bluuebunny/crossref_metadata_2025 huggingface dataset:
S36-03 - Responsibility: Agency and Morals
Authors: Oyebode F.
Published: June 2010

Responsibility can be defined as an obligation or duty that something happens in a situation for which one can be praised or blamed. In this presentation, the constitutive elements of a moral account of responsibility such as whom a moral agent is, under what conditions moral responsibility applies, and the possible objects of responsibility ascriptions will be discussed. The contributions of Aristotle, Strawson, Carl Ginet, Hans Jonas, Daniel Wegner and others to our understanding of responsibility, causal determinism, and the illusion of conscious will be explored. The presentation will conclude by discussion the implications of these ideas for psychiatry particularly with regard to patient autonomy and responsibility.
S36-04 - Addictions: a Psychopathological Perspective of Responsibility
Authors: Dipetta G.
Published: June 2010

This presentation aims to illustrate substance addiction from a point of view of the psychopathological responsibility. Substance abuse has been affecting modern society for more than forty years, and the sanitary, social, economic and the psychopathological impact of substance addictions are becoming more and more disastrous. At the moment there are no signs of any decrease in the number of addicts, on the contrary, the trend continues to spread to all social classes. In all these years a psychopathological perspective has never been sistematically applied to the addiction field. A psychopathological perspective is able to achieve a deeper insight into the problem of substances addiction and thus offer new and stimulating possibilities of treatment. From this point of view a psychopathological perspective implies precise responsibility, not only for the individual working within the Health Service, but for the hole organization of the Health System itself.
S17-04 - Ageing, Care With Optimal QoL and End-of-Life Issues
Authors: Tataru N.
Published: June 2010

After a conceptual definition of normal ageing and of active and successful ageing and their differentiation from morbid ageing, we try to consider not only the presence or absence of a disorder but also its impact in someone's quality of life. Impact of mental disorders on quality of life is one of the changes in criteria for public health priority. Nowadays, it is difficult enough to talk about quality of life of elderly with mental disorders. The psychiatrists and other health care providers have to face at serious medical and ethical challenges in caring the elderly mentally ill at the end-of-life, assuring them the best quality of life as it is possible. Knowledge of the persons’ past experiences and their current abilities could be used as a guide for making decisions affecting their QoL and also their end-of-life.

Following the principles of Declaration of Paris, 2005, we can discuss about the quality of end-of-life of elderly mentally ill and stigma against them, in term of: the right to live versus the right to die; the right to be treated versus the right to refuse the treatment; the right to know versus the right to refuse to know the diagnosis; the valid consent of the person with the capacity to consent and the patient without this capacity. Respect for the individual's expressed wishes and interest, should guide all end-of-life care decisions. The aim of any mental healthy intervention for older adults is to preserve the human rights and patient best interest.
S39-03 - Risk Behavior in Adolescents: What We Need to Know
Authors: Becker K.
Published: June 2010

Objectives

Knowledge of the prevalence and the different types of risk behavior in adolescence is needed to prevent unwanted health consequences.

Methods

In general, risk behavior in adolescence is quite common. It comprises patterns such as smoking, alcohol consumption, hazardous driving, drug use, delinquency, dares, sporting risks, rebellious behavior, school-related risks, sexual intercourse as well as other socially inconspicuous behavior that nonetheless poses a risk to health (e.g. bad nutrition, lack of physical activity, or excessive sunbathing).

Results

The different types of risk behavior are described also addressing the issues of gender differences and individual risk factors as well as protective factors. Temperament factors (novelty seeking) and peer group influences are discussed as well as genetic factors and brain maturation in adolescence.

Conclusions

The knowledge of adolescent risk behavior and the possible causes as well as prevention strategies is important for all professionals dealing with adolescents and young adults.
S22-01 - Preventive Monitoring of Psychiatric Patients at Risk for Compulsory Readmission: Preliminary Results of a Multi-Center RCT
Authors: Gallas C. , Dressing H. , Hess N. , Kief S. , Salize H.J.
Published: June 2010

Objectives

This study aims at reducing the risk for compulsory readmission in psychiatric patients by a comprehensive intervention comprising psychoeducation on warning signs, crisis cards and a continuous telephone monitoring of the patients‘ mental health status and health care utilization over a two-year period. Beyond reducing involuntary admissions, further objectives of the intervention are to reduce number and duration of inpatient stays and to result in a more cost-effective service provision.

Methods

Psychiatric inpatients suffering from schizophrenia or an affective disorder were randomly allocated to the intervention group or the control group (treatment as usual). Risk for compulsory readmission was defined by a current involuntary treatment episode or involuntary treatment within the previous 24 months. Both groups are assessed at baseline, at 12-month and 24-month follow-up. Interviewer ratings cover psychopathology (Positive and Negative Syndrome Scale, Young Mania Rating Scale, Hamilton Depression Sale, Global Assessment of Functioning), psychopathy (Hare Psychopathy Checklist Screening Version) and risk for violence (HCR 20). Treatment satisfaction, empowerment and quality of life is measured by self-report questionnaires. Health care utilization and prescription of psychotropic medication is recorded continuously in the intervention group and over a 3-month period in the control group.

