bluuebunny/crossref_metadata_2025 huggingface dataset:
S28-04 - Pharmacogenetics of Extrapyramidal Motor Side Effects in the Treatment of Schizophrenia
Authors: Musil R. , Rujescu D. , Spellmann I. , Mayr A. , Zill P. , Giegling I. , Bondy B. , Müller N. , Möller H.-J. , Riedel M.
Published: June 2010

Introduction

Since the introduction of second generation antipsychotics (SGA) extrapyramidal-motor symptoms (EPS) have become a lesser problem in the treatment of schizophrenic patients. Yet, some SGAs display these adverse events and first generation antipsychotics are still widely used. Several genetic polymorphisms have been found to be associated with the occurance of EPS.

Objectives

In this study we tried to identify genes related to EPS from an animal model and then replicated the findings in schizophrenic patients.

Aims

To identify new genes and show their relevance in the treatment of schizophrenic patients.

Methods

Rats were treated with haloperidol or saline and differential gene expression was assessed by using microarrays. We genotyped 285 schizophrenic patients for candidate genes and differentially expressed genes derived from the animal model. All patients were treated monotherapeutically with different antipsychotics within randomized controlled trials. EPS were assessed weekly using the ESRS and BAS. We used a linear model (ANCOVA) with PANSS total at baseline, type of medication and premedication as covariates for all investigated SNP's.

Results

We found several SNPs to be associated with the occurance of EPS. The best results were obtained for SNPs within the genes of Phospholipase C epsilon 1 (PLCe1), Methionine Sulfoxide Reductase B3 (MSRB3), Chloride Intracellular Channel 6 (CLIC6), Prolactin Receptor (PRLR) and Dopamine Receptor D4 (DRD4). Effect sizes were between 1.7 and 4.9.

Conclusions

We could replicate some findings of the literature and identified four new genes possibly related to EPS. Some of these genes were recently related to schizophrenia.
S38-01 - The Effects of Recreational Coffee Consumption on Alcohol Withdrawal
Authors: Wiesbeck G.A.
Published: June 2010

The vast majority of alcoholics consumes coffee as well as tobacco in addition to alcohol. The present study investigated the effects of these two psychotropic substances on the alcohol withdrawal syndrome. Therefore, personal structured interviews were performed in 128 alcohol-dependent women and men who were admitted to hospital for alcohol detoxification. They all regularly consumed tobacco and caffeinated coffee. Quantity and frequency of their consumption patterns were recorded. The severity of their alcohol withdrawal syndrome was measured using a validated scale.

A multiple regression analysis revealed a significant positive correlation between quantity of alcohol and the severity of alcohol withdrawal. In addition, we could demonstrate that not only the quantity of alcohol consumed, but also tobacco and coffee consumption influenced the severity of the alcohol withdrawal syndrome. The more the patients smoked and the more coffee they drank, the less they suffered from withdrawal symptoms during alcohol detoxification.
S38-03 - Circadian Rhythmicity, ADHD and Addiction
Authors: Thome J.
Published: June 2010

Introduction

Attention-deficit hyperactivity disorder (ADHD), specifically in adult patients, is often associated with a plethora of comorbid conditions including substance use and addiction. Interestingly, for bot conditions alterations of circadian rhythmicity have been described and variants in so-called CLOCK genes been implicated in their pathophysiology.

Objectives, aims and methods

In order to further clarify the role of CLOCK genes in these conditions, genotyping and quantitative reverse-transcriptase PCR were used to detect possible associations with CLOCK gene variants (polymorphisms) and possibly altered expression patterns of the gene products.

Results

Preliminary data suggest that certain CLOCK gene variants might be associated with both adult ADHD and addiction. Additionally, the circadian gene expression pattern in patients seems to significantly differ from that of controls.

Conclusions

Alterations of CLOCK systems - on the DNA as well as the RNA level - might be a common pathophysiological phenomenon of ADHD and addiction, and represent the molecular basis for fundamental changes in circadian rhythmicity often observed on the clinical level. This may have far-reaching prognostic and therapeutic consequences.
S40-01 - Psychiatry During Pregnancy
Authors: Passov V. , Friedman C. , Passov L. , Alt J.
Published: June 2010

1.

Psychotropic medications and use of other treatment modalities for major psychiatric disorders in pregnancy. Victoria Passov, M.D.

2.

Chemical dependency issues in pregnancy and treatment modalities currently available. Catherine Friedman, M.D.

3.

Developmental outcomes on children born to mothers with psychiatric illness: complications in children of mothers who received treatment for their psychiatric conditions during pregnancy, as well as developmental and psychological consequences in kids born to untreated mothers will be discussed. Leo Passov, M.D.

4.

