bluuebunny/crossref_metadata_2025 huggingface dataset:
Sculpture of the Schyzophrenia
Authors: Kalkan H.S.
Published: March 2009

This project is a documantary about a schyzophrenia patient whose name is Sewusen. Sewusen has got popularity in Tunceli around East region of Turkey. After his death in 1994, the people in Tunceli have established his sculpture at the center of the city. Most of the schyzophrenia patients live around the people at Tunceli and the people behaves well towards them. The difference of Sewusen is that, he has lived about 40 years at the street and he had no relationship between money and goods. When he gets hungry, he eats in any restaurant and nobody demands any money from him. The people look to the situation as normal. With the effect of the religious aspect of the community, they see Sewusen as Holy but not mad.

In that project, I made a documentary which defines in general the point of view about mental disorders of the community of Tunceli but at custom it gives information about Sewusen.

As a result, this project is about cultural psychiatry and it is made against Stigma. It takes 30 minutes to present and it is English subtitled.
Attempted Suicide and HPA Axis Dysregulation as Suicide Predictors in Elderly Mood Disorder Inpatients
Authors: Jokinen J. , Nordström P.
Published: March 2009

Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis function is associated with suicidal behaviour and age-associated alterations in HPA axis functioning may render elderly individuals more susceptible to HPA dysregulation related to mood disorders. Research on the role HPA axis function in suicidal behaviour in elderly mood disorder patients is sparse.The study sample consisted of 99 depressed elderly inpatients 65 years of age or older admitted to the department of Psychiatry at the Karolinska University Hospital between 1980 and 2000. 24 % of patients had attempted suicide just before admission. The hypothesis was that elderly mood disorder inpatients who fail to suppress cortisol in the dexamethasone suppression test (DST) are at higher risk of suicide.

During a mean follow-up time of 17 years (range 6-25.5 years), six suicides were identified from the death certificates. The DST non-suppression distinguished between suicides and survivors in elderly depressed inpatients and the suicide attempt at the index episode was a strong predictor for suicide. Additionally, the DST non-suppression showed higher specificity and predictive value in the suicide attempter group. Due to age associated alterations in HPA axis functioning, the optimal cut-off for DST non-suppression in suicide prediction may be higher in elderly mood disorder inpatients.
Interpersonal Psychoterapy in Portugal
Authors: Gago J.
Published: March 2009

In December of 2007 we create the Portuguese Interpersonal Psychoterapy Society in order to continue the development of this psychotherapy in our country. Before in 2003 it took place two courses of 20 hours each in two hospitals in Lisbon (Hospital S. Francisco Xavier and Hospital Sta Maria) with the partnership of Spanish Interpersonal Psychoterapy Association and colleagues from Madrid (Francisco Aguado and Maria Dièguez) and Barcelona (Sole Puig and Lecina Fernandez). After those courses a group of psychologists and psychiatrists start to use this psychotherapy in clinical practice in Portugal with the supervision of the colleagues from Spain. This psychoterapy was applied in public and private clinic, for depression, anxiety, grief and cronic physical diseases like diabetes.

We will describe the developments of this psychoterapy in Portugal, the future plans for it spread and the ongoing research studies.

Note: This presentation was included in the proposal we did before for the simposium "Developments in Psychoterapy: Interpersonal Psychoetrapy" propose by Dr. Carlos Góis.
IPT in Physical Diseases. The Diabetes Mellitus Case
Authors: Gois C.
Published: March 2009

Introduction:

Prevalence of Major Depression in populations with physical diseases as Diabetes Mellitus is twice or more than in general population. As IPT framework concerns relationships, communication skills and problem solving, all significant in adjustment to chronic disease, it is a potential treatment indication in such a clinical situation. Some IPT work has been done in HIV populations.

Objectives:

Treatment results with IPT or antidepressants in Major Depression in Diabetes Mellitus Type 2. Secondary outcomes are differences in attachment, diabetes psychological adjustment and metabolic control.

Method:

20 adult outpatients with type 2 Diabetes and Major Depression with no other comorbidity (except chronic diabetes complications) randomized to usual treatment (SSRI and consultation or IPT. Combined treatment added if patient wasn't 25% better from basal MADRS score at 6th week. Metabolic control obtained with HbA1c.

Results:

Patients distribution:IPT-7; Usual-7; Combo-2; Dropouts: Usual-3; Combo-1. Patients characteristics: 54,55±6,75 years aged, 85% female gender, 6,25±2,99 years education, HbA1c 8,94%±2,31. Paired samples test comparing basal values and at 6 months: usual treatment and IPT both efficacious in reducing MADRS scores by 50% (p< .01); usual treatment patients with better diabetes psychological adjustment and anxious attachment lowering (both p< .05); metabolic control better with IPT, but not significant (p=0,1).

