bluuebunny/crossref_metadata_2025 huggingface dataset:
FC12-05 - Genetic effects on emotional network connectivity: FMRI study of healthy individuals
Authors: Surguladze S. , Radua J. , El Hage W. , Phillips M.L.
Published: May 2011

Introduction

It has been previously shown that genes implicated in psychiatric disorders modulated Blood oxygenation level dependent (BOLD) effect in brain regions. These studies add to the knowledge of vulnerability to disorders.

Objectives

This study has investigated genetic modulation of brain networks associated with emotion processing.

Aim of this study was to examine the effect of two genetic markers (5HTTLPR and COMT) on BOLD effect connectivity in healthy individuals.

Methods

Ninety-one participants participated in four fMRI experiments (at 3T), with dynamic facial expressions of fear, anger, sadness or happiness. We explored the effect of genetic polymorphisms on empirically defined brain network commonly associated with the responses to any emotional expressions. Connectivity was examined by means of Granger analysis allowing to estimate the directionality of information flow between the defined brain regions.

Results

Perception of dynamic emotional facial expressions was commonly associated with activation of the bilateral fusiform gyrus, right superior temporal sulcus, bilateral dorso-lateral prefrontal cortex and right amygdala. The genetic modulation of this network was observed only in experiments with fearful facial expressions. There was an interaction between the effects of genetic polymorphisms and the measures of connectivity: (p = 0.0002, adjusted R2 = 18%). This was accounted for by lower connectivity in individuals lacking both copies of COMT Val polymorphism who at the same time lacked both copies of L polymorphism of 5HTTLPR gene.

Conclusions

Our results clarify the mechanism of brain network reactivity to emotional signals that is associated with genetic polymorphisms.
FC13-05 - Is african ancestry a protective factor against suicide?
Authors: De Luca V. , Teo C. , Zai C. , Assadzadeh A. , Kennedy J.L.
Published: May 2011

Suicide officially is causing approximately 30,000 deaths annually in the United States. Despite persisting socioeconomic and health disparities, African-Americans register suicide rates less than half that of Whites.

This cross-sectional genetic study uses a sample of schizophrenia patients evaluated for presence of lifetime suicide attempt to assess whether African Ancestry self-reported and determined using informative SNP markers were associated with suicide attempt. Subjects were 233 White, African-American and Asian psychotic patients, whose suicidal behaviour was recorded at the time of the SCID.

The African-American ancestry was estimated using the program STRUCTURE 2.1 using 102 HapMap markers across the genome including subjects from the HapMap Phase 3 in the analysis as reference populations. There were 51 suicide attempters and 182 non-attempters in the sample the estimated African ancestry considering three genetic clusters (k = 3) was 23% in the attempters and 24% in the non-attempters. This difference was not significant (p = 0.635). Genetic data disparities might not explain much of the Black-White suicide rate gap. This simple studys support the hypothesis that different rate in suicide between African-Americans and White Caucasians are due to cultural and social difference rather than genetic difference.
FC13-06 - The analysis of the reasons of suicide behaviour owing to family-sexual disharmonies
Authors: Butkova T. , Kibrik N.
Published: May 2011

Objective

Family-sexual disharmonies - are the frequent reasons of suicide behaviour. Design: Complex inspection of 62 patients, in the age from 18 years has been performed. In the anamnesis patients had suicide behaviour owing to family-sexual disharmonies.

Results

1.

Age when suicide attempts have been accomplished. Middle age has made 31 ± 8,8 years; 20–29 years - 43% (27 person); 30-39 years - 39% (24 person). The other 11 person-were included into the age groups of 40–49, 50–59 years.

2.

The reasons of autoaggressive behaviour: Suicide attempts owing to divorce, ideas of matrimonial incorrectness - 52% (32 person).

Owing to the unfair attitude from the nearest environment or a dissatisfaction with behaviour and personal qualities of significant another - 48% (30 person). Age features: For young age - unavailability of young spouses to home life, absence of tolerance and respect to each other. Average age group - a dissatisfaction with behaviour of the partner. The senior age group - somatic diseases, loneliness, loss of relatives 3. In 66% of cases (41 person) suicide had no in the anamnesis of mental diseases at relatives.

Conclusions

The primary goal at rendering the psychotherapeutic help - revealing and correction of non adaptive installations of the person. Formation of confidential and empathic attitudes in family. It has been confirmed correlation analysis between partners′ satisfaction attitudes, personal characteristics suicident. It is necessary to raise availability of the information on various aspects of sexual health, psychohygiene of intimate relations.
FC14-03 - First results of the compas group (comparison of methylphenidate and psychotherapy in adult ADHD study)
Authors: Philipsen A. , Graf E. , Tebartz van Elst L. , Jans T. , Colla M. , Sobanski E. , Alm B. , Jacob C. , Rösler M. , Matthies S. , Kis B. , Huss M. , Lieb K. , Schlander M. , Berger M. ,   COMPAS Group
Published: May 2011

Attention Deficit Hyperactivity Disorder (ADHD) is a serious risk factor for co-occurring psychiatric disorders and negative psychosocial consequences in adulthood. Given this background, there is great need for an effective treatment of adult ADHD patients.