Psychology of reproductive loss and guidelines for helping families cope with the trauma of a miscarriage or stillbirth. We will discuss what makes reproductive loss unique and the physical and psychological sequelae that women experience after the loss of a pregnancy. Jennifer Alt, M.D.
S06-02 - Cinema, Subjectivity and Psychosis: Towards a Phenomenological Approach
Authors: Matthews P. , Anderson S. ,   Cinema and Psychosis
Published: June 2010

According to the Jasperian model, phenomenology ‘gives a concrete description of the psychic states which patients actually experience and presents them for observation’ (Jaspers, General Psychopathology, 1963, 44). Narrative cinema is arguably no less phenomenological in that it employs a phalanx of aesthetic strategies (visual design, framing, editing, camera angle, point of view) to materialise subjective consciousness and thereby facilitate the process of emotional identification with onscreen characters. But in representing psychosis, most popular cinema resorts to a shorthand of Expressionist cliché and crudely objectifying stereotypes. We suggest that the concern for clinicians and responsible filmmakers is much the same: how to treat psychotic conditions empathetically, testing empirical understanding and knowledge against ‘first-person’ accounts of mental illness. Our paper focuses on a case study of a short film in production. Sal Anderson's observational fiction Froth: Whose Drama is it Anyway? juxtaposes the media-fed public perception of epilepsy with its subjective experience. During shooting, the neurological condition was explored through a series of improvisatory workshops where people with epilepsy re-enacted and then reflected on the stages of a seizure. This methodology is proposed as a template for the development of alternative strategies in the portrayal of psychosis on film. Finally, we offer a speculative link between Jaspers’ notion of the ‘ununderstandable’ in relation to psychosis and the intractably resistant nature of the cinematic image.
S36-02 - The Shift of Responsibility in the Care System During the Last Decades
Authors: Gabriel E.
Published: June 2010

The paper deals with the change in the attribution of responsibility in the care system during the 2nd half of the last century. The shift went from the rather parentalistic attribution of responsibility to the professional site (psychiatrist, psychiatric institution, its runner) with “de-powerment” of patients, to “em-powerment” and attribution of responsibility to patients and their social systems. This development was influenced by general societal movements (as the human rights), ethical teachings (Hans Strotzka in Austria and Hans Jonas internationally) and a growing awareness for the complex process in the illnes itself and the possibilities to behave under the condition of illness. Nowadays there should be a “topography” of responsibility in care processes with changing foci dependent on the respective capacities to cope with responsibility and the result of negotiating the respective coping power. A fair search for balanced results as fairness in the evaluation of outcomes as well is needed - but not allways reached dependent on the conflicting expectations toward professionals in our societies (as protection versus freedom).
S27-01 - Sleep Timing and Sleep Manipulation as Antidepressants
Authors: Wirz-Justice A.
Published: June 2010

Disturbed sleep is an intrinsic symptom of depression and may precede or even initiate it. Thus, it is surprising that depriving a patient of sleep can induce improvement, often within hours - however usually with relapse following recovery sleep. Clinical trials of early and late partial sleep deprivation, or shifting sleep earlier, suggest a critical circadian phase where wakefulness is necessary for the antidepressant response. Combination with medication or light therapy can maintain improvement. There is now sufficient evidence for many chronotherapeutic combinations (Table) to support the use of “wake therapy” - the fastest antidepressant modality known - in general psychiatric practice (1).

THERAPEUTIC RESPONSELATENCYDURATIONTotal (TSD) or partial (PSD) sleep deprivationhours∼ 1 dayPhase advance of the sleep-wake cycle∼ 2 days∼ 2 weeksTSD followed by phase advancehours∼ 2 weeksRepeated TSD or PSDhoursdays/weeksRepeated TSD or PSD + ADshoursweeks/monthsSingle or repeated TSD or PSD + light therapy; phase advance & light therapyhoursweeks/monthsSingle or repeated TSD or PSD + lithium, pindolol, or SSRIshoursmonthsLight therapy (SAD + non-seasonal MD)week(s)weeks/monthsLight therapy + SSRIs (non-seasonal MD)daysmonths

[Circadian and Sleep Therapies of Major Depression]
S27-04 - Sleep Disorders, Mental Health and Quality of Life
Authors: Novak M.
Published: June 2010

Sleep difficulties are often leading symptoms of psychiatric disorders. Furthermore, several longitudinal studies have demonstrated that untreated insomnia predicts the onset of mental health disorders. Other sleep disorders also often cause mood and/or anxiety symptoms. Furthermore, overlapping symptoms of sleep apnea, a sleep disorder with undoubted public health significance, and depression merits special attention.

Sleep disorders have profound effect on daytime functioning causing daytime sleepiness, tiredness, fatigue and impaired cognitive functioning. These symptoms may severely affect both the quality of life of the patient and also the sleep and quality of life of their bedpartners and family members, as well.

It is increasingly appreciated that the majority of medically ill patients suffer from sleep disorders and sleep complaints, which contribute to their impaired quality of life and clinical outcomes. “Sleep Health” is an important aspect of everyone's life but has a special relevance in mentally or medically ill patients.

In our studies focusing on patients with various stages of chronic kidney disease (moderate to severe chronic renal failure, patients on dialysis and kidney transplant recipients) we have found high prevalence of sleep disorders (insomnia, Restless Legs Syndrome, Periodic Leg Movements in Sleep, Sleep apnea). We have shown that they are associated with the presence of depressive symptoms, increased illness intrusiveness and worse quality of life. Furthermore, RLS predicted mortality of kidney transplant recipients.

