bluuebunny/crossref_metadata_2025 huggingface dataset:
Usefulness, Use and Undesirable Effects of Diagnosis of Mental Disorders
Authors: Steffen S.
Published: March 2009

In her talk, Sigrid will focus on a number of aspects that arise as a consequence of an individual's diagnosis as suffering from a severe mental disorder, such as schizophrenia, and particularly how a diagnosis affects the wider family unit.

From the wider family perspective, the onset of any mental illness is very traumatic and frightening, resulting in total confusion, angst and upset for all members - the sufferer, parents and siblings. So when a diagnosis is finally made, a sense of relief prevails but soon this relief changes when a person realises the real impact of such a diagnosis - in other words, the longer term effects and changes which they will face. A lifetime sentence looms for many.

There is a critical need for information to help understand the illness, support and education to help develop one's coping skills, to name just a few issues. Also, a very negative result of someone being diagnosed as suffering with a mental illness is the onset of feelings of stigmatisation, discrimination and isolation. Sigrid will deal with these topics and will explore the efforts which EUFAMI has been employing to counter these.
Affective Processing in Young Adults with Borderline Personality Disorder
Authors: Herpertz S.
Published: March 2009

Individuals diagnosed with borderline personality disorder usually seek for treatment as adolescents or young adults. As age progresses, longitudinal studies suggest that borderline patients improve psychosocially, suggesting that they may somewhat belatedly achieve the milestones of young adulthood. Affect regulation may be particularly subject to major changes in young adulthood, as the prefrontal brain areas involved in affective processing underlie maturation processes up into the late third decade. From studies in healthy volunteers we know that that the capacity to process positive affects improves with age. Young adults with borderline personality disorder, however, display a negativity bias in emotion recognition and they have difficulties in inhibiting the recall of negative information. Neuroimaging data suggest that they suffer from deficient implicit affect regulation but they are able to profit from explicit strategies to suppress negative emotions, an observation which could have interesting implications for treatment. Regarding future research more efforts on developmental psychopathology on the one hand, brain maturation on the other will help to further understand the nature of borderline personality disorder. Regarding clinical issues early treatment designed to foster affect regulating competencies and self-esteem and to develop interpersonal skills might benefit young patients diagnosed with borderline personality disorder.
Methylphenidate Treatment in ADHD/borderline Personality Disorder Adolescent Girls and Smoking Behavior
Authors: Golubchik P. , Sever J. , Shoval G. , Zalsman G. , Weizman A.
Published: March 2009

Background:

Cigarette smoking and nicotine dependence is prevalent among the attention deficit/hyperactivity disorder (ADHD) pediatric population. We assessed the influence of methylphenidate treatment on the smoking behavior of adolescent girls with ADHD/ borderline personality disorder (BPD).

Method:

Twelve ADHD/BPD female adolescent smokers aged 14-19 years were treated with MPH for an 8 week period. The severity of ADHD was assessed by the ADHD Rating Scale (ADHD-RS) and the smoking behavior was rated by Fagerstorm Test for Nicotine Dependence (FTND).

Results:

Significant improvement was detected in ADHD symptomathology, (Baseline vs. endpoint: ADHD-RS : 33.1±6.8 vs. 19.9±6.8, t=6.875, df=11, p=0.0001). A decline in the severity of nicotine dependence, as assessed by FTND (baseline vs. endpoint: 4.1±2.6 vs. 2.0±1.9, t = 4.056, df=11, p= 0.0019), was observed. No significant correlation was found between changes in the ADHD-RS and the FTND following methylphenidate treatment (r=0.09935, p=0.7587).

Conclusion:

Methylphenidate may attenuate smoking behavior in ADHD/BPD female adolescent smokers.
Can Early Onset Schizophrenia be Prevented by Early Recognition and Treatment?
Authors: Resch F. , Parzer P. , Oelkers-Ax R. , Brunner R.
Published: March 2009

In adult psychiatry early recognition and treatment of schizophrenia has become a major goal because of manifold evidence of a relation between delayed initiation of treatment and an unfavourable developmental course. The duration of untreated psychosis (DUP) seems to be significantly prolonged in adolescents compared to adults due to both a protracted sub-threshold development of psychotic features and the failure of families and health professionals to take seriously the initial signs of psychosis that mimic quasi normal adolescent emotional perturbations. Although in adults studies have shown a subset of prodromal signs and attenuated psychotic features to have predictive evidence for the development of schizophrenia, these symptoms however seem of limited specificity in adolescence. Basic symptoms represent subjective experiences of the prodromal phase and will be presented in a sample of schizophrenic adolescents in comparison to non-psychotic patients and normal controls. Results reveal that basic symptoms do not show any specificity for schizophrenia, but schizophrenics present with higher amounts of basic symptoms in the prodromal phase compared to non-psychotic controls. For early recognition a combination of psychopathological and biological markers seems fruitful. First data on perceptual closure and event related potentials of the optic system will be presented that seem to differentiate between early and late onset schizophrenia.
Early Phases of Mental Disorders in adolescence and Young Adulthood
Authors: Wasserman D.
Published: March 2009

Suicide is one of the leading causes of mortality among adolescent suicides. Data from the WHO European Multicentre study on attempted suicide indicates that rates of attempted suicide and suicide in the young co-vary. The association is strongest and significant for male adolescents and young adults. Furthermore, recent studies have reported a shift to suicide methods with higher lethality for both genders.

