bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence-based treatment of anxiety disorders in Europe - an update
Authors: Bandelow B.
Published: May 2011

Anxiety disorders are chronic, disabling conditions with prevalence rates higher than the ones of schizophrenia or diabetes.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are standard treatments for anxiety disorders. The calcium-channel modulator pregabalin is a treatment option for generalized anxiety disorder. Tricyclic antidepressants (TCAs) are as effective as modern antidepressants, but less well tolerated. For short-term treatment and in treatment-resistant cases, benzodiazepines like alprazolam may be used when the patient does not have a history of dependency and tolerance. Combining drug treatment with cognitive behaviour therapy is the most successful treatment strategy in anxiety disorders. Strategies of treatment-resistant anxiety disorders and future anxiolytics will be presented in the symposium.
Neurobiology of anxiety disorders
Authors: Den Boer J.
Published: May 2011

In many psychotherapeutic theories the aim of therapeutic interventions is a restructuring of cognitive appraisals of past and current situations. The question is whether such a ‘dry’ and formal cognitive approach does not unjustly leave out the body. Especially in anxiety disorders brain/bodily changes appear to play an important role in the etiopathogenesis.

There is now a great deal of experimental evidence that the brain does not only store mental representations, but that the brain/body is actively involved in mental operations. As an example of this I will discuss recent evidence indicating that early adverse life events not only lead to psychological (cognitive) disorders, but also leads to abnormal functioning of brain mechanisms and bodily functions.

These changes occur on different levels of organization. Children who have been neglected or abused have smaller brains and a reduced complexity of neuronal dendrites, and also exhibit dysfunctions in neurotransmitter systems and the immune system.

I will specifically discuss recent investigations conducted in our centre in which severely traumatized patients were studied using positron emission tomography, one of the neuroimaging techniques which yields information about brain functioning in vivo.

As a final point I will discuss genetic differences that may explain differences in sensitivity for stressful life events, which may lead to the deveopment of a spectrum of anxiety disorders.
Genetics in anxiety disorders - an update
Authors: Domschke K.
Published: May 2011

Twin studies propose a strong genetic contribution to the pathogenesis of anxiety disorders with a heritability of about 50%. The dissection of the complex-genetic underpinnings of anxiety disorders requires a multi-level approach using molecular genetic, imaging genetic, (cognitive)-behavioral genetic and pharmacogenetic techniques linking basic and clinical research.

The present talk will first give an overview of results from linkage and association studies yielding support for several candidate genes contributing to the genetic risk for anxiety and panic disorder in particular such as the adenosine 2A receptor, the catechol-O-methyltransferase, the neuropeptide S receptor and the serotonin receptor 1A genes. Results from the first genome-wide association studies in the field of anxiety disorders will be discussed. Additionally, studies on gene-environment interactions between anxiety disorder risk variants and environmental factors will be presented. Imaging genetics approaches have yielded evidence for several risk genes to crucially impact activation in brain regions critical for emotional processing. Gene variation has furthermore been found to potentially confer an increased risk for panic disorder via elevated autonomic arousal and dysfunctional cognitions regarding bodily sensations. Finally, there is first evidence for genetic variants impacting treatment response to antidepressant pharmacotherapy in anxiety disorders.

Thus, converging lines of evidence will be presented for several candidate genes of anxiety to exert an increased disease risk potentially via a distorted cortico-limbic interaction during emotional processing, increased physiological arousal or dysfunctional cognition. Additionally, a possible impact of genetic variants on pharmacoresponse in anxiety disorders and its potential clinical implications will be discussed.
High-risk-states for psychoses and schizophrenia
Authors: Klosterkötter J.
Published: May 2011

Revision 5 of the diagnostic and statistical manual for mental disorders (DSM-V) has stimulated a debate about the inclusion of a risk for psychosis syndrome in order to facilitate the prevention of psychosis.

The presentation critically outlines the course of this debate, focusing particularly on the question of how the inclusion of such a syndrome could be justified in DSM-V and ICD-11.

Most participants in the debate have initially opposed the inclusion of a risk for a psychosis syndrome. They justified this dismissive attitude with scientific, clinical and ethical arguments. The predictive power of eligible criteria for first psychotic episodes appeared to be too low. Their use as diagnostic criteria would involve the danger of hastily treating many falsely diagnosed individuals at risk for psychosis with antipsychotics and unjustifiably putting them at risk for side effects. In general, diagnoses should be based on grounds of manifest illnesses and not include at risk states for later diseases.

