bluuebunny/crossref_metadata_2025 huggingface dataset:
Double Blind Randomised Clinical Trial of Bright Light Therapy in Elderly Subjects with Nonseaonal Major Depressive Disorder
Authors: Lieverse R. , Nielen M. , Uitdehaag B. , van Someren E. , Smit J. , Hoogendijk W.
Published: March 2009

Background:

The cause of depression is largely unknown, but several studies point to disturbances of biological rhythmicity. The functioning of the suprachiasmatic nucleus (SCN) is impaired, as evidenced by an increased prevalence of day-night rhythm perturbations, such as sleeping disorders. Moreover, the inhibitory SCN neurons on the hypothalamus-pituitary adrenocortical axis (HPA-axis) have decreased activity and HPA-activity is enhanced, when compared to non-depressed elderly. Using bright light therapy (BLT) the SCN can be stimulated. In addition, the beneficial effects of BLT on seasonal depression are well accepted. BLT is a potentially safe, nonexpensive and well accepted treatment option. But the current literature on BLT for depression is inconclusive.

Methods/design:

RCT (ClinicalTrials.gov identifier: NCT00332670) in 89 subjects, of 60 years and older with a diagnosis of major depressive disorder. After inclusion subjects were randomly allocated to the active (BLT) vs. placebo (dim red light) condition. just before the start of light therapy, after completion of three weeks therapy period, and three weeks thereafter several endocrinological, psychophysiological, psychometrically, neuropsychological measures are performed:

Results:

Main effect analyses on HADRS-17 scores revealed significant antidepressant effects from BLT. Primary results will be presented.

Discussion:

BLT reduces nonseasonal depression in elderly patients. Additional lightning may easily be implemented in the homes of patients to serve as add-on treatment to antidepressants or as a stand-alone treatment in elderly depressed patients. Our data support the role of a dysfunctional biological clock in depressed elderly subjects, such a finding may guide further development of novel chronobiological oriented treatment strategies.
BDNF and Control of Synaptic Plasticity in the Adult Brain
Authors: Bramham C.
Published: March 2009

Experience-dependent changes in synaptic connectivity are thought to play a vital role not only in memory formation, but also in long-term adaptive responses involved in mood regulation, reward behavior, and pain control. The neurotrophin, brain-derived neurotrophic factor (BDNF), which has recently been implicated in memory formation and aspects of major depression, is also an important regulator of long-term synaptic plasticity in the adult mammalian brain. We have investigated BDNF function in the dentate gyrus, a brain region implicated in depression and the action of antidepressant drugs. Local infusion of BDNF into the dentate gyrus generated a long-term potentiation (LTP) of synaptic efficacy at medial perforant path-granule cell synapses. This LTP is associated with expression of the immediate early gene, Arc, in postsynaptic granule cells and transport of Arc mRNA to synaptic regions on dendrites. Using local infusion of antisense oligodeoxynucleotides to block Arc synthesis, we show that Arc is required for the induction and time-dependent consolidation of BDNF-induced LTP. The sustained synthesis of Arc during a critical time-window is required for local expansion of the actin cytoskeletal network in dendritic spines. These results identify Arc as a critical mediator of BDNF in long-term synaptic plasticity in the adult brain. Microarray expression profiling has further revealed a panel of genes that, like Arc, are strongly upregulated following acute BDNF infusion or chronic treatment with the antidepressant fluoxetine.
The Involvement of BDNF in Pathogenesis and Treatment of Depression
Authors: Joubert A.
Published: March 2009

Aims:

Data suggest the involvement of monoaminergic and neurotrophic systems in the pathogenesis and treatment major depressive disorder (MDD). We are particularly interested in their interaction, and therefore studied monoaminergic mechanisms in a series of functional imaging studies using positron emission tomography (PET).

Methods:

Patients with a history of severe trauma and a diagnosis of posttraumatic stress disorder (PTSD) with and without a co-morbid diagnosis of MDD, patients with a diagnosis of MDD and PTSD alone and healthy control with and without a history of severe trauma were studied. Selective radiotracers for the serotonin 1B receptor subtype, the serotonin transporter and the norepinephrine transporter were synthesized using GE's FXC module and/or Bioscan's AutoLoop by methylation with C-11 methyl triflate or C-11 methyl iodide, respectively. Following a transmission scan, the radiotracers were injected by pump over one min and high resolution research tomography (HRRT) list mode data were acquired for 120 min on a HRRT. A summed image was created and registered to the subject's T1-weighted MR images, which, in turn, were registered to an MR template.

Results:

We found evidence for distinctly different neurobiological mechanisms in patients with MDD and PTSD relative to patients with only one diagnosis.

