bluuebunny/crossref_metadata_2025 huggingface dataset:
Education on Old Age Psychiatry at Europe: Facts and Proposals
Authors: Firmino H. , Fernandes L.
Published: March 2009

Old Age Psychiatry is a branch of psychiatry and forms part of the multidisciplinary delivery of mental health care to older people.

The specialty of psychiatry of the elderly requires a grounding in general psychiatry and in general medicine as well as training in the specific aspects of both psychiatric and medical conditions as they occur in older people. Psychiatry of the elderly should be taught in the variety of settings in which it is practised.

Training in mental health care of older people should be offered at both undergraduate and postgraduate level and also during continuing professional development.

It is important to recognise that in some countries, resources, especially in terms of mental health professionals, are very limited. In these countries it will be necessary to establish sensible priorities for mental health problems of the elderly.

In this presentation we goes to consider some ideas to develop educational training at European Countries.
Sexuality and Homosexuality in Old Age
Authors: Krebs-Roubicek E.
Published: March 2009

The nature and frequency of sexual activity among the elderly are unknown. The elderly often view sexuality as an expression of passion, affection, admiration and loyalty; a renewall of romance. Sexual activity is a means for the elderly to affirm physical functioning, to maintain a strong sense of identity and to establish self-confidence.

However, not all elderly persons have positive attitudes towards sexuality. Even healthy elderly persons may internalize the stereotypes towards aging. The elderly will be viewed as:

•

Asexual invalids;

•

Dirty old men;

•

Lecherous old women.

Negative attitude about masturbation and homosexuality can interfere with sexual expression. Many elderly homosexual persons have not publicly revealed their sexual preference. They may experience additional stress due to a perceived need to hide their sexual orientation.
Mental Health of Elderly in Serbia-from Strategy to Reality
Authors: Kalasic A. Milicevic
Published: March 2009

National Mental Health Policy and Action Plan was adopted in January 2007 by Government of Republic Serbia. Elderly persons were brought in focus as growing population with growing number of elderly with mental disorders and services incapable to face this challenge. Last October, Institute of Gerontology promoted Geriatric Manual, published and distributed in Primary Care Facilities in Belgrade as it was supported by Municipal Secretariat of Health. Psychogeriatric issues took a part in Geriatric Manual with recognition of early detection of psychological disorders in elderly and importance of diagnose acute confusion state in everyday practice. It was just the beginning of education of primary care physicians in Belgrade. There were many meetings in Ministry of Health with aim of spreading this knowledge all around Serbia. Mental Health Department of Institute of Gerontology has ran education in psychogeriatric issues for primary care within Project supported by Municipal Secretariat of Health, Belgrade with main aim of developing network for caring of elderly mentally disturbed people. Very important part of network is within social institutions and in a private sector. On other hand in the same time round table within project was a part of antistigma campaign in primary care facilities and in community. A baseline report on health and social institutions accommodating with special focus on elderly with mental disorders were launched under WHO support.
Ageing-ethical Issues and Stigma
Authors: Tataru N. , Dicker A.
Published: March 2009

During the twentieth century, many behavioural and biological theories of aging have been advanced that ageing is a multidimensional phenomenon. Ageing is a progressive decline in function and performance, which accompanies advancing years. Cicero noticed that the old people preserved their intellects if they maintained their interests.

To the social, economical and medical problems that old age arises to the society, one may add the continue increase of old people proportion in the general population. The ageing of population is becoming a reality in developed and in less developed countries too. We talk about a conceptual definition of normal ageing and also about successful and morbid ageing. Normal ageing is an ageing process without any clinical somatic or mental disorder and a morbid ageing is characterized by a process presenting clinical disorders which affects the somatic and mental health, the successful ageing being an ageing process in a favourable environmental conditions to promote individual development. We can consider not only the presence/absence of a disorder but also its impact in someone's life. The functioning capacity loss could be considered as a marker of the presence of a clinical disorder.

Stigma remains a major obstacle to ensuring access to good care for elderly with mental disorders, these patients suffers of a double jeopardy (old age and mental disorders). Both stigma and discrimination against these old persons depend on the type of mental disorder and we have to protect them against discrimination and improve their quality of life.
Successful Ageing for those with Major Psychotic Disorders
Authors: Yang Y.-J.
Published: March 2009

So far, successful ageing is usually a dream or presumed as an unreachable goal for those people with major psychotic disorders, especially the schizophrenia and bipolar I disorder. Thanks to the improvement of general health, better treatment, and decreased discriminations, there are more and more people with major psychotic disorders live into later age. Due to the persistent and active psychotic symptoms, the impaired cognitive performance and malfunctioned supportive system, most of our patients appeared less prepared for their later life. Unfortunately, how and what will they live through the jeopardy has been neglected and under discussed as there are few literatures in this topic.