Therefore, our research group has conducted a first controlled randomized multicenter study on the evaluation of disorder-tailored DBT-based group program in adult ADHD compared to a psychophar-macological treatment.

Between 2007 and 2010, in a four-arm-design 433 patients were randomized to a manualized dialectical behavioural therapy (DBT) based group program plus methylphenidate or placebo or clinical management plus methylphenidate or placebo with weekly sessions in the first twelve weeks and monthly sessions thereafter. Therapists are graduated psychologists or physicians. Treatment integrity is established by independent supervision. Primary endpoint (ADHD symptoms measured by the Conners Adult ADHD Rating Scale) is rated by interviewers blind to the treatment allocation (Current Controlled Trials ISRCTN54096201). The trial is funded by the German Federal Ministry of Research and Education (01GV0606) and is part of the German network for the treatment of ADHD in children and adults (ADHD-NET). In the lecture the first data of our interim analysis are presented (baseline data, results of treatment compliance and adherence).
FC16-05 - Efficacy of social cognitive remediation in schizophrenia patients: a meta-analysis including 22 RCTS
Authors: Mueller D.R. , Schmidt S.J. , Roder V.
Published: May 2011

Introduction

Today there is an increased interest from clinicians and researchers in social cognition as a treatment objective for schizophrenia patients.

Objectives

During the last years, several new Social Cognitive Remediation (SCR) approaches were developed. SCR directly intervene in individual or multiple social cognitive domains declared by the NIMH-MATRICES-Initiative. Some of these approaches integrate social cognitive interventions with therapeutic components intended to ameliorate neurocognitive and social skills or with work rehabilitation.

Aims

Until today no quantitative review to evaluate the efficacy of SCR has been presented.

Methods

22 randomized-controlled trials (RCTs) were identified and included in a meta-analysis. Based on the outcome variables from each study, effect sizes (ES) between SCR and control groups were calculated.

Results

Over an average length of more than 20 weeks a significant global therapy effect of SCR compared to controls was evident (average ES of all conducted variables). Significant effects were found in the proximal outcome addressing social cognition and specifically in the domains of emotional processes, social perception and ToM. Additionally, the neurocognitive area showed significant evidence of amelioration compared with the control groups. More distal effects were found for psychopathology and social functioning. The global therapy effect could be maintained during a mean follow-up period of 10 months. The setting, the type of control groups and the type of intervention in the experimental group were identified as moderators.

Conclusions

The results support strong empirical evidence that SCR has a broad effect on various areas of functioning and symptoms relevant in schizophrenia.
FC18-04 - Cue-induced brain activation mediates subsequent relapse in abstinent alcohol-dependent patients
Authors: Beck A. , Wüstenberg T. , Wrase-Post J. , Schlagenhauf F. , Vollstädt-Klein S. , Hermann D. , Smolka M.N. , Ruf M. , Weber-Fahr W. , Flor H. , Mann K. , Braus D.F. , Heinz A.
Published: May 2011

Introduction

In alcoholism, one relevant mechanism contributing to relapse is the exposure to stimuli that are associated with alcohol intake. Such conditioned cues can elicit conditioned responses like alcohol craving and consumption. In the last decade, considerable progress has been made in identifying basic neuronal mechanisms that underlie cue-induced alcohol craving.

Objectives/ aims

We explored whether functional brain activation during exposure to alcohol-associated stimuli is related to the prospective relapse risk in detoxified alcohol-dependent patients.

Methods

46 alcohol-dependent and 46 healthy volunteers participated in a fMRI study using a cue reactivity paradigm, in which visual alcohol-related and control stimuli were presented. Patients were followed for 3 months. Afterwards data was analysed regarding the subsequent relapse, resulting in 16 abstainers and 30 relapsers.

Results

Alcohol-related versus neutral stimuli activated a frontocortical-limbic network including inferior, medial and middle frontal gyrus as well as putamen in the group of patients relative to healthy controls. Moreover, abstainers showed a stronger activation in orbitofrontal cortex as well as midbrain during the presentation of alcohol-related cues whereas relapsers revealed a stronger activation of cingulate gyrus.

Conclusions

This study suggests that cue-induced activation of orbitofrontal cortex and dopaminergic innervated midbrain is negatively associated with the prospective relapse risk in alcohol-dependent patients. This could indicate a more pronounced and conscious processing of alcohol cues which might serve as a warning signal and a behavioural controlling function. In contrast, prospective relapsers showed a stronger activation of cingulate gyrus, a region involved in the attribution of motivational value.
FC20-03 - Motives for khat use and abstinence in yemen - a gender perspective
Authors: Wedegaertner F. , Al-Warith H. , Hillemacher T. , te Wildt B. , Schneider U. , Bleich S.
Published: May 2011

Background

Khat consumption is widespread in Yemeni society and causes problems both in economic development and public health. The gender-specific motives for khat use and abstinence were studied to create a toe-hold for more specific interventions.