In my presentation I will cover the most important aspects of the complex relationship between sleep disorders, mental and physical health and quality of life.
S34-01 - Gray Matter Volume in Monozygotic Twins Concordant and Discordant for Schizophrenia
Authors: Borgwardt S.J. , Picchioni M.M. , Ettinger U. , Toulopoulou T. , Murray R. , McGuire P.K.
Published: June 2010

Introduction

Alterations in gray matter volume (GMV) are a robust feature of schizophrenia. However, it is not clear to what extent these abnormalities are correlates of the genetic liability to the disorder, as opposed to environmental factors and the disorder itself.

Objectives

We investigated the influence of genetic risk and illness on GMV in monozygotic (MZ) twin pairs concordant and discordant for schizophrenia.

Method

Total and regional GMVs were measured from magnetic resonance images of 80 twins: 14 MZ pairs concordant for schizophrenia, 9 pairs discordant for schizophrenia, and 17 healthy MZ twin pairs. The three groups were matched for age, gender, handedness, level of education, parental socioeconomic status, and ethnicity.

Results

Total GMV was smaller in twins with schizophrenia (t=-3.17, p= 0.003) and non-psychotic co-twins from discordant pairs (t=-2.66, p= 0.011) than in healthy control twins. Twin pairs concordant for schizophrenia displayed reduced regional GMV in the inferior frontal, medial frontal, and anterior cingulate gyri, the caudate, lingual gyrus and cerebellum relative to healthy twins (p< 0.05, corrected). Within discordant pairs, twins with schizophrenia had less GMV than their non-psychotic co-twins in the insula, superior/medial frontal, pre/postcentral, cingulate and superior temporal gyri, and the paracentral lobule. There were no significant differences in regional GMV between non-psychotic co-twins and healthy controls.

Conclusions

The presence of schizophrenia was specifically related to reduced GMV in frontal, insular, cingulate, medial parietal and temporal cortex, over and above effects of genetic risk for the disorder.
S34-03 - Iffusion Tensor Imaging Analyses of Twins with and Without Schizophrenia
Authors: Kanaan R. , Carletti F. , Picchioni M. , Kane F. , Ettinger U. , McGuire P.
Published: June 2010

DTI studies in schizophrenia have consistently reported decreased fractional anisotropy (FA, an index of white matter microstructure) in patients. There is little evidence as to the genetic or environmental determinants of this difference however. Studies of twins with schizophrenia allow us to estimate these influences. We report a cross-sectional case control study of twins with and without schizophrenia.

We recruited mono- and di-zygotic twins concordant and discordant for DSM schizophrenia from across the United Kingdom, referred by their treating psychiatrists. We recruited healthy control twins from the Institute of Psychiatry Volunteer Twin Register and by national media advertisements. Clinical diagnoses were confirmed using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (Spitzer and Endicott, 1978). Zygosity was confirmed by DNA analysis. Eleven pairs of monozygotic twins concordant for schizophrenia, 10 pairs of monozygotic and seven pairs of dizygotic twins discordant for schizophrenia, 24 pairs of healthy monozygotic twins and 20 pairs of healthy dizygotic twins were recruited.

Subjects were scanned with an optimized DTI sequence at 1.5T. Scans were warp-corrected, masked, and FA calculated at each voxel. FA maps were then co-registered to a study-specific FA template using SPM2 and group differences calculated on segmented white-matter FA maps using non-parametric XBAM_v3.4.

Results are presented of analyses comparing twins with schizophrenia with their well co-twin, linear trend analyses comparing healthy controls with well di and mono-zygotic co-twins, and a heritability analysis of the healthy controls.
S25-01 - The Role of Values in the Prodromes of Schizophrenia
Authors: Stanghellini G.
Published: June 2010

The lifeworld of persons who will develop schizophrenia includes an axiological dimension next to a symptomatological one. Values are action-guiding attitudes that subject human activities to be worthy of praise or blame. The value system of prodromal schizophrenics, is argued, conveys an overall crisis of common sense. The outcome of this has been designated as antagonomia - the choice to take an eccentric stand in the face of commonly shared assumptions and the here and now other - and idionomia - the feeling of the radical uniqueness and exceptionality of one's being with respect to common sense and the other human beings. The implications of these persons’ structure of values for understanding their world-view, maximizing therapeutic alliance, enhancing healing programs and reducing stigmatization will be discussed.
S25-04 - Neuroanatomical and Neurofunctional Correlates of the Transition from At-Risk State to Full-Blown Psychosis
Authors: Paolo Fusar Poli
Published: June 2010

In early stage psychosis research the identification of neurobiological correlates of vulnerability to schizophrenia is an important hurdle. Structural and functional imaging techniques have shown the potential to clarify the correlates of an increased vulnerability to psychosis and to address the changes underlying transition from a prodromal state to a first episode of disease. sMRI studies found decreased prefrontal, cingulate, insular and cerebellar gray matter volume in high risk subjects with transition(HR-T) as compared to high-risk subjects without transition (HR-NT). Meta-analysis revealed relatively larger whole brain volumes in HR-T compared to HR-NT subjects Compared to HR-NT, HR-T subjects showed in functional imaging studies reduced brain activation in prefrontal cortex, reduced neuronal density, increased membrane turnover in frontal and cingulate cortex. Structural and neurochemical abnormalities in prefrontal, anterior cingulate, medial temporal and cerebellar cortex might be predictive for development of psychosis within high risk subjects.
S05-04 - Conceptual Aspects and Recent Data on the Prodrome to First Episode Mania
Authors: Conus P. , Ward J. , Cotton S. , Yung A.R. , Berk M. , McGorry P.D.
Published: June 2010

Background

Little is known about the early phases of bipolar disorders (BPAD) and most of current knowledge derives from putative “high-risk” studies conducted in populations of bipolar off-spring; such information may therefore be relevant only to a subgroup of at-risk subjects.