The author will search the articles and theses relevant to this issue from the literature through evidence-based approaches and discuss it in three major parts. The first part of the presentation will be the review of the past condition and the facts of current situation of the people with major psychotic disorder in later life. Epidemiological study profiles with the frame of traditional biopsycho-social construct will be reported. The second part will be the possible ways these people may adopt to achieve successful aging with their efforts in a self-management model. In the third part, the author will propose possible and feasible programs that promote active living for the people with major psychotic disorders, aiming at the goal of successful ageing.

In conclusion, the author hopes that this presentation could become the morning bells and arouse the attention in this field.
Distinct Effects of D9-tetrahydrocannabinol and Cannabidiol on Neural Activation During Emotional Processing
Authors: Fusar-Poli P.
Published: March 2009

Aims:

Cannabis use can both increase and reduce anxiety in humans. The neurophysiological substrates of these effects are unknown.

Method:

Fifteen healthy English-native right-handed men were studied on three separate occasions using an event-related fMRI paradigm while viewing faces that implicitly elicited different levels of anxiety. Each scanning session was preceded by the ingestion of either 10mg of D-9-THC, 600mg of CBD, or a placebo, in a double-blind, randomised, placebo controlled design. Electrodermal activity (Skin Conductance Response, SCR) and objective and subjective ratings of anxiety were recorded durign the scanning.

Results:

D-9THC increased anxiety, as well as levels of intoxication, sedation and psychotic symptoms, whereas there was a trend for a reduction in anxiety following administration of CBD. The number of SCR fluctuations during the processing of intensely fearful faces increased following administration of D-9THC but decreased following administration of CBD. CBD attenuated the BOLD signal in the amygdala and the anterior and posterior cingulate cortex while subjects were processing intensely fearful faces, and its suppression of the amygdalar and posterior cingulate responses was correlated with the concurrent reduction in SCR fluctuations. D-9-THC mainly modulated activation in frontal and parietal areas.

Conclusions:

D-9-THC and CBD had clearly distinct effects on the neural, eclectrodermal and symptomatic response to fearful faces. The effects of CBD on activation in limbic and paralimbic regions may contribute to its ability to reduce autonomic arousal and subjective anxiety, whereas the anxiogenic effects of D-9-THC may be related to effects in other brain regions.
Antipsychotic Effects of Cannabidiol
Authors: Leweke F.M. , Koethe D. , Pahlisch F. , Schreiber D. , Gerth C.W. , Nolden B.M. , Klosterkötter J. , Hellmich M. , Piomelli D.
Published: March 2009

Background:

In contrast to delta-9-tetrahydrocannabinol, the phytocannabinoid cannabidiol does not exert psychotomimetic effects. Cannabidiol was suggested a re-uptake inhibitor of anandamide and potential antipsychotic properties have been hypothesized for it. We therefore performed a clinical trial to investigate thesis hypothesis and to clarify the underlying link to the neurobiology of schizophrenia.

Methods:

We performed an explorative, 4-week, double-blind, controlled clinical trial on the effects of purified cannabidiol in acute schizophrenia compared to the antipsychotic amisulpride. The antipsychotic properties of both drugs were the primary target of the study. Furthermore, side-effects and anxiolytic capabilities of both treatments were investigated.

Results:

42 patients fulfilling DSM-IV criteria of acute paranoid schizophrenia participated in the study. Both treatments were associated with a significant decrease of psychotic symptoms after 2 and 4 weeks as assessed by BPRS and PANSS. However, there was no statistical difference between both treatment groups. In contrast, cannabidiol induced significantly less side effects (EPS, increase in prolactin, weight gain) when compared to amisulpride.

Conclusions:

Cannabidiol revealed substantial antipsychotic properties in acute schizophrenia. This is in line with our suggestion of an adaptive role of the endocannabinoid system in paranoid schizophrenia, and raises further evidence that this adaptive mechanism may represent a valuable target for antipsychotic treatment strategies.

The Stanley Medical Research Institute (00-093 to FML) and the Koeln Fortune Program (107/2000 + 101/2001 to FML) funded this study.
Neurofunctional Effects of Cannabis on Response Inhibition
Authors: Borgwardt S. , Allen P. , Bhattacharyya S. , Fusar-Poli P. , Crippa J.A. , Seal M.L. , Fraccaro V. , Atakan Z. , Martin-Santos R. , O'Carroll C. , Rubia K. , McGuire P.K.
Published: March 2009

Background:

This study examined the effect of Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on brain activation during a motor inhibition task.

Methods:

Functional magnetic resonance imaging and behavioural measures were recorded while 15 healthy volunteers performed a Go/No-Go task following administration of either THC or CBD or placebo in a double-blind, pseudo-randomized, placebo-controlled repeated measures within-subject design.

Results:

Relative to placebo, THC attenuated activation in the right inferior frontal and the anterior cingulate gyrus. In contrast, CBD deactivated the left temporal cortex and insula. These effects were not related to changes in anxiety, intoxication, sedation, and psychotic symptoms.