Methods

In a sample with equal numbers of males, females, abstainers and consumers, 320 subjects were interviewed on their specific opinions about khat and its impact on subjective and public health, and on social and community functioning. Strata were compared in their acceptance and denial of opinions. Notions that could predict abstinence status or gender were identified with multivariate logistic regression analysis.

Results

Male khat users had a strong identification with khat use, while females were more ambivalent. The notion that khat consumption is a bad habit (odds ratio (OR) 3.4) and consumers are malnuorished (OR 2.2) were associated with female gender among khat users. Among the females worries about health impact (OR 3.2) and loss of esteem in the family (OR 3.1) when using khat predicted abstinence. Male abstainers opposed khat users in the belief that khat is the cause of social problems (OR 5.1).

Conclusions

Distinct beliefs allow a differentiation between males, females, khat users and abstainers when targeting preventive measures. In accordance to their specific values female khat users are most ambivalent towards their habit. Positive opinions scored lower than expected in the consumers. Public opinion towards khat may have become slightl more negative in recent years. This finding creates a strong toe-hold for gender-specific public health interventions.
FC21-06 - Schizophrenia after the 1941 farhud (a pogrom in IRAQ); a study of 6,781 IRAQI-born men and women observed as parents in the jerusalem cohort
Authors: Harlap S. , Antonius D. , Kleinhaus K. , Perrin M. , Lichtenberg P. , Manor O. , Malaspina D.
Published: May 2011

Introduction

Maternal stress during pregnancy has been associated with schizophrenia in some settings with evidence suggesting that male and female offspring might be affected differently.

Objectives/aims

In an outbreak of violence in 1941, at least 180 Jews died in Baghdad; rapes, beatings and property damage injured hundreds more in other towns. We questioned whether this stress might be reflected in any change in schizophrenia incidence in people born in 1941.

Methods

We studied admissions to psychiatric hospitals in 39,606 men and 41,208 women, parents of the population-based Jerusalem cohort. We used proportional hazards models to estimate relative incidence of schizophrenia in various groups, over time. Subjects were followed from age in 1950 or immigration, till age at first hospital admission, death or 2004. Schizophrenia was defined by discharge diagnosis, ICD-10 = F20–F29 at any hospital event. Models controlled for secular and cyclic time trends.

Results

For all years combined, the 3,679 male immigrants from Iraq showed a schizophrenia incidence similar to other men (relative risk RR = 0.92, 95% confidence limits 0.67–1.26). But for 141 men born in Iraq in 1941, RR = 4.12 (1.67–10.2, p = .0021 based on 6 cases), compared with men from Iraq born in all other years. Among other men, RR for 1941 births was 1.21 (0.78–1.88,). Women from Iraq showed no significant findings.

Conclusions

These findings enlarge on long-term consequences of ethnic violence. They raise intriguing questions about the relative resilience of the sexes, but should be interpreted cautiously, given that all subjects in this cohort had been able to reproduce.
FC22-05 - Effectiveness of a home aftercare service for patients with schizophrenia and bipolar disorder: A 12-month randomized controlled study
Authors: Sharifi V. , Tehranidoost M. , Yunesian M. , Amini H. , Mohammadi M. , Jalali Roudsari M.
Published: May 2011

Introduction

The revolving door phenomenon of hospitalization and relapse is very common among psychiatric patients in Iran.

Objective

To examine the effectiveness of a home aftercare service for patients with schizophrenia and bipolar disorders.

Methods

Patients admitted to Roozbeh hospital (Tehran, Iran) were consecutively enrolled and were randomized into the home aftercare service and the treatment-as-usual groups. In the home aftercare group, multidisciplinary teams made home visits on a monthly basis that provided education and treatment. The treatment-as-usual group received the existing services. All patients were followed one year after discharge in 4-month intervals in which data about rehospitalisations, symptoms, functioning, quality of life, and service satisfaction were obtained.

Results

A total of 130 patients were enrolled (70 with bipolar disorder and 60 with schizophrenia) and were randomized to receive either home aftercare (66) or treatment-as usual (64). Home aftercare led to greater reduction in mean rehospitalization rate in the follow-up (0.4 in home care vs 0.07 in TAU, p = 0.011). Moreover, patients in the home care group had more improvement in psychotic symptoms (p = 0.003), depressive symptoms (p = 0.003), and clinical global impression of illness severity (p = 0.008), as well as greater patient satisfaction with the service (p < 0.001). In multiple regression analysis, home aftercare and bipolar diagnosis were associated with less rehopsitalization.

Conclusions

Home aftercare is an effective service for patients with severe mental disorders after being discharged from the hospital. Its implementation in aftercare services is suggested.
FC23-06 - Analysis of outpatient care received by over 780,000 statutory health insured individuals diagnosed with depression
Authors: Kocalevent R.D. , Bönisch S. , Mergl R. , Matschinger H. , Wimmer-Brunauer C. , Tauscher M. , Kramer D. , Hegerl U. , Bramesfeld A.
Published: May 2011

Introduction

Former studies show low treatment rates of outpatients with a diagnosis of depression. Various characteristics influence these treatment rates.