Conclusion:

These are preliminary results with a small sample, but pointing towards the usefulness of IPT in depressive type 2 diabetic patients. Discussion will pay particular attention on benefits of psychological change related to Diabetes and to personal life with aid from clinical examples.
Developments in ITP Clinical Applications
Authors: Silva F.
Published: March 2009

Interpersonal psychotherapy was initially developed for treating adult depression. It has since been applied to other forms of psychopathology. Assumed that the different forms of psychopathology are often related to interpersonal processes we will present some of these developments. Indications and evaluation are discussed on the basis of the literature and our pratice in new fields of health psychology, namelly with patients with uremia and candidates to renal translantation.
Empathy as a Complex Construct: Consequences for the Treatment of Sexual Abusers
Authors: Cosyns P. , Koeck S.
Published: March 2009

Nearly all treatment programs for sexual abusers contain a module for empathy enhancement, presuming it will help to prevent future offensive or delinquent behaviour. This appears to be a fair presumption, yet research results reveal a more complex reality. Some sexual abusers do not show a generalized lack of empathy (‘trait’), but have a rather selective and contextual deficit, often limited to their own victims (‘state’). Moreover, the construct of empathy consists of cognitive, emotional and behavioral components, which renders it more difficult to deduct precise assertions on its protective role as a whole. This presentation offers current views on the assessment of empathy and it's effect in the dynamics of sexual offences. Referring to clinical illustrations, guidelines will be presented on the timing (staged interventions) and desirability (contraindications) to address the issue during psychotherapy.
Back to Basics: Challenges in Classification of Depression
Authors: Küey L.
Published: March 2009

Depressive disorders constitute a major health problem worldwide. From feelings of grief of daily human life to psychotic melancholic states, many different forms of depression are recognized. This fact also raises problems of classification in depressive disorders.

This presentation aims to review issues of “threshold level”, “comorbidity”, “the importance of patients’ narrative”, and “identification of core symptoms” in depression.

It is widely accepted that a common core shared in depression is anhedonia; thus, vitality of the person is lost. Mortality and vitality are the two key phenomena to consider in understanding depression.

The reality of mortality has always been a task to overcome emotionally. Human sciences and belief systems have accumulated a huge amount of theory on this issue. But, it is a crucial inevitable challenge for every human being, and this confrontation may also lead to face some sort of depressive way of being. The degree of psychological awareness and of working through the reality of mortality may determine the odds and the forms of depressive state that a person may develop. The phenomenology of depressive disorders will also be discussed in the context of mortality vs. vitality using clinical vignettes from the authors’ clinical practice to broaden the scope of discussion.
Role of Tryptophan-kynurenine Pathway in Depression: Psychopathological Aspect
Authors: Myint A.-M.
Published: March 2009

It was reported that cytokines such as IFN-γ reduce the synthesis of 5-HT by stimulating the activity of indoleamine 2,3 dioxygenase (IDO) enzyme which degrades tryptophan to kynurenine. Kynurenine is further metabolized to kynurenic acid (KYNA), 3-hydroxykynurenine (3OHK) and quinolinic acid (QA) by kynurenine aminotransferase (KAT), kynurenine 3-monooxygenase (KMO) and kynureninase. Both KMO and kynureninase are also shown to be activated by IFNγ. The 3OHK is neurotoxic apoptotic while QA is the excitotoxic N-methyl-D-aspartate (NMDA) receptor agonist. Conversely KYNA is an antagonist of all three ionotropic excitatory amino acid receptors and considered neuroprotective. In the brain, tryptophan catabolism occurs in the astrocytes and. The astrocytes are shown to produce mainly KYNA whereas microglia and macrophages produced mainly 3OHK and QA. The astrocytes have been demonstrated to metabolise the QA produced by the neighbouring microglia.

Tryptophan breakdown has been found to be increased but KYNA, the neuroprotective metabolite is decreased in both blood and cerebrospinal fluid of the patients with major depression compared to healthy controls. Moreover, the ratio between KYNA and 3OHK showed significant correlation with response to treatment. These findings lead to the hypothesis an imbalance neuroprotection-neurodegener-ation in terms of kynurenine metabolites and their immunological and biochemical interactions in the brain might further induce the apoptosis of the neuroprotective astrocytes and the vulnerability to stress is thereby enhanced.
The Sayle Research Project
Authors: Carli V.
Published: March 2009

High prevalence of self-destructive behaviours during adolescence - both as expression of early psychopathology and as “paraphysiological” developmental behaviors - challenges the implementation of health promotion strategies specifically addressed to an age bracket in which plasticity of psychical structure can favour an overall successful outcome.

SAYLE is a European research project with the aim of promoting healthy behaviours in adolescents, at a high school level of intervention. During the presentation targets and structure of the prevention program will be described. The projects has been designed in order to compare the efficacy of different prevention strategies for adolescents: a general health promotion program targeting students’ awareness on healthy/unhealthy behaviours and students" self-efficacy in diminishing unhealthy behaviours; a screening by professionals of at-risk students through a questionnaire (TeenScreen) - for adolescents identified as high risk (screen positives) the program includes referral to mental health treatment and ensuring compliance; a gatekeepers’ program, training all adult staff at schools (teachers, counselors, nurses etc.) and parents on how to recognize & refer a student with risk-taking behaviours or suffering from mental illness to mental-health help resources (QPR -Question, Persuade & Refer).
Suicidology and Substance abuse in Adolescence
Authors: Werner N. , Kahn J.-P.
Published: March 2009

Adolescence is a critical period for suicidal risk. Suicide currently ranks as the second or third leading cause of mortality among adolescents in developped countries. It has been shown that a history of suicidal act, of depressive disorder and of a substance use disorder (SUD), alcohol and drugs, are the most prominent risk factors for suicidal behaviour among adolescents.