Conclusions:

These data suggest that THC attenuates the engagement of brain regions that mediate response inhibition. CBD modulated function in regions not usually implicated in response inhibition.
Disability in Schizophrenic Disorders
Authors: Wancata J. , Freidl M. , Friedrich F. , Matschnig T. , Unger A. , Stockinger A. , Dantendorfer K.
Published: March 2009

Aims:

The purpose of this study was to investigate disability among patients suffering from schizophrenia and to identify predictors of disability.

Methods:

101 patients from different types of psychiatric services in Vienna and diagnosed with schizophrenia according to ICD-10 were included. They were investigates by means of 36-Item self-administered version of the WHO Disability Assessment Schedule II (WHO-DAS-II) and the PANSS-scale. Patients’ mothers and fathers were asked to fill in the Family Problem Questionnaire.

Results:

The mean total score of the WHO-DAS-II was 74.1 (SD 21.9). When using weighted sub-scores the highest disability scores were found for social contacts, participation in society and household (means 2.58, 2.57 and 2.51 respectively). Using logistic regression, overall disability was positively associated with patient's age, overall severity of symptoms (PANSS) and number of previous hospital admissions. Overall disability was not associated with duration of illness and or patient's gender. The subjective burden experienced by patients’ fathers and mothers were increased by reduced social contacts and impaired participation in society, while we could not find an association with other domains of patient's disability (understanding, mobility, self-care, household).

Conclusions:

This study shows that schizophrenia results in disability in several domains. Family caregivers’ burden was predominantly increased by social consequences of schizophrenia.
Disorders of Functioning in Neurotic Disorders
Authors: Linden M.
Published: March 2009

Background:

The International Classification of Functioning, Disability and Health, ICF, discriminates between functions, activities/capacities, context factors and participation. There is only limited information on disorders of capacity in neurotic disorders.

Method:

213 inpatients of a department of behavioral and psychosomatic medicine (70% women, median age 45 years) were rated with the “Mini-ICF-Rating for Pychological Disorders, Mini-ICF-P”. This instrument assesses thirteen dimensions of capacity, derived fom the ICF, which can be impaired by mental disorders. Rating varies between 0 (no problem) to 4 (can not fullfill respective requirements at all).

61% of patients suffered from disorders from section F4 (neurotic, adjustment and somatoform disorders) of the ICD-10 (WHO, 1991), 29% from F3 (affective disorders) and 10% from F6 (personality disorders).

Results:

41% were on sick leave before admission. The average global score of the Mini-ICF-P was 0,84 (SD = 0,56), corresponding to “mild disability”. Highest disability was found for “flexibility” (M = 1,64, SD = 0,94), and lowest for “self maintenance” (M = 0,19, SD = 0,44) and “mobility” (M = 0,43, SD = 0,85). The Mini-ICF-P-score and profile was correlated with rate and duration of sick leave, but also type of disorder (e.g. depression vs. phobias), and course of treatment.

Conclusion:

Comparatively minor disorders of capacity are associated with high rates of sick leave, i.e. disorders of participation. Not only restoration of functons but also of capacities should be targets of treatment.
Disability and ICF Core Sets in Mood Disorders
Authors: Ayuso-Mateos J.L.
Published: March 2009

The concept of disability has changed enormously, from a notion of handicap (ICIDM,1980) to the idea of person with disability (ICF,2001). The ICF considers three different levels of disability: body, person and environment, offering a possibility to address it in a universal, integrative and interactive perspective. The utility of the ICF in shifting the attention from a medical to a biopsychosocial perspective is therefore accepted. Having 1464 categories, it is hardly applicable to clinical practice and research. Mood disorders are characterized by a variety of psychiatric and somatic symptoms, associated with a significant loss of quality of life and functioning. Practical tools, such as Core Sets, that cover the spectrum of problems are needed. ICF Core Sets have been developed for depression and are currently being developed by our group for bipolar disorder. The ICF Comprehensive Core Sets for depression is the second larger among 12 Comprehensive ICF Core Sets for chronic disorders. This fact reflects the complex limitations in functioning and the numerous interactions with environmental factors. From the first version of the ICF Core Sets for depression as well as the preliminary studies for the bipolar disorder's core sets mental functions are mostly represented among the body functions domain. Few aspects important to mood disorders, as suicide, have been found to be relevant from both a systematic literature review and an expert survey in BD and in the consensus conference were the Core Sets for depression were establish but are not covered in the ICF.
The International Classification of Functioning, Disability and Health from the Few Point of Social Psychiatry
Authors: Rössler W.
Published: March 2009

Social psychiatry has always suffered from an inappropriate diagnostic classification system. Social psychiatry is directed toward the integration of disabled persons into their family, profession and society in general. As such the exclusive assessment of symptoms is only of minor value for the objectives of social psychiatric approaches. It lies in the core of social psychiatry to assess patients’ problems with functioning. This has already been possible by using the International Classification of Impairment Disability and Handicap (ICIDH) which primarily focused on the deficits of affected persons. The International Classification of Functioning, Disability and Health now allows to classify not only deficits of affected persons but also their resources. Disability is always defined as an interaction of deficits in functioning on one side and the environment on the other side. This is a much more dynamic approach to rehabilitation than previously conceptualized.