Results

Preliminary results of this ongoing study will be presented, illustrating sample characteristics and first results of the one year follow-up. Focusing on data of type, number and duration of inpatient stays, the potential of the intervention to reduce the risk for involuntary readmission to psychiatry will be discussed.
S22-02 - The Organization of the Psychiatric Service and Criminality Committed by the Mentally Ill
Authors: Kramp P. , Gabrielsen G.
Published: June 2010

Introduction

During the past 40 years there has been an increase in the number of mentally ill criminals. The purpose of this study is to analyse the correlations between the reorganisation of the psychiatric treatment system the growing number of forensic patients and the increase in serious crime, homicide and arson associated with the mentally ill.

Materials and methods

We estimated the annual positive or negative growth rate of consumed psychiatric beds and in social and community psychiatry (explanatory variables) and in prevalence and incidence of forensic patients, homicide and arson (response variables) from 1980 to 1997 for each of the 14 Danish counties. The long-term effect was analysed in the form of between-county analysis with both single and multiple regressions.

Results

Bed closure had no immediate effect on either the number of forensic patients or serious criminality. Over time the (negative) growth rate in number of consumed beds is significantly correlated with the (positive) growth rates for forensic patients, homicide and arson. Social and community psychiatry have little effect, if any.

Discussion

We have used two sets of data firstly the number of forensic patients and, secondly the reported number of crimes associated with the mentally ill. The uniformity of the results leads us to consider that the decreasing effort invested in inpatient treatment is causing an increase in the crime rate among the mentally ill.

Conclusion

Forensic patients are not only offenders, but also the victims of an inadequate treatment system. Modern inpatient treatment facilities should be established.
S22-04 - Community Psychiatry and Coercive Treatment: a Delicate Relationship
Authors: Schanda H.
Published: June 2010

Introduction

Psychiatry has always had a special position among the medical disciplines. Patients were perceived by the public as potentially dangerous, psychiatrists as representatives of an uncontrolled “total” institution. The mental health reforms initiated during the 2nd half of the 20th century focussed on a “normalization” of this special position by means of a reduction of coercion to the absolute minimum and to an adaptation of the principles of treatment and care to that of all other medical specialities.

Results

In all European countries, the prevalence of mentally disordered offenders is on the rise. As, surprisingly, the same holds good for the rates of involuntary admissions to psychiatric hospitals, a supposed transfer of coercive measures from the civil to the penal law sector seems to be unlikely. According to epidemiologic data, there is also no direct relation with the reduction of general mental hospital beds or with the sometimes insufficient provision of community services. Rather, the changed attitude of mental health professionals in dealing with a subgroup of “difficult-to-treat” patients seems to be crucial factor.

Discussion

Recent data confirm an association between psychosis and violence. Not least for that reason psychiatry does have - against all affirmations - a special position among the medical disciplines. The denial of this fact by the representatives of modern community psychiatry was not able to reduce coercive measures against mental patients - rather, coercion is now applied in a hidden way, obviously insufficient so damaging the reputation of both psychiatry and its patients.
S27-02 - Group Cognitive Behavioural Therapy (CBT) for Insomnia, the Bristol UK Experience
Authors: Hicks J. , Green A. , Wilson S.
Published: June 2010

It is now well established that CBT for chronic insomnia is as efficacious as hypnotic medication and is also likely to be better at maintaining improved sleep. Most studies have looked at the use of individual CBT; there have been only a few studies looking at CBT for insomnia given in a group format.

For nearly ten years the Bristol Insomnia Group has offered cognitive behavioural management and support for people with chronic insomnia.

The seven group sessions are led by up to three members of a team consisting of a doctor (sleep specialist), an occupational therapist and a research sleep scientist. Components of the group intervention include education about sleep science, information on insomnia medication, sleep hygiene, relaxation, and cognitive therapy. To assess efficacy participants complete sleep diaries, a quality of life scale (SF36) and the dysfunctional beliefs and attitudes scale (DBAS) pre and post group.

Sleep diaries (n=68) showed significant differences in Total Sleep Time (TST), Sleep Onset Latency (SOL) and Sleep Quality (SQ). Approximately half of the participants had clinically significant improvements in their TST (increased by 30 minutes) and about a third had a clinically significant decrease (by 30 minutes) in their SOL. SF36 scores showed statistically improved scores in all nine domains, DBAS scores showed statistically significant decreased scores post group.

These results demonstrate promising sleep parameter and quality of life improvements after attendance at the group. CBT for insomnia is a clinically and cost effective approach for the treatment of chronic insomnia.
S34-02 - Heritability of Cortical Thickness Change Over Time in Schizophrenia Patients and Their Discordant Co-Twins
Authors: van Haren N. , Brans R. , van Baal C. , Schnack H. , Kahn R. , Hulshoff Pol H.
Published: June 2010

Introduction

Structural brain abnormalities have consistently been found in schizophrenia, with increased familial risk for the disease associated with these abnormalities. Some brain volume changes are progressive over the course of the illness.