Data on alcohol and drug use disorders and suicide consisted primarily of reports on alcohol use disorders and, to a lesser extent, opioid use disorder. The magnitude of the association with other drugs is still unclear.

The relationships between substance use disorder and suicidal behaviour are multiple: In the long term, SUD may be associated with increases in stress and co-occuring psychopathology (poor self esteem, feeling of worthlessness, isolation).These elements may reach a level where a suicide attempt is viewed as a means to cope with perceived unsolvable difficulties. During life crises, SUD can also be responsible for inhibiting adaptative coping and desinhibiting suicidal behaviour. Finally, SUD and suicidal behaviour share common vulnerability factors: history of childhood abuse, genetically determined dimensions such as impulsivity or psychiatric disorders, particularly unipolar depressive and bipolar disorder.

Given the comorbidity between SUD and suicide, it is essential for treatment and prevention that all suicidal adolescents be screened for SUD and vice versa. Ideally, adolescents who receive diagnosis of SUD and co-occuring suicidality should follow an integrated treatment protocol that addresses both conditions.
Follow up of Adolescent Suicide Attempters
Authors: Apter A.
Published: March 2009

Objectives:

To follow adolescent suicide attempters attending an emergency room in southern Israel through their induction examination for military service and then for the duration of this service.

Methods:

117 attempters were evaluated after a suicide attempt, and then followed up for up to five years. Outcome was assessed by their achievements on pre-induction psychometric and psychological testing at the induction center and by the quality of their service. Repeated suicidal behavior was also assessed.

Results:

In general boys had a worse prognosis than girls and suicidal behavior associated with poor educational achievements was particularly associated with a poor psychosocial outcome.

Conclusions:

Adolescent suicidal behavior in general has a good prognosis but boys with educational difficulties who attempt suicide are at great risk for adjustment problems.
Gender Differences in Suicidal Behaviour and Self-injurious Behaviour in Adolescents: Results from a German school survey
Authors: Brunner R. , Parzer P. , Haffner J. , Resch F.
Published: March 2009

Aims:

The primary aim of our study was to determine gender differences of the prevalence rates of suicidal behaviour (suicidal ideation, plans and attempts) and self-injurious behaviour (intentional self-mutilative acts like cutting and burning).

Method:

Self-report cross-sectional survey. A representative sample of school students of the 9th grade (n = 5759, mean age = 14.98 (SD=0.73), 49,8% female adolescents) from the Rhein-Neckar-District in Germany has been investigated.

Results:

Moderate forms of intentional self-mutilative acts in the previous year was reported by 630 of 5759 (10.9%) school students. Additional 229 (4.0%) students reported repetitive forms of self-mutilation. In comparison with the male students the risk of moderate forms of self-mutilative acts (relative risk ratio: RRR=1.60) was significantly increased for female students, for repetitive acts (RRR=2.64), respectively. With regard to suicidal behaviour 14.4% of the adolescents reported suicidal ideas and 7.9% one or more suicidal attempts during their life time. Adolescent girls who smoked demonstrated a high rate of risk for DSH; there was no significant association between smoking and DSH in adolescent boys. Compared with participants without a history of DSH, adolescents with DSH scored significantly higher on the YSR-subscales of somatic complaints, anxiety and depressive symptoms and delinquent behaviour.

Conclusion:

Moderate forms of intentional self-mutilative acts and severe forms as well as suicidal behaviour were found to be associated with pronounced emotional and behavioral problems. In particular female adolescents are at higher risk for DSH in comparison to male adolescents.
Deficit in Theory of Mind is a Risk Factor for Relapse of Major Depression
Authors: Kanba S.
Published: March 2009

Background:

Recently, we reported that patients with depression have theory of mind (ToM) deficit during remission from acute episodes. ToM deficit means difficulty in social adjustment and thus may indicate a poorer prognosis.

Methods:

We evaluated ToM ability of 50 patients during remission from major depressive episodes. The patients were followed for 1 year and their outcome observed.

Results:

After 1 year, patients who had ToM deficit in a second order false question relapsed significantly more frequently as compared with patients who did not have a deficit (Fisher"s exact test pb0.0001; relative risk (RR)=8.105; CI 2.020, 32.524).

Significant differences were shown in scores of the Global Assessment of Functioning Scale (p< 0.0001) between the two groups.