Objectives/aims

To examine the effects of individual and regional characteristics on getting depression-specific treatment in the federal state of Bavaria.

Methods

Outpatient treatment for depression as well as individual and regional characteristics of outpatients diagnosed with depression were analyzed based on secondary data from the Association of Statutory Health Insurance Physicians Bavaria in 2006 (N = 780,226). Depression-specific treatment was classified in “Threshold” and “Subthreshold” treatment according to its intensity. Descriptive analyses were followed by logistic regression analysis (STATA, PASW).

Results

More than half of the patients diagnosed with depression did not use any depression-specific treatment within one year. Individual factors which heighten the rates of a depression-specific treatment were female gender, middle age, a moderate or severe depression, a psychiatric comorbidity and no somatic comorbidity. Interestingly, living in a more rural area increased the chance of using “Threshold” treatment.

Conclusions

The knowledge about the influence of individual characteristics on getting a depression-specific treatment is important to reach the risk groups. A possible reason for higher rates of “Threshold” treatment in rural areas is the higher rate of pharmacotherapy in rural areas, which was more often classified as “Threshold” treatment than psychotherapy according to our classification.
FC28-05 - Prevalence of psychiatric diagnoses and challenging behaviours in a community based population of individuals with intellectual disability
Authors: Grey I. , McClean B. , MacAuley N.
Published: May 2011

Introduction

Previous research has suggested substantial variation in prevalence rates of psychiatric disorders in individuals with intellectual disability and also differential patterns of associations between psychiatric disorders and challenging behaviours in people with intellectual disabilities. The aim of this study was to determine with the prevalence rate of specific psychiatric disorders and challenging behaviours and the relationship between them in a community based sample of individuals with intellectual disability.

Method

A community based sample of 159 adults primarily with mild and moderate intellectual disabilities was surveyed for the presence of psychiatric disorders and challenging behaviour using the Behaviour Problem Inventory (BPI) and the Psychiatric Assessment Schedule (PAS-ADD). Individuals who met threshold on the PAS-ADD were subsequently evaluated using the Mini- PAS-ADD Interview.

Results

Screening for psychiatric disorder using the PAS-ADD indicated a prevalence rate of 10%. There was a large discrepancy between the overall rate of challenging behaviour (45%) and the rate of psychiatric disorders identified by the Mini PAS-ADD Interview (6%). However, the rate of more severe behaviour problems (8%) was closer to the rate of psychiatric disorders (6%). Thirty one percent of people with severe challenging behaviours also were rated as having psychiatric disorders and odd ratio analysis indicates that individuals with severe challenging behaviour are substantially more likely to present with a psychiatric disorder. However, there does not appear to be a relationship between different topographies of challenging behaviour and discrete diagnostic categories of psychiatric disorder.
FC28-06 - ADHD in elderly. First data from a dutch epidemiological cohort (LASA study)
Authors: Kooij J.J.S. ,   LASA Study Group, VUmc Amsterdam
Published: May 2011

Introduction

ADHD occurs in 3–5% of children and adults. Yet little is known about ADHD in elderly.

Objectives

To review the literature and to present first Dutch epidemiological data on ADHD in elderly (VUmc/LASA and PsyQ).

Aims

The study aims to estimate the prevalence of ADHD in eldery and to correlate symptoms of ADHD with comorbidity patterns, cognitive decline and somatic disorders. This knowledge may help predict the future of the current group of adults with ADHD.

Methods

The Longitudinal Aging Study Amsterdam (LASA) included a selfreport questionnaire for ADHD in 2009 in around 1500 elderly, aged 63–94 years. From those with low, intermediate and high scores, a random sample was interviewed using the DIVA, a structured Diagnostic Interview for ADHD in adults (N = 234).

Results

First data on prevalence of ADHD in elderly in the general Dutch population will be discussed. The long term consequences of the persistence of the disorder in adults and elderly, and the impact for the organisation of treatment of this lifespan disorder will be reviewed.

Conclusions

The continuity of ADHD symptoms and impairment from childhood into to old age, may pose psychiatric services for important questions like the usefulness of separate treatment facilities for different age groups in case of a lifespan disorder like ADHD.
FC31-03 - There is no place for them
Authors: García J.A. , Raya A.S. , del Arco E.S.
Published: May 2011

Presentation

The example of a real case with autism opens the eyes to us and denounces the current lack of centers and services as well as of certain treatments and programs personalized of psycho-social-health intervention.

Remarks

-

-Its problems is promoted by the problematic ones of other interns

-

-Its problems is promoted in environments designed for persons with problems of social adaptation.

