE (National Institute of Clinical Excellence) guidelines recommend the application of guided self-help as a first step in the treatment of bulimia nervosa before continuing with face-to-face psychotherapy. Most of the self-help supports - available as books, CD-Rom or on an Internet surface - are based on cognitive behavioural concepts and have been proven to be effective. In this workshop we will present advantages of this treatment approach and provide you with a survey of research work implementing new technologies in the treatment of BN. We will give you an insight into the treatment modules involved in SALUT - BN developed by Netunion in cooperation with the University of Geneva and present the latest results and longterm outcome of a RCT comparing Internet-based Self program for BN with bibliotherapy.
Internet-based psychotherapeutic interventions for social phobia: How much and what kind of therapeutic contact is needed?
Authors: Berger T. , Caspar F.
Published: May 2011

Internet-based self-help for social phobia with minimal therapist support via email have shown efficacy in several controlled trials by independent research teams. The role and necessity of therapist guidance is, however, still largely unclear. The present study compared the benefits of a 10-week web-based unguided self-help treatment for social phobia with the same intervention complemented with minimal, although weekly, therapist support via email. Further, a third treatment arm was included, in which the level of support was flexibly stepped up, from no support to email or telephone contact, on demand of the participants. Eighty-one individuals meeting diagnostic criteria for social phobia were randomly assigned to one of the three conditions. Results showed significant symptom reductions in all three treatment groups with large effect sizes for primary social phobia measures (Cohen's d = 1.47) and for secondary outcome measures (d = 1.16). No substantial and significant between-groups effects were found on any of the measures (Cohen's d = .00−.36). Moreover, no difference between the three conditions was found regarding diagnosis-free status, clinically significant change, dropout rates, or adherence measures such as sessions or exercises completed.
Efficacy of an internet delivered intervention strategy for recurrent depression: A multi-center randomized controlled trial
Authors: Wolf M. , Backenstraß M. , Becker T. , Bürgy M. , Freyberger H.J. , Hegerl U. , Hüsing J. , Vedder H. , Kordy H.
Published: May 2011

Despite considerable advances in the evidence-based treatments, the long-term management of depressive disorders remains a challenge. Many depressive disorders follow a chronic or recurrent course. Substantial proportions of patients end treatment, especially those with residual symptoms, leave treatment with considerable risk for relapses and/or persistent psychosocial impairment. Long-term strategies are needed that can effectively help patients minimize the negative consequences of their illness without imposing a too much of an extra burden. We present the protocol of a multi-center RCT on the efficacy of an Internet based disease management strategy for the specific health conditions in recurrent depression. 234 patients who are treated for their minimum third episode of a major depression (MD) in one of the six participating centers will participate post-treatment in one of two internet delivered interventions or usual care alone. The interventions continue over 12 months and consist of supportive monitoring, an online forum for peer support, and individual crisis management either with or without personal clinical support. Primary outcome of the trial is the ratio of “well” to “unwell weeks” over a 24-month observation period after index treatment assessed with the Longitudinal Interval Follow-Up Evaluation. We would like to discuss the new options that information and communication technology offers for long-term disease management strategies for patients with recurrent depression and invite for a discussion about strategies for other chronic mental disorders.
The effect of family psychoeducational interventions on patients with depression
Authors: Fiorillo A. , Malangone C. , Del Vecchio V. , De Rosa C. , Luciano M. , Giacco D. , Sampogna G. , Del Gaudio L. , Maj M.
Published: May 2011

While the efficacy of family psychoeducational interventions in the treatment of schizophrenia is now well documented, few data are available on its efficacy in major depression. This study aimed to verify the effectiveness of a family psychoeducational intervention according to the Falloon model on patients’ clinical status, social functioning and lifestyle and on relatives’ burden and social network.

The study was coordinated by the Department of Psychiatry of the University of Naples SUN and carried out in 7 Italian mental health centres. In each centre, 8 patients with major depression and their relatives were recruited if they fulfilled the following criteria: a) diagnosis of unipolar major depression according to the DSM-IV; b) aged between 18 and 65 years; c) in charge to the local mental health centre for at least 6 months; d) at least one depressive episode in the last two years; e) living with at least one relative aged between 18 and 70 years.

Recruited families have been randomly allocated to the experimental group, which received the psychoducational intervention for 6 months, or to the control group, which received the treatment as usual plus an informative brief intervention.