A good example for a modern view on the deficits and resources of affected persons is their occupational functioning. Only lately professionals almost without exception agreed on the fact that it is impossible to reintegrate or rehabilitate affected persons in the first labour market. For that reasons disabled persons were excluded from the labour market and trained and employed mainly in sheltered workshops. Today using a more interactive approach to occupational rehabilitation, professionals are much more optimistic to integrate disabled persons in the first labour market. This development in occupational rehabilitation will be described shortly and related to the International Classification of Functioning Disability and Health.
New Developments in Diagnosis and Therapy of Depression in Cardiovascular Disease
Authors: Lederbogen F.
Published: March 2009

Introduction:

Repeatedly, it has been demonstrated that depression increases the risk of developing cardiovascular disorders; vice versa, in subjects with pre-existing heart disease, comorbid depression was found to predict an unfavourable cardiovascular prognosis. However, several studies failed to observe that treatment of depression positively influences cardiac risk. Therefore, focus of research has shifted to identification of subjects, who would benefit from antidepressant therapy that is tailored to their individual needs.

Method:

Search of literature databases, focusing latest goals and advances in diagnosis and therapy of depression in subjects with cardiovascular disease.

Results and discussion:

Screening cardiac patients for depression seems to result in a different population of depressed patients, as compared with most trials testing antidepressant agents. This different inclusion process obviously favoured oversampling of subjects with minor or reversible depressive syndromes such as adjustment disorders. It is known that in these conditions placebo treatment is powerful, sometimes equalling verum condition in effectiveness.

This hypothesis is supported by re-analysis of former studies revealing selective serotonin reuptake inhibitors (SSRI) to be more effective in subjects with severe or recurrent depression or in patients, in whom depression had begun prior to the onset of cardiovascular disease (e.g., myocardial infarction). Surprisingly, some data support the notion that treatment with SSRIs ameliorates cardiac prognosis irrespective of their antidepressant action. Ongoing studies deal with treatment of depression in patients with heart failure or stroke, and with psychotherapy aimed at reducing cardiac risk factors.
Transcultural Aspects in CL-Psychiatry
Authors: Varandas P.
Published: March 2009

Modern psychiatry must take into account more and more the so called cultural differences in its practice. These differences are not merely the evident cultural aspects of diverse ethnic origin, but also the differences determined by economic, social and cultural reasons.

The main paradox of our times is that we try to believe on the ilusion of people homogenicity consequent to the globalization process, when we see that everyone access to the same markets, products, services and news or when we see that everyone can communicate with everyone all over the world. This ilusion is reinforced by the higher cosmopolitism levels of our towns, where we can see people from different ethnic or cultural backgrounds sharing the same space in a reasonable harmonic way.

However, this ilusion is covering the intimate aspiration of any person or group to preserve his identity and afirm his own values. In fact we are living in a society that expresses multiethnic, multiculture and multisocial differences in an interdepedent diversity.

Hospitals are in a way microsocieties where this paradox emerge or in purely sociologic terms described above, but also by the clinical expression of this diversity.

CL-Psychiatry is the field where this subject must be known and researched. This presentation will reviewed the situation.
Guidelines in Consultation-liaison-psychiatry: A Critical Comment (TRAC-NR. 1824 5-17-2008)
Authors: Diefenbacher A. , Georgescu D. , Gaebel W.
Published: March 2009

Background and aims:

Psychiatric comorbidity of general hospitals inpatients leads to complicated courses of illness and to increased health car costs as compared to patients that suffer from somatic illnesses alone. Such patients are cared for by psychiatric Consultation-Liaison (CL) services. When analyze guidelines that deal with the organization of psychiatric CL-services in USA and the UK, as well with a guideline developed for psychosomatic CL-services in Germany, and an Dutch guideline released in 2008

Methods:

Literature search and review of guidelines.

Results:

Existing guidelines in CL-psychiatry are in part controversial with regard to recommendation for treatments, preferences as to concentrate on clinical, or on organizational issues, and differ even in the grade of evidence given to single topics, such as effectiveness of CL-interventions.

Conclusions:

To improve the efficiency of CL-psychiatry, guidelines might be important, as well for the treatment of psychiatric diseases in general, but even more so for diseases that are frequent in general hospitals such as delirium. However, reliability of guidelines in CL-psychiatry differing among countries should be improved.
Bipolar and Unipolar Major Depression are not Associated with the P2RX7-gene (SNP rs2230912) in an European Case-control Sample
Authors: Grigoroiu-Serbanescu M. , Herms S. , Georgi A. , Hauser J. , Czerski P. , Diaconu C.C. , Babadjanova G. , Jamra R. Abou , Rietschel M. , Noethen M.M. , Cichon S.
Published: March 2009

Background:

In two recent studies the SNP rs2230912 (Gln460Arg) located in exon 13 of P2RX7-gene (chromosome 12q24) provided the strongest evidence of association with bipolar disorder (BP) (Barden et al,2006; McQuillin et al, 2008) and in one study with the unipolar major depression (Mdd-UP) ( Lucae et al, 2006).