Objective

To investigate whether these progressive brain volume changes are mediated by genetic or disease-related factors.

Methods

We carried out a 5-year follow-up study in monozygotic (MZ) and dizygotic (DZ) twin pairs discordant for schizophrenia (DISC) and healthy comparison (HC) twin pairs using brain magnetic resonance imaging. A total of 92 participants completed the study (DISC: 9 MZ and 10 DZ; HC: 14 MZ and 13 DZ). Percentage volume changes of the whole brain and cerebral gray and white matter were estimated. Structural equation modeling was applied to estimate contributions of additive genetic and common and unique environmental factors.

Results

Significant decreases over time in whole brain volume was found in patients with schizophrenia and their unaffected co-twins compared with control twins. Bivariate structural equation modeling using cross-trait/cross-twin correlations revealed significant additive genetic influences on the correlations between schizophrenia liability and progressive whole brain (66%; 95% confidence interval [CI], 51%-100%), frontal lobe (76%; 95% CI, 54%-100%), and temporal lobe (79%; CI, 56%-100%) volume change.

Conclusions

The progressive brain volume loss found in patients with schizophrenia and their unaffected co-twins is at least partly attributable to genetic factors related to the illness.
S34-04 - Genetic and Non-Genetic Influences on Brain Function in Schizophrenia: An FMRI Study in Twins
Authors: Picchioni M. , Toulopoulou T. , Fu C. , Valli I. , Ettinger U. , Hall M.-H. , Brammer M. , Giampietro V. , Gasston D. , Murray R. , McGuire P.
Published: June 2010

Introduction

Altered neurocognitive function in schizophrenia could reflect both genetic and illness-specific effects.

Objectives

To use functional magnetic resonance imaging to discriminate between the influences of the genetic risk for schizophrenia and environmental factors on the neural substrate of verbal fluency, a candidate schizophrenia endophenotype using a case control twin design.

Methods

We studied 23 monozygotic twin pairs: 13 pairs discordant for schizophrenia and 10 pairs of healthy volunteer twins. Groups were matched for age, gender, handedness, level of education, parental socio-economic status, and ethnicity. Behavioural performance and regional brain activation during a phonological verbal fluency task were assessed.

Results

Relative to healthy control twins, both patients and their non-psychotic co-twins produced fewer correct responses and showed less activation in the medial temporal region and inferior frontal gyrus. Twins with schizophrenia showed greater activation than both their non-psychotic co-twins and controls in right lateral temporal cortex, reflecting reduced deactivation during word generation while their non-psychotic co-twins showed greater activation in the left temporal cortex.

Conclusions

Both genetic vulnerability to schizophrenia and schizophrenia were associated with impaired verbal fluency performance, reduced engagement of the medial temporal region and dorsal inferior frontal gyrus. Schizophrenia was specifically associated with an additional reduction in deactivation in the right temporal cortex.
S41-01 - The Neural Organization of the Hippocampus and Schizophrenia
Authors: Boyer P. , Ledoux A.A.
Published: June 2010

The disturbances of explicit memory functions in schizophrenia are widely recognized. More precisely the mechanisms related to the episodic memory subsystem seem to play a significant role in the pathophysiology of the disease. Errors during the encoding phase could be responsible for this dysfunction even if retrieval per se is not totally spared. The main process in encoding episodic memory is contextual binding as evidenced by numerous neuropsychological studies. Since the hippocampal formation is considered to be the central element for contextual binding the neural support of this last mechanism is most likely rooted in the hippocampus. This assumption is confirmed by numerous neuroanatomical, neurodevelopmental, biochemical and genetic studies reporting a significant disorganization of the neural network and its scaffolding structure at the level of the hippocampus. More precisely a synaptic disorganization within the CA3 and CA1 regions (pyramidal cells and neurons) could explain for which reason episodic memory processes are impaired in schizophrenia. Associative binding occurred at the CA3 the level of the hippocampus. This corresponds to the crucial role of this region for acquiring representations of stimulus conjunction. In particular the spatial characteristics of a stimulus are probably bound thanks to the activity of the CA3 area. We hypothesize that separated CA3 representations are not correctly formed in schizophrenia. Consequently the flow which comes to the cortex into the entorhinal pathway and then to the dentate gyrus and CA3 does not result in a pattern of separated representations. Evidences supporting this hypothesis will be presented.
S05-02 - Transcultural Perspectives of Medicine [E105]
Authors: Qureshi A.
Published: June 2010