Conclusions:

Our data suggest biological endophentotypes for co-morbid PTSD and MDD which will not only support further research on the neurobiological systems that implement the psychopathology, but may stimulate translational research to develop preventive or treatment interventions for co-morbid patients.
New Insight into Role of BDNF in Anxiety
Authors: Maron E.
Published: March 2009

Recent investigations have implicated brain-derived neurotrophic factor (BDNF) in pathogenesis and treatment of psychiatric disorders. Studies in patients with major depression have demonstrated significant decline of serum BDNF concentration that correlated to the severity of depressive symptoms and restored to normal values after chronic treatment with antidepressants (Gervasoni et al., 2005). The involvement of BDNF in anxiety disorders has been less clear. Preliminary studies in patients with panic disorder did not find any changes in serum BDNF levels (Kobayashi et al., 2005) or associations with its gene polymorphisms (Lam et al., 2005). These findings are at odds with data from animal studies consistently confirming the involvement of BDNF in the regulation of anxiety-like behaviours. For example, decreased BDNF levels in the amygdala had provoked anxiety-like behaviors in rats (Pandey et al., 2006), whereas BDNF mRNA levels in this region significantly increased in response to higher stress (Aguilar-Valles et al., 2005). Moreover, Govindarajan et al. (2006) have shown that transgenic over-expression of BDNF may facilitate anxiety-like behavior, magnitude of which was positively related to BDNF levels in the dorsal hippocampus in another study using the elevated plus maze (Yee et al., 2007). Considering these conflicting data between animal and human studies we assumed that using experimental challenge in healthy subjects could shed more light on the role of BDNF in anxio- and panicogenesis. Our recent findings suggested a general involvement of BDNF in the regulation of anxiety rather than a specific role of BDNF in disposition to panic attacks.
Depression-like Behaviour in Neural Cell Adhesion Molecule (NCAM) Deficient Mice and its Reversal by an NCAM-derived Peptide, FGL
Authors: Zharkovsky A.
Published: March 2009

Neural cell adhesion (NCAM) plays important roles in the structural and functional plasticity in the CNS. Recent years much attention was put on the role brain plasticity in relation to depressive state. Mice deficient in NCAM molecule demonstrated signs of depression-like behavior in the tail suspension- and sucrose consumption tests. Analysis of hippocampal neurogenesis in NCAM deficient mice revealed a reduced survival of the newborn cells and their differentiation into calbindin-positive granule neurons. NCAM-deficient mice have also demonstrated reduction of CREB phosphorylation in the basolateral nucleus of amygdala, pre- and frontal cortex and CA3 regions of hippocampus. Since BDNF signaling system plays a significant role in the mechanisms of depression and in the effects of antidepressants, we measured the levels of BDNF and the level of phosphorylation of TrkB receptor in the brain of NCAM-/- mice. Experiments demonstrated a reduced BDNF signaling in the brains of NCAM-/- ice as a reduced level of phosphorylated Trk B receptor evidenced it. The depression-like signs in NCAM-/- mice were reversed by the NCAM-mimetic peptide FGL. In addition, repeated FGL administration enhanced survival of the newly generated cells in the dentate gyrus of NCAM-/- mice. Our data suggest that reduced brain plasticity due to deficiency in NCAM plays a role in the development of depressive state and NCAM mimetic peptide FGL might represent a new class of drugs with antidepressant activity.
Methodological Approaches and Evidence for Effectiveness in Clinical Trials
Authors: Davis L.
Published: March 2009

Recent publications by the Institute of Medicine have unearthed several fundamental flaws in clinical trial methodology that, if corrected by the next generation of clinical investigators, can transform the field of mental health intervention research. Using a clinician-friendly approach, Dr. Davis will succinctly review the essential elements of optimal design and implementation of a randomized controlled clinical study. These elements include the need for a hypothesis that has clinical relevance based on sound theoretical reasoning, reasonable and generalizable inclusion and exclusion criteria, feasibility of an enrollment goal and study time-line, and appropriate choice of a comparator intervention and primary outcome. Techniques to reduce the study's costs, risks, and participant burden will be described. Examples from psychopharmacologic, psychotherapy, and vocational rehabilitation trials for the treatment of posttraumatic stress disorder will be discussed. Following the didactic session by the two presenters, the participants will be encouraged to bring forth their own questions regarding clinical trial design for a 45-minute interactive discussion with the presenters. The objectives of the workshop are to improve the participants’ understanding of the goals of clinical trial design and methods to achieve those goals in order to improve their own research techniques, grantsmanship, and abilities to more accurately judge the results of studies presented in the literature.
Enhancing Signal Detection in Clinical Trials
Authors: Leon A.
Published: March 2009

Dr. Leon will present the biostatistical considerations that contribute to a clinical trial design and the strategies to enhance signal detection. These include minimizing bias in the estimate of treatment effect while maintaining a nominal level of type I error (i.e., false positive results) and maintaining sufficient statistical power (i.e. reducing the likelihood of false negative results). Particular attention will be paid to reducing the problems of attrition and the hazards of multiplicity. Methods to examine moderators of the treatment effect will also be explored. Examples from psychopharmacologic and psychotherapy trials for the treatment of depression and panic disorder will be provided to illustrate these issues. Following the didactic session, the participants will be encouraged to bring forth their own questions regarding clinical trial design for a 45-minute interactive discussion with the presenters. The objectives of the workshop are to improve the participants’ understanding of the goals of clinical trial design and methods to achieve those goals in order to improve their own research techniques, grantsmanship, and abilities to more accurately judge the results of studies presented in the literature.
Forensic Psychiatry and Older People - a UK Perspective
Authors: Yorston G.
Published: March 2009

