bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis, Classification and Treament of Psychopathology in Infants and Toddlers: Incorporating an Infant Mental Health Approach
Authors: Shah P. , Almeida M.C.
Published: March 2009

Aims:

This workshop will present a theoretical framework to conceptualize early childhood behavior problems in the context of the early parent-child relationship, and will demonstrate how this relational framework can be used to diagnose, classify, and treat child behavior concerns in children under the age of five.

Background:

There is increasing evidence to suggest that a significant number of very young children manifest signs of early psychopathology, and that behavioral problems that emerge early are likely to persist, and warrant further assessment and intervention. One of the challenges to identifying early psychopathology in young children is how to diagnose and classify early behavioral disturbances using a developmental and relational framework.

Methods:

This presentation will describe an “infant mental health approach” to diagnose and intervene with young children with behavioral concerns. This comprehensive model of behavioral assessment incorporates an assessment of the parent's perceptions of the child, observations of dyadic interactions, and utilizes a developmental context to diagnose, classify and treat early behavioral concerns in children under the age of five. Using the DC 0-3R, this model will highlight how an understanding of child behavior in the context of the parent-child relationship can be a helpful framework to diagnose and treat early behavioral disturbances in children under the age of 5. Participants will learn how to identify vulnerabilities in the parent-child relationship, how to diagnose and conceptualize early psychopathology in young children, and how to formulate interventions to support dyads at risk.
The Aesthetics of Badness
Authors: Bernegger G.
Published: March 2009

What are the aesthetic characteristics of badness? Is repulsion the only reaction to the wickedness, mess and disorderliness characterizing it? Or can it, depending on particular conditions, generate fascination? How does it challenge the clinical practice?

One of our analyses deals with the many meanings and uses of the term, in the moral as well as in the aesthetic sphere, referring to the breaking of the rules in both fields.

Besides an initial interpretation of badness, related to something which our mind cannot contain or make sense of, we also consider it as a legitimate aesthetic value. It is then the sublime and tragic categories that allow us to grasp the fascination and awe, the difficulty of judgment and the pleasure, due to the excessiveness, the disproportion, and the playing on the edge of the norms.

We examined the roles that the category of badness, as well as those of the sublime and tragic, play vis-à-vis the category of madness, on both the patient's and the therapist's side, on the diagnostic front and on the therapeutic one. To this purpose, we referred to some clinical and artistic, narrative and pictorial examples.
Impact of Childhood Adversity and Premorbid Personality on the Onset and Course of Major Bipolar Disorder
Authors: Angst J. , Gamma A. , Ajdacic-Gross V. , Rössler W.
Published: March 2009

Background:

Clinical studies have demonstrated the great clinical relevance of long-term depression (LTD). Our study aims to characterise long-term bipolar disorder (LTBP) in comparison with episodic (non-chronic) bipolar major depressive episodes (EBP) on the basis of data from a community sample.

Method:

The Zurich Cohort Study is a prospective study of young adults followed from age 20/21 to 40/41 with six interviews. The stratified sample consisted of two thirds high scorers and one third lower scorers on the Symptom Checklist-90 R (SCL-90-R). LTBP, which was assessed from age 27/28 to 40/41, was defined as threshold or subthreshold depressive syndrome plus hypomanic symptoms, present for more days than not over the past year, plus work or social impairment.

Results:

The cumulative incidence of LTBP was 6.3%, and of episodic BP 15.3%. The two groups did not differ in mean age of onset (13.7 vs. 13.1 years). Age of onset was significantly earlier in subjects with a positive FH of depression and was inversely correlated with the somatisation score of the SCL-90R as assessed at age 19/20. The age of onset increased with increasing levels of childhood family problems in subjects with a positive FH, but decreased in subjects without an FH of depression. Chronic BP was associated with early childhood adversity and low self-esteem and, at a trend-level, with no family history of depression.

Conclusions:

The results are surprising and counter-intuitive, a genetic disposition seeming to be correlated more with periodicity than with chronicity.
Familial Risk Factors for the Course of Bipolar Disorder
Authors: Preisig M. , Ferrero F.
Published: March 2009

Aims:

The major aims of the present paper were to:

1.

assess associations between the course of bipolar-I disorder in probands and the presence and course characteristics of mood disorders in their relatives and

2.

assess associations between manic and depressive symptoms in probands and relatives.

Methods:

A family study including 125 bipolar-I patients and all available first-degree relatives has been conducted at two Swiss sites. All participants were evaluated using the Diagnostic Interview for Genetic Studies. Assessed course variables included the age of onset, the number of episodes and social functioning in terms of GAF scores. Among the 237 interviewed relatives of bipolar probands, 32 also exhibited bipolar disorder.

Results:

The occurrence of bipolar disorders in relatives was not associated with course variables in bipolar probands, whereas the occurrence of unipolar depression in relatives was associated with a more favorable course in probands in terms of higher lifetime GAF scores. Regarding the expression of symptoms during episodes, associations between disorders in probands and relatives were observed for dysphoric and psychotic rather than for typical manic symptom patterns.