Conclusions:

Patients with ToM deficit in second order false belief during remission may be a high risk group for recurrence and lower social function 1 year after recovering from a major depressive episode.
A Model of Dissociable Networks for Cognitive and Emotional Empathy: Evidence from Imaging, Lesion and Psychiatry Research
Authors: Shamay-Tsoory S.
Published: March 2009

Empathy has been a central focus of research and popular interest over the last decade. There has been several well acknowledged controversies in psychology, biology and ethology, over whether empathy is an emotional (sensing another"s feelings) versus cognitive (understanding another"s perspective) construct. In our studies we attempt to address this by combining lesion studies and psychiatry research to support the notion of two separate systems for empathy: an emotional system (involving the mirror neuron system) and a cognitive system (involving medial prefrontal cortices). We examined our model with several psychiatric populations such as schizophrenia, borderline personality disorder and psychopathy and show that the dissociation between cognitive and emotional empathy is implicated in these populations.
“Mentalising” and Executive Functioning in Schizophrenia: A Comparison between Forensic and Non-forensic Patients
Authors: Brüne M.
Published: March 2009

Previous studies in forensic patients with schizophrenia have shown that delinquent patients may outperform non-delinquent patients with regards to their ability to appreciate mental states. Findings were, however, confounded by a lack of control for neurocognitive functioning. We examined 33 forensic patients with schizophrenia regarding their mentalising abilities, intelligence, executive functioning and psychopathology. Results were compared with a non-forensic schizophrenia sample and a group of healthy controls. Both patient groups performed more poorly on most measures compared to controls. Forensic and non-forensic patients did not differ in task performance. In the forensic group mentalising correlated inversely with “excitement” and cognitive symptom scores of the PANSS. When “excitement” was co-varied out, forensic patients outperformed non-forensic patients with regards to their mentalising abilities. This study supports the hypothesis that schizophrenic patients with a criminal record are equally impaired in their ability to infer mental states compared to non-forensic patients, but for different reasons associated with a divergent psychopathological profile.
Disulfiram, Naltrexone and Acamprosate in the Treatment of Alcohol Dependence
Authors: Alho H.
Published: March 2009

Acamprosate, naltrexone and disulfiram have been shown to reduce drinking and/or improve abstinence. We performed a randomized, multicenter study in two phases; first, 12-week continuous supervised medication, followed by targeted medication up to 52 weeks in addition to a 67-week follow up period. 243 voluntary treatment-seeking alcohol-dependent adult outpatients were randomized 1:1:1 to receive supervised naltrexone, acamprosate or disulfiram, 50 mg, 1998 mg or 200 mg respectively per day and brief manual-based cognitive behavioral intervention. The primary outcome measures were the time to first heavy drinking day (HDD) and time during the first 3 months to the first drinking day after medication started. All three study groups showed marked reduction in drinking from baseline to the end of the study. During the continuous medication phase, treatment with disulfiram was more effective in reducing HDDs and average weekly alcohol consumption, and increasing time to the first drink as well as the number of abstinent days. During the targeted medication period, there were no significant differences between the groups in time to first HDD and days to first drinking, but the abstinence days were significantly more frequent in the DIS group than ACA and NTX. However, naltrexone was better than acamprosate in reducing the severity of alcohol dependence indicator SADD scores. We conclude that acamprosate, naltrexone and disulfiram combined with brief manual-based cognitive behavioral intervention significantly reduce alcohol consumption and improve the quality of life. Supervised disulfiram was superior, especially during the continuous medication period, to naltrexone and acamprosate.
Alcohol Misuse in People with Schizophrenia: Findings from the Paddi (psychiatric and Addictive Dual Diagnosis in Italy) Study
Authors: Carrà G. , Lusignani G. Segagni , Sciarini P. , Borrelli P. , Popa I. , Montomoli C. , Clerici M.
Published: March 2009

Background:

Comorbid alcohol misuse in schizophrenia and severe mental illness is associated with significant clinical, social and legal problems. An epidemiologically informed approach to planning service delivery requires an understanding of which clinical populations are at particularly high risk for alcohol misuse. Most evidence about the prevalence of this comorbidity comes from the USA, Canada and Australia, and, though at a different pace, also from Europe.

Method:

A cross-sectional survey design has been used to determine the prevalence In Italy of comorbid drug and alcohol and any - even minor - mental disorders. Staff ratings was used to assess comorbid substance use.

Results:

Though overall dual diagnosis prevalence is around 2%, significantly higher rates were found in inner cities. Furthermore significant differences were found between different geographical areas (Northern vs. Centre vs. Southern Italy). Peculiar diagnostic subgroups showed higher risk to develop such comorbid condition, whilst a number of clinical and sociodemographic variables, including area of residence, were associated with the risk to develop a dependence syndrome.

Conclusions:

Sampling and assessment procedures are major limitations which might explain the lower rates as compared with the current Anglo-Saxon literature. However, such variability emphasizes also that high comorbid alcohol misuse rates are not necessarily the direct result of biological features inherent in schizophrenia, but that social factors play an important role. Finally, a number of risk factors associated with dual diagnosis could build up an evidence base about the nature of their substance use, providing targeted service planning and policy making.
HPA-axis Function and Depression in Adolescence: Are they Related to Prenatal Early Life Stress?
Authors: Van den Bergh B. , Van Calster B. , Smits T. , Van Huffel S. , Simons A. , Lagae L.
Published: March 2009