22 families have been treated with the experimental intervention and 22 with the control one. At the end of the intervention, patients’ clinical status and life-style significantly improved in the treated group, as well as family objective burden and social contacts.

Family psychoeducational intervention are useful in reducing personal and family difficulties caused by depression and in improving patients’ lifestyles.
Cancer and depression: Integrating scientific evidence with clinical practice
Authors: Eraslan D.
Published: May 2011

A diagnosis of cancer is one of the most distressing events in life. It changes the course of everyday life and causes an existential crisis. This makes some clinicians think that depression is a normal reaction to a diagnosis of cancer. However, the body of evidence suggests that not all people diagnosed with cancer develop depression, but patients with cancer have an increased rate of depression. This presentation will try to combine the latest data on depression and cancer, including the mechanisms underlying depression in these patients and the impact of psychiatric diagnosis on the outcome of cancer. We will then focus on the implications of these data on the diagnosis and management of depression in the clinical setting.
Depression and dementia: A conspiracy ?
Authors: Hanon C.
Published: May 2011

Depression and dementia are two very common clinical entities in the elderly population. Differential diagnosis of these disorders may pose difficulties. On the other hand, when they are comorbid, depression and dementia may affect the outcome of each other. When adequate treatment for depression is provided, patients with dementia may experience a significant improvement in cognitive functioning. Therefore, the possibility of comorbid depression and dementia should always be taken into account in the elderly population. This presentation will address the common clinical obstacles encountered while managing these disorders. Using the latest scientific data, the adequate treatment of depression and dementia will be discussed.
UK nice guidelines for depression in people with a chronic physical illness
Authors: Creed F. , Rizzo M.
Published: May 2011

The UK National Institue of Clinical Excellence development group performed a systematic review to determine the efficacy of pharmacological and non-pharmacological treatments for depression in people with depression and chronic physical health problems. The primary outcome of interest was depression.61 studies of antidepressants met our inclusion criteria. Of non-pharmacological RCTs 33 met our inclusion criteria and 21 were meta-analysed. Antidepressants appear to be effective and reasonably well-tolerated in the treatment of depression occurring in the context of chronic physical illness. No particular drug or drug group is preferred, although SSRIs may be better tolerated than TCAs and have a clear benefit on quality of life. Despite clinical concerns over adverse effects and drug interactions, antidepressants should not be withheld in the treatment of depression associated with chronic physical illness. For non-pharmacological treatments, the largest and strongest evidence base supports individual- and group-based cognitive and behavioural interventions (18 trials). The evidence was strongest for those interventions aimed at reducing depression in comparison to those aimed at reducing psychosocial stress. There is also some support for peer (self-help) support and guided self-help interventions based on cognitive and behavioural principles. Overall, the efficacy of pharmacological and non-pharmacological interventions for people with depression and chronic physical health problems is comparable to their efficacy in people with depression without chronic physical health problems. They should be used more widely.
European Network of Bipolar Research Expert Centres (ENBREC): an overview of the project
Authors: Henry C.
Published: May 2011

ENBREC (European Network of Bipolar Research Expert Centres) is a disease-oriented network designed to set up a EU-wide network of expert centres, specialized in research and care in bipolar disorders. The European added value is to share expertise in the different fields of research and to have access to large cohorts of patient. It is an FP7 project whith 6 countries involved.

ENBREC will provide an EU-integrated facility for research on epidemiology, diagnosis, treatment and on the mechanisms of bipolar disorders.

A preliminary step was to develop a computerized medical file to collect in a same manner a minimum set of clinical data to perform observational studies. We also include a common cognitive battery. Patients will be re-assessed every 6 months. This systematic assessment is the minimum required to be involved as an expert centre of the network. In parallel, we will collect DNA samples to perform genetic studies on well-characterized patients. Moreover, data from scanners performed for diagnostic purpose will be pooled to provide a large sample of structural brain pictures.

Other modules are proposed in the framework of the expert centres for observational studies with a high frequency of assessment to be able to capture more detailed description in psychopathological variables and in treatment response.