-

-The promotion of its problems increases the high place conduct, and the highest, risk for its life and that of the others

-

-The promotion of its problems increases the suffering

-

-The promotion of its problems increases the deployment of resources and social expense

Conclusions

-

-They are not delinquents

-

-They are not in court order

-

-They do not come from the social services

-

-They do not have intellectual disability

-

-They have need for specializing professional attention

They have need for temporary income of average or long stay but THERE IS NO PLACE ADAPTED TO THEM
FC31-05 - Mental disorder and moral responsibility
Authors: Meynen G.
Published: May 2011

Introduction

Mental disorders are often considered to be able to undermine a person's moral responsibility, at least in some respect. Yet, it is unclear exactly how mental disorders would be capable of compromising a person's responsibility. Sometimes, it is suggested that mental disorders undermine responsibility via some detrimental effect on free will.

Objectives

Establishing to what extent the effect of mental disorder on moral responsibility might be due to an effect on free will, and to what extent other factors might play a role.

Aims

Providing an analysis of the concept of free will and assessing the relevance of the elements of this concept with respect to mental disorders. Second, establishing what other - not free will related - factors might be relevant to the intuition that mental disorders can undermine responsibility.

Methods

Conceptual analysis with respect to free will and moral responsibility on the one hand and specific features of mental disorders on the other.

Results

Some of the responsibility-undermining features of mental disorders could have to do primarily with free will related issues. However, for some other aspects it is less clear. In fact, they might be more epistemic in nature instead of having to do with free will.

Conclusions

The possible effects of mental disorders on moral responsibility are likely to involve also other than free will related factors.
FC31-06 - Recurrent health issues and missed vaccines (immunization) affect the cognitive function in general public primary school children
Authors: Shaheen A. , Ullah S.
Published: May 2011

Objectives

The study was aimed to assess the relationship of general health and cognitive function of primary school children in Pakistan.

Method

Prospective observational study conducted in 2 state and 2 private schools in a small district.

Results

Two hundred children age 7-12 years class 3, 4 and 5 were assessed using McCarthy scale of child cognition. 11(5.5%) children stated missing some immunization whereas 15(7.5%) found to have recurrent health issues.

Healthy children demonstrated better verbal and linguistic skills. (Mean score 3.94 ± 0.85 vs 3.27 ± 1.03, P = 0.004).Similarly children receiving full immunization demonstrated better verbal and linguistic skills (score 3.91 ± 0.87 vs 3.18 ± 0.87, P = 0.01).

Mathematical ability was assessed by 3 tests and was scored 1–3. Children with no recurrent health issues demonstrated better mathematical ability (2.56±0.62 vs. 1.93± 0.70, P=< 0.000). Similarly children compliant with immunization demonstrated better mathematical ability (P = 0.02).

Reasoning in conversation was assessed on scale of 1-7. Immunization compliant group expressed better reasoning score (P = 0.03).There was no statistical difference between the group with recurrent health issues and the healthy group (P = 0.51).

Memory was assessed on a scale of 1–4. Better memory was observed in the immunization compliant group (P = 0.006) whereas no significant difference observed between the healthy group and the group with recurrent health issues (P = 0.51).

Gross movements were assessed on a scale of 1–5. The Immunisation compliant and the healthy group demonstrated better performance (P = 0.03 and 0.07) respectively.

Results

This study demonstrates that missing immunisation and recurrent health problems result in poor cognitive function and school performance.
PL03-01 - When does Depression Become a Mental Disorder?
Authors: Maj M.
Published: May 2011

Major depressive disorder is reported to be the most common mental disorder, with a lifetime prevalence in the community ranging from 10 to 25% in women and from 5 to 12% in men. These figures are frequently quoted in the psychiatric literature, but are viewed by many, both outside and within the psychiatric field, with a substantial degree of skepticism. From outside the psychiatric field, it has been pointed out that “determining when relatively common experiences such as sadness should be considered evidence of some disorder requires the setting of boundaries that are largely arbitrary, not scientific, unlike setting the boundaries for what constitutes cancer or pneumonia” (1). From within the psychiatric field, it has been stated that “based on the high prevalence rates identified in both the ECA and the NCS, it is reasonable to hypothesize that some syndromes in the community represent transient homeostatic responses to internal or internal stimuli that do not represent true psychopathologic disorders” (2). It is likely that these arguments will be increasingly endorsed by the public opinion in the years to come, and it is therefore crucial for our profession to articulate a convincing response to the question “When does depression become a mental disorder?”. In this presentation, I will summarize three approaches to this issue, pointing out their weaknesses and the lessons we may take from each of them. The first approach is the one proposed by Wakefield (3), emphasizing the context in which depressive symptoms occur. The second approach is the one endorsed by several European psychopathologists, according to whom there is a qualitative difference between true depression and normal sadness, a difference which has been lost in the recent process of oversimplification of psychopathology. The third approach is the one according to which, since there is a continuity between “normal” sadness and clinical depression, the boundary has to be decided arbitrarily on pragmatic grounds. This is what the DSM-IV actually tries to achieve, regarding depression as a “disorder” when it reaches a given threshold in terms of severity, duration and degree of suffering or functional impairment, thus deserving clinical attention. The problem is, however, that the threshold fixed by the DSM-IV for the diagnosis of major depression is not only arbitrary, but also not based on reasonably solid pragmatic grounds (4).
Early Detection and Intervention of Psychosis: the Child and Adolescent Perspective
Authors: Schimmelmann B.G.
Published: May 2011