The number of older people in prison has quadrupled in the UK in recent years, such that older prisoners now make up 2.6% of the total prison population, despite the fact that the number of offences committed by older adults has remained static. Older prisoners have high levels of psychiatric and physical morbidity, and forensic psychiatric services are receiving increasing numbers of referrals of older adults. In the past, few of these referrals resulted in admissions to secure psychiatric beds, however, reflecting a reluctance by forensic psychiatrists to admit older adults, who were perceived as being at risk from younger patients. Over the past 10 years, however, specialist secure inpatient units have been established in the UK for the assessment and management of older mentally disordered offenders. This seminar will explore the research evidence and clinical experience relating to this group of patients.
The Patient that we Love to Hate: Cognitive Behavioral Treatment of the Narcissistic Personality Disorder (mini workshop)
Authors: Freeman A.
Published: March 2009

The patient with a narcissistic personality disorder may be among the most difficult patients in the clinician's caseload to treat. They may take more time in therapy, more of the theraapist's energy, and overwhelm the therapist's ability to dea;l with the countertransference. Given their self-serving and demanding style, they are more frequently "sent" to therapy than electing to come for treatment. Thus the morivation for therapy and for change is severely limited. The patient's ability to establish a working therapeutic bond is also limited by the very nature of their disorder. Given all of this they can be treated. The active, directive, structred, and problem oriented facets of Cognitive Behavior Therapy make this model an ideal treatment modality. Helping the patient to examine what is in their best personal interest, the therapy proceeds by examining the patienbt's thoughts, feelings, and behaviors.
A Different DNA Methylation Profile is Obtained from a Recently Published MZ Study of Psychiatry
Authors: Liang M. , Hu Y. , Chen D.
Published: March 2009

Aim:

To get a more robust DNA methylation profile from the data given by a published article of a MZ study of psychiatry.

Method:

Considering the relevance of birth weight with DNA methylation profiles, we reanalyzed the data from the paper of Mill etc. (DOI: 10.1002/ajmg.b.30316) with rearrangement of the group order within twin pair, prior if lighter in birth weight. Statistical methods used are including mean, correlation and paired-samples t-test (considering twins’ particularity).

Results:

We calculated twin difference by lighter twin's methylation percentage minus that of heavier twin. The mean of CpG1 methylation differences is -7.08% while -7.17% for CpG2. The two means have no statistical significant difference in a paired-samples t-test (t=0.027, p=0.979, 2-tailed). These results are different from the original paper: 10.3% for CpG1 and 16.1% for CpG2, which are statistical significantly different (t=-2.792, p=0.018, 2-tailed). Besides, we found that in the lighter twin group, the methylation percentage are statistical significantly different between CpG1 and CpG2 (t=2.627, p=0.024, 2-tailed). As to correlation analysis, we got a slightly different result: correlation between MZ differences in two sites is weaker after rearrangement (r=0.875, while r=0.913 before arrangement, both p< 0.001).

Conclusion:

According to our study, the results imply that twin differences may not be the only thing worthy of investigation. Different patterns among CpGs in certain kinds of subgroups should also need attention. We need conduct a robust data analysis strategy in our researches on the epigenetic aspects of psychiatry, where monozygotic twins have a favorable utility.
Conditional Acceptance as a Distinct Feature of Socially-prescribed Perfectionism: A Study in Portuguese Pregnant Women
Authors: Macedo A. , Bos S. Carvalho , Maia B. , Soares M.J. , Marques M. , Pereira A.T. , Gomes A. Allen , Valente J. , Azevedo M.H.
Published: March 2009

Aim:

To investigate associations between perfectionism dimensions and psychological distress 421 pregnant women (M=29.8, SD=4.48 years) completed measures of Self-Oriented Perfectionism (SOP), Socially-Prescribed Perfectionism (SPP) (MPS; Hewitt & Flett, 1991; Soares et al., 2003), mood (POMS; McNair et al., 1971; Azevedo et al., 1991) and depressive symptomatology (BDI-II; Beck et al., 1996; Coelho et al., 2002).

Methods:

A 2-factor model of Perfectionism with SOP and SPP dimensions and a 3-factor model with SOP, SPP-Others’ High Standards and SPP-Conditional Acceptance factors were explored. Correlations and Linear Regressions were calculated between perfectionism factors and mood variables/depressive symptoms.

Results:

Higher levels of SPP factors were in general associated with increased Anxiety, Depression, Anger, Fatigue and Confusion, with decreased Vigour and with more severe depressive symptomatology. SPP dimension and both SPP sub-scales explained depressive symptoms.

Conclusion:

Our results, in contrast with those from the study of Campbell and DiPaula (2002) did not confirm a preferential association between SPP-Conditional Acceptance and psychological distress (PD), revealing that both components of SPP were associated with PD.
Applied Positive Psychology Therapy (APPT): Empowerment Instead of “curing”
Authors: Ronen T.
Published: March 2009

The founders of Positive Psychology promoted the study of the "positive end" of human functioning such as happiness, strengths, virtues etc". One of the major findings of a decade of research on the positive side of human behavior, cognitions and emotions is that the positive aspects are qualitatively different from the negative aspects on a number of dimensions (e.g., negative emotions occur automatically whereas one has to be active in order to produce positive emotions). Hence, we propose a new approach to psychotherapy that is based on current conceptualization of positive psychology: Applied Positive Psychology Therapy (APPT). It is a meta theory for a therapeutic approach based n positive psychology principles. More specifically, APPT is based on the following assumptions:

1.

The long range goals of most human beings are to feel good and be psychologically satisfied.