Suicide prevention strategies are directed at the general population and health care services. Suicide risk is high among adolescents with psychiatric illness, so adequate treatment and detection of psychiatric illnesses in young people is essential. Preventive measures in health care services after a suicide attempt and early recognition of young people at risk in schools are also essential strategies.

The emphasis of suicide prevention work needs to shift to an earlier stage of the suicidal process. This question is addressed by the global suicide prevention initiative SUPRE (SUicide PREvention), in the WHO publication Preventing suicide: a resource for teachers and other school staff, which can be adapted to local conditions and inserted in syllabuses for training both pupils and staff.

An intervention project called SAYLE: Saving Young lives in Europe is funded by the EU for adolescents in European schools over 12 EU countries. Its main objectives are to lead adolescents to better health through decreased risk taking and suicidal behaviours. Outcomes of preventive programs will be evaluated and culturally adjusted models for promoting health of adolescents in different European countries are planned to be developed.
Therapeutic Drug Monitoring (TDM) During Pregnancy and Breast Feeding
Authors: Conca A. , Bergemann N. , Waschgler R. , Adami P. Steger
Published: March 2009

Epidemiological data indicate that about one third of all pregnant women receive at least one psychotropic drug (Goldberg & Nissim 1994). Women with mental disorders bear a considerable risk of relapse when psychotropic medication is discontinued during pregnancy and the postpartal period.

TDM aims to better individualize dosing regimens taking into account relevant pregnancy-induced metabolism returning to baseline activities within 24 hours (Adab 2006).

Despite the frequent use of psychotropic drugs in pregnancy, for several psychotropic drugs only few documented cases regarding their influence on organogenesis, delivery complications or long term effects are available. Therefore, one should follow some general guidelines when treating pregnant women (cf. Bergemann & Conca). Furthermore, it is recommended to guide any psychopharmacological therapy by TDM. TDM in pregnant women and/or mothers is recommended to be carried out at least once per trimester and within 24 hours after delivery. For TDM at delivery umbilical cord blood of neonates exposed in utero to psychotropic drugs should be collected, since possible neonatal symptoms has to be differentiated from a withdrawal syndrome versus toxic effects of the substances (cf. Koren 2006, Pakalapati et al. 2006).

The use of psychotropic medications during breast-feeding has some implications. All psychotropic medications enter breast milk. However, current data do not support monitoring breast milk levels in attempt to estimate individual infant plasma levels, since the effective drug concentration in the neonate is essentially determined by its own metabolism (Weissman et al. 2004). A systematic monitoring of mother and child including TDM is recommended.
Dose-related Reference Ranges for Therapeutic Drug Monitoring in Human Blood Specimens
Authors: Haen E. , Greiner C.
Published: March 2009

A dose related reference range is calculated as a concentration range within that a drug concentration has to be expected in human blood specimens under medication with a given dose of the drug. The calculation is based on the direct correlation of the drug dose De (constant dose under long term therapy) to its blood concentration c with the total clearance of the drug (Clt) being the correlation coefficient (De = D / t = c × Clt). The clearance is taken as arithmetic mean ± standard deviation from phase II clinical trials of the drug. Thus the dose related reference range will statistically contain 68,27 % of all the drug concentrations determined under normal condition in the blood of a normal patient, where “normal” is defined as the patient population in the respective phase II clinical trial. It usually consists of patients 18-65 years of age without relevant comorbidity, comedication, and genetic abnormalities in drug metabolism. Therefore, any drug concentration determined outside its dose-related reference range creates a signal to alert for individual abnormalities in a patient such as drug-drug-interactions, gene polymorphisms that give rise to slow/rapid metabolizers, altered function of the excretion organs liver and kidneys by age and/or disease, compliance problems, a missing pharmacokinetic steady state and even signal overlay in the laboratory analysis. A table listing factors that allows the calculation of dose-related reference ranges for all relevant psychopharmaca will be included in the first update of the TDM consensus guideline to be published in Pharmacopsychiatry.
The critical period
Authors: Birchwood M.
Published: March 2009

Aim:

Evidence from long-term follow-up studies of schizophrenia and from the ‘new epidemiology’ of psychoses has forced us to rewrite the textbooks and challenge accepted wisdom. In this paper I aim to review the concept of my ‘Critical Period’ in the long-term trajectory of schizophrenia.

Method:

I will review long-term follow-up studies of first episode psychosis.