Objective:

In the present study we investigated the involvement of the SNP rs2230912 in BPI in four European samples from Germany, Poland, Romania and Russia and in the combined sample (N=1445) in comparison with a combined sample of 2006 normal controls. Additionally, a Mdd-UP sample (N=640) from Germany was studied.

Method:

All patients were diagnosed according to DSM-IV-R. The BPI sample consisted of 802 females (55.5%) and 643 males (44.5%); the mean AO was 26.9 (SD=10.6); the mean age-at-interview was 42.7 (SD=12.5). The control sample had a mean age of 39.74 (SD=11.22) [1113 females (55.5%); 893 males (44.5%)]. Genotyping of all national samples was performed at Bonn University using the Mass ARRAY system on a Sequenom Compact MALDI-TOF-device. The single marker analysis was performed with FAMHAP software.

Results:

There was no allelic association between the G-allele of the SNP rs2230912 and either BPI or Mdd-UP both in the national samples and in the combined sample. The genotypic analysis also indicated no significant results. Our samples of patients and controls had genotypic distributions similar to those of the previously published studies and even in these studies there were no significant differences in genotype frequencies between BPI patients and controls.
Vulnerability to Stress and Physical and Mental Illness
Authors: Amaral A.P. , Serra A. Vaz
Published: March 2009

Aims:

The purpose of this study was to examine whether vulnerability to stress is associated with physical and mental illness. We have two main goals:

1.

Studying the importance of vulnerability to stress in the state of health of the individual;

2.

Examining the effects of interactions between the life events, vulnerability to stress and social support in physical and mental symptoms.

Method:

Multivariate analyses were used in a sample of 255 subjects of general population, evaluated in four different moments, spaced of three months. Regression analysis was used to identify the factors explaining the state of health, at every moment.

Results:

The results suggest that vulnerability to stress emerge as the larger predictor of changes in health status of individuals in each moment of assessment. Its role is strongest regarding mental health. The longitudinal study suggest two interactions:

1.

The interaction between life events and factor 1 of vulnerability to stress (perfectionism and low tolerance to frustration), which might explain the changes that occur in mental health.

2.

The interaction between life events, the factor 7 of vulnerability to stress (deprivation of affection and rejection) and social support explains the changes that occur in physical health, along the study.

Conclusion:

Findings suggest the importance of vulnerability to stress in physical and mental health.
Obsessive-compulsive Symptoms in Primary Dystonia: Reactive and Psychogenic or Primary and Neurophysiological?
Authors: Barahona-Corrêa B. , Bugalho P. , Guimarães J. , Xavier M.
Published: March 2009

Introduction:

Primary dystonia (PDy) is an idiopathic neurological disorder causing involuntary muscle contraction. Its pathophysiology is believed to involve basal-ganglia (BG) dysfunction. A possible association with Obsessive-compulsive symptoms (OCS) is regarded as further evidence of BG involvement but remains controversial due to contradictory research data. We proposed to answer three questions:

1.

Do PDy patients have high OCS scores?

2.

Are OCS in PDy reactive?

3.

Does botulinum toxin treatment (BT) influence PDy psycopathology?

Subjects:

45 patients with blepharospasm, spasmodic torticollis, writer's cramp; 43 patients with hemifacial spasm, cervical spondilarthropathy, peripheral hand neuropathy; 27 healthy volunteers.

Assessment: non-structured DSM-IV based psychiatric interview; Symptom Checklist 90 Revised (SCL-90R); Yale-Brown Obsessive-Compulsive Scale (YBOCS); Unified Dystonia Rating Scale (UDRS).

Results:

PDy patients scored significantly higher than controls and healthy controls on the YBOCS (11.1 ± 7.24; 5.98 ± 4.33; 2.07 ± 0.92, both p< 0.001). Controls’ mean score was also significantly higher than healthy subjects’. Controls scored higher than PDy and healthy subjects on the SCL-90R somatization scale. BT treated PDy patients had significantly lower anxiety and somatization but higher UDRS and similar YBOCS ratings compared to untreated patients.

Discussion:

Higher ratings of OCS but not of depression, anxiety or somatization in PDy patients suggests a neurophysiological origin for OCS in PDy. However, diseased controls also scored higher than healthy subjects, suggesting that OCS may nevertheless be partly reactive in PDy. BT may decrease anxiety/depressive symptoms but not OCS, lending further strength to a possible neurophysiological aetiology for OCS in PDy.
Genetics of Intermediate Phenotypes in Suicidal Behavor - Focus on Aggression
Authors: Rujescu D. , Hartmann A. , Schneider B. , Thalmeier A. , Schnabel A. , Maurer K. , Moeller H. , Giegling I.
Published: March 2009

Family and twin studies point towards a partial heritability of suicidal behavior. We investigated the role of a comprehensive set of genes in this behavior. Their selection was driven by results from post mortem and genetic studies. 250 suicide attempters with various psychiatric disorders were compared with 2200 volunteers which were randomly selected from the general population. All subjects were administered standard psychiatric interviews including SCID as well as self-report questionnaires for anger-related traits. Especially, aggressive-impulsive behavior has been studied and associations with these intermediate phenotypes will be presented.