Meanwhile, the understanding, that the risk of disease symptoms already has a pathological significance and therefore requires treatment has by now begun to be accepted. This applies both to the risk symptoms in the early initial prodrome, as well as to the high risk symptoms in the late initial prodrome. It would therefore be reasonable to use these two sets of criteria for the definitional operationalisation of the new diagnostic category in the classification systems. This would allow the continuation of preventive efforts but also the development of evidence-based treatment within standard care.
At-risk-states for bipolar disorder
Authors: Conus P.
Published: May 2011

Early intervention strategies have been developed over the past 20 years for psychotic disorders and recent studies have proven their efficacy. However, most of the attention has been drawn to schizophrenia, and affective psychoses have been neglected. In the recent past, new research has identified a similar need for earlier intervention in bipolar disorders, and prodrome to bipolar disorder has emerged as a key domain to investigate. Despite the complexity of this issue due to the lack of a clear consensus regarding definitions of the various stages of the disorder, some progress has been made in this domain.

Two recent retrospective studies have identified a prodromal phase to first episode mania lasting between 6 and 18 months, and have identified a range of symptoms that occur during this period. It is however likely that on the basis of symptomatic profile, identification of at risk patients would be difficult, considering their low specificity. Two complementary directions have been recently proposed in order to refine such an approach. The first strategy, based on at-risk profiles inspired by the Ultra High Risk concept developed for psychosis, has yielded some promising results on a small sample of patients. The second is based on the combination of identified risk symptoms with both risk factors and markers of vulnerability into a First Episode Mania Prodrome Inventory which is currently under validation.
The WHO-EC partnership project on empowerment in mental health
Authors: Baumann A.
Published: May 2011

People with mental health problems and their families have not been involved as equal partners in decision-making processes on mental health services, and they continue to be at risk of social exclusion and discrimination in all facets of life. In a mental health context, empowerment refers to the level of choice, influence and control that users of mental health services can exercise over events in their lives, and the key to empowerment is the removal of formal or informal barriers and the transformation of power relations between individuals, communities, services and governments. Despite all achievements that have been made over the past decade, there is still a strong need for empowerment of people with mental health problems and their families. The World Health Organization Regional Office for Europe and the European Commission started a three years lasting "Partnership Project on Empowerment in Mental Health" in 2008 which aims to support Member States in the European Region in creating societies in which people with mental health problems are enabled to develop and express their full potential as equal citizens. The WHO Statement on Empowerment in Mental Health has been published, about 100 examples of empowerment practice across Europe have been collected, and indicators for empowerment applicable at national level have been identified. The project outcomes and possibilities for their implementation at country level will be presented.
Trialog - concept and research
Authors: Amering M.
Published: May 2011

The active involvement of users of services and their families and friends into mental health care and research is essential for the success of mental health services and initiatives worldwide. Also, co-operations between mental health professionals, users and carers are needed to solve methodological problems of evaluative research and generate new models of needs-orientated interventions. However, accepting each other in a working partnership for a multiperspective evidence base is still a challenge for professionals as well as for users and relatives and friends. Changes in structures as well as in forms of communication are warranted.

In Trialogue-groups users, carers and mental health workers meet regularly in an open discussion forum, that is located on ‘neutral terrain’ - outside any therapeutic, familial or institutional context - with the aim of communicating about and discussing the experiences and consequences of mental health problems and ways to deal with them. This setting offers new possibilities for gaining knowledge and insight and developing new forms of communication. It also functions as a basis and starting point for trialogic activities on different levels - e.g. serving on quality control boards - and different topics - e.g. anti-stigma projects. In German speaking countries well over hundred Trialogue groups are regularly attended by altogether ∼ five thousand people. Trialogues are inexpensive and a great number of people seem to benefit from participation. Current ideas for the scientific evaluation of Trialogues regarding process as well as possible outcomes pose conceptual and methodological challenges.
World psychiatric association task force on best practice in working with service users and carers
Authors: Herrman H.
Published: May 2011

The WPA has invited service users and family carers to join in its work as members of a taskforce, recognising their essential contribution to improving mental health in any country. WPA President Prof. Mario Maj established the project within the WPA Action Plan 2008 to 2011. The taskforce has prepared recommendations for the international mental health community on best practices in working with service users and carers. It has also worked with the WPA Standing Committee on Ethics to prepare a new paragraph for the WPA Declaration of Madrid. The WHO Department of Mental Health has offered its experience and advice.