This cohort will allow selecting and recruiting patients for interventional studies or in specific programmes of research. Large cohorts of well-characterized patients are needed to improve the knowledge of this heterogeneous disease and to translate research outcomes into health improvements.
Effective strategies for health information, self-help and psychoeducation in bipolar disorder
Authors: Barbato A. ,   European Network of Bipolar Research Expert Centers
Published: May 2011

Introduction

Many patients with bipolar disorders do not achieve clinical and functional recovery, even with good pharmacotherapy compliance. The influence of patients’ attitudes, behavior, subjective state and interpersonal environment on course of the disorder points out the importance of psychosocial interventions and patients’ active role to improve outcome.

Methods

A survey of recent guidelines, systematic reviews and clinical trials of psychosocial interventions for bipolar disorders was performed.

Results

Research evidence supports the efficacy and likely effectiveness of a number of psychosocial treatments: Individual and group psychoeducation, family-focused therapy, interpersonal and social rhythm therapy, cognitive behavior therapy. The lower cost and potential ease of dissemination of group psychoeducation suggest that this should be the first-line approach, with more complex interventions reserved to selected subgroups of patients. The following elements should be included in a basic psychoeducation package: information about the disorder and available treatment options, identification of early warning signs, encouragement of structured routines and healthy lifestyles, use of a mood diary and life-event charting to monitor mood patterns and effectiveness of intervention, improvement of communication skills, emotional self-regulation and social skills, reduction of self-stigmatization, stabilization of sleep/wake cycles, awareness of medication effects and improvement of decision-making skills on drug treatment in a collaborative way, acquisition of balanced attitudes towards the self in relation to the illness.

Conclusion

The introduction of psychoeducation interventions with a focus on self-help strategies and patients empowerment and the adaptation of research models to everyday practice, can improve the outcome of bipolar disorders in real world.
Neuroimaging findings in bipolar disorder - opportunities for network projects
Authors: Andreassen O. ,   ENBREC
Published: May 2011

The overall aim of the Imaging work package in ENBREC is to develop a common magnetic resonance imaging (MRI) protocol which allows pooling of data acquired from different MRI scanners, that can be used in multi-site studies of bipolar disorders.

Structural MRI studies usually provide global estimates of gray or white matter volume changes, or a small number of regions of interest (ROIs). Recent advances in structural imaging now allow for a more comprehensive evaluation of brain changes by providing continuous maps of cortical thickness and surface area, subcortical volumes, and measures of white matter microstructure throughout the brain. Such high-resolution structural MRI for morphometric analyses is now being used for automatic quantification of brain structures. There are recent reports of cortical abnormalities in bipolar disorder, which will be reviewed.

White matter can now be quantified using diffusion tensor imaging (DTI). This MRI variant for quantifying the integrity of white matter structure throughout the brain measures water diffusion and its directionality. The degree of anisotropy of overall motion in a voxel is expressed as an index of the directionality of diffusion (fractional anisotropy; FA). Lower FA values are thought to reflect factors such as demyelination and axonal injury, and has been used to show white matter abnormalities in bipolar disorder.

A suggestion for protocol for multi-site brain imaging study in bipolar disorder will be presented.
Treatment optimization: The long-term perspective in bipolar disorder
Authors: Bauer M. , Ritter P. , Pfennig A.
Published: May 2011

Bipolar disorder is for most patients a life-long illness, associated with a recurrent, chronic course, and functional disability. Primary treatment goals are to stabilize the patient and prevent recurrence of episodes and suicide.

Although bipolar disorder has traditionally been regarded as an illness with good prognosis and most patients returning to normal functioning when a mood episode is over, several longitudinal studies suggest that the long-term outcome is less favorable than previously thought. Combinations of drugs are frequently used in clinical practice for mood stabilization, especially for those who have not responded to monotherapy. Although combination treatments are commonly administered, full interepisode recovery is not achieved in all patients, and as a consequence, bipolar disorder is one of the leading causes of disability.

Among clinicians and in international guidelines, lithium is widely considered as the ‘gold standard’ for long-term treatment. The choice of treatments is undergoing considerable change as new treatments are available, anticonvulsants and atypical antipsychotics are taking a more prominent position. However, the evidence available for the newer treatment options including the various combination treatments varies greatly.

The episodic nature of bipolar disorder requires prophylactic long-term treatment. Many previous worthwhile treatment effects of available mood stabilizing agents and psychotherapeutic interventions on major outcomes in bipolar disorder are only of moderate size and therefore require large-scale studies. Such trials to investigate longer-term outcomes are logistically challenging and expensive, and therefore only feasible within a multisite and multinational approach based on a common documentation system of the illness course.