Over the last two decades, much progress in the prevention and early detection of first-episode psychosis has been achieved. And currently, the inclusion of a psychosis risk syndrome in DSM-V is discussed. But while differences between early-onset and adult-onset psychoses have frequently been pointed out, in the early detection of psychoses, developmental aspects are rarely considered, and results that have been derived from predominately adult samples, i.e., at-risk criteria are generally just transferred to children and adolescents. Emerging evidence from child and adolescent general population, birth cohort and clinical samples, however, question this unrestricted transferability of these results to younger age groups. This presentation will therefore outline the special aspects in the early detection of psychosis that should be considered in children and adolescents. The presentation will cover (i) evidence for the need of a validation of at-risk criteria in children and adolescents and (ii) evidence for a longer DUP in adolescent onset compared to adult onset psychosis and its clinical implications.
Depression and Suicide in Early Onset Schizophrenia
Authors: Zalsman G.
Published: May 2011

Purpose

Suicide is a major cause of death in adolescents with first-episode schizophrenia (FES). We compared suicide-related traits between subjects with FES and with other psychopathologies in order to evaluate risk factors for suicidal behavior.

Subjects and methods

Twenty-five inpatient adolescents with FES and a control group of 28 psychiatric inpatients matched for gender and age were assessed for depression, anger, criminal behavior, aggression, and suicidal ideation, risk and potential.

Results

The adolescents with FES had significantly lower depression (p=0.003) anger (p=0.025) and criminal behavior (p=0.022) than did the controls. However, while suicide ideation was greater in the subjects with FES (p=0.003), suicide risk was significantly lower than controls (p=0.004).

Discussion

Decreased levels of both depression and anger as part of affective constriction in the schizophrenia group could explain why the increased suicide ideation did not lead to a higher suicide risk in these inpatients.

Conclusion

This study highlights the importance of distinguishing between suicidal ideation and actual suicide risk. We demonstrated that thoughts of suicide do not necessarily translate into an actual risk of suicidal behavior in adolescents with schizophrenia.
Treatment resistance in Schizophrenia
Authors: Fleischhacker W.
Published: May 2011

Diagnosis

The diagnosis of treatment resistant schizophrenia generally follows two not always consistent lines of thinking: one is based on research strategies, the other one on every day clinical practice. Both require a failure to respond to at least two (sometimes three) treatment attempts of adequate duration with an adequate dose of an antipsychotic.

In research, one needs to define clearly operationalized criteria which can be applied and reproduced in different settings. Response data are usually operationalized using rating scales scores. Under routine treatment conditions physicians often have to rely upon poor drug response histories or less than perfect chart notes. A more general view of the patient's condition, often including social functioning and quality of life, will then be amalgamated for the clinical diagnosis of treatment resistant schizophrenia.

Management

Once the diagnosis has been established, alternative treatment strategies can be discussed. The treatment option which is substantiated by the largest research base is clozapine.

If a trial with clozapine is unsuccessful, various alternatives are currently discussed. These range from adding another antipsychotic, mood stabilizers, benzodiazepines, serotonin antagonists, serotonin reuptake-inhibitors, glutamatergic drugs to dopaminergic agents and electroconvulsive therapy. None of these have proved unequivocally efficacious in sufficiently large patient samples. There is some evidence, that treatment resistant patients need more time until they show a positive response. Although this evidence is tentative, for practical matters last resort trials will be extended anyway since very little treatment options remain after these have failed.
Longitudinal neuropsychological findings in the at-risk mental state for psychosis
Authors: Linszen D.
Published: May 2011

Background

Cognitive impairment is considered to be a core characteristic of schizophrenia. The relationship between psychosis and cognitive deterioration, however, remains unclear. This longitudinal study investigated the neuropsychological functioning of patients before and after their first psychotic episode. Cognitive functioning of participants who later developed a psychosis was compared to that of people at ultra-high risk (UHR) for psychosis who did not develop psychosis at follow-up and healthy controls.

Methods

Participants were 41 persons at UHR for psychosis (the UHR group), of whom 17 developed psychosis between the first and second assessment. Seventeen healthy controls were included in the study. Cognitive performance was assessed at intake (T0) and again after 18 months (T1). The areas of cognitive functioning assessed include verbal memory and learning, visuo-spatial working memory, executive function, sustained attention and motor speed.

Results

The transition group did not perform significantly worse at the second assessment than at the first on any of the outcome measures. The UHR group performed better on a verbal learning and memory test at T1 compared to T0. At T0, the control group scored significantly better than the UHR group and the transition group on the verbal learning and memory test and the verbal fluency test.