Methods

Retrospective assessment of the phase preceding the emergence of mania and of premorbid characteristics of patients treated for a first episode of psychotic mania. The collected data was used mainly to generate hypotheses.

Results

Before onset of a first episode of psychotic mania, patients go through a phase of change from previous mental state where they present mood symptoms, sleep disruption and general functional decline. These clinical manifestations are likely to have low specificity. However, their occurrence in patients presenting certain risk factors or markers of vulnerability that were identified at a relatively high prevalence in our sample, may be an indicator of impending first episode mania.

Limitations

This is a retrospective study, in a small sample of patients presenting with psychotic mania. Criteria identified need therefore to be validated in larger prospective studies.

Conclusions

Early identification of patients at risk to develop a first episode of psychotic mania is unlikely to be possible on the basis of symptoms alone. However, the occurrence of certain clinical characteristics in patients who have risk factors or markers of vulnerability to BPAD may be a sign of impending first episode mania.
S31-01 - Cortex Gyrification and Auditory Hallucinations in Schizophrenia
Authors: Cachia A.
Published: June 2010

Introduction

One century ago, Elmer Southard investigated developmental brain lesions in schizophrenia from the analysis of cortex macroscopic anatomy. So far, a number of epidemiologic, genetic, and brain imaging studies have further supported the hypothesis that abnormal brain development could be a risk factor for schizophrenia. However, the mechanisms underlying its symptomatological expression are still debated, in particular for the auditory verbal hallucinations (AVH).

Objectives and aims

Brain imaging studies in schizophrenia patients with AVH have reported both functional and anatomical deviations in language-related cortical regions but it is still unclear whether these deviations relate to neurodevelopmental impairments. We investigated the cortex gyrification in schizophrenia patients with AVH as gyrification can be considered an indirect marker of gyration and sulcation, namely the development of gyri and sulci.

Methods and results

Using recent sophisticated computer-based morphometry methods, we detected abnormal gyrification in the language-related cortex in schizophrenia patients with persistent AVH. In addition, in comparison to healthy subjects, opposite displacements of the junction between the superior temporal sulcus and its anterior branch were found in patients with AVH heard inside the head in comparison to patients with AVH heard outside the head.

Conclusions

Such sulcal abnormalities support a neurodevelopmental component to AVH in schizophrenia. Furthermore, the “sulcal dysjunction” suggests impairments during early brain maturation, when the STS and its anterior branch appear and merge. Recent results on the genetic, neurochemical and biomechanical processes involved on the cortex gyrification will provide new insight into the pathophysiology of AVH in schizophrenia.
S03-01 - The Immunological Background of Major Depression: a Genetic Study
Authors: Claes S. , Myint A. , Domschke K. , Rothermundt M.
Published: June 2010

Immune system dusfunction is a consistent finding in mood disorder research. One of the relevant metabolic pathways in this regard is the kynurenine pathway which forms a bridge between immune activation, serotonergic deficiency and disturbed NMDA-R function. Given the potential importance of the kynurenine pathway in the pathogenesis of MDD, a SNP based gene association analysis was undertaken, focusing on three major players in this pathway: the genes coding for Trytophan Hydroxylase 2 (neuronal THP, TPH2), Kynurenine-3-MonoOxygenase (K3MO), and Kynurenine AminoTransferase III (KATIII). In order to assess the potential role of these three genes, SNP maps covering the gene were constructed, and single SNP and haplotype association analyses were performed in a sample of 338 German patients with mood disorders and 310 control individuals matched for age, ethnicity and gender.

At the single SNP level, SNP rs1053230 in the K3MO gene shows borderline significant evidence for association. Looking at the haplotype analysis (using the Plink program), the KATIII gene showed significantly different overall haplotype distributions (OMNIBUS) between patients and control individuals for all windows (p-values between 1.75 × 10−5 and 0.006). These findings were mainly due to an overrepreseantation of the CGCTCT risk haplotype, with a frequency of 7,1% in bipolar patients, 5,3% in MDD patients and 1,9% in healthy control individuals.

The identification of a KATIII risk haplotype for mood disorders should be considered preliminary. A next step would be to completely sequence the KATIII promoter, exons and intron-exon-boundaries in patients carrying the risk haplotype.
S03-02 - Immune-Tryptophan Pathway Interaction: Possible Pathophysiological Role in Major Depressive Disorder
Authors: Myint A.-M. , Schwarz M.
Published: June 2010

Background

The involvement of immune mechanism in psychiatric disorders was proposed in macrophage theories of depression and schizophrenia. Later, the involvement of the inflammatory related changes beyond the cytokines including the interaction between inflammatory response system and neurotransmitters was considered in pathophysiology of neuropsychiatric disorders. The neurodegeneration hypothesis of depression stressed the importance of imbalance between the pro- and anti-inflammatory cytokines that leads to another imbalance in neuroprotective kynurenic acid arm and neurodegenerative 3-hydroxykynurenine and quinolinic acid arm of the tryptophan catabolic pathway.