Conclusion:

Our data did not provide support for a significant association between the course of bipolar disorder and the presence or the course characteristics of bipolar disorders in relatives. Surprisingly, the presence of unipolar depression in relatives was even associated with a better course of the bipolar disorder in probands. Nevertheless, bipolar disorder revealed some degree of similarity across family members, particularly regarding the expression of dysphoric and psychotic symptom patterns.
Psychological Treatments and Prevention in Bipolar Disorder - Recent Developments
Authors: Kuehner C.
Published: March 2009

This contribution provides a systematic review on recent developments in psychological interventions for bipolar disorder. The main focus of research to date has investigated the role of different psychotherapeutic approaches (cognitive behavioural therapy, family focused therapy, interpersonal and social rhythm therapy, psychoeducation) as an adjunct to pharmacotherapy for remission and relapse prevention. The review will assess efficacy and effectiveness of these interventions, their common ingredients, limitations and predictors of outcome. It will further explore the potential role of psychological interventions for primary prevention of bipolar disorders in high risk children and adolescents. Suggestions will be made for future work in these areas.
Core Symposium: Suicide Across Europe. Epidemiology of Completed Suicide in Europe: Main Tendencies and Trends
Authors: Rozanov V. , Reytarova T.E.
Published: March 2009

Suicide is well represented in the WHO mortality databases, providing the opportunity to study and discuss how ethno-genetic, cultural, religious, economical and political issues may influence suicide rates in different regions and countries. The problem is that all these factors act together and often with contrasting effect. Suicide rates in Europe vary widely - from about 30 per 100000 of population in Lithuania, Russian Federation, Belarus and Kazakhstan to about 1-2 per 100000 in Cyprus, Azerbaijan, Georgia, Armenia and Greece. It is possible to see from the map, that suicide rates diminish when moving from North to South and from East to West. This may be discussed within the so called “Finno-Ugrian hypothesis”. Gender is one of the issues most widely discussed in suicidal behavior. Across Europe males commit suicides 3-5 times more often than females. Dramatic changes in suicide rates on the post-soviet space are associated with male suicides, while female suicides remained almost unchanged. One explaination is a higher susceptibility of males to socio-economic stress while females seem to be more protected. There is a general rule that suicide rates go up with increasing age. In countries like Ukraine, suicide is significantly higher in rural than in urban areas. Other factors influencing suicides are seasonality, alcohol and substance abuse in the given population. Life-stress and its equivalents seem to be very important, as many other conditions (like cardiovascular and cerebrovascular diseases and accidents) have the same pattern as suicide when studying mortality rates across Europe.
Core Symposium: Suicide Across Europe. A GP-based Suicide Prevention Program in Hungary
Authors: Rihmer Z. , Szántó K. , Kalmár S. , Hendin H. , Mann J.
Published: March 2009

Suicide, particularly in the case of current major depression, is quite common among patients who contact their GPs some weeks or months before their death. However, prior studies have shown that GP’s education, regarding the diagnosis and treatment of depressive disorders, can reduce suicide mortality in the given area served by trained GPs. The aim of our present study was to evaluate the effectiveness of a depression-management educational program for GPs in a region with a very high suicide rate (over 50 per 100.000) in Hungary. Twenty-eight GPs and their lead nurses, servicing 73,000 inhabitants in the region of Kiskunhalas, participated the 5-year educational program together with estabilishment of a Depression Outpatient Clinic and psychiatrist telephone consultation service. The annual suicide rate in the Kiskunhalas region decreased from 59.7/100.000 (5-year preintervention average) to 49.9/100.000. This decrease was significantly greater than both the county and whole Hungary (p=0.001 and p=0.001, respectively). However, the increase of antidepressant prescription was greater in the intervention region compared with both the county and whole Hungary and in women compared with men (p=0.02). There was no change in alcohol-related deaths or rate of unemployment in the intervention region during the whole study period (1996-2000 vs 2001 and 2005). The findings support earlier studies showing that continuous GP education on diagnosis and treatment of depression is an effective method of suicide prevention. The high importance of alcoholism in local suicides was unanticipated and not addressed, suggesting that optimal suicide prevention plans must also consider major local risk factors.
Core Symposium: Suicide Across Europe: The European Alliance Against Depression (EAAD): Evidence Base for Cost-Efficiency
Authors: Hegerl U.
Published: March 2009

The European Alliance Against Depression (EAAD) is a 4-level, community-based intervention programme to improve the care of depressed patients and prevent suicidality in Europe (1). Effects of this intervention concept have been evaluated in the intervention regions concerning the number of suicidal acts as primary outcome (2) but also concerning several other aspects, such as changes in attitudes towards depression in the general population, prescription rates of antidepressants or media coverage. Results provide first evidence that this intervention concept is highly cost-efficient. The European Commission listed EAAD as a ‘best practice’ model in its Green Paper (European Commission 2005).
Overview of Common Diagnostic Systems in Psychiatry in Relation to Cross Cultural Validity Issues
Authors: Soomro M.
Published: March 2009