Results:

Studies suggest that:

a.

the course of the psychoses is very variable;

b.

much of this variability is laid down during the ‘prodromal’ and first 3 - 5 years following the first episode;

c.

the ‘disability’ plateaus quickly, much of it occuring before the positive symptoms develop (the ‘symptom-disability gap’) but

d.

the psychosocial and ecological risk factors that have now been uncovered, suggest a more protean, malleable process in the development of psychosis, as witnessed, for example by the considerable number of ‘at risk’ individuals with low-level, but disabling psychotic symptoms, who escape psychosis (the misnomer of the ‘false positive’).

Conclusion:

This picture presents a fresh take on my concept of the ‘critical period’ with implications for public health and prevention.
OPUS -trial: Five-year Follow-up of a RCT of Specialized Treatment for Patients with First Episode Psychosis
Authors: Nordentoft M. , Bertelsen M. , Jeppesen P. , Petersen L. , Thorup A. , Le Quack P. , Krarup G. , Jørgensen P.
Published: March 2009

Objective:

To determine long term effects of intensive early intervention programme (OPUS)for first episode psychotic patients.

Design:

RCT of two years of intensive early-intervention programme versus standard treatment. Follow-up was two and five years.

Patients:

547 first-episode psychotic patients were included and interviewed after two years (N=369) and five years (N=301). Registerbased information was available for all patients.

Interventions:

The intensive early intervention programme OPUS consisted of ACT with family involvement and social skills training.

Results:

At five-year follow-up, the positive effect of the OPUS treatment seen after two years had equalized between treatment groups. A significantly smaller percentage of patients from the experimental group were living in supported housing (4% vs. 10%, OR 2.3, 95% CI 1.1 to 4.8, P =0.02) and were hospitalized fewer days (mean days 149 vs. 193, mean difference 44, 95% CI 0.15 to 88,12 P= 0.05) during the five-year period.

Conclusions:

The OPUS treatment improved clinical outcome after two years, but the effects were not sustainable up to five years after. A difference on supported housing and use of bed days were found after five years in favour of the OPUS treatment.
A Pilot Randomized Controlled Evaluation of “Extended Specialized Early Intervention Service” vs. “Regular Care” for Longterm Management of Early Psychosis
Authors: Malla A.
Published: March 2009

Introduction:

Short term benefits of Specialized Early Intervention (SEI) services for treatment of first episode of psychosis (FEP) are not sustained after transfer to regular care. Optimum length of SEI services remains to be determined.

Objective:

To carry out a randomized controlled trial (RCT) of extending SEI service for an additional three years compared to “regular” care after both groups have received two years of SEI treatment.

Hypothesis:

The experimental group (extended SEI) will have better clinical (remission length and proportion) and functional outcomes and be cost effective compared to the control group (regular care).

Methods:

Remission (length and proportion in remission) are the primary outcomes. We aim to randomize a total of 212 patients following two years of SEI service for their FEP. Outcome evaluations to assess symptoms, functioning and service utilization are carried out at entry and every three months. In this presentation we will report only the method and preliminary results (success of urn randomization, drop out and relapse rates) on the sample recruited thus far.

Results:

Of the 58 patients approached 50 (86%) agreed to be randomized. Patients were young (mean age 25), mostly male (with a diagnosis of Schizophrenia Spectrum Psychosis (71%). The average length of follow up to date is 13.2 months (s.d. = 5.4). Treatment discontinuation in the experimental and control conditions were 0 and 4 (15%), respectively.

Conclusion:

The pilot results show the feasibility for carrying out such a study. The methodological challenges of conducting this long term RCT will be discussed.
Do the Benefits of Early Intervention (EI) Treatments for Schizophrenia Persist?
Authors: Gafoor R. , Craig T. , Garety P. , Power P. , McGuire P.
Published: March 2009

Introduction:

Early Intervention (EI) services aim to reduce progression to chronic illness for patients with schizophrenia. The Lambeth Early Onset study (2002) demonstrated reduced hospitalisation at 18 months for patients exposed to EI services. This study assesses the durability of these benefits at 5 years.

Methods:

Hospital use in the LEO cohort was assessed by case note review.

Results:

There was no statistically significant difference in terms of ever being admitted at 5 years (OR 1.42; 95% CI 0.550 - 3.68; p=0.468)). Although the mean number of admissions was lower in the EI group: 1.65 (SD = 0.86) versus 1.83 (SD= 0.92), this difference was not significant (coefficient = 0.096; 95% CI -0.550 - 0.742; p=0.770). At 5 years patients assigned to EI used 42.25 days (SD 112.8 days) versus 51.41 days (SD 125 days); coefficient = 6.344; 95% CI -46 - 58.7; p= 0.810. The primary outcome was robust to potentially extreme admission rates for missing subjects on sensitivity analysis.