Early-life exposure to adverse environmental cues during critical windows of time in the prenatal and/or early postnatal life period could predispose the individual for somatic andmental diseases. This especially holds for stress-related disorders such as depression in which HPA-axis dysregulation plays a pathophysiological role. This is in line with the ‘fetal (or developmental) programming-hypothesis’ which has been tested in numerous preclinical experimental. We tested this hypothesis in humans in a prospective longitudinal study in which maternal emotional state was measured during each pregnancy trimester and after pregnancy. When the offspring was 14-15 years old, HPA-axis function was measured through establishing a saliva day-time cortisol profile. Severity of depressive symptoms was measured with the Children's Depression Inventory. Repeated measurements regression analysis and ordinary least-squares regression analyses indicated that maternal anxiety at 12-22 weeks of pregnancy was in female and male offspring associated with a diurnal cortisol profile that was attenuated due to elevated cortisol secretion in the evening. Moreover, in female adolescents this flattened cortisol curve was associated with depressive symptoms. Our results indicate that maternal anxiety during pregnancy enhances neurobiological vulnerability to depressive symptoms, possibly by altering (or ‘programming") foetal physiology. If our results can be replicated in future research they may lead to a re-orientation of the target of primary prevention and treatment of depressive symptoms. Preliminary results of a study on the association between prenatal exposure to maternal anxiety and cortisol stress responsivity during inoculation in the four month old will be presented.
Antenatal Stress and Anxiety, Effects on Behavioural and Cognitive Outcomes for the Child, and the Role of the HPA Axis
Authors: Glover V.
Published: March 2009

There is now good evidence from several prospective studies that antenatal maternal stress, anxiety or depression can have long term consequences for the development of the fetus and the child. There can be a wide range of effects and both behavioural and cognitive outcomes can be altered. Such fetal programming is independent of the postnatal environment, although the nature of maternal care may have a modifying influence. The effects are clinically significant; about 15% of behavioural problems such as attention deficit/hyperactivity disorder may be attributable to prenatal stress. Not all children are affected, and those that are can be affected in different ways. Presumably there is an interaction with the genetic predisposition, but this has not yet been studied. There is little agreement about the gestational windows of vulnerability, which are probably different for different outcomes. Also we do not know the nature of the stress which is most harmful, although there is some evidence that stress due to a bad relationship with the partner is damaging, and anxiety has greater influence than depression.

In animal models there is good evidence for the mediating effects of the HPA axis in both mother and fetus. In humans the evidence is less clear. Several studies have found little or no association between anxiety or depression and maternal cortisol in later pregnancy. However we have found an inverse association between amniotic fluid cortisol and child cognitive ability at 17 months, which is only apparent in insecurely attached children.
The Impact of Prenatal Risk Factors in ADHD: Potential for Gene x Environment Interactions
Authors: Rodriguez A.
Published: March 2009

The intrauterine environment is likely to play a key role in the etiology of psychopathology because the brain is particularly sensitive during the entire gestation as it undergoes the most rapid period of development. Neurodevelopmental deficits, such as attention problems, are a manifestation of these brain disturbances, which can in the end be linked to disorders, the most common being Attention Deficit Hyperactivity Disorder (ADHD). Animal models provide strong evidence in support for programming. Human studies present added complexity as genetic predisposition in mothers can increase the risk of e.g. pregnancy smoking or distress, thus, the effect may be carried entirely or in part by genetic transmission. However, neither genes nor environment operate in isolation, but rather in a complex interplay. Although ADHD has been the focus of intense research, little is known about the gene-environment interaction because such studies require very large sample sizes to be sufficiently statistically powered, thus necessitating multi-site collaborations. This presentation covers methodological difficulties associated with gene-environment studies and some of the ways in which our team has tackled these challenges. Data is presented on common maternal lifestyle factors during pregnancy and their relation to mental health problems in children, particularly ADHD, in a backdrop of genetic predisposition.
Stress Responsivity in Childhood and Adulthood: Role of the Glucocorticoid Receptor Gene
Authors: Claes S. , van West D. , Del-Favero J. , Deboutte D.
Published: March 2009

Aims:

Prenatal stress has been associated with lifelong disturbances in stress response systems and with an increased vulnerability for psychiatric disorders. However, the effect of prenatal stress is at least partially determined by individual genetic makeup. Recent data confim the potential role of the glucocorticoid receptor (GR) gene in modulating stress response and in the liability to develop mood disorders. In genetic association studies, single nucleotide polymorphisms (SNPs) in the GR gene were linked to variation in stress response systems (1). In a preliminary investigation, we studied 106 prepubertal children to estimate the impact of four GR gene polymorphisms on cortisol responses after a psychosocial stress test.

Results:

Carriers of the ER22/23EK mutation displayed significant lower cortisol responses to psychosocial stress compared to noncarriers. This particular polymorphism has earlier been associated to the vulnerability to develop MDD by our own research group (2) and independently by another publication (3).

Conclusion:

These findings support the relevance of GR gene polymorphisms in general and of the ER22/23EK polymorphism in particular in HPA axis regulation and in the vulnerability for psychiatric disorders.
Revealing the Role of Context, Experience and Individual Differences in the Assessment of Heroin Addicts’ Decision Making Abilities
Authors: Newman C.G.J. , Crome I. , Frisher M.
Published: March 2009

The development of decision making paradigms has prompted a consideration that an underlying deficit may assist in explaining substance dependence. However, despite these advances, little progress has been made in accounting for large inter-subject variance within previous studies. This failure continues to undermine many of the previous attempts to explain individual difference.