Additionally a large-scale gene expression analysis using cDNA-microarrays to identify new candidate-genes for suicide was conducted. We found several genes to be differentially expressed in the orbitofrontal cortex of suicide completers. Cross-validation experiments using quantitative RT-PCR validated a few genes so far. These genes have been genotyped in our patients and controls and associations with suicidal behavior and intermediate phenotypes, like aggression and impulsivity will be presented.
Severity of Somatic Morbidity and Anxiety: Pathological Realangst
Authors: Linden M. , Muschalla B.
Published: March 2009

Background:

Pathological anxiety is typically characterized by the absence of a real threat or danger. But, a persistent reason for anxiety, such as a severe life threatening illness, does not prevent the development of additional pathological anxieties, which has been described as “Pathological Realangst”.

The question is to what degree pathological realangst can be explained by the real threat or preexisting anxiety.

Method:

209 patients (37,8% female) of a cardiology inpatient unit were given the State-Trait-Anxiety-Inventory, the Heart-Anxiety-Questionnaire, and the Progression Anxiety Questionnaire. Treating physicians gave a rating on the severity of somatic morbidity including subjective suffering, short and long term prognosis, impairment in daily living, degree of acute and chronic multimorbitity, and objective parameters of the cardiac condition.

Result:

Global or specific ratings on the severity of somatic morbidity did not correlate with general or heart related anxiety. Correlation coefficients ranged between .001 and a maximum of .22 (heart anxiety and subjective suffering).

Conclusion:

The results speak against the assumption that the threat by the illness is the explanation for the present anxiety. Instead, anxious patients who are suffering from a somatic illness are also afraid of their health status and present this as cause of their anxiety. Inspite of the persistent threat this anxiety is pathological i.e. realangst. It should be treated like other anxiety disorders, although it is more difficult to convince the patient and possibly their treating physicians that the present anxiety is not “normal” but pathological and in need of treatment.
Diagnosis and Assessment of Female sexual Dysfunction(s)
Authors: Balon R.
Published: March 2009

The first challenge in diagnosing female sexual dysfunction(s) originates in our diagnostic system. The traditional model of classifying sexual dysfunction is anchored in the sexual response cycle: desire - arousal - orgasm - resolution. However, as some experts have pointed out, this classification may be problematic in the area of female sexuality. Both the diagnoses of female hypoactive sexual desire disorder (FHSDD) and female arousal disorder (FSAD) probably need to be redefined and refined. Examples include adding the lack of responsive desire to the FHSDD criteria and creating categories of subjective FSAD and genital FSAD.

The second challenge in diagnosis female dysfunction is the lack of solid diagnostic instruments, diagnosis-specific laboratory assays and other specific testing. Specific measures of female sexual functioning, such as Female Sexual Functioning Index, Profile of Female Sexual Functioning, Sexual Function Questionnaire, Sexual Desire and Interest Inventory, and Female Sexual Distress Scale were mostly developed as outcome measures. No solid diagnostic instrument for sexual dysfunction exists, not even a version of the Structured Clinical Interview for DSM sexual dysfunctions. The contribution of imaging techniques, such as ultrasonography, magnetic resonance imaging or thermography, to the diagnosis is unclear, and these techniques are far (if ever) from clinical use.

Thus, a detailed comprehensive clinical interview combined with physical examination, possibly a gynecological examination, and in some cases laboratory hormonal testing remains the cornerstone of diagnosing and assessing female sexual dysfunctions.
Issues in Differential Diagnosis of Sesxual Dysfunction: Mental and Physical Dysorders
Authors: Zemishlany Z.
Published: March 2009

Sexuality is the ultimate union of mind and body; sexual functioning or dysfunction depends on complex bio-psycho-social conditions.

Sexual dysfunction (SD) may be primarily due to physical disorders, including endocrinologic (diabetes, androgen deficiency, hyperprolactinemia, hypothyroidism and hyperthyroidism), cardiovascular and pelvic illnesses. SD can be secondary or indirectly related to impairments of the physical disorder such as fatigue, weakness and bladder incontinence, or to the psychosocial stress of the illness. Not only the disease itself, but the treatment prescribed, may also cause sexual impairment.

SD is prevalent among psychiatric patients and maybe related to both the psychopathology and the psychopharmacology. SD has been reported in as many as 30%-60% of patients with schizophrenia treated with antipsychotic medication, up to 78% of individuals with depression treated with antidepressants and up to 80% in patients suffering from anxiety disorder. Eating disorders and personality disorders, mainly borderline personality disorder, are also associated with SD.

Psychosocial factors, like interpersonal relationships, length of relationship, lifestyle, socioeconomic class and cultural background have been shown to correlate with SD, especially in hypoactive sexual desire disorder in women.