Conclusions

The results indicate that no cognitive deterioration occurs during the first psychotic episode. Problems in verbal memory may be present before the first episode of psychosis.
Subjective quality of life and its changes in patients at-risk for psychosis results of the EPOS study
Authors: Salokangas R. , Svirskis T. , Heinimaa M. , Klosterkötter J. , Ruhrmann S. , Graf von Reventlow H. , Linszen D. , Dingemans P. , Birchwood M. , Patterson P.
Published: May 2011

Objectives

In the European Prediction of Psychosis Study (EPOS) a large sample of young patients at high risk of psychosis (HR) were examined and their conversion rate to psychosis during 18 months follow-up was estimated. This presentation describes quality of life (QoL) and its changes in patients at risk of psychosis who did or did not convert to psychosis.

Methods

In all, 245 young HR patients were recruited and followed for 9 and 18 months. Risk of psychosis was defined by occurrence of basic symptoms (BS), attenuated psychotic symptoms (ATP), brief, limited or intermittent psychotic symptoms (BLIPS) or familial risk plus reduced functioning (FR-RF). QoL was assessed at baseline and at 9 and 18 months’ follow-ups, and analysed in the HR-patients who converted (HR-P; n = 40) or did not converted to psychosis (HR-NP; n = 205).

Results

There were no differences in the course of QoL between the HR-P and HR-NP patients. Of the inclusion criteria, only BS associated with poor QoL at baseline. Among HR-NP subjects, depressive symptoms associated with QoL at baseline and predicted poor QoL at 9 and 18 month follow-ups.

Conclusions

QoL of the HR-NP patients is as poor as that of the HR-P. From the QoL point of view, all HR patients require intensive treatment intervention from the first contact on. Especially, depressive disorders need to be treated vigorously.
Treatment in the at-risk mental state for psychosis - a comparison of four european countries
Authors: Birchwood M.
Published: May 2011

EPOS presented a unique opportunity to document all 'treatments as usual' offered and received in the participating centres to help-seeking patients who fulfilled criteria for UHR status. The EPOS centres were drawn from very different healthcare systems, employing different treatment concepts and using different methods of ascertainment. EPOS ascertained n = 245 UHR patients who were then followed up at 9 and 18 months, taking repeat measures of prodromal symptoms (SIPS), PANSS and depression. In this paper I will describe the different treatments offered in each EPOS centre and the impact of each treatment class on the course of symptoms over time, including ‘transition’ to psychosis. These data will have important bearing on the misnomer of the ‘false positive’ in high risk research and on the other risks and outcomes linked to the UHR/PACE paradigm and their treatment.
Pre- and postnatal factors in child mental health: The importance of prospective longitudinal studies
Authors: Rodriguez A.
Published: May 2011

Introduction

Does the prenatal environment contribute to subsequent mental health in childhood? --A question that has been around since antiquity, but still remains difficult to answer. Compelling evidence from epidemiological studies and animal experiments support the concept of developmental origins of health and disease whereby risk is conferred via early environmental influences rather than genetic transmission. However, it is difficult to disentangle the effect of confounding factors.

Objectives

To critically explore biologically plausible mechanisms and potential postnatal moderators in child mental health using evidence from epidemiological studies. Examples are drawn from work on Attention Deficit Hyperactivity Disorder (ADHD) symptoms.

Methods

Data come from prospective pregnancy cohorts primarily gathered in Sweden as well as in other Northern European countries. The research is based on longitudinal design and emphasizes the critical role that development plays in the manifestation of behavior problems.

Results

Longitudinal modeling reveals that both prenatal and postnatal environmental factors have an impact on child mental health problems.

Conclusions

Exposure to adverse environmental factors related to maternal lifestyle during prenatal development have a lasting impact on child development. Therefore, the time of pregnancy offers a critical window of opportunity for prevention.
Neuroimaging and neurogenesis of depression
Authors: Frodl T.
Published: May 2011

Introduction

Until only a few years ago, the adult brain was considered to be an organ with a fixed structure, unable to remodel or repair itself. Today, neuroscientists and neurobiologists use the term “neuroplasticity” to indicate an ability of some nervous system regions to change their structure, eventually altering their overall functionality.

Aim

The presentation reviews the implication for the conceptualization of and investigation of depression arising from neuroplastic change and neurogenesis in the brain.

Results

Animal experimental and human studies have shown the effects of stress and depression to affect brain structure and function, e.g. of the hippocampus. Exercise, learning and antidepressant treatment was shown to have beneficial neuroplastic effects.

Discussion

Long-term interventions should also target the molecular mechanisms linked with neuroplastic adaptive dysfunctions in the brain. Possibilities how psychotherapy and pharmacotherapy could achieve this aim will be discussed.
Delirium in the general hospital: Why and how cl-psychiatry must tackle a major health care problem
Authors: Diefenbacher A.
Published: May 2011

Delirium in patients older than 70 years is a frequnet problem on somatic wards in the general hospital, leading to adverse events such as falls, and/or prolonged length of hospitals stay.

Albeit c-l-psychiatrists and geriatricians since long have advocated the necessitiy to improve this situation, nothing really happens.