A study was undertaken to develop methods for analysing and describing individual response behaviours within a decision-making task. In addition, the effect of task manipulations such as feedback, penalties and practice were examined. Substitute medication maintained adults males were recruited for this study.

Findings from this research offer new insight into a possible link between task design and the response behaviours exhibited. This study emphasised the importance of individual response behaviours, and the necessity to consider individual data as a route to understanding concepts drawn from between groups analysis. Significant issues are raised that might impact on other existing paradigms and implications are proposed in relation to the assessment and treatment of substance dependence.
Addiction Services in Cyprus: Results of the EU Twinning Project Evaluation
Authors: Agorastos A. , Zurhold H. , Petridou A. , Haasen C.
Published: March 2009

In April 2007 a European twinning project started between Cyprus and Germany, in order to assist Cyprus as a new Candidate Country in the implementation and harmonisation with the European Community's legislation, by evaluating the governmental drug services in Cyprus and their coordination and promoting the improvement and introduction of new drug treatment services. A field investigation studied parameters as population in need, treatment demand and coverage, as well as high risk patterns and their trend over the last years, showing an individual place of Cyprus in the international drug ranking, with the highest prevalence of cannabis and second highest on ecstasy abuse and one of the smallest in opiates and amphetamine consumption. Nevertheless heroin remains the primary drug of abuse in persons seeking treatment, although Cyprus was until 2008 the only country of the European Union without a substitution treatment. Furthermore this project studies in detail the current availability of the governmental drug facilities, their structure and coordination as well as the legal framework in which they operate, showing a still adapting drug care system, trying to keep up with the increasing special needs of the Cypriot population, but offering the presuppositions for an efficient and good functioning drug care system in the future.
Chronic Non Cancer Pain and Misuse and Dependence of Analgesic Drugs
Authors: Baldacchino A.
Published: March 2009

As the chronic disease model is now accepted as the model to treat individuals in the community in the UK, it has become important to recognise that individuals tend to present with more than one concomittant problem (comorbidity). A increasing patient centred approach to treatment and recovery has helped to recognise the dual concept of pain and dependence within the clinical environment. There is an ever increasing prevalence of this dual presentation and this has helped to effectively manage individuals with a substance misuse history and associated chronic pain and others treated for their chronic pain with strong analgesic and subsequently experiencing substance misuse and dependence problems.

This presenation aims to provide the literature overview of these populations, clinical characteristics and problems presenting in a pain and dependence clinic in Scotland. Several models of practice will also be presented.
Principles of Analgesic Effects of Opioids and Dependence of Opioids (F.E. Tramadol)
Authors: Havemann-Reinecke U. , Manouchehr S.
Published: March 2009

German epidemiological data (Poser and Havemann-Reinecke 2002) showed 12% of all addicted treated patients in Lower Saxony being dependent from prescribed opioid analgesics.

Here we report new clinical data of 150 patients being treated because of dependence on the opioid analgesic tramadol. The documents of these patients were evaluated to social-, family-, pain- and addiction development - data, psychiatric and somatic diseases; suicidality, source of tramadol (prescription: "legal", black market: "illegal" ), withdrawl symptoms, therapy.

Results:

Of 140 patients (P) 123 P (88%) were "legally" dependent on tramadol (51% f, 49 m), 17 P (12.%) "illegally" dependent (54% f, 47% m). The ages of "legally" dependent P were: 20-30J: 7%; 30-40J: 16% ; 40-50J: 24%; 50-60J: 21%; 60-70J: 19%; 70-80J: 14%. In the group of "legally dependent" patients 20% were medical staff (16% nurses, 4% medical doctors), and 16% had academic professions; 19% reported an addiction disease of the parents (mostly of alcohol), 16% another psychiatric disease of the parents. 75% of the "legally" dependent patients suffered from depression, 40 % had performed suicidal trial(s), 53% have had a somatic disease before the intake of tramadol, 17% after the treatment of tramadol dependence. 69% suffered from pain before intake of tramadol (22% disc/ back, 15% megrim/ head, 5% tooth, maxillary sinus, 6% pancreas, 4% legs, 2 % abdomen, bile), 22% had no experience of pain before first intake of tramadol. 76% of the pain-patients were also ill with depression. Seizures were documented in 23% of all patients with tramadol dependence/withdrawal as cause.

Conclusion:

Pain, depression and pain, somatic diseases, previous addiction diseases, psychiatric family history, being a member of medical staff increase the risk to develop dependence to prescribed tramadol. Tramadol dependent patients show a high rate of suicidal trials and of seizures. Different therapies are under evaluation. Data will be discussed with respect to pathophysiological principles of analgesic and addiction effects of opioids.
Neurobiological Effects of Opioids - Data from Brain Imaging
Authors: Kienast T. , Heinz A. , Wrase J.
Published: March 2009