This presentation will give a brief overview of comparison of DSMIV and ICD10 classification systems for mental and behavioural disorders. It will summarise what work was carried out in developing these systems in terms of their cross-cultural validity and reliability. It will also review the subsequent research into the validity and reliability of these systems. Finally some of the relevant approaches and methods would be discussed in relation to the issue of cross-cultural validity and reliability of diagnostic classification
Diagnostic Differences Among Different Ethnic Groups Contacting Mental Health Services
Authors: Kastrup M.
Published: March 2009

Aim:

A nationwide register study was carried out in Denmark comprising 50,877 persons aged 18-66, who were registered in 2003 in the Danish Psychiatric Register or the National Patient Register with a psychiatric ICD-10 diagnosis with the aim to compare diagnostic profiles and use of services.

Method:

The study is a register survey linking Psychiatric/and National Patient Register with Statistical Bureau data.

Results:

Of the population 87.1% were ethnic Danes, 7.8% migrants, 4.0% descendants with one Danish born parent, 0.7% descendants with both parents born outside Denmark and 0.3% foreign adoptees. Males comprised 49%, women 51% of the population. The 5 ethnic groups had significant differences in utilization of care, in diagnostic distribution and in the use of coercion. Diagnostically, contacts due to schizophrenia were significantly higher among non-Danish patients and highest among young descendant males. Personality disorders were significantly higher among women than men and highes in adopted and descendant young women. PTSD had a preponderance among migrant men. Substance abuse was higher among men in all ethnic groups, but lower among migrant groups compared to Danes. Self-mutilating behaviour was seen more frequently among female descendants from non-Western countries than among migrant women from non-Western countries as well as among young adopted women.

Conclusion:

Significant diagnostic differences were observed. Possible explanatory models to these findings will be discussed.
Cross-Cultural Challenges in the Diagnosis of Depression
Authors: Schouler-Ocak M. , Aichberger M. , Rapp M. , Heinz A.
Published: March 2009

For a long time it was assumed that depressive disorders were a classic western problem specific to industrial states. However, the World Bank discovered in a study as early as 1993 that depression in Third World countries was already fifth on the list of illnesses which comprise the largest contribution to the Global Burden of Disease. Affective and behavioural disorders as well as somatic complaints represent the three central categories of symptoms in depression. In western cultures an affective disorder is seen as the main characteristic of a depression, whereas in other cultures different symptoms can be in the foreground. The increase in supraregional communication and cooperation as well as the worldwide increase in immigrant populations demand that cultural aspects are considered in the diagnosis and treatment of depression. Physicians need to consider the cultural background of their patients in order to achieve an optimal therapy. If the sociocultural aspects, which cannot always be fully appreciated, of a culturally sensitive diagnosis are not taken into consideration, this can lead to an artificial prevalence of the disorder by making false diagnoses. In order to minimize these mistakes, the guideline for judging cultural influencing factors should be used to complete the diagnosis.

Not only the development of culturally adequate therapy concepts and institutions, but also the expansion of knowledge about the psychopathology and epidemiolgy of psychic disorders, e. g. of depression in immigrant groups and the examination of their use of treatment facilities, are the goals of cross-cultural psychiatry and psychotherapy.
Technical Aspects of Electroconvulsive Therapy: An Update
Authors: Sienaert P.
Published: March 2009

In an ongoing attempt to improve efficacy of electroconvulsive therapy (ECT) while minimizing side-effects, both different electrode placements and stimulus parameters have been studied. It has been shown that the traditional bitemporal electrode placement and modern techniques such as bifrontal and unilateral ECT are efficacious, depending on the stimulus used. Modern ECT-devices deliver a square wave brief pulse stimulus. An unresolved issue in the use of brief pulse stimulation concerns the optimal pulse width. It has been suggested that the use of a stimulus with an ultra brief (UB) pulse width, i.e. 0.3 ms, is substantially more efficient in seizure induction, thus needing less energy, and producing less cognitive side-effects than standard pulse width (i.e. 0.5-2 ms) stimulation. There has been a concern, however, of lower antidepressant efficacy of UB ECT, with patients needing additional treatment sessions. Moreover, it has been suggested that the diminished antidepressive efficacy is encountered solely with the combination of an ultra-brief pulse width and bilateral electrode placement, as compared to unilateral UB ECT or standard pulse ECT. In a randomized trial, the antidepressive efficacy and cognitive side-effects of bifrontal and right unilateral UB ECT were compared. It was shown that, using an ultra-brief pulse width, BF ECT is as efficacious as UL ECT, although patients receiving UL ECT achieved response/remission-criteria after a smaller number of treatments. In both treatment conditions there was an improvement of cognitive function, both during and after the treatment course.
Continuation and Maintenance ECT: An Update
Authors: Ferreira B. , Borja-Santos N. , Gamito A. , Almeida S. , Cunha I. , Parente J. , Alexandre J. , Ramos J. , Ribeiro J. , Trancas B. , Vieira C. , Luengo A. , Pereira B.
Published: March 2009