The psy fields are predicated on the cartesian notion of a mind-body dualism.
Suffering is understood to stem either from problems of mind or from problems of
physiology. A related dualism is that of the “biological” and that
of “cultural”. Recent commentators have worked at great length to
collapse this dualism in day to day work with patients. At the same time, it
clearly forms a fundamental part of medical epistemology. From a transcultural
perspective, it is increasingly clear that there exists the possibility for
considerable difference in the four “Es”: Experience, expression,
explanation and expectations related to suffering. This variation is in large
part related to the epistemic structure underlying any given culture, and, taken
as such, can present a considerable challenge to consultation-liason psychiatry.
A patient may experience suffering that is expressed in the form of strange
sensations in a specific parts of the body. This is then explained as a
consequence of a certain process that is culturally syntonic, and then expects a
certain course of suffering as well as treatment. Given that we tend to take our
epistemic perspectives for granted as representative of the “world as it
is”. The C-L psychiatrist who does not take these variations into
consideration could all to easily arrive at a misdiagnosis and as such
erroeneous treatment.
S09-01 - Nicotine Dependence, Psychological Distress, Personality Traits as Possible Predictors of Smoking Cessation. Results of a Double-Blind Study with Nicotine Patch
Authors: Cosci F. , Corlando A. , Fornai E. , Pistelli F. , Paoletti P. , Carrozzi L.
Published: June 2010

Objectives

Although Nicotine replacement therapy (NRT) is an effective treatment for smokers who want to quit, the rates of smoking cessation can be still improved. In an effort to increase these proportions, factors that may influence the occurrence of relapse have been increasingly studied (e.g. pharmacotherapy, socio-demographic characteristics) and there has been a growing interest in psychological and psychiatric clinical factors.

Methods

Nicotine dependence (assessed via the Fagerström Tolerance Questionnaire, FTQ), psychological distress (measured via the Symptom Rating Test, SRT), and personality traits (evaluated via the Adult Eysenck Personality Inventory, AEPI) were evaluated as possible predictors of smoking cessation in a sample of 297 cigarette smokers followed for one year as part of a NRT double-blind, parallel group, randomized trial.

Results

Baseline nicotine dependence (weeks 12 and 26: p < 0.05), AEPI neuroticism (weeks 12 and 52: p < 0.05), and AEPI psychoticism (weeks 12 and 52: p < 0.05) scores significantly influenced the outcome of smoking cessation during one - year of follow-up. An increase in psychological distress during follow-up was associated with a lower probability of quitting smoking (p = 0.000).

Conclusions

Nicotine dependence, neuroticism, psychoticism and, over time, psychological distress were the main factors influencing the long-term outcome (i.e., up to 12 months) of smoking cessation under NRT. Thus, psychological distress and personality characteristics should be evaluated in smokers who apply for assistance in smoking cessation with the aim to have a complete assessment and propose tailor-made interventions.
S10-02 - Is Cognitive Impairment in Schizophrenia Independent of Other Psychopathological Dimensions?
Authors: Galderisi S.
Published: June 2010

Cognitive impairment (CI) is present in the majority of subjects with schizophrenia, is not an epiphenomenon of symptoms, is a risk factor for psychotic disorders and contributes to poor functional outcome. Most probably, in the near future clinicians will be faced with the need of assessing CI in order to complete the diagnostic work-up and to choose among treatment options aimed to target cognitive deficits.

In spite of the progress made by research in this field, relationships between cognitive impairment and other dimensions of schizophrenia remain controversial. On the one hand, empirical data show that CI is independent from psychopathological dimensions, on the other hand, significant associations between CI and negative symptoms have been frequently reported, and associations with positive symptoms or disorganization were also found, although less consistently. Reasons for discrepancies include differences between study samples, cognitive test batteries, medication status, variability of dimensions severity, but also the lack of adequate modelling of the investigated associations. In the presentation, the role of CI in cognitive accounts of psychopathological dimensions will be discussed, limitations of current research on the topic will be highlighted and directions for future research will be outlined.
S10-04 - Edges of Understanding: Unworlding and the Experiential Vulnerability to Psychosis
Authors: Raballo A.
Published: June 2010

Schizophrenia is characterised by profound distortions of the tacit world-embeddedness, which can be articulated both in flamboyant, characteristic symptoms - such as positive, negative and disorganised ones - or more subtle, quasi-ineffable changes in the structure of subjective experience. Such dislocation from the tacit milieu of common sense, rests in-between the jaspersian articulations of understanding and explanation, and remains problematically unsaturated even in the comprehensive post-jaspersian frames offered by existential, narrative-hermeneutic, psychodynamic, constructivist and cognitive-behavioural modes of understanding.In this context, a phenomenologically-informed approach can illuminate - in the very hic et nunc of the clinical-therapeutic encounter - those structural changes in the field of awareness which constitute the antepredicative, pre-psychological matrix of schizotropic vulnerability.
S01-03 - The Search for Fast Acting Antidepressant
Authors: Millet B.
Published: June 2010

Objectives

Many researches conducted in antidepressant therapeutics aimed to obtain a reduction of the delay of action of the drugs. Until now, neither antidepressant per se, nor potentialization strategies (5HT1A agonists), have obtained some significant results. Deep Brain Stimulation (DBS) techniques used in resistant and severe depressive patients have shown a rapid improvement of several patients from the first week of treatment. In that sense, mechanism of action of DBS could represent a model for improving the duration of action of antidepressant.