Neuroimaging provides insight into the main biological mechanisms underlying drug and alcohol dependence. Cardinal symptoms of drug dependence are the development of tolerance against drug effects, withdrawal symptoms, drug craving, reduced control over drug intake and harmful consequences of drug consumption. Brain imaging studies support the hypothesis that tolerance development can be understood as a neuroadaptive mechanism to ensure homeostasis during chronic drug intake. When drug consumption is suddenly interrupted during detoxification, the loss of homeostasis can manifest as a withdrawal syndrome. While tolerance development reduces the effects of chronic drug intake, sensitization is a neuroadaptive process that increases the effects of a drug dose. Brain imaging studies indicate that sensitisation and drug craving are associated with neuroadaptive processes in the brain reward system. This lecture gives a short review about the neurobiological background of opioid addiction
Managing Co-morbid Pain and Addiction
Authors: Bannister J.
Published: March 2009

It is important to remember that patients who misuse substances experience pain just as acutely, and probably more so, than “normal” patients. Their lives are chaotic and difficult and they often suffer from concurrent mental health problems. This in itself increases stress and distress and may make their experience of pain worse. Their coping mechanisms are heavily biased towards use of chemicals to deal with distress and they may not respond easily to non-pharmaceutical measures for pain control. Addiction is a chronically relapsing illness and we should expect our patients to respond accordingly. If a patient who has been stable and productive becomes unstable and chaotic again, this is not an indication of therapeutic failure and a signal to retreat and disengage; it means we have to change our management and try again.

Addiction and chronic pain are rarely curable, just as diabetes is rarely curable. We are tasked with helping these patients to best manage their chronic diseases and we should expect setbacks as much as we enjoy success.

We can use any technique we would use in pain uncomplicated by addiction. Thus we use unconventional analgesics such as tricyclic antidepressants and anticonvulsants for neuropathic pain. Regular paracetamol and short course NSAIDs have the same benefits in musculoskeletal pain. Physical approaches such as physiotherapy, TENS (transcutaneous electrical nerve stimulation) and acupuncture have their place. Behavioural modification with psychology is vital. Opioids do have analgesic effects in opioid misusers, even though popular myths have many patients believing otherwise.
A Randomized Naturalistic Open Long-term Treatment of Panic Disorder with Clonazepam or Paroxetine
Authors: Nardi A.E. , Valença A.M. , Freire R.C. , Lopes F.L. , Nascimento I. , King A.L. , Sardinha A. , Levitan M.N. , de Carvalho M.R. , de-Melo-Neto V.L. , Mezzasalma M.A. , Soares-Filho G.L. , de Cerqueira A.C. , da Costa R.T. , Versiani M.
Published: March 2009

Objective:

To describe with prospective methodology the therapeutic response to clonazepam or paroxetine in a 3-year treatment of panic disorder (PD).

Methods:

A total of 120 PD outpatients (DSM-IV) were openly treated with clonazepam or paroxetine for 8 weeks. Those who responded entered a 3-year follow-up. Demographic and clinical features were compared in the two groups.

Results:

Efficacy was evaluated by Intent to treat, last value carried forward. The Hamilton Scale for Anxiety (HAMA) did not differ between the groups at baseline and during the first two months. In the acute treatment phase and at the end of the long-term follow-up both groups had a significant and similar response - 86.8% of the clonazepam group and 73.0% of the paroxetine group had a complete remission of panic attacks. The mean dose for clonazepam was 1.9 ± 0.2 mg/day and for paroxetine 33.8 ± 9.8 mg/day. There was no difference in the scale scores, and the reduction in panic attacks from baseline to end-point did not differ significantly between the groups. The most common adverse events during treatment were tremor/shaking, nausea/vomiting, sexual dysfunction and appetite/weight change in the paroxetine group and drowsiness, sexual dysfunction and memory/concentration complains in the clonazepam group.

Conclusion:

PD patients using clonazepam or paroxetine had an equivalent response during acute and long term treatment. The patients using clonazepam had significantly less side effects than the paroxetine group.

Acknowledgements: Brazilian Council for scientific and technological development (CNPq).

Grant: 554411/2005-9.
Translation of Randomised Controlled Trial Findings into Clinical Practice: Comparison of Olanzapine and Valproate in the Emblem Study
Authors: Novick D. , Gonzalez-Pinto A. , Haro J.M. , Bertsch J. , Reed C. , Perrin E. , Tohen M.
Published: March 2009

Aims:

To contrast the outcomes of olanzapine- and valproate-treated patients in an observational study of acute mania with the results of a RCT assessing the same treatments (Tohen et al., 2002).

Methods:

EMBLEM (European Mania in Bipolar Evaluation of Medication) was a 2-year, prospective, observational study of health outcomes associated with treatment of mania. Severity of mania and depression was assessed at baseline and 6 weeks using the YMRS and 5-item version of the HAMD, respectively. The RCT was a 3-week, randomised, double-blind comparison of olanzapine (n=125) and divalproate-treated (n=123) patients hospitalised for acute manic or mixed episodes. The YMRS and HAMD were used to quantify manic and depressive symptoms, respectively.

Results:

621 EMBLEM patients were analysed (n=107 valproate, n=514 olanzapine). Both observed groups improved from baseline to 6 weeks in mean YMRS and HAMD-5 total scores, with significantly greater mean improvements in the olanzapine compared with the valproate group using linear regression to adjust for baseline differences. The RCT reported significantly greater mean YMRS improvement (but not HAMD) in the olanzapine-treated group. EMBLEM patients treated with olanzapine experienced significantly greater weight gain than patients treated with valproate, similar to RCT results. There was a significantly greater incidence of treatment-emergent gastrointestinal adverse events in EMBLEM patients treated with valproate.