Conclusions:

There is no evidence from these data that EI services statistically significantly reduce hospital use at 5 years follow-up (vis a vis care as usual) despite some interim benefits at 18 months. We only considered a limited number of outcomes and more work needs to be done in this area.
Recognition of Movement Disorders in Psychiatry: Video Fragments
Authors: van Harten P.N. , Hoek H.W.
Published: March 2009

Movement disorders in psychiatry can be divided in those related to an underlying neurological or other somatic disease, related to a psychiatric syndrome, drug induced and psychogenic. In this workshop the typical clinical aspects of each of these movement disorders will be discussed and shown on video with the focus on drug induced. Drug induced can be divided in acute and tardive movement disorders. Acute movement disorders such as acute dystonia, akathisia, parkinsonism and mycoclonus, start short after taking dopamine receptor blocking agents, often an antipsychotic. Once recognized they are relatively easy to treat. Tardive movement disorders such as tardive dyskinesia and tardive dystonia start months or years after using dopamine receptor blocking agents. Treatment is often disappointing, therefore prevention is needed.
Hypomania Check List Scale 32 in Treatment-resistant Depression - Polish TRES-DEP Study
Authors: Rybakowski J.
Published: March 2009

The Polish TRES-DEP study assesses a number of demographic, clinical and psychometric features comparing patients with treatment-resistant and treatment non-resistant depression. The study included 1083 patients with single or recurrent depressive episode among which 570 met the criteria for treatment-resistant depression, on account of lack of significant improvement following at least two adequate courses of antidepressant treatment. All 1083 patients were assessed by means of the Polish version of Hypomania Check List 32 Scale. The Cronbach's alpha for entire scale was 0.94 which indicates high degree of consistency. Exploratory factor analysis resulted in five factors, of which the biggest (mostly overactivity and elation) containing items1-6, 7-19, 21, 23 and 27 had eigenvalue 10.95 and accounted for 34.2% and the second (irritability), items 25-26, with eigenvalue 2.92, accounted for 9.1% of total variation. Significant differences were obtained between patients with treatment-resistant and treatment non-resistant depression as to the scores of HCL-32. The mean score of HCL-32 was significantly higher in treatment-resistant vs non-resistant depression (11.9±8.3 vs 8.8±7.7, respectively, p< 0.001). Also, the percentage of patients having positive response to 14 or more items of the scale was significantly higher in treatment-resistant than in non-resistant depression (44% vs 29%, respectively, p< 0.001). Based on the results of HCL-32 scale, it may be concluded that the features of bipolarity make the patient more resistant to antidepressant treatment.
Antipsychotics in Anxiety Disorders
Authors: Allgulander C.
Published: March 2009

In 1970 antipsychotics (haloperidol, levomepromazine, thiothixene) were recommended in Sweden as 1st line treatment of anxiety in organic brain syndromes, psychoasthenia, and substance abuse. The benzodiazepines came to dominate treatment of anxious patients in the 1970s and are still appreciated for their rapid anxiolytic effect, low clinical toxicity and low price. Evidence-based guidelines, however, recommend the SSRIs, venlafaxine, and pregabalin as first line treatment in anxiety disorders.

Studies are currently ongoing to assess the utility of new antipsychotics in primary anxiety disorders: quetiapine, risperidone, aripiprazole, ziprazidone, and olanzapine. This is justified in the light of that a large proportion of these patients, about 1/3, do not respond to 1st line treatments or discontinue due to adverse drug effects. Augmentation therapy with antipsychotics may enhance response rates. Primary anxiety disorders may include psychotic symptoms such as dissociation, or severe insomnia, that may be targeted with these medications.

Another important patient category are patients with substance use disorders, particularly alcohol, in whom there are few or no controlled studies of conventional anxiolytics. Anxiety is also common among patients with psychoses, bipolar disorder, ADHD or borderline personality disorder, and few controlled studies have addressed that issue.

Emerging reports indicate that new antipsychotics may be useful as 1st line therapy, as augmenters, and in patients with anxiety due to psychoses and bipolar disorder. In this educational update, the results regarding symptoms, adverse effects, and functioning of these recent studies will be discussed.
A Pilot Study of at-risk Criteria for Bipolar Disorders in Help Seeking Adolescents and Young Adults
Authors: Bechdolf A. , Nelson B. , Cotton S.M. , Chanen A. , Thompson A. , Conus P. , Yung A.R. , Berk M. , McGorry P.D.
Published: March 2009

Introduction:

We have developed ultra-high risk criteria for bipolar affective disorder (bipolar at-risk - BAR) which include general criteria such as being in the peak age range of the onset of the disorder and a combination of specific criteria including sub-threshold mania, depressive symptoms, cyclothymic features and genetic risk. In the current study, the predictive and discriminant validity of these criteria were tested in help seeking adolescents and young adults.

Method:

This medical file-audit study was conducted at ORYGEN Youth Health (OYH), a public mental health program for young people aged between 15 and 24 years and living in metropolitan Melbourne, Australia. BAR criteria were applied to the intake assessments of all non-psychotic patients who were being treated in OYH on 31 January.08. All entries were then checked for conversion criteria. Hypomania/mania related additions or alterations to existing treatments or initiation of new treatment by the treating psychiatrist served as conversion criteria to mania.

Results:

The BAR criteria were applied to 173 intake assessments. Of these, 22 patients (12.7%) met BAR criteria. The follow-up period of the sample was 265.5 days on average (SD 214.7). There were significantly more cases in the BAR group (22.7%, n = 5) than in the non-BAR group (0.7%, n = 1) who met conversion criteria (p < .001).