Method

A series of studies on human plasma and CSF changes and their associations to clinical symptoms and response to treatment and certain SNPs polymorphisms were carried out. Some studies were also done in cell culture system and post mortem morphology.

Results

It was observed that the neuroprotective, kynurenic acid was significantly lower and one of the neurodegenerative metabolites 3-hydroxykynurenine was significantly higher in the plasma of drug naïve depressed patients. The plasma kynurenic acid concentration and neuroprotective ratio gave clear discrimination between the patients and controls with reasonable sensitivity and the specificity. The CSF findings showed similar direction. The findings were also supported by the findings from SNPs polymorphism and post-mortem studies.

Conclusion

The major depressive disorder is associated with imbalanced immune-metabolic-neurochemical systems.
S03-03 - Antiinflammatory Treatment Approaches in Major Depression
Authors: Müller N. , Schwarz M.J.
Published: June 2010

Proinflammatory cytokines, such as IL-6, IL-1 and TNF-a appear to be elevated at least in the peripheral blood of depressed patients. Thus IDO activity may be enhanced in depressed patients through these cytokines. Although IL-6 does not directly act on IDO, its elevated levels in serum may contribute to IDO activation within the CNS by the stimulatory effect on PGE2, which acts as cofactor in the activation of IDO. This fits with a report on the correlation of increased in vitro IL-6 production with decreased tryptophan levels in depressed. Due to the increase of proinflammatory cytokines and PGE2 in some psychiatric patients, antiinflammatory treatment would be expected to show advantagous effects in schizophrenic and depressed patients. Cyclo-oxygenase-2 inhibitors have been evaluated in major depression. We were able to demonstrate a statistically significant therapeutic effect of the COX-2 inhibitor on depressive symptoms in a randomized double blind pilot add-on study using the selective COX-2 inhibitor celecoxib in MD. Another randomized double-blind study in fifty depressed patients suffering from MD also showed an statistically significant better outcome of the COX-2 inhibitor celecoxib plus fluoxetine compared to fluoxetine alone. Further therapeutic strategies based on immune-modulatory effects will be discussed, too.
S01-02 - Faster and Safer Antidepressant-like Response Induced by Pharmacological Blockade of 5-HT7 Receptors
Authors: Haddjeri N.
Published: June 2010

Objectives

In term of efficacy and onset of action, current antidepressant drugs still suffer from important drawbacks. Hence, we recently assessed whether the pharmacological blockade of serotonin 7 receptors [5-hydroxytryptamine (5-HT7) receptors] can produce a faster and safer antidepressant response than fluoxetine (Prozac®), the most prescribed antidepressant.

Methods and results

In rats, we showed that SB-269970, a selective 5-HT7 receptor antagonist, exerts an effective antidepressant-like effect as assessed in the forced swim test. Moreover, we revealed in vivo that 5-HT7 receptors negatively regulate the firing activity of dorsal raphe 5-HT neurons and become desensitised after a chronic treatment with fluoxetine. In contrast to fluoxetine, a one-week treatment with SB-269970 did not decrease 5-HT neuronal firing activity but desensitized 5-HT autoreceptors, enhanced the hippocampal cellular proliferation rate and counteracted the anxious/depressive-like behaviour that present the olfactory bulbectomized rat model. Finally, early life treatment with fluoxetine, but not with SB-269970, induced anxious/depressive-like behaviours in adulthood.

Conclusions

These results indicated that the 5-HT7 receptor participates in both mood regulation and the antidepressant effect of SSRIs, and that 5-HT7 receptor antagonists may represent a new class of antidepressant drugs with safer and faster therapeutic action.
S04-04 - The teaching of the behavioural sciences and psychiatry in Malta
Authors: Cassar D. , Sullivan C. , Cassar J. , Felice E. , Grech A. , Muscat P.
Published: June 2010

The development of the medical student is not based solely on the acquisition of knowledge but also on development of skills and appropriate attitude. This requires ability to communicate effectively with patients and colleagues, sensitivity to patient needs, and the capability to influence patients to take the appropriate decisions and maintain behaviour change.

Recent years have seen marked changes in medical school curricula to support this and greater emphasis has also been made post Shipman.

The Faculty of Medicine and Surgery of the University of Malta has moved strongly in this direction. The Department of Psychiatry has led this and developed new courses, longitudinally throughout the curriculum.

The course in Behavioural Sciences was developed with emphasis on student-centred learning in small groups. It focuses on interpersonal communication, teamwork, reflective experience, holistic and patient-centred care, personal development and avoidance of burn out.

A vertical course in Psychology and Sociology in Relation to Health Care has also been introduced and the Course in Psychiatry has been redeveloped in accordance with recommendations of the World Federation of Medical Education and the World Psychiatric Association.