Methods

Comparison of data extracted from clinical trials using antidepressants and those obtained from brain electro stimulation techniques.

Results

The current data do not allow to conclude to a faster action of DBS technique in depression. However, results obtained from randomized control trials will provide some more powerful data.

Conclusions

a better comprehension of the mechanism of action of DBS is crucial for the improvement of the action rapidity of new antidepressants.
S01-04 - 5-HT2C Receptor Activation Inhibits Stress-Induced Increase in 5-HT Transmission: Relevance to the Effects of Antidepressant Drugs
Authors: Mongeau R. , Martin C. , Chevarin C. , Maldonaldo R. , Hamon M. , Robledo P. , Lanfumey L.
Published: June 2010

Objectives

5-HT2C receptors are well known to be involved in anxiety, but their implication in stress-induced changes of 5-HT transmission remained to be investigated. We thus assess the behavioral and neurochemical effects of 5-HT2C receptor activation in naïve and stressed mice, and after chronic paroxetine known to exert anxiolytic effects in humans.

Methods and results

The effects of the preferential 5-HT2C agonists m-chlorophenylpiperazine (mCPP) and RO60-0175, the selective 5-HT2C receptor antagonist SB242,084 and restraint-stress on anxiety-like behavior in mice were assessed using the social interaction test, while the neurochemical effects of these treatments on 5-HT turnover (5-HIAA/5-HT ratio) and extracellular 5-HT were determined using HPLC and microdialysis. Both mCPP and restraint-stress increased anxiety-like behavior in the social interaction test, and these effects were blocked by pretreatment with SB242,084. Restraint-stress increased 5-HT turnover in various brain areas, and this effect could be prevented by the 5-HT2C receptor agonist RO60-0175. Acute administration of SB242,084 potentiated the stress-induced increase in 5-HT turnover and blocked the inhibitory effect of RO60-0175. Microdialysis studies in frontal cortex revealed that RO60-0175 has an inhibitory effect on the stress-induced increase in extracellular 5-HT levels, but not on basal 5-HT levels. Chronic paroxetine prevented the anxiogenic effect of mCPP and prevented the inhibitory effect of RO60-0175 on restraint-stress-induced increase in 5-HT turnover.

Conclusions

These data strongly suggest that 5-HT2C receptor activation mediates the anxiogenic effect of stress. In addition, the anxiolytic action of long term treatment with SSRIs might be causally related to a clear-cut 5-HT2C receptor desensitization.
W03-01 - A Randomised Controlled Trial of Co-Improvisational Music Therapy for Inpatients with Schizophrenia, London/UK
Authors: Maratos A.
Published: June 2010

This workshop will describe the methods and results of a small RCT of active music therapy, and discuss some of the challenges of conducting outcome studies in this treatment modality and how to overcome them.
W01-04 - Position statements by psychiatric organizations concerning mental health of gay men and lesbians
Authors: Nakajima G.
Published: June 2010

Objectives

In this workshop, Dr. Nakajima will discuss position statements that the American Psychiatric Association (APA) has taken concerning gay and lesbian issues and mental health.

Method

A review of position statements by the American Psychiatric Association and European psychiatric organizations about gay and lesbian mental health issues.

Results

The APA was the first psychiatric organization to delete homosexuality as a mental illness from its nosology, DSM-II back in 1973. When homosexuality was deleted the APA also passed a resolution affirming the civil rights of gay men and lesbians. These position statements in 1973 were the first of a long number of positions statements that the APA has taken concerning mental health issues for gay men and lesbians. In 1987 the APA voted against keeping egodystonic homosexuality in DSM-III R and currently there is no diagnoses related to homosexuality in DSM-IV. The APA has also taken position statement concerning adoption and co-parenting of same-sex couples as well as discrimination of gay and lesbians in the US military. In the past few years the APA has developed position statements against therapies to change sexual orientation, which is sometimes referred to as “conversion or reparative therapy,” and in support of same sex marriage. Some European psychiatric associations including Norway's and the United Kingdom's have followed the APA in passing position statements against conversion therapies.

Conclusions

We will discuss the importance of Psychiatric Organizations to make formal position statements to advance the mental well being of lesbians and gay men.
W02-01 - An Evaluation of the Cost Effectiveness of a Four Arm School Based Mental Health Intervention
Authors: Burke L.-A.
Published: June 2010

Objectives

The objective of implementing a cost effective analysis on four arms of a schools based mental health intervention is to find the most cost effective way of detecting suicidal ideation among young people with the ultimate aim of preventing suicide. These interventions are as follows; a professional screening of young people, a question persuade and refer programme, an awareness programme and a poster campaign.

Methods

Cost data on the four arms of the mental health intervention is collected using costing questionnaires. Each cost relating to the interventions is recorded. The main focus is on direct costs, primarily derived from the personnel costs associated with the health professionals involved. A cost effective analysis will be carried out. This means that the costs of each intervention will be measured against the health outcomes of each intervention and a cost effectiveness ratio is calculated.