Ten recommendations are ready for dissemination after extensive consultation. Each country will need specific guidelines to apply these recommendations. The recommendations begin by declaration that respecting human rights is the basis of successful partnerships for mental health. The second recommendation is that legislation, policy and clinical practice relevant to the lives and care of people with mental disorders need to be developed in collaboration with users and carers. The series continues with a recommendation that the best clinical care of any person in acute or rehabilitation situations is done in collaboration between the user, the carers and the clinicians. Education, research and quality improvement in mental health care also require this collaboration. The next step is developing a series of projects to apply these broad principles in each country and local communities. The WPA hopes to support partnership and participatory developments worldwide, and learn from these experiences.
General principles for treating personality disorder with a prominent inhibitedness trait
Authors: Dimaggio G.
Published: May 2011

Psychotherapists need to perform tasks such as being empathetic, performing an ongoing assessment of cases, self-disclosing, making explicit treatment contracts, validating patients’ experiences and promoting awareness of psychological experience, if they are to be effective in treating personality disorder (PD). Successful therapy also requires a systematic accurate PD model. We suggest here that it is still unclear how, when and according to what session markers therapists need to perform specific operations to maximize therapeutic gains. This article describes and operationalizes a step-by-step procedure for organizing and delivering the interventions necessary for effective outcomes, such as maintaining a good therapeutic relationship, increasing understanding of mental states, reducing symptoms and improving social adaptation. The procedure is illustrated by reference to the treatment of cases of emotionally overly-constricted PDs. We include a theoretical proposal to facilitate the development of measures for evaluating the efficacy of therapist actions.
The effectiveness of schema focused therapy; Indirect, experimental measures of emotional change in forensic patients
Authors: Nentjes L. , Bernstein D.
Published: May 2011

According to recent literature, 50 to 90 percent of criminal offenders have personality disorders (PDs), with cluster B PDs being the most prevalent in forensic settings. The latter type of PD is associated with an increased risk of violence and recidivism. Among forensic patients with a cluster B diagnosis, psychopathic offenders are at particularly high risk for re-offending. Psychopaths are believed to be untreatable, but evidence for this view is weak.

The current study aims at determining the effectiveness of Schema Focused Therapy (SFT) versus ‘treatment as usual’ in male forensic patients (including psychopaths) with Antisocial, Borderline, Narcissistic, and Paranoid PDs, within a 3-year multi-center randomized clinical trial. SFT is an integrative form of psychotherapy combining cognitive, behavioral, psychodynamic object relations, and humanistic/existential approaches, and was developed as a treatment for PDs and other longstanding problems. SFT aims at changing early maladaptive schema modes, thereby producing changes on a structural, emotional level.

The goal of a second study that runs within the same project is to objectively determine the nature of the emotional deficiencies that are thought to be central to psychopathy. By administering forensic patients an extensive test battery that assesses various affective capacities (e.g., moral emotion, emotional expressive behavior, cognitive and emotional empathy), we aim at constructing an integrative picture of psychopaths’ emotional functioning. Within the SFT effectiveness study, patients are tested twice (with a one year interval), to see whether these affective capacities are subject to change in the context of therapy.
Detection of dementia
Authors: Stoppe G.
Published: May 2011

Detection of dementia is usually a two-step procedure, consisting of screening and application of diagnostic instruments. Screening has to be done on the background of fears for stigma and loss of autonomy.

There are many screening instruments available for the detection of dementia. However, they were not tested in very old age and often not in the primary care setting for which they are developed. We present results of a study in primary care, where we tested which elements of common tests (MMSE, TFDD, DEMTECT, Clock Test…) would be best for this age group. All available screenings showed a good effect size of >0.70.

For the application of further diagnostic tools an update of the current guidelines is given and compared to the available evidence regarding guideline implementation. As far as possible, results of an ongoing study in Switzerland will be presented.
Issues in pharmacological management of behavioural and psychological symptoms of dementia: English ministerial review of the use of antipsychotic drugs for people with dementia
Authors: Banerjee S.
Published: May 2011

Introduction

In response to increasing concerns about the use of anti-psychotic drugs in dementia, the Department of Health in England commissioned an independent ministerial review.

Aims and methods

The report was based upon an expert review of policy and publications; systematic review of the benefits and harms; and new pharmacoepidemiology.

Results

This review finds that these drugs are used too often in dementia and potential benefits are outweighed by their risks overall. It estimates 180,000 people with dementia receive antipsychotic medication in the UK per year. Of these, 20% (36,000) will derive some benefit. Negative effects directly attributable to antipsychotics equates to an additional 1,620 cerebrovascular adverse events (around half severe), and an additional 1,800 deaths per year. The report's analysis is that this overuse is a specific symptom of a general cumulative failure over the years in health and social care systems to develop an effective response to dementia.