Conclusions:

These findings support the notion that people who develop a first episode of mania can be identified during the prodromal phase. The proposed criteria need further evaluation in prospective clinical trials.
First Clinical Signs of the Bipolar Prodrome
Authors: Juckel G.
Published: March 2009

Temperament and mood swings are promising indicator for the characterization of mood-spectrum vulnerability. The aim of this study was to investigate the relationship between affective temperament and mood swings in bipolar disorder. We explored these clinical features retrospectively. Patients who met the criteria for Bipolar I disorder were enrolled in the study. Exclusion criteria were partial remittance and a full affective or psychotic episode. Data concerning illness and family history, mood swings (semi-structured interview) and depression (BDI) were obtained. We examined premorbid temperament with TEMPS-A, and with the validated German version TEMPS-M. Patients with and without mood swings were compared with respect to the dominant temperament. Out of 20 bipolar patients, 6 subjects reported mood swings prior to the onset of affective disorder. Subjects with mood swings significantly correlated with a positive family history of affective disorders. Concerning cyclothymic, irritable, and hyperthymic temperament, bipolar affective patients with mood swings had higher scores. No differences were found between males and females. Our findings support the assumption that mood swings, as represented by the cyclothymic temperament, could be prodromes of bipolar disorder. These traits may represent vulnerability markers and could presumably be used to identify individuals at high risk for developing bipolar disorder in order to prevent this illness or to modify its course. A further retrospective study with a larger sample size was started to deepen knowledge about putative prodromal symptoms of bipolar disorder.
Rehabilitation in Social Cognition for Bipolar Patients: A State of the Art
Authors: Montes J.
Published: March 2009

Deficits in social cognition have been reported in euthymic bipolar patients. Thus, these deficits could be determining the disability observed in these patients for achieving the functionality expected at work or in sociability. In this way, there is a need for specific programs of rehabilitation in social cognition in bipolar disorder. Unfortunately, there is a paucity of programmes designed for improving social cognition in bipolar patients. A review of these programmes will be presented.
Leadership in New Organisations
Authors: Buwalda V.
Published: March 2009

In the last decade I served as president of the Dutch Association of Psychiatric Trainees, Secretary General of the European Federation of Psychiatric Trainees and first president ever of the World Association of Young Psychiatrists and Trainees. My ideas were bases on my experience as one of the European leaders of the European Federation of Psychiatric Trainees (EFPT). Psyched and trilled as I was having opportunities faced in the EFPT I thought it would be great to start an world wide association for psychiatric trainees and young psychiatrists. In this presentations I will share my experience as an (new) international leader in Psychiatry and the lessons I learned, the strength, challenges and difference of the World Association of Young Psychiatrists and Trainees (WAYPT) in comparison with the European and Dutch experience.

Learning objectives:

1.

the attendee will learn about the competencies an international leader in Psychiatry needs;

2.

the attendee will learn about the challenges a international leader faces;

3.

the attendee will learn to overview different levels of the organization: national, continental and worldwide.
Clinical Research Evidence for the Use of Antipsychotics
Authors: Vieta E.
Published: March 2009

The use of atypical antipsychotics in the treatment of mania has become standard practice as supported by most currently available treatment guidelines. Aripiprazole, asenapine, olanzapine, paliperidone, quetiapine, risperidone, and ziprasidone have shown efficacy in placebo-controlled studies in acute mania. Not all these compounds, though, have been tested in maintenance therapy. Aripiprazole, for example, has been evaluated in numerous clinical trials in patients with bipolar disorder. Its efficacy was first established in two 3-week, placebo-controlled trials, and data are now available from a double-blind study of 100 weeks’ duration in manic patients, demonstrating both the effective stabilisation offered by aripiprazole and its superiority over placebo in preventing bipolar recurrence, primarily in preventing recurrence into mania.

Furthermore, the addition of aripiprazole to lithium or valproate in patients who are partially non-responsive to these latter agents, can lead to significant improvement in mania symptoms. Several other atypical antipsychotics have also demonstrated adjunctive efficacy in patients with bipolar disorder, including olanzapine, quetiapine and risperidone. Studies comparing different atypical agents have generally shown that efficacy is similar, although the side effect and tolerability profiles differ between agents.

In conclusion, atypical antipsychotics such as aripiprazole have proven short-and long-term efficacy as monotherapy or adjunctive treatment for bipolar mania, providing physicians with additional options when selecting the best treatment for their patients.
The Reality of Taking Antipsychotic Medication
Authors: Alptekin K.
Published: March 2009

Antipsychotic medication provides effective treatment for patients with schizophrenia and bipolar disorder. Patient satisfaction with antipsychotics is positively associated with improvement in psychotic symptoms and treatment adherence. However, some patients, whilst recognising their need for effective intervention, have specific concerns over their management. If these concerns are not adequately addressed the patients remain unsatisfied and may become non-adherent.