These new developments in the curriculum are described and explored.
S30-02 - Psychological Treatment of Minor Depression
Authors: Peter Schönknecht
Published: June 2010

Minor depression, subsyndromal and subthreshold depression are frequent conditions in primary care which do not fulfil the criteria of a depressive disorder but are associated with functional disability, impairment of quality of life, and health care use. The symposium will discuss studies on the clinical evidence of pharmacotherapy, psychotherapy, and primary care improving interventions. To this concern, it will be critically discussed if clinical relevance may be concluded from placebo-verum-differences of the respective studies, with respect to psychopharmacological and psychotherapeutic approaches. Pragmatic therapeutic approaches in those patients due to lacking clinical evidence will be introduced. Moreover, the symposium will emphasize when exploring the efficacy of antidepressants in depression the core items depression have to be considered as demonstrated in recent studies. The relation between baseline severity of depression and outcome in clinical trials will be critically discussed. Although symptom severity is a most important issue when treating depression in primary care the relationship between patients’ treatment preference and the treatment they actually are evident and will be addressed in the symposium.
W03-02 - Body Psychotherapy in Chronic Schizophrenia - Randomized Controlled Trials and a Naturalistic Study on Effectiveness of Manualised Intervention Strategies
Authors: Röhricht F.
Published: June 2010

Following a successful randomized controlled trial (Röhricht & Priebe 2006, results will be briefly reported), another trial was conducted aiming to investigate as to whether body oriented group psychotherapy (BOPT) will be effective in chronic schizophrenia under “real-life” clinical conditions in order to establish the effectiveness of this novel intervention. The therapy was provided by three different therapists at two different outpatient sites in London, and the therapists were all trained to administer a manualised approach. Data regarding main outcome criteria (PANSS negative symptom scores) and secondary outcome measures (Social Functioning scale and Quality of Life scores) as well as mediating factors and processes under therapy (Differential Emotional Scale) will be reported.
W01-03 - Homosexuality as a risk factor for depression and suicidality among men. Facts and ignorance of facts
Authors: Plöderl M. , Kralovec K. , Fartacek C. , Fartacek R.
Published: June 2010

The presentation highlights the importance of homosexuality in understanding depression and suicidality among men. This issue is not sufficiently acknowledged in research and practice even though international studies report homosexual and bisexual men to be at high risk for depression and suicidality. Results from a meta-analysis of international studies will be presented and they are consonant with the few study results from German speaking countries. In the scientific literature, the increased risk is mostly explained through the harmful effects of “minority stress”, i.e., expected or actual violence and discrimination resulting from being homosexual or bisexual. In addition to minority stress, many homosexual and bisexual men are also confronted with negative social reactions long before coming out because of gender role nonconformity, and that increases the risk for later psychological distress. These findings highlight the need to consider sexual orientation issues in the prevention and treatment of depression and suicidality. There has been some progress in this respect but examples of related ignorance are encountered in the current mental health literature and in suicide prevention programs.
W02-02 - Saving and Empowering Young Lives in Europe (SEYLE): a European Project for Mental Health Promotion Among European Adolescents
Authors: Carli V. , Wasserman C. , Hoven C. , Sarchiapone M. , Wasserman D. ,   The SEYLE Consortium
Published: June 2010

SAYLE is a health promoting programme, funded by the EU Commission for adolescents in European schools. Its main objectives are to lead adolescents to better health through decreased risk taking and suicidal behaviours, to evaluate outcomes of different preventive programmes and to recommend effective culturally adjusted models for promoting health of adolescents in different European countries. It is developed by a consortium of 12 countries: Austria; Estonia; France; Germany; Ireland; Hungary; Italy; Israel; Romania; Slovenia; Spain and Sweden (coordinating centre). In this health promotion programme, an intervention study will be implemented to assess the effects of three different health promoting/suicide preventing programmes in comparison with control groups in 11,000 students across 12 European countries. The three interventions are:

1.

A general health promotion programme targeting students awareness on healthy/unhealthy behaviors and students self-efficacy in diminishing unhealthy behaviors;

2.

TeenScreen - screening by professionals of at-risk students through a questionnaire. For adolescents identified as high risk, the program includes individual assessment and referral to mental health treatment and measures ensuring compliance;

3.

QPR (Question, Persuade & Refer) - a gatekeeper's program, training all adult staff at schools (teachers, counselors, nurses etc) and parents on how to recognize and refer a student with risk-taking behaviours or those suffering from mental illness to mental-health help resources.
W04-02 - Differential Diagnosis of Catatonic Psychoses
Authors: Pfuhlmann B.
Published: June 2010

Originally considered by Kahlbaum to be an independent disease entity characterized by mental and motor abnormalities, catatonia was later viewed as a subtype of schizophrenia as it is the case in current classifications like ICD-10 and DSM-IV. Since catatonic symptoms were observable not only in schizophrenic psychoses, but also in affective, somatic or even psychogenic disorders, many researchers today consider catatonia as a nosologically unspecific syndrome. In the end, the traditional conceptions did not succeed in defining catatonia as a clinically homogeneous and valid diagnosis.