Results

The interventions are currently being undertaken and therefore the costs have not been collected yet. However, instruments have been designed to aid in the collation of the costs. Once the interventions are completed, the costs and the number of young people reporting, and being treated, for suicide ideation is recorded. Preliminary results are expected shortly thereafter.

Conclusions

It is expected that the four schools based mental health interventions will detect cases of suicide ideation among young people. The exact numbers are as yet unknown.
W05-02 - Does Early Improvement in Major Depression Protect Against Treatment Emergent Suicidal ideation?
Authors: Seemüller F. , Schennach-Wolff R. , Obermeier M. , Henkel V. , Möller H.-J. , Riedel M.
Published: June 2010

Objective

To investigate the association of early improvement and treatment emergent suicidal ideation in a large sample (N=705) of naturalistically treated inpatients with major depressive disorder

Method

In line with previous reports early improvement was defined as a 20% HAMD improvement within the first two weeks of antidepressant treatment. Treatment emergent suicidal ideation was defined by a sudden increase from 0 or 1 to at least 3 on HAM-D item-3 and from 0,1 to at least 4 on MADR item 10 for suicidal ideation. Early improvers were compared with non-early improvers with respect to the occurrence of treatment emergent suicidality during treatment.

Results

Early improvers were 3 (MADRS) to 3.4 (HAMD) times less likely to experience new emergence of suicidal ideation during the treatment course than non-improvers. In addition, early improvement was associated with significantly less pessimistic thoughts.

Limitations

The analysis is based on secondary analysis of prospectively collected data. No controlled study design.

Conclusion

Early improvement is associated with significantly less treatment emergent suicidal ideation for it my may provide rapid symptom relief and reduce hopelessness.
CS03-01 - Epidemiology of Co-Morbid Diabetes and Depression
Authors: Hermanns N.
Published: June 2010

Depression is a frequent co-morbid condition in diabetic patients. In controlled studies 9% fulfilled criteria for major depression and 26% reported elevated depressive symptoms. Depression rates are twofold higher in diabetic patients than in the non-diabetic population (major depression 5%; elevated depressive symptoms 14%). Diabetes specific risk factors like occurrence of complications, poor glycaemic control, insulin therapy in type 2 diabetic patients are statically associated with elevated depression rates. Furthermore the presence of depressive symptoms in non-diabetic subjects is associated with a significant higher diabetes risk in the future.

Depression in diabetic patients is linked with poorer diabetes self care behaviour like adherence to medication, keeping a healthy diet and physical exercise. The co-morbidity of diabetes and depression has also a negative impact on quality of life, which is greater than the comorbidty of depression and other chronic somatic diseases. Longitudinal studies indicate that depression in diabetes is related to a poorer prognosis. The risk for the development of complications is significantly higher in depressed than in non-depressed diabetic patients. Representative studies showed a significantly higher mortality in diabetic patients with depression than in non-depressed diabetic patients (hazard ratios between 1.67 to 2.6). The results also suggest that these negative consequences of depression are not only present in diabetic patients with severe forms of depression but also in patients with rather mild depression. In summary epidemiological findings imply that depression in diabetes is an important clinical condition warranting clinical attention as well as scientific interest.
CS03-02 - The Pathogenesis of Co-Morbid Diabetes and Depression: are they More in Common than we Thought?
Authors: Ismail K.
Published: June 2010

The mechanism or pathogenesis that underlies the strong association between depression and diabetes is poorly understood but there are tentative models to explain the co-morbidity. The conventional model, namely that the psychological burden of living with diabetes leads to higher rates of depression, is not fully supported by the current evidence. Additional models include

a)

the possibility of shared developmental origins between diabetes and depression

b)

the direct effects of hyperglycaemia, hypoglycaemia and related metabolic dysfunction on the brain and

c)

common mediators such as chronic stress response leading to pro-inflammation.

The potential for research into the above postulated pathways is vast and may lead to identification of new modifiable targets for intervention.
CS03-03 - Treatment of Depression and Diabetes when Co-Morbid
Authors: van der Feltz-Cornelis C.
Published: June 2010

In this lecture, an overview will be given of the literature concerning treatment for comorbid diabetes and depression. A systematic review and analysis will be presented. It turns out that, although many clinicians and researchers find this an important subject of research, and although the clinical implications of such research seem obvious, randomized clinical trials evaluating effectiveness of treatment are scarce and often the numbers of patients included are small. However, all RCTs point in the direction of efficacy of treatment of this combined condition in terms of combined impact. Severity of depressive symptoms and glycemic control are most often used as outcome measures. Psychotherapeutic interventions show a moderate to large effect on both ; antidepressant treatment as well as collaborative care show moderate effects on depressive symptom severity. The clinical, public health and research implications of these findings will be discussed.
CS04-02 - Subthreshold Depression: a Clinically Relevant Condition?
Authors: Cuijpers P.
Published: June 2010