2.

Failures to materialize these goals are not a function of deep seated pathologies but lack of skills or knowledge how to materialize these goals.

3.

The goal of therapy is not to cure clients from their pathologies (i.e., the "causes" of their anxieties, phobia, or aggression) but to train them in self-control skills and other skills that would enable them to achieve psychological well being in the most effective way and in harmony with their long range goals.

In the present paper I will bring two examples how APPT is practiced with aggressive adolescents and marital difficulties. In both cases clients are told to define the most essential goals of their lives and how they can master their strengths and skills in order to regain their basic life goals. In contrast to the prevailing disease model of psychological problems, APPT is based on a psych-educational model.
Helping Adolescents with Social Phobia: A New Treatment Protocol to Empower them is Social Situations
Authors: Salvador M.C. , Pinto-Gouveia J.
Published: March 2009

Contrasting with the invalidation social phobia with an early beginning may have, research on cognitive-behavioural conceptualization and treatment in children and adolescents with social phobia is scarce.

In our presentation, we will propose a new treatment protocol for adolescents with social phobia, based on the most widely accepted conceptualization model of social phobia in adulthood - Clark & Wells, 1995 - taking into consideration idiosyncrasies in this age group, and also incorporating a positive and acceptant attitude towards themselves and their symptoms, and a curiosity attitude in the changing process. The aim is not only to overcome their social phobia but also to enable the adolescents with a positive view of themselves and of their strengths to empower them to overcome other difficulties and to promote their self-determination, in order to pursue their life-long projects and values.
Imparting Self Control Skills for Reducing Aggression among Adolescence
Authors: Ronen T.
Published: March 2009

The lecture describes a school-based aggression reduction learning intervention. The intervention program aimed to impart children with learned resourcefulness repertoire for reducing aggressive behavior. Based on the self-control intervention model developed by Ronen and Rosenbaum (2001), and in light of positive psychology theory the intervention focused on increasing children's coping, teach them to work toward positive goals such as increasing social relationships, and help themselves change.

447 ninth grade students participated in this study. 167 students participated in the intervention groups and 280 students from the same schools who received no intervention and served as a control group.

The outcomes point to the efficacy of the model in reducing aggression. The rate of aggression in the intervention group decreased significantly in compare with their base-line grade and in compare with the control group. Also hostile thought and negative emotion did not change - the child could control those and not behave in an aggressive way. Analysis showed that the changed in reducing aggression results from the increase in self-control skills.
Pharmacotherapy of Borderline Personality Disorder: A Metaanalysis of Randomised Controlled Trials [PW01-02]
Authors: Stoffers J. , Völlm B. , Rücker G. , Timmer A. , Lieb K.
Published: March 2009

Background:

In Borderline Personality Disorder (BPD), pharmacotherapy is used for the treatment of specific BPD pathology facets, such as cognitive-perceptual, affective, or impulsivity symptoms. Due to the polymorphic phenomenology of the disorder, different classes of drugs are used, e.g., antipsychotics, antidepressants, or mood stabilizers.

Aims:

To evaluate the up-to-date evidence of drug treatment efficacy for BPD.

Method:

A systematic review and metaanalysis of randomised controlled trials was done. All randomised comparisons of drug vs. placebo, drug vs. drug, or drug vs. a combination of drugs in adult BPD patients were eligible for inclusion. Outcomes comprised BPD core pathology as depicted by DSM criteria, associated pathology, i.e., depression and anxiety, general measures of overall psychopathology severity and mental health status, tolerability, and adverse effects. With support of the Cochrane Collaboration, a thorough search was conducted to identify both published and unpublished trials. The findings were scrutinized by two reviewers independently.

Results:

Twenty-six trials were included, investigating first- and second-generation antipsychotics, mood stabilizers, antidepressants, and omega-3 fatty acids.

Conclusion:

Findings indicate beneficial effects for all classes of drugs investigated, and suggest mood stabilizers and second-generation antipsychotic agents as first-line treatments for BPD due to their efficacy in the treatment of different domains of BPD and associated pathology. However, psychotherapeutic treatment should clearly be targeted at predefined specific symptoms.
Neurocognitive Basis of Impulsivity in Personality Disorders [PW01-03]
Authors: Mudholkar S.
Published: March 2009

Aim:

1.

Whether patients with personality disorders of borderline and antisocial type have a specific pattern of neurocognitive deficits.

2.

Whether impulsivity measured with clinical rating scales is related with performance on neuropsychological tests of risk taking which is sensitive to ventrofrontal cortex lesions.

Method:

20 patients and their age, sex and IQ matched controls participated in the study. Each patient and control was administered validated clinical rating scales in order to:

1.

Ascertain the diagnosis with respect to DSM-IV criteria (Structured Clinical Interview for DSM: Personality Disorder.

2.

Obtain a measure of clinical impulsivity (Barratt Impulsiveness scale).

3.

Ascertain the presence of heritable personality traits (Dimensional Aspects Of Personality Pathology Disorder-Basic Questionnaire).

4.

Exclude other major psychiatric disorders (Clinical Psychopathology Rating Scale).

They were administered National Adult Reading Test (NART) to estimate IQ.A battery of neuropsychological tests of memory and executive function specifically sensitive to frontal (dorsal or ventral) or temporal lobe damage were administered from Cambridge Automated Neuropsychological Test battery (CANTAB).