Health-related attitudes and beliefs of the patients and insights about their illness may affect patients’ decisions on taking medications in the short and long term. Therefore, it is essential for physicians to communicate with their patients about their beliefs regarding their mental and physical health. Careful assessment of the environmental characteristics of the patient relevant to health may also decrease the risk of non-adherence. Improvement of a patient's treatment adherence using specific motivational interview techniques should also be discussed.

At the outset patients are often concerned over the possibility of treatment-related adverse events (AEs) such as headache, somnolence and weight gain with antipsychotic treatment. If such AEs do occur, patients have to develop coping strategies and may be tempted to self-manage, which can lead to treatment discontinuation and/or selective adherence.

A joint decision-making process between patient and clinician will allow a rational approach to treatment selection and adherence, and the provision of supportive networks will ensure that there is an opportunity for patients to learn about the effects of their medication.
How Art may be a Tool for Understanding Other Cultures and their Perception of Illness
Authors: Kastrup M.
Published: March 2009

Cultural background has a significant influence upon how we perceive illness, our attitudes to illness and our help-seeking behaviour.

But culture is only one of many influences on our health related beliefs and behaviours. Other factors include e.g. individual factors related to age, gender, sociodemographic background, but also environmental factors such as urban or rural setting, pollution, globalization.

If we want to understand and assess the impact of culture in a particular clinical case, the use of art may be a valuable tool to facilitate this understanding and serve as a bridge over cultural incongruities.

The paper will discuss ways in which the application of artistic elements in the therapeutic process may serve as a useful intervention and ultimately as a vehicle to increase the cultural competence of mental health staff. In an increasingly complex, globalised world with patient populations originating from all parts of the world this may prove to be a profitable instrument.
Cultural Mediations in the Therapeutic Process with Border Lines Adolescents
Authors: Botbol M.
Published: March 2009

Psychopathology of bounding is a central feature in Border Line Adolescents. This feature is underlying both their violent acting and their reluctance to engage in a therapeutic relation. In a milieu treatment, cultural mediations appear as one of the best way to overcome this difficulty because they put the focus on pleasurable activities rather than on the relation itself. It allows the therapeutic staff to find a way out of the paradox where relation which is the main therapeutic solution is at the same time the main psychopathological problem.
Overlap Between Schizophrenia and Bipolar Disorders in Terms of Symptoms and Course
Authors: Marneros A.
Published: March 2009

At the end of the 19th century Emil Kraepelin dichotomized the so-called “endogenous psychoses” into dementia praecox (later schizophrenia) and manic-depressive insanity (later mood disorders). According to Kraepelin there are significant differences between the two groups regarding age at onset, phenomenology, and prognosis. But some years later Kraepelin himself recognized that there was a domain between the two groups showing a lot of overlaps and thus making a distinction impossible. Modern research confirmed this observation and opinion of Kraepelin: There are psychopathological syndromes showing characteristics of both mood and schizophrenic spectra. The overlap of the spectra gives rise to syndromes like schizoaffective disorders or acute and transient psychotic disorders having their own characteristics which differ from core schizophrenia or core mood disorders. Obviously there is a genetic determination of the overlap. The characteristics of syndromes created by the overlap of the spectra and the therapeutic consequences will be discussed.
FDG-PET and Structural MRI in Subjective Memory Impairment
Authors: Jessen F.
Published: March 2009

Early recognition of Alzheimer's Disease (AD) is a prerequisite for future strategies against the rapidly increasing prevalence of dementia. Mild cognitive impairment (MCI) has been identified as a clinical pre-dementia syndrome in the course of AD. Epidemiological studies suggest that MCI is preceded by subjective memory impairment (SMI) with still intact cognitive functioning. Studies on biological indicators of AD in SMI, however, are still rare. We compared glucose metabolism using fluorodeoxyglucose F18-positron emission tomography (FDG-PET) and grey matter structure using magnetic resonance imaging (MRI) of 29 SMI subjects and 52 non-complaining volunteers. We found reduced glucose metabolism in the posterior cingulate gyrus/precuneus and in the left parietal lobe and reduced grey matter in bilateral medial temporal lobe areas in SMI. These patterns of hypometabolism and grey matter reduction resemble those of early AD and those that predict cognitive decline in MCI. Our data provides biological support from two independent neuroimaging modalities for SMI as the initial clinical manifestation of AD prior to MCI.
Anterior Hippocampus Orchestrates Successful Encoding and Retrieval of Non-relational Memory: An Event-related FMRI Study
Authors: Kircher T.
Published: March 2009