An independent conception of catatonia was elaborated by the Wernicke-Kleist-Leonhard school of psychiatry. Based on a precise differentiation of diagnostically specific qualitative psychomotor disturbances, two essentially distinct forms of catatonic psychoses have been separated which differ in symptomatology, prognosis and treatment: on the one hand periodic catatonia, and on the other hand the group of systematic catatonias.

Periodic catatonia usually has an acute onset, shows a bipolar and polymorphous symptomatology and runs an intermittent course. After one or more acute attacks, adynamic residual states of varying degrees of severity develop. Hyperkinetic and akinetic distortions of psychomotor activity are characteristically intermingled in attacks and residual states.

In contrast, systematic catatonias begin insidiously, run a chronically progredient course without remissions and develop clear-cut and stable residual states. Six subtypes can be distinguished, each of which is characterized by a specific symptom constellation.
W04-03 - Prevalence of Catatonia in Psychoses
Authors: van der Heijden F.M.M.A. , Verhoeven W.M.A.
Published: June 2010

Aims

The prevalence of the diagnosis of catatonic schizophrenia has decreased considerably over the last decades. The aim is to establish whether or not the perceived decline of catatonic schizophrenia is real or merely the result of underrecognition due to external factors.

Methods

Reviews of the literature on the epidemiology of catatonic schizophrenia can be divided into cross-sectional studies and data about change over time in one particular hospital.

Results

The frequency of the diagnosis catatonic schizophrenia in a large sample of admitted psychiatric patients (n=19309) in The Netherlands dropped from nearly 8 percent in 1980-1989 to about 1 percent in 1990-2001.

Although a significant decrease of catatonic schizophrenia has been demonstrated, incidences and rates of decline vary a lot across investigations. Several explanations for this decline have been put forward. Changes in the diagnostic criteria and the diagnostic procedure itself, different populations and treatment options, as well as fluctuations in the frequency of underlying disorders have been considered responsible for this phenomenon.

Modern factor analytical studies have demonstrated the presence of the catatonic dimension in about ten percent of newly admitted patients with affective or schizophrenic psychoses.

Conclusions

The prevalence of catatonic schizophrenia is highly dependent on the applied diagnostic procedure. Until it is clear how many relevant symptom clusters and clinical characteristics are involved in catatonia, it is recommended to use catatonia rating scales systematically. Adequate recognition of catatonia is of clinical importance since it entails major pharmacological and other treatment implications and may disclose prognostic cues.
W04-05 - A Retrospective Study of 34 Patients with Catatonia: Clinical Data and Outcome
Authors: Tuerlings J. , van Waarde J. , Verwey B.
Published: June 2010

Objective

To describe the data and outcome of patients clinically diagnosed with catatonia. In addition, a discussion is provided on a diagnostic work up protocol and therapeutic guidelines.

Method

Retrospective case study on patients hospitalized for severe neuropsychiatric disorders.

Results

Out of a total of 285 patients, treated during one or more episodes with ECT at our inpatient department of psychiatry, twenty seven were diagnosed with catatonia. An additional 7 patients were selected from our catatonia registry (2006-2009). These 34 patients had a total of 40 catatonic episodes. Catatonia was diagnosed in sixteen patients, and lethal catatonia in nine patients, while the remaining nine had a neuroleptic malignant syndrome. A total of 55 additional psychiatric diagnoses were present, and in half of the patients co-morbid somatic disorders were present. ECT resulted in a clinically complete remission in 61% of the patients. Average time (delay) between diagnosis and first treatment (lorazepam), and diagnosis and ECT was respectively 14 days and 60 days while the average duration of admission was 102 days.

Conclusions

A case series of 34 catatonic patients admitted to a neuropsychiatry department of a large general hospital revealed a great variety of psychiatric diagnosis and somatic co-morbidity. Such patients require a diagnostic work up and the presence of a specialized psychmed unit together with an instant availability of ECT and an intensive care unit. Treatment was effective in more than half of patients. Time delay between diagnosis and treatment, and duration of hospital stay is discussed.
CS01-01 - Electrophysiology of Schizophrenia
Authors: Galderisi S.
Published: June 2010

The history of electrophysiological methods in Psychiatry is studded with ups and downs. Recently, several factors contributed to the renascence of the electrophysiological methods in schizophrenia research; in particular: a) the validation of previously reported electrophysiological findings by means of functional brain imaging techniques; b) the possibility offered by electrophysiological techniques to study brain's systems physiological and pathological activity with a high temporal resolution; c) a different conceptualizations of psychopathological phenomena, no longer considered as the result of a dysfunction of one or more brain regions, but as a consequence of the failure to integrate the activity of different areas. Main deliveries of such renascence include: advances in the study of abnormal functional connectivity underlying schizophrenia symptoms and the identification of electrophysiological endophenotypes. Notwithstanding the fact that electrophysiological abnormalities were shown to be related to diagnostic subtypes, risk factors, symptom dimensions and prognosis, electrophysiological methods are still of limited impact in clinical settings, and their application is confined to the exclusion of “organic” brain pathology.
CS05-02 - The Involvement of Dopamine in Human Sexuality
Authors: Zemishlany Z.
Published: June 2010

Studies in humans and animals have suggested that the central dopaminergic system is involved in all components of male and female sexual behavior: desire, erection, orgasm and satisfaction. Copulating activity enhances DA release in the nucleus accumbens as measured by microdialysis in male rats. This rise in DA release lasts until ejaculation and then declines during the refractory period.