Results:

On Neuropsychological testing patients fared poorly on tests sensitive to planning and risk taking compared to controls. Patients had high mean scores on Barratt impulsiveness scale. The high scores were associated with performance on Tower Of London, Bechara test and paired associated learning. Impulsivity was associated with anxiousness and rejection traits of DAPP-BQ. There was a co-relation between some basic dispositional traits of DAPP-BQ with performance on Bechara, Gambling and Paired Associated Learning tests.

Conclusion:

Personality disordered patients show broad range of neurocognitive deficits on test s sensitive to frontal cortex.
Organisation and Practice of Prison Mental Health Care in Europe - the EUPRIS Study [PW01-04]
Authors: Salize H.J. , Dressing H.
Published: March 2009

Among the more than 9.25 million people currently being held in penal institutions worldwide, mentally disordered inmates constitute a serious problem. Despite the standard doctrine in most countries that mentally ill offenders lacking criminal responsibility have to be referred to in forensic psychiatric facilities for specialised care, the prevalence of psychiatric morbidity among prisoners by far exceeds the rate of mental disorders in the general population. However, international research on this issue is scarce. The EU has recently funded a study on the overall concepts and capacities of mental health care in prisons from 25 European countries. Hindered by very bad health reporting standards, the study revealed deficient mental state screening and assessment procedures at prison entry as well as during the term or prior to release. This is an obstacle for implementing adequate primary, secondary or tertiary prevention programmes for most prevalent mental disorders in prisons. Additionally it increases the risk of relapsing and re-offending of released prisoners. None of the included countries provides regular national statistics on the frequency of mental disorders of prisoners or on the availability of psychiatric treatments. Together with a mostly unknown share of general psychiatry involvement into prison mental health care, the information gap currently prevents from identifying favourable concepts of prison mental health care in Europe. The paper presents the data collected during the study as well as a suggested set of standardized indicators whose implementation would enable to describe and evaluate this seriously neglected field.
Homicide and Schizophrenia: A Review of 14 Cases from 210 Forensic Examinations of Murderers [PW01-05]
Authors: Richard-Devantoy S. , Bouyer-Richard A.-I. , Gigaux J. , Duflot J.-P. , Lhuillier J.-P. , Gohier B. , Garré J.-B.
Published: March 2009

Aim:

To establish the social, clinical and forensic differences between murderers with schizophrenia and murderers without any psychiatric disorder and to compare their respective relationship with their victim.

Method:

We identified the socio-demographic, clinical and criminological profiles of 14 murderers with schizophrenia from 210 forensic examinations of murderers, and compared their profiles with those of murderers without any mental disorder (n=73).

Results:

Murderers with schizophrenia are characterized by a specific socio-professional status (single, living alone and jobless). Previous psychiatric history was significantly more common in the schizophrenia group than in the group of persons without mental disorder, as it was the case as regards previous contact with the police.

Schizophrenic murderers generally commit, alone, a non-premeditated murder. They usually strangle their victim in a sudden attack, whereas murderers without any pathology usually premeditate their crime. 86% of perpetrators with schizophrenia have been in a delirium at the time they committed murder, among four main themes: persecution, thought insertion, mysticism and megalomania.

Victims of murderers with schizophrenia were family members in 21% of cases, acquaintances in 57% and a stranger in 14%. The victim was known to the perpetrator significantly more often in the schizophrenia group than in the no mental disorder group (86% versus 77%, p=0,002).

Conclusion:

The main difference between murderers with schizophrenia and murderers without any mental disorder is the psychopathology of the morbid process which underlies the homicide. The most schizophrenics’ homicide was more likely to be against intimates than strangers.
Challenges for Medical Models of Addiction [PW02-02]
Authors: Sullivan J. , Kincaid H.
Published: March 2009

It is standard in current neurobiological research on addiction to describe addiction as a chronic disease. Working from this perspective, much effort has gone into characterizing the symptomology of addiction and the brain changes that underlie them. Evidence for involvement of dopamine transmission changes in the ventral tagament area and nucleus accumbens have received the greatest attention. Kaur and Malenka (2007) put it well: “drugs of abuse can co-opt synaptic plasticity mechanisms in brain circuits involved in reinforcement and reward processing”.

Our goal in this paper is to provide an explicit description of the assumptions of medical models, the different forms they may take, and the challenges they face in providing explanations of addiction with solid evidence. We first spell out the requirements of disease models and use them to point out ambiguities in the claims of those who defend medical models. After that, we ask to what extent DSM categorization is suitable to medical models and what aspects of the life course of addiction medical models are supposed to explain. In the third section, we note that a primary aim of the neurobiology of addiction is to localize the causes of addiction to cellular and molecular pathways in the brain's reward system. We investigate how well current neurobiological approaches approximate towards such a unified causal account of addiction, and what challenges current approaches still face. We finish with a survey of some of the important social processes in addiction and the challenges they raise for medical models.
Are there Differences between Primary Psicosis and Substance-induced Psicosis? [PW02-03]
Authors: Digon L. Diaz , Sanvisens D. Martinez , Fernandez L. Morro , Codina G. Mateu , Torres A. Merino , Melich M. Torrens
Published: March 2009

Introduction:

Substance-induced psychoses (SIP) are associated with greater conjugal ties, greater substance dependence, homelessness, parental substance abuse, poorer family support and visual hallucinations, while primary psychotic disorders (PP) have greater symptom severity.