Episodic memory encoding and retrieva processes have been linked to different neural networks. However, the common brain regions associated with non-relational memory processing during successful encoding (subsequent memory effect) and successful retrieval (recognition effect) have not yet been investigated. Further, the majority of functional imaging studies have been conducted in young subjects, whereas patients from lesion studies, where most neuropsychological models are still based upon, are usually older. Inferences from younger subjects cannot necessarily be applied to the elderly, an issue becoming particularly relevant with our ageing society. Using an event-related fMRI approach we studied 29 healthy elderly subjects (mean age 67.8, SD 5.4 years) with a non-associative task of intentional word list encoding and retrieval. For each subject, behavioural responses were individually classified into four event types (hits, misses, false alarms, correct rejections). Brain areas activated during successful memory encoding comprised the anterior left hippocampus extending into the surrounding parahippocampal gyrus. Regions associated with successful memory retrieval involved a widespread network of anterior left parahippocampal gyrus, bilateral temporal cortices and bilateral ventral and dorsal prefrontal areas. Regions contributing to both successful encoding and retrieval, evidenced by a conjunction analysis, revealed prominent left lateralized activations of the anterior hippocampus and the inferior parietal lobe. Our results indicate that the anterior left hippocampus plays an important role during successful memory encoding and during successful memory retrieval in a task of simple, non-associative wordlist learning in healthy elderly subjects.
The Neural Basis of Disorganized Symptoms in Schizophrenia
Authors: Leube D.
Published: March 2009

Structural brain changes in schizophrenia patients have been reported in many studies. It is still unclear how these changes relate to psychopathological symptom clusters. The aim of the present study was to investigate whether scores of the subscales from a five factorial model of the PANSS correlate with changes of brain morphology.

High-resolution magnetic resonance imaging scans from 54 patients with schizophrenia were analyzed with voxel based morphometry, a voxel-wise whole brain morphometric technique. We correlated grey matter density with the subscales of a five factor component analysis of the PANSS score. Additionally we performed a two group comparison with 101 healthy control subjects.

Significant negative correlations of the disorganization score with grey matter density were found for clusters of voxels in the right inferior frontal, right insular cortex, left temporal pole and left superior temporal gyrus, as well as cingulate cortex and cerebellum. No morphological correlate was found for the other four subscales. P atients showed significant less grey matter density than control subjects in the left and right insula lobe and superior temporal gyrus, left inferior frontal gyrus, right middle frontal gyrus and left anterior cingulate cortex.

The disorganisation syndrome in schizophrenia is linked to particular morphological grey matter reductions in key areas of the disorder. The data support the hypothesis that different symptom clusters in schizophrenia might have different neural substrates.
Subjective Cognitive Impairment: Functional MRI During Divided Attention and Measurement of Amyloid Load Using 11C-PIB PET
Authors: Rodda J. , Dannhauser T. , Cutinha D. , Okello A. , Shergill S. , Brooks D. , Walker Z.
Published: March 2009

Background:

Evidence suggests that healthy older adults with subjective memory complaints are at increased risk of dementia. Subjective Cognitive Impairment (SCI) may precede Mild Cognitive Impairment (MCI) in the clinical continuum of Alzheimer's disease (AD). Attentional deficits may be present early in AD, and associated functional changes have been reported in both MCI and AD. In the present study, activation during divided attention in SCI subjects was investigated using functional magnetic resonance imaging (fMRI). Additionally, amyloid uptake was investigated using 11C-PIB with positron emission tomography (PET).

Methods:

Brain activation in 11 SCI subjects and 10 controls was compared during a divided attention task using fMRI. Additionally, five SCI subjects and 14 cognitively normal healthy controls underwent 11C-PIB PET scanning. Criteria for diagnosis of SCI were:

1.

self-reported memory complaints,

2.

objectively normal cognition on detailed neurocognitive testing,

3.

absence of psychiatric or causative physical illness,

4.

normal activities of daily living and

5.

absence of MCI or dementia.

Results:

There were no differences in performance between SCI and control groups in terms of cognitive or behavioural measures. However, SCIs had increased activation in left medial temporal lobe, and bilateral thalamus, posterior cingulate and caudate. One SCI subject and one control subject had a pattern of 11C-PIB uptake similar to that seen in AD.

Conclusions:

The activation changes identified in SCI may relate to compensatory increased activation in the face of early AD pathology. Larger, longitudinal studies are needed to determine the extent and significance of PIB uptake in SCI.
Dissociative Disorders - Clinical Manifestation and Management
Authors: Prasko J. , Raszka M. , Pastucha P.
Published: March 2009

Dissociative disorders are heterogeneous group of mental disorders with dissociation as dominant symptoms. Dissociation is often defined as partial or total disconnection between memories of the past, awareness of identity and of immediate sensations, and control of bodily movements, often resulting from traumatic experiences, intolerable problems, or disturbed relationships. Etiopatogenezis of dissociative disorders have not exactly known yet. The process of dissociation is independently associated with several distressing conditions such as psychiatric diagnoses, somatization, current psychological distress, and past sexual and physical victimization. The disturbance may have a sudden or gradual onset and may be temporary or chronic in its course. Dissociation has a negative impact on treatment oucome. Additionaly, dissociative patients may have an insecure attachment pattern negatively affecting the therapeutic relationship. Conceptually, the course of treatment is to improve coping, maintain reality, and establish normal integrative functions. Goals:

1.

improve thought processes;

2.

maintain a sense of reality;

3.

improve coping skills;

4.

develop stress management abilities;

5.

increase identity integration.