Conclusions

The report contains 11 recommendations to reduce the use of these drugs to the level where benefit will outweigh risk. These include: making reduction a clinical governance priority; audit to drive down the level and up the quality of use of these drugs; specialist services to support primary care in its work in care homes and the community; research on alternatives to antipsychotic medication. The report estimates that, if this is implemented then we can reduce the rate of use of antipsychotic medication to a third of its current level safely over a 36 months.
The mirror neuron system in social interactions and schizophrenia
Authors: Kicher T.
Published: May 2011

The term social cognition comprises of the perception and cognitive processing of stimuli of the social environment that is necessary to understand one's own behaviour and that of others. Social cognition is important for conscious and unconscious behaviour in social interactions and is composed of the recognition and interpretation of emotions in faces, body language and speech, reflection of one's own mental state and intentions as well as the realization of others’ intentions, thoughts and feelings. The mirror neuron system is involved in empathetic processes. Several aspects of the neural correlates of social interaction, embodiment and the mirror neuron system in schizophrenia and autism will be reported.
Embodied cognition and language comprehension: motor chains and social aspects
Authors: Borghi A.
Published: May 2011

According to the neural exploitation hypothesis (Gallese, 2008; see also Glenberg, 2008) the linguistic system re-uses the structures and the organization characterizing the motor system. It follows that language comprehension is grounded in the perception, action and emotional systems. I will focus on two aspects which characterize action organization and the relationship between words and action. A major aspect of action organization is its goal derived structure and its hierarchical structuring in motor chains (Fogassi et al., 2005). I will discuss recent evidence on language comprehension showing that language shares with action the goal-directed structure and the motor chain organization. In addition, I will present results showing that the social context in which words are embedded influences the way in which these aspects are encoded. I will conclude that language re-uses and reflects action characteristics, but also modulates and constrains them.
Stress reactivity in patients with drug dependence and personality disorders
Authors: Walter M. , Gerber H. , Wiesbeck G.A. , Riecher-Rössler A. , Borgwardt S.J.
Published: May 2011

Drug dependence is defined as a chronic relapsing brain disorder that is defined by a compulsion to seek and use drugs despite negative consequences. Drug-related cues and stress are known to be key factors for drug use. It has been argued that drug use could be seen as self-medication in patients with drug dependence and co-occurring personality disorders. However, the relevance of co-occurring personality disorders for stress reactivity after drug use is not clear.

Thirty drug-dependent patients on stable opioid maintenance treatment with and without personality disorders were examined in a randomized placebo-controlled crossover study to investigate the effects of diacetylmorphine (DAM = heroin) on stress reactivity. They were compared with 20 healthy volunteers receiving saline. The drug-dependent patients administered either their individual prescribed DAM dose or saline. Afterwards they completed four emotional tasks while brain responses were measured with functional magnetic resonance imaging (fMRI). Before and after the fMRI investigation, adrenocorticotropic hormone (ACTH), cortisol, DAM blood levels, and psychological stress parameters, such as anxiety, anger, and craving were measured.

The findings of DAM effects on stress reactivity in patients with drug dependence and co-occurring personality disorders will be reported and clinical implications regarding specific psychosocial interventions will be discussed.
The nosological role of comorbidity in patients with internet and video-game addiction
Authors: te Wildt B.T. , Putzig I. , Vukicevic A. , Wedegärtner F.
Published: May 2011

Background and Objectives

With the Cyberspace's exponential growth of influence questions arise about its mental impacts. The presented study examines the question whether the dependent use of the Internet can be understood as an impulse control disorder, an addiction or as a symptom of other psychiatric conditions.

Methods

Internet dependent patients seeking for psychiatric assistance and fulfilling the criteria for pathological Internet use (PIU) were examined with the Structured Clinical Interview according to DSM-IV (SCID), and a variety of questionnaires including the Barratt Impulsiveness Scale (BIS), the Beck Depression Inventory (BDI) and the Dissociative Experience Scale (DES). The patient group was compared to a matched group of healthy controls.

Results

The adult patient-group consisted of 25 subjects, 76% male, with a mean age of 29.36 years. Average time spent in Cyberspace was 6.47 h/d, mostly in online-role-playing games. According to SCID I and BDI, 19 patients (76%) suffered from a depressive syndrome, with 10 cases of major depressive disorder (40%) and 8 cases of adjustment disorder with depression (32%). Six patients (24%) suffered from a comorbid anxiety disorder. Compared to controls, the patient group presented significantly higher levels of depression (BDI), impulsivity (BIS) and dissociation (DES).