Subclinical depression is a condition in which a person has clinically relevant depressive symptoms, but does not meet criteria for a depressive disorder. In this presentation, the different operationalizations of subthreshold depression will be presented, and we will focus on the importance from a clinical point of view, as well as from a public health public point of view. Subthreshold depression has important consequences for the quality of life, but not as much as major depression. It also results in huge economic costs on the individual level, but again less than the costs associated with major depression. Because subthreshold depression is more prevalent, the total costs of subthreshold depression on the population level are, however, comparable to those of major depression. It is also clear that subjects with subthreshold depression have an increased risk of developing a major depression. How large that chance is depends on several factors, including the definition of subthreshold depression. Finally, the results of a meta-analysis will be presented in which the effects of psychological treatments of subthreshold depression are examined. This meta-analysis shows that psychological treatments can be treated effectively, and there is a trend indicating that these interventions can prevent the onset of major depression.
CS05-01 - The Genetics of Lifelong Premature Ejaculation
Authors: Waldinger M.
Published: June 2010

In the last two decades enormous progress has been made in the characterization of premature ejaculation (PE). Although lifelong (primary) PE and acquired (secondary) PE has been known since the 1980s, a new classification of PE has been proposed in 2006 by Waldinger et al., who distinguished two other PE subtypes, e.g., premature-like ejaculatory disfunction and natural variable PE. In 1943, Bernhard Schapiro noted that family members of men with PE often have PE as well. In 1998, Waldinger et al postulated that lifelong PE, and particularly the short intravaginal ejaculation latency time (IELT), may be genetically determined. They postulated that the IELT is distributed according to a continuum, from men who always ejaculate very rapidly to men who always ejaculate after a very long intravaginal ejaculation time. Research in male rats showed this continuum. In two stopwatch studies, such a continuum was also shown in a random sample of men. In 2009, Janssen et al. publish ed a DNA study performed in men with lifelong PE. This study showed that 5-HTT polymorphism was involved in the ejaculation latency time. It appeared that in men with lifelong PE, males with LL genotype had a 100% faster ejaculation time than men with an SS genotype. It is postulated that the IELT is genetically determined by a cluster of genetic polymorphisms of the 5-HTT, 5-HT receptors, 5-HT enzymes and/or polymorphisms of other neurotransmitter systems.
CS02-01 - Diagnosis and Comorbidity: Progress Towards a New Diagnostic Classification of Mood Disorders
Authors: Angst J. , Zimmermann P. , Merikangas K. , Gamma A.
Published: June 2010

Objectives

Our knowledge of the comorbidity of mood disorders depends heavily on their diagnostic classification, which is currently in a state of flux.

Method

A diagnostic specifier for bipolarity was developed and applied to data collected on major depression in several studies: Zurich Study, EDSP Study Munich, NCS-R Study USA, and Bridge Study (Vieta et al. 2010).

Results

In all four studies, about 40% of DSM-IV major depressive disorder diagnoses were re-classified as sub-threshold bipolar II disorders, resulting in a major change in comorbidity. The comorbidity of major depression with substance use disorder (SUD) (especially alcohol use) and panic disorder shifted substantially towards an association with hidden bipolar depression. The highest comorbidity was found in bipolar-I disorders. Pure and preponderantly manic or hypomanic subjects seem to be protected against comorbidity with anxiety disorders but are at risk for SUD.

Conclusions

The current classification of mood disorders over-estimates a diagnosis of pure depression. New data suggest that 40% to 50% of all subjects with mood disorders are bipolars. This has a considerable impact on comorbidity, treatment and future research. Self-assessment instruments for the detection of hypomania are recommendable.
Schema Therapy for Borderline Personality Disorder
Authors: Nadort Marjon
Published: June 2010

Schema Therapy (ST) for Borderline Personality Disorder (BPD) is a (cost-) effective treatment compared to a psychodynamic specialized treatment and treatment as usual (TAU). This presentation focuses on recent development in ST for BPD. First the results of the BPD RCT by Giesen-Bloo et al. (2006) will be presented. Then the new results of an implementation study of ST for BPD in regular practice will be presented. This study also tested to what degree telephone availability of the therapist in case of crisis had a medium of large effect on the results of ST (Nadort et al., 2009). Thirdly, a special group format seems to catalyze the processes of change used by ST. We will present results of a recent RCT comparing group ST for BPD to TAU and discuss the specific ingredients of this group-ST approach (Farrell et al. 2009).
Posttraumatic Stress Disorder in Survivors of Severe Somatic Illness and ICU Treatment
Authors: Kapfhammer H.P.
Published: June 2010

Aim

Patients suffering from severe somatic illness (e.g. burns, traumatic injuries, myocardial infarction, major surgery, acute respiratory distress, septic shock) that leads to ICU treatment face a high risk of psychiatric morbidity. There is a major challenge to C-/L-psychiatry both during acute treatment and long-term. The presentation will focus on the PTSD risk in survivors of acute respiratory distress syndrome (ARDS) and septic shock.