The efficacy of electroconvulsive therapy (ECT) is widely recognized and indications are well defined for acute treatments. Surprisingly, the use of continuation and maintenance ECT (M-ECT) is uncommon after acute remission. This is partly because of the scarcity of scientific evidence. Indications are poorly defined and the practice is based on case reports and small open studies. Recent data suggest that M-ECT is a viable treatment option in severe affective and psychotic illnesses, especially in recurring, drug-resistant or medically compromised patients who suffer toxic effects with psychotropics.

Studies regarding the duration and frequency of treatment sessions are laking. The time interval between sessions and duration of treatment vary according to clinical requirements, and should be individualized. The length of treatment and deciding when to stop it are still uncertain. Controversial data about the relation between the frequency of sessions and diagnostic is found. An inverse relation between good prognostic factors for each patient and the frequency of M-ECT was described. During continuation and maintenance ECT, seizure threshold increases until a plateau not being clear when the plateau is reached and if it depends on other treatment variables.

The risk of cognitive dysfunction following M-ECT is one major concern. A transient memory and attention dysfunction are described after acute ECT. Recent studies seem to suggest that M-ECT is cognitively safe.
Electroconvulsive Therapy: The Role of Hippocampal Neurogenesis
Authors: Bolwig T.
Published: March 2009

During recent years magnetic (MRI) studies have pointed to a reduction in hippocampal volume in patients with severe depression. Volumetric changes reflect the actual number of days that individuals have been depressed (1). These findings have heightened interest in studying hippocampal structure and function in experimental animals, especially during and after electroconvulsive seizures -the most powerful of antidepressant therapies (2). Both before and after 2000, with the earliest report on hippocampal neurogenesis following seizures, findings of gliogenesis and synaptogenesis have been reported (3). During the last decade further studies of neurotropic factors have supported ideas of the role of neuroplasticity related to ECT in humans (4). All antidepressant medications, but not antipsychotics, have a similar, but weaker effect on hippocampal neurogenesis. We hypothesize that an induction of neurotropic factors leading to hippocampal neurogenesis may play a major role for the action of ECT (5).
The Expectations of Practising Psychiatrists Towards New Antidepressive Drugs
Authors: Möller H.J.
Published: March 2009

Although there is no doubt about its efficiency, pharmacotherapy of depression still faces several problems that have to be focused upon and hopefully solved. Besides the problem of drug-resistance and delayed response, the need to achieve remission has become increasingly important.

As for the near future, there is great hope that new mechanisms of action can overcome the limitations of the traditional and current antidepressant medications. Unfortunately, some of the recent developments that raised the most interest either turned out to be less effective than hoped, such as the substance P antagonists, or did not yet lead to a drug likely to be marketed in the near future, such as CRF antagonists, for example. On the other hand the first melatonergic antidepressant, agomelatine, is seen as a successful new development.

Drug development can currently be based on improved brain imaging techniques, better animal models, and an increased knowledge of genetic markers. Hopefully this will result in a change in the pharmacotherapy of depression and psychiatric diseases in general. From a clinical point of view, new antidepressants should target the following unmet needs: early onset of action; increased proportion of remission; broad spectrum of efficacy including physical symptoms, pain, sleep disorders, circadian rhythm disorders, etc; good efficacy in subtypes of depression, such as atypical depression; efficacy in bipolar depression without inducing switches to mania; lack of side effects of TCAs and modern antidepressants, especially lack of cardiac side effects, anticholinergic side effects, sedation, weight gain, sexual side effects, etc.
Clinical Development of Antidepressive Drugs - the Viewpoint of the Industry
Authors: de Bodinat C. , Delalleau B.
Published: March 2009

The clinical development program strategy of a new treatment of depression to be registered in Europe must be built in agreement with recommendations of the CHMP guidance.

Demonstration that an antidepressant is effective in treatment of major depressive disorders requires consideration of specific recommendations notably regarding the use of placebo and reference drugs, efficacy assessment, designs features and safety aspects.

In the field of depression, comparisons between test medicinal product and reference drugs are difficult to interpretate since the level of placebo response is high and variable. An adequate evaluation of antidepressant efficacy is firstly based on randomised double blind comparison versus placebo. For short term efficacy, studies with 6 week-treatment period are required and three arm trials including placebo and active control are recommended. Regarding the long term efficacy, relapse prevention study is the design recommended for demonstrating that the short term effect can be maintained over time.