Conclusions

PIU shares common psychopathological features and comorbidities with substance related disorders. Therefore, it might be seen as a diagnostic entity in itself within a spectrum of behavioral and substance dependencies. Especially Internet role play may contain an addictive potential for adolescents and adults with subclinical psychopathology.
Mental health and european big cities: London
Authors: Priebe S. ,   PROMO Study
Published: May 2011

Big cities in Europe are characterised by social factors that can influence mental health and impact on the provision of mental health care. These factors include social inequalities, social marginalisation and fragmentation, large scale immigration, and a high proportion of mobile populations. Big cities tend to have higher levels of morbidity and higher costs of service provision than other parts of the same country. This leads to specific challenges, particularly in inner city areas. The paper summarises how mh services in London approach these challenges, how they are organised and how they have changed over the last 10 years. Services are provided by the NHS with an emphasis on care in the community. Whilst there have been large investments in mental health care and the establishment of a range of new teams with specialised functions over the last 10 years, recently funding has come under pressure and service provision may need to be reduced. There has also been a stronger focus on risk issues and the introduction of compulsory treatment in the community.

Taking the example of East London as the most deprived area in London, the paper will illustrate how traditional principles of sectorisation, catchment area responsibility and continuity of care have been put into question with potentially new solutions to old problems. The paper will also briefly describe how mental health care for socially marginalised groups is provided and compare the situation in London against that in other European capitals as investigated in the EC funded PROMO Study.
Mental health in paris: The homeless issue
Authors: Petitjean F.
Published: May 2011

The Paris population covered, in 2007 2.181.000 inhabitants. This covers the city itself. When adding the surrounding towns, the total figure reaches 6.507.000, more than half the total Ile de France region.

A recent study (LAPORTE, 2010) gives an estimate of 21.000 persons being homeless in the Paris megapole. A third of these individuals suffer from severe mental illness, with a prevalence of 13, 2% for psychotic disorders, 6,7% for affective disorders, 12,2% for anxiety and 21% for personality disorders.

Psychoactive substances are to of concern for 29% of the homeless population.

The author will present data from a two consecutive studies carried out in the Paris megapole concerning the homeless population. (KOVESS, 2001; LAPORTE, 2010).

The author will present data from a two consecutive studies carried out in the Paris megapole concerning the homeless population. (KOVESS, 2001; LAPORTE, 2010).
Toxoplasma gondii-altered host behaviour: Clues as to mechanisms of action and implications for its role in some cases of human schizophrenia
Authors: Webster J. , Kaushik M. , Prandovszky E. , McConkey G.
Published: May 2011

Introduction

Recognition of the role of infectious agents in a range of both acute and chronic diseases is increasing. One key example is the potential epidemiological and neuropathological association between some cases of schizophrenia with the protozoan Toxoplasma gondii. T. gondii establishes persistent infection within the CNS and can alter host behaviour. Altered dopamine levels have been reported for both T. gondii infection and schizophrenia. Several medications used to treat schizophrenia demonstrate anti-T. gondii properties, and haloperidol, a dopamine antagonist, can prevent the development of T. gondii-altered behaviour in rodents. Furthermore, T. gondii may actually be a source of dopamine, as it encodes a copy of the mammalian enzyme tyrosine hydroxylase, which represents the rate-limiting step in dopamine synthesis.

Aims

Using the epidemiologically and clinically applicable rat-T. gondii model, and incorporating a battery of classical and novel non-invasive behavioural and physiological assays, we aim to further elucidate the impact of T. gondii on behaviour and the mechanisms involved.

Results

T. gondii increases the rats’ propensity for predation risk through enhanced activity, visibility and manipulation of their perception of predation risk, turning innate aversion into a ‘suicidal’ feline attraction. There is little indication that T. gondii alters the rats generalized anxiety, nor potential to enhanced predation by non-definitive mammalian host species. Preliminary associative analyses into the relationship between individual behavioural alterations and neurotransmitter and brain cysts localisation profiles will be presented.

Conclusions

Our results provide further evidence for a role of T. gondii in the aetiology of some cases of schizophrenia.
Neurological sequalae and toxoplasma infection: Possible mechanisms to explain associations with schizophrenia
Authors: McConkey G. , Webster J. , Prandovszky E. , Kaushik M.
Published: May 2011