An evaluation of SD should take into consideration the primary sexual functioning, the physical and mental disorders, the various medications and the psychosocial factors.

It is recommended to identify the specific cause of the SD and to treat the patient according to the individual's mental disorder, physical disorder and interpersonal relationship.
Group Therapy for Adults with ADHD
Authors: Philipsen A.
Published: March 2009

Adult ADHD is a serious risk factor for co-occuring psychiatric disorders and negative psychosocial consequences. Given this background, instead of or in addition to psychopharmacological treatment there is a need for effective psychotherapeutic treatment options for adults with ADHD. Previous trials on psychotherapeutic concepts were based on cognitive behavioural and/or dialectical behavioural approaches and showed significant effects. In a pilot study, our structured skills training group program for adult ADHD led to significant symptomatic improvements (Hesslinger et al. 2007). The following study evaluated the program's effectiveness, feasibility and patient acceptability in a multicentre setting (N = 72, Philipsen et al. 2007). The therapy was well tolerated and led to significant improvements of ADHD, depressive symptoms and personal health status (p < 0.001). Patients regarded the program topics “behavioural analyses”, “mindfulness” and “emotion regulation” as the most helpful. As in our initial study, patients in the multicentre study rated the group setting as highly effective. This might be explained as result of greater peer support and the opportunity of learning from positive role models (e.g. during homework discussion). Following our staged approach, we are currently running a large randomized multicentre placebo-controlled study for the evaluation of the efficacy of this structured group program in adult ADHD that has been approved by the German Federal Ministry of Research and Education. In this study we compare the effects of purely medical management, specific psychotherapy, and the combination of both, comparable with the Multimodal Treatment Study of Children with ADHD (MTA).
Imaginative Death Experience in Hypochondriasis
Authors: Prasko J. , Latalova K. , Raszka M.
Published: March 2009

Patients with health-anxiety are very often unable to describe concrete consequences of their putative somatic diseases. They block their thoughts due to anxiety attended this thoughts. The health-anxious patients try not to think about illness at all, by attempting to control their thoughts or by distraction. Our method is based on therapeutic dialogue, using Socratic questioning, and inductive methods which force patient to think beyond actual blocks.

In second step, patients are asked to think out all other possibilities of newly discovered future. They are forced to imagine the worse consequences of all dread situations. Dialogue is led through one's serious illness status, with its somatic, psychological and social consequences, and the dying experience to the moment of death, which has to be described with all related emotions and details. Further, we ask patients to fantasize and constellate possible "after death experiences". In the next session the patient brings a written conception of the redoubtable situation previously discussed. Than we work with this text as in imaginative exposure therapy.

This method seems to be quite effective and not too time-consuming. Several patients with health-anxiety underwent this exposure in our therapeutical groups. All of these patients profited from this therapy, as confirmed by follow-up data.

Participants will learn:

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conceptualization of health anxiety with the patient;

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Socratic questioning with the hypochondriacal patient;

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how to apply the exposure to the imaginative death experience.

Supported by the research project No. 1M0517 from Ministry of Education, Youth and Sports, the Czech Republic.
Organizing the Work in German-speaking Countries: The ICD10-questionnaire in 2008
Authors: Zielasek J.
Published: March 2009

In the revision of the International Classification of Mental Disorders (currently 10th revision, hence ICD-10), an international scientific partnership network group was founded by the World Health Organisation (Chair: N. Sartorius, Geneva) in order to review the international scientific evidence of putative significance for the revision of ICD-10 in different language areas. The group of German-speaking countries was founded during the annual congress of the German Society of Psychiatry, Psychotherapy and Nervous Diseases in 2007. The core group consists of representatives from Austria, Germany, Switzerland and representatives of other German-speaking countries.

A major task of the German-speaking group was to design and test an international survey questionnaire addressing the perceived need for changes to the classification criteria in ICD-10 for mental disorders, the scientific rationale for such proposals, and a general assessment of the foodnes of fit with which the current classification criteria represent the respective mental disorders. The survey was started in August 2008 and results will be presented in this symposium.

The results of and experiences with this questionnaire are expected to influence the questionnaires to be distributed in other language areas, allowing for regional or national differences to be reflected, but also allowing a comparison with previous editions used when ICD-10 was developed. Taken together, the questionnaire is expected to yield insights into the perceived need to adjust ICD-11 to comply with new scientific evidence, but also with practical clinical experiences with its predecessors.
Issues in Implementing Family Work in Services
Authors: Fadden G.
Published: March 2009

Family work for psychosis has a strong evidence base demonstrating that a marked reduction in relapse rates can be achieved when information and support is offered to the family, and when relatives are helped to develop effective strategies to deal with the challenging situations they face. In some countries such as the UK, the strength of the evidence base has resulted in the development of guidelines and policies stipulating that families should receive appropriate interventions. In other countries, where such policies do not exist, whether or not families receive support tends to depend on the interests of individual clinicians.