The treatment is possible with psychotherapy or pharmacotherapy or both. We will introduce the CBT approach. Participants will learn:

•

pharmacological possibilities in the treatment of dissociative disorders;

•

CBT model of dissociative disorders;

•

motivational interviewing with dissociative patient;

•

how to develope therapeutic relationship with dissociative patient;

•

conceptualization of dissociative disorder with the patient;

•

Socratic questioning;

•

working with cognitive, emotional and behavioral avoidance;

•

exposure technique with dissociative problems;

•

problem solving.

Supported by the research project IGA NR 9323-3.
The phenomenology of acute THC-psychosis
Authors: Morrison P. , Kapur S. , Murray R.
Published: March 2009

It has long been known that cannabis can elicit an acute psychotic reaction. Recent work shows that, of the 60 cannabinoid molecules in the plant, delta-9-tetrahydrocannibinol is responsible for the central effects of cannabis. Here we aimed to investigate, in more detail, the psychological effects of synthetic intravenous THC in healthy subjects. Over 2 experimental sessions, participants (N=22) were administered 2.5mg IV THC or placebo under randomised, double-blind conditions. Psychological reactions were assessed using standard rating instruments and a battery of cognitive tests was completed.

Following THC, there was a significant increase in self-rated and observer-rated positive psychotic symptoms which were highly correlated (r=0.62, p=0.001).Phenomena centered on de-synchronisation of self-agency (ipseity disturbance) and hypersalience/paranoia. Participants also reported a significant increase in negative symptomatology under THC conditions, which was not explained by sedation. Finally, working memory/executive functioning was markedly and consistently impaired by THC.

Here we provide further evidence that THC can elicit an acute psychotic reaction in a proportion of healthy subjects. Acute THC-psychosis elicits positive, negative and cognitive symptoms. Compared with other drug models THC recreates symptomatology across 3 major dimensions of schizophrenic psychosis without sedation/clouding of consciousness. Here we also present preliminary evidence that the molecule cannabidiol (CBD) inhibits THC-elicited positive symptoms. Current work in our laboratory is exploring the underlying mechanisms.
Development of Psychosis: Prevention through Therapy Groups
Authors: Sanchez F. Collazos , Roncero C.
Published: March 2009

It is well known that psychosis is one of the most severe consequences related to cannabis consumption. Despite the clear negative impacts that this kind of drug abuse might exert upon users, the rates of consumption in Spain are alarmingly high and becoming a serious concern for both politicians and clinicians. Within the Psychiatry Service of the University Hospital Vall d’Hebron, a study has been conducted in order to assess the level of adherence to treatment. The study focuses on the use of group therapy, as an method to reduce cannabis dependence/consumption. Data from this study is presented as are various factors related to an improvement in the adherence to treatment are described.
Gender Specific and Structured Approach to Violence Risk Assessment - the Munich Prognosis Project (MPP)
Authors: Nedopil N.
Published: March 2009

A clear structured approach to violence risk assessment that is both, evidence-based and gender specific- is high on the political and mental health agendas. The individual risk of perpetrators depends on several parameters that are incorporated into assessment instruments. Most data about risk factors included in risk assessment instruments were derived only on male offenders.

This study is part of Germany's biggest risk assessment study, -the Munich Prognosis project (MPP) - and focuses on factors included in risk assessment instruments associated with criminal and violent recidivism in a sample of male and female delinquents referred for forensic-psychiatric evaluation prior sentencing. The predictive validity of four instruments (HCR 20, ILRV, VRAG and PCL-R) for violent and general repeat offenses was analyzed.

When comparing the predictive validity of the four instruments for male offenders, the results were in favor of the PCL-R, i.e. PCL-R Factor 2 when focusing on violent recidivism.

For female offenders ROC analysis found superior results of the HCR 20-R items (AUC .793 p< .05), the ILRV D variables (AUC .814), p< .05) and the VRAG (AUC .864, p< .05) for violent recidivism. They were in favor of the PCL-R Factor 1 (AUC .666, p< .05) when focusing on general recidivism.

The importance of gender specific violence risk assessment will be discussed.
Results from a Validation Study Comparing Ideographic and Nomothetic Risk Assessment Instruments
Authors: Rossegger A. , Laubacher A.
Published: March 2009

During the judicial process there are several decision points which require an assessment of recidivism risk: e.g. decisions regarding sentence severity or the form of detention (i.e. low or high security unit), level of treatment, or decisions regarding transfers to open correctional facilities or release. Psychiatric experts called on by the court are required to not only assess recidivism risk, but also state if risk may be lowered by forensic psychotherapy. In the case of treated sex and violent offenders treatment progress has to be evaluated by the therapist and by external experts, before an offender will be released from a correctional institution. When considering the variety of available risk assessment instruments the question arises, which instrument is most suited for decision making. For instance, the “value” of an instrument can be determined by its validity for a specific target population, and by its validity for a specific outcome: Is the instrument valid for a specific offender population or judicial or correctional setting? For what kind of outcome criterion has the instrument been developed and validated?