Latent infection with the common intracellular protozoan parasite Toxoplasma gondii has been shown to result in altered behaviour of its host. This behaviour manipulation has been proposed to increase predation of the intermediate host (e.g. rodents and birds) enhancing parasite transmission. Other psychologicalsequalae have also been associated with latent toxoplasmosis including human affective disorders, as human are accidental hosts for Toxoplasma. During cyst stages of the life cycle found in the brain and other tissues, there is a complex interaction between the parasite and the host. Our research is concerned with the possibility that the parasite-induced behavioural changes are mediated by neurotransmitters. Potential factors in neurotransmitter levels include the location of the cyst, the host immune response, and direct parasite products. The cyst is found in many brain regions but elevated numbers have been reported in the hippocampus, amygdala, and nucleus accumbens. The host response involves interferon gamma suppressing growth through tryptophan degradation that could decrease serotonin levels. The parasite could directly manipulate the host brain through altering dopamine levels. We have found a change in dopamine associated with infection. Indeed, the parasite itself encodes the rate-limiting enzyme in dopamine synthesis, tyrosine hydroxylase. Dopamine's role is also supported by finding haloperidol, a dopamine antagonist, blocks manipulation of rodents by Toxoplasma. Our current investigations of alterations in neurotransmitter levels during chronic infection and association with brain cysts will be presented. Our data presents an interesting interplay with the ‘dopamine hypothesis’ that has postulated a link between elevated dopamine and schizophrenia.
Different impact of t.gondii seropositivity on the brain morphometry in schizophrenia and healthy control groups
Authors: Horacek J. , Flegr J. , Holub D. , Tintera J. , Novak T. , Brunovsky M. , Höschl C.
Published: May 2011

Background

The role of coccidian protozoa Toxoplasma gondii represents one of the most enigmatic and unexplained questions in the field of pathophysiology of schizophrenia. To address the role of latent Toxoplasma gondii (T. gondii) infection in pathophysiology of schizophrenia we studied the influence of latent toxoplasmosis on brain morphology in schizophrenia.

Methods

Magnetic resonance imaging was analyzed by an optimized voxel-based-morphometry (VBM) in 44 schizophrenic patients (12 T. gondii positive) and 56 controls (13 T. gondii positive). The full factorial model of analysis of variance with diagnosis and seropositivity for latent toxoplasmosis as factors was used to address the differences in gray and white matter.

Findings

VBM analyses showed the grey matter (GM) volume reduction in schizophrenia patients compared with controls bilaterally in the neocortical regions, hippocampus, middle and posterior cingulate and in the caudate. In the subgroup of patients and controls seropositive to T. gondii the reduction of GM was located in the same regions as in the whole sample and consisted of 11660 over-threshold voxels (p£0.05, FWR corrected). The differences between T. gondii negative patients and controls consisted only of 289 voxels in temporal and mediotemporal regions.

Discussion

Our study is the first to document that latent toxoplasmosis reduces GM in schizophrenia but not in controls. The higher morphological vulnerability of patients but not controls to T. gondii infection represents an indirect support for the epidemiological evidence of the role of latent toxoplasmosis in schizophrenia.

Acknowledgments

This work was supported by grants 1M0517.
Clinical differences between toxoplasma gondii seropositive and seronegative schizophrenia patients in czech and international studies
Authors: Holub D. , Bankovská Motlová L. , Dragomirecká E. , Rodriguez M. , Preiss M. , Novák T. , Ĉermák J. , Horáĉek J. , Libiger J. , Flegr J.
Published: May 2011

Toxoplasma is considered as one of the most promising candidates of infectious agent that might trigger psychotic disorder in predisposed subjects or modulate the course of the disease. A clinical pattern has not been established yet in Toxoplasma infected schizophrenia patients. Psychopathological, cognitive and treatment response features of Toxoplasma seropositive and seronegative individuals suffering from schizophrenia spectrum disorder has been studied in China, Czech Republic, Ethiopia, Germany, Turkey, United States and other countries to determine whether schizophrenia and Toxoplasma infection co-morbidity modifies clinical presentation and illness course. Prague Psychiatric Centre project consisted of 251 patients with schizophrenia spectrum disorder consecutively admitted to between 2000 and 2010. Toxoplasma-infected patients spent more days in hospital during their last admission compared to Toxoplasma-free patients (p = 0.003; mean difference 32.9 days). Schizophrenia started approximately one year earlier in Toxoplasma-infected men and about 3 years later in Toxoplasma-infected women than in Toxoplasma-free patients, which corresponds to gender related toxoplasmosis incidence curves in the Czech Republic. All infected patients scored higher in the Positive Subscale of Positive and Negative Symptom Scale (PANSS). The PANSS scores and composite PANSS scores also correlated negatively with the concentration of anti-Toxoplasma antibodies indicating the increase of psychopathology with infection duration. Our findings support the hypothesis that toxoplasmosis may represent a risk factor for schizophrenia spectrum disorders.
From mirror neurons to embodied simulation: A new neuroscientific perspective on intersubjectivity
Authors: Gallese V.
Published: May 2011

Our seemingly effortless capacity of conceiving of the acting bodies inhabiting our social world as goal-oriented individuals like us depends on the constitution of a shared “we-centric” space. I have proposed that this shared manifold space can be characterized at the functional level as embodied simulation, a basic functional mechanism by means of which our brain/body system models its interactions with the world.