Method

A literature survey on the general topic will be given in the introductory part of the presentation (1). Some major findings derived from own empirical studies on ARDS and septic shock will be summarized (2, 3).

Results

ARDS and septic shock define medical conditions of acute respiratory insufficiency or/and systemic inflammation. Both medical conditions are often associated with multiorgan dysfunctions. As a rule, intensive care is based on mechanical ventilation often requiring high doses of sedatives and narcotics. Despite major progresses in intensive care medicine the rate of mortality is still very high among these patients. Several disabling psychological sequelae, such as cognitive dysfunctions, anxiety and mood disorders, posttraumatic stress disorders (PTSD) have to be evaluated in long-term survivors regarding a persisting negative impact on health-related quality of life. Several factors influencing the risk of PTSD in ARDS survivors may be discussed: increased CO2 triggering panic affects, mismatch of norepinephric overstimulation and Cortisol insufficiency, negative effects of high doses of benzodiazepines resulting in oversedation, prolonged phases of weaning and more frequent states of delirium, number of traumatic memories during ICU. Consolidation and retrieval of traumatic memories of the ICU stay are influenced by complex factors. From a clinical point of view prophylactic stress doses of hydrocortisone may reduce the major risk of PTSD associated with ARDS and septic shock.

Conclusion

ARDS or septic shock not only define a major challenge to C-/L-psychiatry but offer an interesting model to elucidate some basic neurobiological mechanisms underlying the pathophysiology of PTSD and to develop some new prophylactic strategies for this often chronically disabling psychiatric condition.
FC01-03 - Deep Brain Stimulation Of Subcallosal Cingulate Gyrus for Treatment Resistant Depression
Authors: Puigdemont D. , Portella M.J. , Pérez-Egea R. , Radua J. , de Diego-Adeliño J. , Molet J. , Gironell A. , Alvarez E. , Pérez V.
Published: June 2010

Background

Deep brain stimulation (DBS) of the subcallosal cingulate gyrus (SCG) has been suggested to improve depressive symptoms in treatment-resistant depression (TRD). We now report preliminary results of DBS and one-year follow up in six patients.

Methods

Six patients with severe TRD (Thase Resistance Index>4) underwent DBS surgery and subsequent monthly assessments. DBS response was defined as ≥50% reduction in the 17-item Hamilton Depression Rating Scale (HDRS) or HDRS< 8 (remission). Electrodes location was assessed in each patient by means of pre/post-DBS MRIs co-registration.

Results

DBS led to early and late reductions of average HDRS (from 22.5 to 9.8 and 6.25 respectively, see Figure 1 for evolution of HDRS mean scores). One month after surgery 16.7% of patients met criteria for response and for remission. Three months after response rates increased to 66.7% while remission rates were maintained. At six months, 66.7% of patients were responders. After 9 months, response rates arose up to 83.4% and these rates were largely maintained at 12 months. Remission rates showed similar growth over follow-up. No substantial differences were observed in electrodes location, and they were not found to be related to response or remission rates. The number of serious adverse effects was small with no patient experiencing permanent deficits.

Conclusions

This study suggests that DBS is relatively safe and provides significant improvement in patients with TRD. Improvement on average seems to be linearly progressive and, once melioration is achieved, it is maintained for at least one year. The procedure is well tolerated.
FC01-05 - Self-rating scales assessing subjective well-being and distress correlate with CBF in PTSD-sensitive regions
Authors: Pagani M. , Nardo D. , Högberg G. , Jacobsson H. , Larsson S.A.
Published: June 2010

Objective

The aim of this study was to investigate the distribution of the regional cerebral blood flow (rCBF) in occupational related PTSD subjects and to seek for possible correlations between brain perfusion and self-rating scales (SRSs) in order to cross-check their diagnostic value and to look for their neural correlates.

Method

Sixteen traumatized underground and long-distance train drivers developing (S) and 17 not developing (NS) PTSD after having experienced a “person-under-train” accident underwent clinical assessment and 99mTc-HMPAO-SPECT during trauma scripts. Statistical parametric mapping (SPM2) was applied to analyse rCBF changes in S as compared to NS, and to search for correlations between rCBF and SRSs scores, modeling age, months since trauma and the ratio ‘gray matter/intra-cranial volume’ as nuisance variables.

Results

Significantly higher activity was observed during trauma script in left posterior insula, posterior cingulate, inferior parietal lobule, precuneus, and caudate in S as compared to NS. Impact of Event Scale (IES) and World Health Organisation (ten) Well-Being Index (WHO-10) scores highly correlated with tracer uptake to a great extent in the same regions in which rCBF differences between S and NS were found.

Conclusions

These findings support the involvement of posterior insular, cingulated, and parietal cortices (as well as the caudate) in the pathogenesis of PTSD and in the processing of related subjective well-being and distress. Our findings seem to provide a cross-validation for IES and WHO-10 scales by means of SPECT data, supporting their validity in the diagnosis of PTSD, and suggesting their use in future works.