Objective:

To describe differential characteristics between PP and SIP in a dual diagnosis unit.

Method:

We collected sociodemographic, employment data, admission reasons, family substance abuse and main drug of abuse.

Results:

•

23 patients were admitted with psychosis (87% males; mean age 35,6±10,1). Two groups were performed: PP (N=12) and SIP (N=11).

•

Mean length of admission was 17,78±13,17 days. Most prevalent co-occurrent diagnoses were psychotic disorders-cocaine use disorders (43,5%).

•

The only significant difference between PP and SIP was shorter length of admission in SIP (days: mean [s.d]) (26,6±14,9 vs. 13,8±7,5; p< 0.05). Other variables studied were: (1) main reasons for admission: hallucinations/delusions (33,3% vs. 90,9%), suicide ideation (33,3% vs. 0%); (2) main drug of abuse: cocaine (50% vs. 45,5%), alcohol (33,3% vs. 0%), psychoestimulants (0% vs. 27,3%), cannabis (8,3% vs. 18,2%); (3) marital status: married/cohabiting (25% vs. 36,4%), divorced (16,7% vs. 0%), single (58,3% vs. 63,6%); (4) employment: employed (33,3% vs. 50%) and unemployed (66,7% vs. 50%); (5) age, years: mean (s.d): 37,8 (10,6) vs 33,2 (9,5); (6) parental substance abuse (65,7% vs. 83,3%).

Conclusions:

•

No significant differences were found between both groups (PP vs. SIP) except for shorter length of admission in SIP.

•

The most frequent co-ocurrent diagnosis was psychotic disorder+cocaine use disorder.
Violence and Psychosis; Treating the Untreatable (Novel Pharmacological Approaches) [PW02-04]
Authors: Launer M.
Published: March 2009

Often the final pathway for psychosis is the forensic services. In many other cases the only options are prison or no care at all. Despite much research into the psychopharmacological approach many patients are either unresponsive or unable or unwilling to take medication. Many clinicians would support the early use of clozapine for these patients but despite the availability of clozapine in Europe for nearly 20 years the numbers who are treatment resistant are still highly significant. This affects patients, carers and indeed potential victims and staff who are increasingly vulnerable. The eclipse of the typical anti-psychotics and the fear of extra-pyramidal side effects has led to many patients being prescribed oral atypical agents which they do not actually take. The result of, in many cases years, of untreated or part treated psychosis is severe cognitive damage. This then contributes to difficulty in managing the patient and lack of engagement in the therapy process. The emergence of new depot preparations may be the answer but the degree of D2 blockade may still not be sufficient and the addition of 5HT blockade may be also useful. In the forensic settings there is much made of risk assessment but the most efficient predictor of future risk is a stable patient on an effective treatment regime. Several options are described including double depot, high dose olanzapine and clozapine enhancement.
How “DUP” and “EE” Predict the Dynamic OD Syndromes in the Long - Termcourse of Schizophrenia? [PW03-02]
Authors: Cechnicki A. , Polczyk R. , Bielańska A.
Published: March 2009

Objective:

The study in Krakow investigated the way in which EE and DUP correlated with long term outcomes of the treatment and the course of illness.

Subjects and methods:

58 out of 80 DSM III schizophrenia diagnosed patients took part in 1, 3, 7 and 12 follow-up. The Follow-Up Chart, BPRS, and CFI were used. As the outcome criteria only dynamic of symptoms were included. The dynamic of the symptoms and the relation between DUP and EE were analyzed by repeated measures of ANOVA.

Results:

1.

General, positive and negative syndromes decreased rapidly after the first hospitalization, and increased slightly between 7 and 12 yrs. (ps < 0.001). The negative syndrome decreased less rapidly during the first year.

2.

The dynamic of general and positive syndrome were modified by the DUP and by EE. In long DUP (general syndrome: p = 0.028; positive syndrome: p = 0.001) the dynamic was worse. High EE subjects had more severe syndromes at the admission. After the first hospitalization their results became as good as in the case of low EE (general syndrome: p = 0.004; positive syndrome: p = 0.044).

3.

The dynamic of negative syndrome was neither modified by DUP (p = 0.896) or by EE (p = 0.309).

Conclusion:

The dynamic of general and positive syndromes were modified by DUP during 12 years follow-up and by EE only in acute state in the first episode. The dynamic of negative syndrome was not modified by DUP and EE.
Antipsychotics Efficacy in Treatment of Schizophrenia Negative Symptoms: Meta-analysis of Randomized Clinical Trials [PW03-03]
Authors: Darbá J. , Minoves A. , Rojo E. , Jiménez F. , Rejas J.
Published: March 2009

Purpose:

To examine the efficacy of second-generation-antipsychotics (SGAs) in the treatment of negative symptoms in Schizophrenia.

Methods:

Two meta-analyses were carried out using placebo or haloperidol as comparators. Studies were identified by searching for randomized, double-blind, placebo and/or haloperidol -controlled trials reporting data on efficacy of SGAs. Search was extended to the following databases: Pubmed, The Cochrane Central Register of Controlled Trials, Proquest Health and Medical Complete, Science Citation Index Expanded, and Current Contents Connect. The outcome measure used was the change in negative symptoms, choosing a standardized statistic (Cohen's d) to synthesize data.