Assessment of efficacy criteria includes both clinical relevance and statisitical significance, particularly:

Improvement expressed as difference between baseline and post-treatment score in symptomatology and as proportion of responders.

Remission, defined as a condition where no or only few signs remained, with a justified cut-off on a validated rating-scale.

In randomised withdrawal trials, efficacy is expressed as number of patients relapsing and/or time to relapse.

The acceptable scales for use as primary endpoint include the HAM-D17 scale, the MADRS scale. Cautions regarding designs features, safety assessment and the global methodological issues faced in conducting such program will be detailed in the presentation.
How to Interpret Efficacy and Safety Data of Antidepressive Drugs and Placebo Response Rates?
Authors: Czobor P. , Bitter I.
Published: March 2009

During the process of drug development, the sponsoring pharmaceutical manufacturers conduct numerous clinical trials to demonstrate the therapeutic efficacy and safety of new antidepressive agents. These trials are required to provide ‘substantial evidence of effectiveness’ in accordance to terms and conditions codified by law. Accordingly, the design and conduct of clinical studies of new antidepressants are strongly impacted by the need to comply with scientific standards as well as by regulatory requirements for approval. Regulatory requirements are typically published in standard ‘Guidance documents’, but in practice the ‘one size fits all’ approach has room for interpretation for specific indications and clinical trials. Detailed statistical criteria applied for the regulatory evaluation of individual drug trials are typically not available in the standard medical literature, but are accessable via the FDA's Summary Basis of Approval Documents (SBAs). This presentation will examine SBA materials and published scientific literature to gain insight into factors that were considered for the establishment of substantial evidence of effectiveness from a statistical perspective. Specifically, the presentation will investigate critical elements considered for the evaluation of results of controlled trials of new antidepressive agents. Such elements include the measurement of relevant clinical outcomes, definition of endpoints, effect sizes, multiple inferences, and principal trial design choices such as placebo- or active-controlled trials. In addition, the presentation will review the contribution of placebo response to the frequent negative results in antidepressant clinical trials, and discusses the implicatons of this knowledge of the placebo response for future trials and clinical practice.
Epidemiology of Substance Use in Pregnancy [S16-01]
Authors: Kumar M.T.
Published: March 2009

An understanding of the epidemiology of alcohol and drug use in young women is important to appreciate the considerable morbidity and mortality associated with it and to understand the impact of such use on offspring. Although abstention rates are consistently higher among women than men in general substance misuse is increasing in young women. Differences in definitions, measurement techniques, availability, social acceptability and affordability partly explain the great variability in reported prevalence rates. Alcohol exposure among pregnant women varies from 0.2% to 14.8%. An Australian national survey revealed that nearly half of pregnant and or breast-feeding women up to 6 months postpartum were using alcohol. A Swedish study reported risky use of alcohol during the first 6 weeks of pregnancy, at 15%. Cannabis use among pregnant women varies from 1.8% to 15%. The reported prevalence of opiate use during pregnancy ranges from 1.65 to 8.5%. Cocaine use among pregnant women is reported to be between 0.3% and 9.5. Most pregnant women stop or reduce their substance use during pregnancy and this might be an opportune moment for detection and treatment. Substance use tends to increase sharply in the postpartum period with adverse consequences on mother and baby. Perinatal substance misuse interventions can reduce adverse neonatal outcomes. On the basis of relatively high rate of substance use disorders during pregnancy and postpartum period, effective screening and intervention strategies should be implemented.
Psychological Interventions for Substance Misuse in Pregnancy
Authors: Crome I.
Published: March 2009

Knowledge of the epidemiology of substance use and associated problems demonstrates that a sizeable minority of pregnant women are using substances, and following delivery the majority revert to higher levels of misuse which is to the detriment of themselves and their babies. There is a rapidly accumulating range of effective interventions for substance misuse. Pregnancy can be a turning point for the delivery of such treatments as women attend obstetric services. This is an opportune moment for detection and treatment, if generalists have the skills to manage less severe problems and referral to specialists is possible. It is important to be able to determine when a patient requires specialist referral for the health and safety of the patient, their baby and the family and for the integration of provision by professionals involved in their care. This symposium will outline the basis of expert assessment and judgement regarding appropriate psychological treatment interventions for this group of young women within the framework of comprehensive service models.
Memory Reorganization by Synaptic Protein Degradation
Authors: Kaang B.-K.
Published: March 2009