Those attempting to implement family work in routine mental health services can encounter various obstacles. Some staff do not posses the skills to deliver family work. Some services, particularly in adult mental health, concentrate on the individual with the mental health difficulties and are not aware of the importance of the person's social network in their recovery. Some managers do not prioritise family work or facilitate their staff in having the time needed for training or for implementing this type of intervention.

This paper will outline effective strategies for ensuring that evidence-based family interventions are available to the families of those with psychosis and other serious mental health difficulties. These will include strategies to address the following:

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Organisational issues;

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Training of staff;

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Supervision;

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Role of management;

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Involving family members to advocate for change;

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Changing service structures to ensure the delivery of family work.
Implementing Family Supportive Interventions for Schizophrenia in Public Mental Health Centres
Authors: Fiorillo A. , Magliano L. , Maj M.
Published: March 2009

Studies aimed at implementing supportive treatments for families in clinical practice report that after a training course 7 to 27 percent of professionals apply these treatments in clinical work and a mean of 1.4 to 1.7 families per trainee receive these interventions.

We carried out a study in 23 Italian mental health centres in order to explore the feasibility of providing psychoeducational interventions for persons with schizophrenia and their families in routine conditions.

Two professionals from each center attended three monthly training sessions for psychoeducational interventions. After the training, each professional provided informative sessions on schizophrenia to five families of service users with schizophrenia, which consisted of three meetings with each family on clinical aspects of schizophrenia, drug treatments, and detection of early signs of relapse. Each professional then provided the intervention to families for six months.

Thirty-eight of the 46 participants completed the training course, and 34 provided the intervention to 71 families. Twenty-nine of the 34 provided the entire intervention to the families and five of the 34 held only informative sessions on schizophrenia. Ninety-one percent of the participants who completed the study reported difficulties in integrating the intervention with their work responsibilities, and 96 percent acknowledged the positive effect that the intervention had on the center's relationship with patients with schizophrenia and their families.

These results support the idea that it is possible to introduce psychoeducational interventions in mental health centres after a relatively brief period of training and supervision.
The FAPS Study on Severe Mental Illness: Views on the Implementation of Psychoeducational Family Work in Portuguese Settings
Authors: Pereira M. Gonçalves , Papoila A. , Xavier M.
Published: March 2009

Background and aims:

Caregiving consequences have been addressed through strategies including family psychoeducation. Groups for relatives are feasible and target part of family needs. Although some forms of family work (FW) influence prognosis of schizophrenia, there is lack of evidence that relatives’ groups lower relapse rates or improve patients’ social functioning per se. Effectiveness of this approach is to be adequately tested in Portugal. The Families of Psychotic Patients (FAPS) survey nested a quasi-experimental group intervention study.

Methods:

Non-randomised sampling: caregivers of patients with ICD-10 schizophrenia/related disorders, in Lisbon community mental health services (n=108). Relatives’ baseline assessments included caregiving consequences, distress, social support, coping and sense of coherence. Patients were given the BPRS,WHO-DASII and GAF. Family psychoeducational groups were offered to all caregivers and those who accepted were screened for illness-related information.

Results:

Needs for FW were not invariably expressed at baseline (adherence: 23,2%), but there were no intervention dropouts. Although satisfaction was remarkable, significant gains were only achieved in part of assessed outcomes: caregivers’ knowledge; some positive aspects of caregiving; social, practical and emotional support; positive communication.

Conclusions:

Strain does not imply adherence to FW, sometimes in discrepancy with staff's expectations (as in another Portuguese FW implementation trial, within the Psychoedutraining Study). Our group intervention, albeit remarkably valuable, did not improve patients’ parameters and failed to diminish relatives’ burden or distress in a straightforward way. Results must be cautiously interpreted (accounting for sampling bias), but re-emphasise one should tailor FW approaches to each family unit in each moment of intervention.
National Mental Health Plan: An Opportunity to Implement Psychoeducation in Portugal?
Authors: Xavier M. , Goncalves-Pereira M. , de Almeida J. Caldas
Published: March 2009

It is well known that due to deinstitutionalization, faster discharge from wards and insufficient community resources, direct contact of the severe mentally ill patients with their families has increased a lot in the last years.

In the last two decades, mental health services across Europe developed a diversified offer of programmes, including psychoeducation and family interventions, in order to ensure an effective response to the different care needs.

In Portugal, the lack of planning and consistent support in the improvement of mental health services means that the country is lagging behind significantly in this field in relation to other European countries.

Concerning the specific subject of psychoeducation and family interventions for psychotic patients and their families, its true that treatment in Portugal seldom comport with the best scientific evidence, but so far there has been no pressure on the services to change this oddly situation.

The new National Mental Health Plan, launched in 2008, sets that i. People with mental disorders should be involved and participate in the planning and development of the services they benefit from, and that ii. Family members of the mentally ill should be considered as important partners in care provision, and encouraged to participate in this provision and to receive the necessary training and education.

Based on these principles, the Mental Health Plan may be a critical opportunity to implement psychoeducation and family interventions in Portugal. The authors address this issue, discussing also the potential role of new models of contracting, financing, accounting and monitoring.