The mirroring mechanism for action and other mirroring mechanisms in our brain represent sub-personal instantiations of embodied simulation. Embodied simulation provides a new empirically based notion of intersubjectivity, viewed first and foremost as intercorporeity. Embodied simulation challenges the notion that Folk-psychology is the sole account of interpersonal understanding. Before and below mind reading is intercorporeity as the main source of knowledge we directly gather about others.

By means of embodied simulation we can map others’ actions onto our own motor representations, as well as others’ emotions and sensations onto our own viscero-motor and somatosensory representations. “Representation”, as used here, refers to a particular type of content, generated by the relations that our situated and inter-acting brain-body system instantiates with the world. Such content is pre-linguistic and pre-theoretical, but nevertheless has attributes normally and uniquely attributed to conceptual content.Social cognition is not only explicitly reasoning about the contents of someone else's mind. Embodied simulation, gives us a direct insight of other minds thus enabling our capacity to empathize with others.

This proposal opens new perspectives on our understanding of autism and other psychopathological states such as schizophrenia.
Putative cerebral correlates of abberant pain processing in depression
Authors: Bär K.J. , Terhaar J. , Boettger M.K.
Published: May 2011

The complex sensory experience of pain involves cognitive, behavioural and emotional aspects which are closely interrelated. While patients suffering from major depressive disorder (MDD) mainly exhibit increased thresholds towards experimentally induced thermal pain applied to the skin, the induction of sad mood increases pain perception in healthy controls.

Neurobiological underpinnings of the discrepancy of pain perception in depression and after sad mood induction in healthy volunteers will help to understand aberrant pain perception in the disease. Patients and controls were rated on mood scales and results were correlated to brain activity assessed in fMRI sessions. Similarly, autonomic modulation in respect to pain perception was assessed in patients.

We found a highly significant reduction in heat pain threshold on the left hand after sad mood induction in patients and controls. Subjects were scanned twice, one group before and after sad-mood induction and another group before and after neutral-mood induction, respectively. Our main finding was a significant group×mood induction interaction bilaterally in the ventrolateral nucleus of the thalamus indicating a BOLD signal increase after sad-mood induction and a BOLD signal decrease in the control group.

We present evidence that induced sad affect leads to reduced heat pain thresholds in healthy subjects and depressed patients. This is probably due to altered lateral thalamic activity, which is potentially associated with changed attentional processes. Furthermore we present evidence for similar changes in depressed patients after sad mood induction. Autonomic modulation is less likely to interfere with pain perception in the disease.
Pain processing in Schizophrenia
Authors: Bonnot O. , Tordjman S.
Published: May 2011

We will propose a critical review of the scientific literature regarding pain and schizophrenia, examine the empirical basis for the reported pain insensitivity of schizophrenia, and emphasize the distinction between behavioral responses to pain or self-reported pain and physiological response to painful stimuli. Litterature is scarse and could be classified in 4 groups: case reports (n = 9), clinical studies (n = 23), experimental research (n = 20) and review articles (n = 5).

The analysis of Case reports and clinical studies show reduced pain reactivity in patients with schizophrenia compared to healthy controls or other psychiatric patients. In the same vein, experimental studies using self-report measures of pain reactivity generally reported higher pain perception thresholds in patients with schizophrenia. However, the only experimental study using a neurophysiological measure of pain reactivity (the nociceptive RIII reflex) demonstrated a normal pain threshold in schizophrenia.

Review of clinical and experimental data indicates that in most situations behavioral pain reactivity and self-reported responses to pain are reduced in schizophrenia. However, there is little or no physiological evidence supporting pain insensitivity in schizophrenia. It can be suggested that the widely accepted notion of reduced pain sensitivity in schizophrenia is related more to a different mode of pain expression than to a real endogenous analgesia. We will also present preliminary data on pain sensitivity associating behavioural pain reactivity measurements, "objective" electrophysiological assessments and neurovegetative function recordings. Our results are in the line of the literature and strongly suggest that there is no analgesia in schizophrenia but a different mode of pain expression.
Experimental pain in dementia
Authors: Lautenbacher S. , Kunz M.
Published: May 2011