Results:

A total of 46 homogeneous trials (Q=45.18, df=50, p=0.667, I2=0%) were included. In the placebo-controlled meta-analysis, the effect sizes (Cohen's d) obtained for amisulpride, haloperidol, olanzapine, quetiapine, risperidone and ziprasidone were 0.52, 0.34, 0.43, 0.36, 0.40 and 0.46, respectively, favoring active treatment against placebo (p< 0.001 in all cases). Comparing SGAs against haloperidol, showed just a statistically significant trend favoring SGA's in treatment of negative symptoms (Cohen's d = 0.15, p=0.008). Comparisons by drug showed a significant low and low-to-moderate standardized mean favoring SGA: Cohen's d = 0.34, p< 0.001; Cohen's d = 0.27, p< 0.001 and Cohen's d = 0.19, p=0.030, respectively for ziprasidone, risperidone and olanzapine.

Conclusion:

Most antipsychotics (aminosulpride, haloperidol, olanzapine. quetiapine, risperidone, ziprasidone) are effective in treatment of negative symptoms, showing moderate effect sizes. Amisulpride and ziprasidone were slightly better than the rest of drugs when compared with placebo. Compared with haloperidol, SGA showed controversial results.
Volumetric Changes in PTSD and in a Subgroup of PTSD Patients not Responding to EMDR Psychotherapy [PW04-01]
Authors: Pagani M. , Nardo D. , Flumeri F. , Salmaso D. , Looi J. , Sanchez-Crespo A. , Larsson S.A. , Sundin Ö. , Högberg G. , Bejerot S.
Published: March 2009

Background:

Several studies have reported limbic structures volume decrease in Post-Traumatic Stress Disorder (PTSD). However, in PTSD the effect of therapy on brain structures has seldom been investigated. The aim of the study was to evaluate the grey matter (GM) loss in occupational related PTSD and to assess the volumetric differences between patients responding (R) and non-responding (NR) to psychotherapy.

Methods:

Pre-EMDR MRI data of 21 train drives who did develop PTSD (S) and 22 who did not develop PTSD (NS) after person-under-the-train accidents were compared. Within S further comparisons were made between 10 R to Eye Movement Desensitisation Reprocessing (EMDR) therapy and 5 NR. Data were analysed by optimised voxel-based morphometry as implemented in Statistical Parametric Mapping.

Results:

As compared to NS, S showed a significant GM volume reduction in precuneus, lingual gyrus, posterior cingulate and parahippocampal cortex. The R>NR comparison highlighted a significant GM reduction in NR in bilateral posterior cingulate, left middle frontal cortex and right parahippocampal, insular and temporal cortices.

Conclusions:

Comparing two large groups of subjects significant GM volumetric reductions were found in PTSD in posterior limbic structures. NR showed, as compared to R, volume reduction in cortical structures including posterior cingulate and parahippocampal cortex. These latter two structures seem to be the hallmark for both PTSD diagnosis and therapy outcome prediction.
Description of the Elderly Psychiatric Admissions in Recent Years [PW04-03]
Authors: Rico-Villademoros P. , Touzon R. , Garnica E.
Published: March 2009

Aims:

To analyze the characteristics of the admissions of elderly patients in an acute psychiatric unit in recent years, to see if there have been any changes in the number, the average stay or in their referral from the hospital.

Method:

Details of all admissions in a psychiatric unit for acute patients aged over 65 since 1999 are collected by means of a computer system. The number of admissions, the average length of stay and where they go when discharged are taken into account.

Results:

In recent years the number of patients over 65 entering our unit has remained relatively stable. The average stay time remains high over all the studied years. It is proved that a large number of patients need to be moved to residences or other assistive devices when discharged.

Conclusions:

Despite the increase in elderly population, the number of patients over 65 who enter this unit has not significantly increased. Their average stay remains always high over the years. It is striking the number of patients who can no longer go home when discharged, once they have been admitted.
Psychodrama and Neurosciences [PW04-04]
Authors: Fonseca E.
Published: March 2009

In this work I try to combine Goldberg's findings in “The Executive Brain” about the biological and changing Ego accoording to the Body Image.

Antonio Damasio's Subjectivity (“Descartes' Error”) that does not need spoken languaje, and the so called Kandel Principles.

Kandel, in his Proyect of the Human Brain, on the long run structural changes of the plastic neurons (Psicones), that appear as a result of treatments with psychochemicals as well as in Psychodramatic Learning with psychodrama's characteristics, that is a method that utilizes The Body.

I would like to explain how Psychodrama can be an integrant Psychotherapy that will bring a Human meaning to advances in neurosciences.
Predictors of Mania in a Sample of Patients Treated with Antidepressants (Preliminary Results) [PW05-01]
Authors: Amedei S. Gorini
Published: March 2009

Aims:

From 35% to 60% of cases the initial presentation of illness in bipolar disorder is different from mania or hypomania. So far the studies that have investigated predictors of (hypo)mania have been concentrated on samples suffering from depression. On one hand is well known that antidepressant drugs are commonly prescribed in a broad spectrum of disorders other than depression. On the other hand there are strong connections within bipolar disorder and anxiety disorders that have been reported to be a possible clinical onset of a subsequent bipolar disorder.In all these cases patients are likely to be treated with antidepressants drugs, the effects of which has been associated with a worsened course of bipolar illness, from switching to mania to a rapid cycling course. This is the reason that led to perform a research on predictors of bipolar evolution on an antidepressant treated sample of outpatients irrespective of the diagnosis.This study examines clinical features at the first presentation of the illness that can be considered predictive of the subsequent bipolar course of illness.