Dopaminergic agonists such as L-dopa, apomorphine, amantadine, bupropion, amphetamines and cocaine have been reported to arouse sexual behavior. Short term use of cocaine and other drugs that increase dopaminergic activity (Marijuana, MDMA) facilitate sexual desire and erection and delay ejaculation. These effects are reversed in chronic abuse when brain DA is depleted.

Central dopaminergic blockers, like first generation antipsychotics suppress sexual functioning via the D2 receptors blockade and the corresponding elevation in plasma prolactin levels. Due to their weak antagonistic activity at D2 receptors, second generation antipsychotics are associated with fewer sexual side effects and thus provide an option in the treatment of patients with schizophrenia.

Enhancement of dopaminergic activity by the addition of the DA agonists or bupropion, a norepinephrine-dopamine reuptake inhibitor, has been reported as an effective approach in the management of antidepressant-induced sexual dysfunction. The significant facilitating role of the DA system on sexual function should not be viewed independently. The dopaminergic system interacts with other systems like gonadal hormones, Nitric Oxide and serotonine in the complex neurobiology of sexual function.
CS05-04 - Reconsidering the Definitions of Sexual Disorders in DSM-V
Authors: Balon R.
Published: June 2010

The research of neurobiology and treatment of various disorders requires certain degree of homogeneity of the studied entities. In an ideal word, common etiology and/or pathogenesis would help to define homogenous entities. As our understanding of etiology and/or pathogenesis of mental disorders and diseases is lacking, we rely on various diagnostic systems to help us reach some degree of homogeneity.

The diagnostic criteria of sexual dysfunction(s) in the DSM-IV are rather vague and imprecise. Interestingly, we are not even clear when a sexual problem becomes a sexual dysfunction. As the new versions of the diagnostic systems (e.g., DSM-V) are being prepared, the classification and definitions of sexual disorders/dysfunctions are being considered.

The general classification issues that need to be and are addressed are specific duration of sexual dysfunctions, use of distress s a diagnostic criterion and quantification of severity and frequency. Strengthening and clarifying these three classification issues would probably help in defining more homogenous entities.

The broader yet more specific issues to be considered are inclusions of new diagnostic entities (persistent genital arousal disorder in women; adjustment disorder with disturbed sexual functioning; coercive paraphilic disorder), possible removal or reclassification of some sexual dysfunctions (e.g., sexual aversion disorder - remove or reclassify as specific phobia); collapsing some entities into one (dyspareunia and vaginismus into genitor-pelvic pain/penetration disorder) changing the names of some dysfunctions (premature ejaculation to rapid ejaculation); and redefining some dysfunctions (e.g. sexual desire and subjective sexual arousal in women).
CS05-05 - Sex in the Scanner: Neuroimaging Contributions to Understanding the Neurobiology of the Human Sexual Response
Authors: Georgiadis J.
Published: June 2010

Reigning theories about how the brain governs sexual behavior are the product of experimental investigations and observations in rodents. However, there is a growing appreciation of the fact that these animal models can not account for the sheer complexity of human sexuality. The need for human studies coincides with the exponential growth of the use of medical scanners for the purpose of visualizing human brain activity in vivo. Over the last decade, some 50 of these brain imaging - or neuroimaging - studies have appeared in the field of sexuality research.

In this lecture I will give an overview of the contribution neuroimaging has made to knowledge about the sexual brain. These studies cover a large area of human sexuality, including sexual orientation and preference, sexual desire and arousal, genital stimulation and orgasm, as well as sexual dysfunction and paraphilic disorders. Significant progress, relative to animal studies, has been made in understanding the role of the cerebral cortex, the prefrontal cortex in particular. At the end of the lecture, I will touch upon possible future research directions in the field of human neurosexology.
Cognitive Behavioural Treatment for Eating Disorders
Authors: Grave Riccardo Dalle
Published: June 2010

Over than 20 randomised controlled trials (RCTs) showed that cognitive behaviour therapy (CBT) is the most efficacy treatment for adults with bulimia nervosa (BN). CBT-BN is more effective than delayed treatment, pharmacotherapy, and as effective as, or more effective than, all the psychological treatments evaluated. The leading alternative treatment is interpersonal psychotherapy which is comparable in its effects but much slower to act. However, CBT-BN is not effective enough: at best, only half the patients make a full remission and it has not been designed for treating anorexia nervosa (AN), and eating disorder (ED) not otherwise specified patients, that together represent 2/3 of ED patients. CBT-Enhanced (CBT-E) has been designed to overcome these limits. CBT-E adopts more modern and potent procedures and strategies to address ED psychopathology, and it is suitable for all forms of clinical EDs. CBT-E has been originally designed for adults in standard outpatient settings, but it has been adapted for use with younger patients (under 18 years), with patients with medical and psychiatric comorbidity, and with patients treated in intensive settings (e.g. intensive outpatient, day-hospital and inpatient. Data from a recent RCT show that CBT-E is effective both for BN and not underweight EDNOS. Emerging data shows that CBT-E is a also a promising treatment for outpatient AN and for severe inpatient ED patients.