An accumulating body of evidence shows that the retrieval process of long-term memory is not static and requires de novo protein synthesis. Thus long-term memories are dynamic and particularly become fragile during its retrieval. Importantly, memory retrieval is regarded as a step necessary for incorporating new information into preexisting memories. We have examined whether protein degradation is involved in the memory reorganization or not. In this presentation I will present the evidence that synaptic proteins are degraded by polyubiquitination and proteasome pathway in the hippocampus after the retrieval of contextual fear conditioning. In addition, we found that the infusion of a proteasome inhibitor into the hippocampus prevented the memory impairment induced by anisomycin, a protein synthesis inhibitor. This indicates that ubiquitin/proteasome-dependent protein degradation is involved in destabilization processes accompanying the memory retrieval. It also supports our hypothesis that preexisting memory is disrupted by synaptic protein degradation before updated memory is strengthened by protein synthesis. Our data also showed that synaptic protein degradation plays a critical role in fear memory extinction, a simple form of memory reorganization. Taken together, synaptic protein degradation is critically involved in the reorganization of the preexisting memories.
Alpha-CAMKII Deficiency Causes Immature Dentate Gyrus, a Novel Candidate Endophenotype of Psychiatric Disorders
Authors: Miyakawa T.
Published: March 2009

Elucidating the neural and genetic factors underlying psychiatric illness is hampered by current methods of clinical diagnosis. The identification and investigation of clinical endophenotypes may be one solution, but represents a considerable challenge in human subjects. Here I show that mice heterozygous for a null mutation of the alpha-isoform of calcium/calmodulin-dependent protein kinase II have profoundly dysregulated behaviours and impaired neuronal development in the dentate gyrus (DG). The behavioral abnormalities include a severe working memory deficit and an exaggerated infradian rhythm, which are similar to symptoms seen in schizophrenia, bipolar mood disorder and other psychiatric disorders. Transcriptome analysis of the hippocampus of these mutants revealed that the expression levels of more than 2000 genes were changed. Whereas BrdU incorporated cells in the mutant mouse DG was increased by more than 50 percent, the number of mature neuronsw as dramatically decreased. Morphological and physiological features of the DG neurons in the mutants were strikingly similar to those of immature DG neurons in normal rodents. Statistical clustering of human post-mortem brains using 10 genes derived from the mutant mice were used to classify individuals into two clusters, one of which contained 16 of 18 schizophrenic patients. Nearly half of the differentially-expressed probes in the schizophrenia-enriched cluster encoded genes that are involved in neurogenesis or in neuronal migration/maturation, including calbindin, a marker for mature DG neurons. Based on these results, we propose that an “immature DG” in adulthood might serve as a promising candidate endophenotype of schizophrenia and other human psychiatric disorders.
Roles of CREB Signaling Pathway in Regulation of Fear Memory
Authors: Kida S.
Published: March 2009

Activity-dependent gene expression through activation of Ca2+-CREB signal transduction pathways has been thought to play a central role in fear memory formation. On the other hand, retrieval of fear memory triggers two time-dependent phases of reactivated memory; reconsolidation and extinction. To understand the mechanisms for determining the fate of the reactivated fear memory, we investigated roles of CREB in reconsolidation and extinction of contextual fear memory and then analyzed the brain-regions regulating reconsolidation and extinction by identifying regions where CREB-mediated gene expression is activated and then examining the role of protein synthesis in those regions on reconsolidation and extinction. We first showed that activation of CREB-mediated transcription is required for reconsolidation and long-term extinction of contextual fear memory. Using immunocytochemical analyses, we demonstrated that CREB is activated in the hippocampus/amygdala and amygdala/medial prefrontal cortex (mPFC) in the reconsolidation and extinction phases, respectively. Similar results were observed by analyzing the expression of a CREB-dependent gene, Arc. We finally showed that reconsolidation and long-term extinction of the contextual fear memory depended on new gene expression in the hippocampus/amygdala and amygdala/mPFC, respectively. Thus reactivated contextual fear memory is reconsolidated or extinguished through distinct CREB-mediated gene expression regulation in the hippocampus, amygdala and mPFC.
First Experience and Later Risk of Alcohol Dependence: An Epidemiological and Genetic Approach on a Large Sample of Young Adults
Authors: Le Strat Y. , Gorwood P.
Published: March 2009

Many risk factors for alcohol dependence have been pointed out on the basis of large cohort analyses, including antisocial personality disorder, familial history of substance abuse and initial effect of the first consumption of alcohol, these factors having large overlaps. In addition, a low level of response to first alcohol drink has been reported to increase the risk of future alcohol-dependence. This response to first dinks is a genetically influenced characteristic, but the genes involved remain unknown.

The Susceptibility Addiction Gene Environment (SAGE) cohort was designed to assess addictions and psychiatric disorders in a cohort of young adults. All 3.895 college students of the French region “Champagne Ardennes” were eligible. Of them, 3.056 (1.834 males and 1.224 females; mean age 20.42 years, s.d 1.4) were enrolled on their campus during a single day and completed an intake assessment. The final sample was based on 2.730 subjects (70.08%) who fulfilled the inclusion criteria, namely having ever drink at least once in their lifetime. The level of response to alcohol during early consumption was assessed, as well as the DSM criteria for alcohol dependence at the time of interview. DNA was also collected.