Conclusions:

The EMBLEM results support those of the RCT, which suggest that olanzapine monotherapy may be more effective than valproate monotherapy in the treatment of acute mania. Contrasting observational and RCT results present methodological challenges but can provide important complementary information.
The Lundby Study - Background and Recent Findings in a 50-year Perspective
Authors: Nettelbladt P. , Mattisson C. , Bogren M. , Brådvik L.
Published: March 2009

Aims:

To describe the Lundby Study and present recent data for the period 1947-1997.

Methods:

The Lundby population consisting of 3563 probands was investigated by semi-structured interviews in 1947, 1957, 1972 and 1997. Sufficient information was available for 94-99%. Best estimate consensus diagnoses have been used since 1957 together with DSM-IV and ICD-10 in 1997.

Results:

From 1947-1972 to 1972-1997 a decrease in almost all age- and sex-specific incidences of neurotic and organic disorders was observed, whereas psychotic disorders increased consistently in males, but decreased in most age intervals in females. Women had higher first incidence depression rates than men and the average annual rate was lower for women and tended to be lower for men 1972-1997 as compared with 1947-1972. Median age at first onset of depression was around 35 years for individuals followed up for 30-49 years. The recurrence rate was about 40% and varied from 17% to 76% depending on length of follow-up. Transition to diagnoses other than depression was registered in 21% of the total sample, alcohol disorders in 7% and bipolar disorders in 2%.

The overall long-term suicide risk varied from 5,6% to 6.8%. The long term suicide risk was 3.1% for medium and 13.7% for severe MDD. Severity and male sex were risk factors. After the introduction of TCAs a fall in suicide rates among depressed individuals was observed. Certain clusters of personality traits may predict functional psychosis.

Conclusions:

Low attrition rates over 50 years and reasonable diagnostic uniformity make comparisons over time justifiable.
Depression is Associated with Decreased 25-hydroxyvitamin-D and Increased Parathyroid Hormone Levels in Old Age
Authors: Hoogendijk W. , Beekman A. , Deeg D. , Lips P. , Penninx B.
Published: March 2009

About 13 percent of older individuals have symptoms of depression, and other researchers have speculated that vitamin D may be linked to depression. Underlying causes of vitamin D deficiency such as less sun exposure as a result of decreased outdoor activity, different housing or clothing habits and decreased vitamin intake may be secondary to depression, but depression may also be the consequence of poor vitamin D status. Moreover, poor vitamin D status causes an increase in serum parathyroid hormone levels. Overactive parathyroid glands are frequently accompanied by symptoms of depression that disappear after treatment of the condition. We recently measured blood levels of vitamin D and parathyroid hormone and assessed symptoms of depression among 1,282 community residents age 65 to 95 and found a strong decrease in vitamin D level and increase in parathyroid hormone level (Hoogendijk et al., Arch Gen Psychiat 2008;65(5):508-512). This finding may be important to patients because both low blood vitamin D levels and high parathyroid hormone levels can be treated with higher dietary intake of vitamin D or calcium and increased sunlight exposure. Moreover light treatment has been used successfully to treat seasonal affective disorder. Taking these two lines of studies together, sunlight may have an antidepressant effect via the eye-biological clock tract and via the skin-vitamin D-tract. Interestingly, the biological clock is located in the hypothalamus, where vitamin D receptor is most abundant.
Developmental Vitamin D Deficiency (DVD) and Brain Dopamine Ontogeny
Authors: Eyles D. , Cui X. , Pelekanos M. , Kesby J. , Burne T. , McGrath J.
Published: March 2009

Our group has pioneered research indicating that Developmental vitamin D (DVD) deficiency (a candidate risk factor for schizophrenia) alters both brain development and function. We have convergent evidence indicating a disturbance in dopamine signalling in this model. 1stly the superior colliculus (the proto-basal ganglia) is the initial site where the vitamin D receptor is expressed in foetal brain; 2ndly we show a reduction in Catechol-O-methyl transferase (a major metabolic enzyme for dopamine) in these foetal brains; 3rdly dopamine metabolites in the DVD deplete neonatal brain reflect this enzymatic change. When we allow these animals to mature under vitamin D normal conditions we repeatedly observe alterations in both spontaneous and psychomimetic enhanced locomotion. Consistent with the theme of persistent changes in dopamine signalling in this model we now present new data showing that dopamine transporter density and/or affinity are altered in DVD deplete female offspring whilst DA 1 receptor density and dopamine cell number are reduced in DVD deplete male offspring (all P< 0.05 n>8).

Our most recent studies indicate that Nurr-1, a nuclear transcription regulator important in both bone and dopamine neuron development and survival may be a molecular mediator of these processes. Nurr-1 is upregulated by parathyroid hormone (PTH). PTH levels are 2-3 fold greater in vitamin D deficient Dams across gestation. Most importantly we have just shown that Nurr-1 is dose-dependently upregulated by parathyroid hormone (PTH) in a neuroblastoma cell line.

Conclusions:

Our findings strongly suggest that vitamin D directly (or indirectly via PTH) mediates dopamine neuron development.