Method:

A sample of outpatients treated for the first time in their life with antidepressant drugs has been prospectively evaluated in order to assess the clinical features associated with the later onset of bipolar disorder.
Spanish Consensus on Physical Health in Patients with Bipolar Disorder [PW05-04]
Authors: Saiz-Ruiz J. , Bobes J. , Vieta E. , Mostaza J.
Published: March 2009

Background and objective:

Bipolar disorder is a serious mental illness which may affect between 2% and 5% of the population. These patients present much higher morbidity and mortality rates than the general population. In addition to a higher mortality rate from suicide, they also have a higher prevalence of other physical disorders.

The purpose of this consensus is to establish recommendations for diagnostic procedures and clinical interventions in order to control the risk factors which have repercussions on the physical health of the patients.

Methods:

After carrying out a systematic review of medical co-morbidity and mortality rates in bipolar disorder, two multidisciplinary consensus meetings were held in which 31 psychiatrists and 11 experts from other medical specialities participated.

Working groups were formed for each speciality for the purposes of adapting the guidelines applied in the general population to these patients.

Results:

The bibliographical review revealed an increased risk of hypertension, obesity, smoking, pulmonary diseases, migraine and HIV infection. There is evidence of higher mortality rates from cardiovascular and respiratory diseases and infections, as well as from suicide. The expert group reached consensus on a series of basic measures for detecting medical co-morbidity. The resulting recommendations will be validated by Spanish Psychiatry and General Medicine Associations.

Conclusion:

The physical health of patients with bipolar disorder could be improved. It is hoped that the publication of this consensus will have an impact in terms of better psychosocial functioning, quality of life and life expectancy for these patients in Spain.
Bipolar Disorder and Suicide: 10 Years Follow-up/retrospective Survey/
Authors: Breznoscakova D. , Palova E. , Dragasek J. , Losonciova K. , Uhrin J.
Published: March 2009

Introduction:

Bipolar disorder (BD) is chronic psychiatric disorder by mood swings, symptoms of BD are serious and life-threating. Suicide risk in patients with BD is 25-50%, more frequent during depressive episode (Compton,2000) but with adequate treatment suicide risk can be presented in nearby 50% of patients only (Goodwin, Jamison,2006). Despite these facts data about the changes of treatment habits over the longer period of time under naturalistic condition are lacking.

The aim of study:

To assess presence of suicidal thoughts and attempts in inpatients with BD and follow-up changes of treatment with lithium over the period of time.

Patients and methods:

It was retrospective survey of in-patient's files hospitalized at the 1st Dept. of Psychiatry, UPJS, Kosice (1997-2007) with typical limitations for retrospective case survey. All patients had diagnosis of BD (DSM-IV), n=125 (67% of women and 33% of men). We discovered changes in suicidal behaviour with/without treatment of lithium.

Results:

The first episode was depressive in 62% of patients, average number of episodes: 8,2. There was trend of decrease in use of lithium over the time (68% vs 84% in men, 29% vs 60% in women). The suicidal thoughts were more frequent during depressive episode (in 50% of women and 18% of men). Suicidal thoughts and attempts were 3 times more frequent in women vs men with BD. Suicidal attempts were 4 times more frequent in women with treatment with lithium vs without lithium.
Meta-analysis of Magnetic Resonance Imaging Studies in Bipolar Disorder and Schizophrenia [PW05-06]
Authors: Arnone D. , Cavanagh J. , Gerber D. , Lawrie S.M. , Ebmeier K.P. , Mcintosh A.M.
Published: March 2009

Introduction:

Several MRI studies have identified structural abnormalities in association with bipolar disorder. The literature is however heterogeneous and there is remaining uncertainty about the brain areas pivotal to the pathogenesis of the condition. The aim of this study was to identify, appraise and summarise volumetric MRI studies of brain regions comparing bipolar disorder with an unrelated control group and/or patients with schizophrenia.

Methods:

A systematic review and random-effects meta-analysis was carried out to identify key areas of structural abnormality in bipolar disorder and whether the pattern of affected areas separated bipolar disorder from schizophrenia. Excessive variability was explored using meta-regression analyses.

Results:

Seventy two reports met inclusion criteria. Subjects with bipolar disorder showed significant whole brain and prefrontal lobe volume reductions, and also increases in the volume of the globus pallidus. Enlargement of the lateral ventricles in bipolar disorder was confirmed, although the magnitude of enlargement was smaller than in schizophrenia. Subjects with schizophrenia, but not bipolar disorder, showed significant reductions in right amygdala volumes. Heterogeneity was statistically significant for many of the analyses and could amongst others be explained by age, duration of illness and year of publication.

Conclusion:

There appear to be robust changes in brain volume in bipolar disorder compared with healthy volunteers. Age and duration of illness appear to be key issues in determining the magnitude of observed effect sizes.