Our results confirm the strong association between low level of response to alcohol and the risk of dependence. Furthermore, the genotyping of several candidate genes allowed disentangling the potential intermediate factors between the first consumption and the development of later dependence. These findings emphasize the utility of the endophenotype approach in the genetic study of addictive disorders
Dialectical Behavior Therapy for Inpatients with Borderline Personality Disorder and Concomitant Alcohol Dependence: Results of a Pilot Study
Authors: Kienast T. , von Hoerner H. , Reiske S. , Renneberg B. , Wrase J. , Heinz A.
Published: March 2009

Purpose of study:

Psychotherapy with patients suffering from borderline personality disorder (BPD) and concomitant alcoholism requires an integrative approach. Dialectical Behavioral Therapy (DBT) is an evaluated and effective program for patients with BPD, whereas behavior therapy, commitment therapy and self-help groups have all been found to be effective in the treatment of alcoholism. In this pilot study, we give an initial report of the concept and efficacy of an eight week inpatient therapy program integrating an evaluated therapy of alcoholism with standard DBT. The changes of symptoms were evaluated using the Borderline Symptom List (BSL), the European Addiction Severity Index (EuropASI), Lifetime Parasuicide Count (LPC), and Beck-Depression-Inventory.

Findings:

Five case reports were included. All show improvements in various subscores of BSL and EuropASI, and had a decrease in the LPC score.

With this pilot study we test the efficacy of an extended DBT program for inpatients with BPD and alcoholism who failed outpatient treatment, and found significant improvements in the study in all outcome measures. This promising result points to the necessity for clinical trials that compare standard care with extended DBT in larger cohorts.
Psychoanalytic Psychotherapy and Venlafaxine Among Acutely sSuicidal Borderline Patients: A Randomized Clinical Study
Authors: Andreoli A. , Burnand Y. , Cochennec M.F. , Marie D. , Di Clemente T. , Ohlendorf P.
Published: March 2009

Background:

Psychoanalytic psychotherapy was found superior to usual treatment among borderline patients and should be further investigated in subject samples with adequate adherence to effective treatment and careful evaluation of psychotherapy process and its relationship to outcome. According to this rationale we tested the comparative cost-effectiveness of an innovative model of time limited psychoanalytic psychotherapy aimed at working-out conflicting mourning process associated with traumatic abandonment from a romantic partner.

Methods:

Eighty patients aged 18-60, who had been referred to medical emergency room with self-intoxication, DSMIV-R major depression and DSMIV-R borderline personality disorder were investigated in a 3-month randomized clinical trial. At general hospital discharge consecutive subjects were allocated to time-limited mourning focused psychoanalytic psychotherapy and venlafaxine and psychodynamic crisis intervention and venlafaxine. Reliable evaluations were conducted at intake, treatment discharge and 6-month follow-up on a battery of standardized instruments. Service consume was assessed via the computerized case register of the Geneva state health services system.

Results:

Intensive psychoanalytic psychotherapy was found a cost-effective treatment choice among borderline patients in a suicidal crisis.

Comment:

A combination of ambulatory psychoanalytic psychotherapy and venlafaxine protocol is a feasible, safe and cost-effective treatment for acutely suicidal borderline patients.
Schema Focused Therapy for Forensic Patients with Personality Disorders: New Research Findings
Authors: Bernstein D. , Arntz A.
Published: March 2009

Rationale:

Schema Focused Therapy (SFT) has proven effective in outpatients with Borderline Personality Disorder (PD)(Giesen-Bloo et al., 2006). To test the effectiveness of SFT with forensic patients, we have begun a multi-center randomized clinical trial of SFT for male forensic patients with Antisocial, Borderline, Narcissistic, or Paranoid PDs.

Methods:

One hundred twenty patients will be enrolled from 7 high security forensic hospitals (“TBS clinics”) in The Netherlands. Patients are randomly assigned to receive either SFT or usual forensic treatment. Patients receive 3 years of therapy, and are assessed every 6 months for changes in PD symptoms, recidivism risk, and other outcomes. Following treatment completion, patients will be followed an additional 3 years to assess actual recidivism.

Results:

Since 2007, 39 patients (mean PCL-R score = 25.0, SD = 6.6) have been enrolled in the study, 22 have completed their 12-month assessments, and 11 their 18-month assessments. Only 3 have dropped out. Recruitment is ongoing, with expected completion of the project in 2012. Pilot data on a different sample of N = 18 forensic PD inpatients treated in SFT for a mean of 1.9 years (SD = 0.8) is encouraging. Nine of the 18 patients showed reliable improvement, and only one showed reliable deterioration (mean d-score = 0.84, SD = 0.95, p < .01).