This lecture discusses problems, perils and pitfalls of this unsatisfying situation and tries to answer questions such as whether guidelines could be of help here, and whether pilot projects could be useful to lead the field further. The latter issue will be illustrated with two examples from Germany.
Neurobiological susbtrates in deficit and non deficit schizophrenia
Authors: Arango C.
Published: May 2011

The deficit syndrome defines a subgroup of schizophrenia patients with prominent and enduring primary negative symptoms (1). Behavioral, structural, and functional neuroimaging studies have implicated mainly the dorsolateral prefrontal - thalamocortical circuit. Deficit syndrome patients seem to have larger ventricles in MRI studies (2). Neurological soft signs suggest parietal involvement with greater sensory integration impairment in deficit syndrome patients (3). On the contrary, some biological markers such as P50 gating have not shown any difference between deficit and non-deficit schizophrenia (4). Finally, no pharmacological treatment has so far proven effective for the treatment of primary enduring negative symptoms (5). In conclusion, deficit pathology in schizophrenia seems to involve the prefrontal and parietal lobes and have different neurobiological substrates than positive symptoms.
The assessment of self experiences in patients with primary negative symptoms
Authors: Bitter I.
Published: May 2011

Introduction

Negative symptoms in schizophrenia are present both in behavior and in the subjective experiences of the patients. However the latter are not represented in most rating instruments.

Objectives

To review assessment methods for the subjective experiences of primary negative and related symptoms in schizophrenia.

Methods

Literature review and comparison of negative symptoms as judged by the rater with reports of self experiences.

Results

The Scale for Assessment of Negative Symptoms (SANS) is an instrument concerning the positive-negative distinction in schizophrenia. The SANS is based on the judgment of the rater about the behavior of the patient. Items reflecting subjective experiences of the patients were initially included in the SANS, buy they were not significantly correlated with the behavioral items, and were therefore excluded from this scale by its author.

Huber's group emphasized subjective experiences in schizophrenia. According to this concept the lack of behavioral negative symptoms does not exclude subjective experiences of deficiencies (part of „basic symptoms”, „pure defect”). Nineteen such symptoms were included in the Subjective Deficit Syndrome Scale (SDSS).

We compared negatives symptoms measured by SANS with the corresponding subjective experiences measured by SDSS in patients with the diagnosis of schizophrenia and schizoaffective disorder (n = 122).

D2 receptor occupancy during antipsychotic treatment was found to be associated with subjective experiences/well being, which can be assessed with specific rating scales (e.g.: Drug Attitude Inventory and Subjective Well-Being under Neuroleptic Treatment).

Conclusions

Behavioral symptoms and the subjective experiences of the negative syndrome are not correlated with each other.
Efficacy of combinations of antidepressants in the treatment of resistant depression
Authors: Hoschl C. , Bareš M. , Novák T. , Kopeček M. , Stopková P.
Published: May 2011

In order to compare efficacy of antidepressant monotherapies and combinations of antidepressants, we reviewed retrospectively chart documents of treatment resistant depressive inpatients treated at least 4 weeks with a new antidepressant. Depressive symptoms were assessed using Montgomery and Åsberg Depression Rating Scale (MADRS), Beck Depression Inventory-Short Form and Clinical Global Impression at the baseline, week 2, and at the end of treatment. We identified 78 patients (27 treated with combinations and 51 with monotherapies) that fulfilled the criteria for analyses. In comparison with patients on monotherapy, the combination group achieved higher reduction of MADRS score (14.6 vs 10.2 pts., p = 0.02) and response rate (≥ 50% reduction of MADRS, 67% vs 39%, p=0.03). Number needed to treat for response was 4. Based on these results, we suggest that combination of antidepressants might be more effective than monotherapy in clinical practice.
Manifesto for a European anxiety disorders research network
Authors: Baldwin D.
Published: May 2011

Anxiety disorders are common, have an early onset, run a long course, cause substantial distress, impair overall function, reduce quality of life and impose a major economic burden, and therefore represent an important public health problem. Many patients do not present or are not recognized, the standard of care is often sub-optimal, and the effectiveness of interventions in real-world practice can be disappointing: there is considerable room for improvement in recognition, care and treatment.

The causes remain largely unknown and this hinders accurate diagnosis, prediction of prognosis, and development of refined treatment approaches. There is much co-morbidity between the disorders and with conditions such as bipolar disorder, depressive illness and physical illness. Research findings in patient samples without co-morbidity may have limited applicability to wider practice, and there is a need to undertake research in fully representative groups. Little is known about determinants of non-response, or next steps in management after the failure of first-line interventions, and there is a clear need for research in the substantial proportion with ‘treatment-resistant’ conditions.

The unmet public health, clinical and research needs could therefore be addressed by developing an independent collaborative European Anxiety Disorders Research Network. This would facilitate harmonization of research and clinical databases and refinement of research methodologies. It should contribute to greater accuracy when predicting clinical outcome, and encourage the evaluation of innovative interventions, particularly in important groups such as in the early stages of illness, those with comorbid disorders, and those who have not responded to initial treatment approaches.