Conclusions:

SFT appears to be a promising treatment for forensic patients with Antisocial and other Cluster B PDs.
Is Decision Making in Clinical Psychopharmacotherapy Depending on Syndromes or Nosological Entities or Both?
Authors: Moeller H.-J.
Published: March 2009

The basis for decision making in pharmacopsychiatry is not as trivial as one might think. There was a tradition to believe that we have more or less specific drugs with a more or less specific mode of pharmacological mode of action for special indications, such as schizophrenia depression etc. However, the situation is apparently much more complex and the clinical decision making is far from being that trivial. The current development of new psychopharmaca is heading for different directions: either broadening the indication for one compound, or looking for subtypes of a more general indication. Some of these main aspects shall be discussed in the presentation.

The decision making in pharmacopsychiatry is rather complex, involving nosological and syndromatological aspects. We have to understand that the pharmacological mechanism of a psychopharmacon is not directly associated with only one psychiatric disorder but often with several. This is already true for psychopharmaca, which have only one mechanism, such as SSRIs, but even more so for drugs like the modern antipsychotics, which have a wide spectrum of receptor interactions and can therefore be effective in quite a variety of psychiatric disorders. Apart from broadening the indication of a psychopharmacon, a development in the direction of exceeding specification and, amongst others, of involving new mechanisms of action can be observed.
Pharmacological Properties of Psychopharmaca in Relationship to their Clinical Indications
Authors: Kasper S.
Published: March 2009

Empirical evidence for psychopharmacological treatment has grown over the past decade substantially. While it was quite difficult to perform metaanalyses 20 years before, we now have a large body of evidence available to perform metaanalytic studies, not only on data published in the literature, but also on individual databases called a pooled-analysis. The field moved from eminence-based psychiatry to evidence-based psychiatry. Since indications for psychotropic agents are with a few exceptions given for diseases and not syndromes, it is obvious that the available empirical database is diagnosis-driven. However, recent developments in psychopharmacology indicate that medications primarily used for one diagnosis can also be useful for other diagnoses as we learnt from the serotonin-reuptake-inhibitors (SSRIs), which were firstly used for depression and then for different forms of anxiety disorders. A recent example is quetiapine, for which the first indication was schizophrenia, then bipolar disorder and now depression and general anxiety disorders. Does this mean a denosologisation of psychopharmacology? Not really, however recent developments could be indicative that trials should be performed not only on a diagnostic but also on a syndromatology-level as has been shown for suicidality within schizophrenia, but for instance not in depression.
Differential Diagnosis Between Depression and “Normal Sadness”: A Clinical, Scientific and Ethical Issue to be Addressed by DSM-V and ICD-11
Authors: Maj M.
Published: March 2009

The issue of the differentiation between depression and “understandable” intense sadness (representing a “normal” response to an adverse life event) has significant clinical, scientific, political and ethical implications, which have become particularly visible in the past few decades, in parallel with the escalation of the prevalence rates of depression in the community, of the estimated social costs of depression, of the number of people on treatment for depression, and of the prescriptions of antidepressant medications. According to the DSM-IV, periods of sadness are inherent aspects of the human experience, which should not be diagnosed as a major depressive episode unless criteria are met for severity, duration and clinically significant distress or impairment. The implication of this statement is that “understandable” intense sadness following an adverse life event does qualify for the diagnosis of major depression if the severity, duration and impairment criteria are fulfilled. The proposal has been recently put forward to exclude loss-triggered uncomplicated intense sadness from the DSM-V diagnosis of major depression (i.e., to introduce a “contextual” criterion excluding intense sadness which appears “proportionate” to a loss). However, further research is needed to explore the applicability and reliability of this “contextual” criterion and its clinical utility for the prediction of treatment response and clinical outcome. The limited available research evidence suggests that “situational” major depression does not differ from “non-situational” major depression on many clinical and psychosocial variables, and that response to antidepressant medications is unrelated to whether or not major depression is preceded by a life event.
Ethical Issues Arising in Revising Classifications of Mental Disorders
Authors: Sartorius N.
Published: March 2009

The classification of mental disorders in the International Classification of Diseases (ICD) will be revised in the course of the next three years and its publication (as the 11th Revision of the ICD) will be published, after the approval of the World Health Assembly in 2014. In parallel, the American Psychiatric Association created a Task Force which has begun work on the proposals for the revision of its Diagnostic and Statistical Manual which is to be published as the DSM 5th Revision, in 2012. The World Health Organization has established a special advisory group that should assist it in developing proposals for the classification of mental disorders for the 11th Revision of the ICD and this group collaborates closely with the APA Task Force creating the DSM5 proposals.

Numerous ethical issues arise in this process and need to be discussed now so as to inform the process of agreeing on the proposals for the new classifications. They include the importance of an internationally accepted classification as a protection against abuses of psychiatric patients; the need to set the threshold for the diagnosis of a mental disorder at a level ensuring that people with such disorders receive help, the need to avoid imposition of diagnostic systems or categories without sufficient evidence and others. The presentation will briefly discuss the process of constructing the proposals for the new classifications and ways in which the groups established by the WHO and the APA handle these ethical questions.