Two study lines will be presented. One is focussing on the changes in experimental pain responsiveness in patients with dementia compared to healthy elderly and individuals with MCI. Patients with dementia appeared as more pain responsive (lower RIII-reflex thresholds, more pain-related facial responses, no difference in ratings) whereas the results of the MCI group were indistinguishable from those of the health elderly. Only the sympathetic skin response was similarly smaller in patients with dementia and the MCI individuals. The clinical reports of less frequent pain and less requirements of analgesics in dementia were not corroborated by the present experimental data. In the second study line, neuropsychological correlates of experimental pain sensitivity (rating, RIII-reflex, facial responses) were investigated in patients with MCI and dementia. The scores of a screening battery for dementia (SIDAM) and a modified version of the TMT-A were used. Significant correlations were found but only for the R-III threshold. Especially the scale for executive functions helped to explain the R-III reflex thresholds, suggesting frontal contributions to changes in pain processing in dementia. Depression, who often impacts pain processing, did not mediate the relationship between experimental pain and neuropsychology.
Chronobiological issues of sleep and circadian rhythms
Authors: Hajak G.
Published: May 2011

Progress in unravelling the cellular and molecular basis of mammalian circadian regulation over the past decade has provided us with data that deteriorations in measurable circadian output parameters, such as sleep/wake deficits and dysregulation of circulating hormone levels, are common features of most central nervous system disorders.

At the core of the mammalian circadian system is a complex of molecular oscillations within the hypothalamic suprachiasmatic nucleus. These oscillations are modifiable by afferent signals from the environment, and integrated signals are subsequently conveyed to remote central neural circuits where specific output rhythms are regulated. Usually our sleep/wake cycle, temperature and melatonin rhythms are internally synchronized with a stable phase relationship. When there is a desynchrony between the sleep/wake cycle and circadian rhythm, sleep disorders such as advanced and delayed sleep phase syndrome can arise as well as transient chronobiologic disturbances, for example from jet lag and shift work.

Increasing evidence suggests that disrupted temporal organization of biological functions impairs behaviour, cognition, affect, and emotion. Furthermore, disruption of circadian clock genes impairs the sleep-wake cycle and social rhythms, which may be implicated in particular in mental disorders. An increasing number of journal publications point to a crucial role of circadian rhythm dysregulations in particular for affective disorders, which should e addressed specifically in modern psychiatry.
The four season brain - circannual changes in Neurobiology
Authors: Spindelegger C. ,   Functional Neuroimaging - PET & fMRI
Published: May 2011

Objective

Climate, in particular sunshine, is known to influence mood and energy levels, leading to a positive upswing on bright, sunny days and negative downswing in the cold, dark winter seasons. Increased serotonin transporter availability in healthy human subjects has been revealed in times of lesser light exposure and lower serotonin levels have been examined in the winter season.

Methods

36 drug naive healthy human subjects underwent this retrospective study, investigatin light-dependent alteration of serotonin-1A (5-HT1A) receptor binding in the human brain. 5-HT1A receptor binding was quantified using positron emission tomography and the selective radioligand [carbonyl-11C]WAY-100635.

In a next step, 5-HT1A binding potentials were correlated with the amount of individual exposure to global radiation and sunshine.

Results

A significant positive correlation between the regional postsynaptic serotonin-1A receptor binding and global radiation accumulated over a period of 5 days was found. Furthermore, significant differences between subjects of low and high exposure to global radiation were revealed, whereas subjects who were exposed to a lower amount of global radiation showed 20–30% lower serotonin-1A receptor binding.

Conclusions

Our results showed a significant positive relationship between the accumulated amount of global radiation (5 days) and the serotonin-1A receptor binding in several limbic regions. Together with recently demonstrated seasonal fluctuations in serotonin turnover and transporter availability, our results underline the influence of seasonal factors in the regulation of brain serotonin transmission and might help to elucidate the pathogenesis of seasonal affective disorders.
Clock genes and mood disorders: Which role?
Authors: Serretti A.
Published: May 2011

The Circadian Locomotor Output Cycles Kaput (CLOCK) gene is thought to be involved in the regulation of circadian rhythms, with its protein products driving transcription of other genetic components of the molecular oscillator. The possible role of 3111T/C CLOCK gene polymorphism and a number of other variants in psychiatry is currently under investigation. A polymorphism in the 3’ flanking region of the CLOCK gene have been shown to affect mRNA stability and half-life, with possible significant effects on the level of protein finally being translated. In mice, a mutation of CLOCK gene, called “C” variant, has been shown to lead to a lengthened circadian period and in healthy humans the CLOCK*C allele has been investigated as a predictor of “eveningness.” Finally, a significantly higher recurrence rate of illness episodes has been found in bipolar patients homozygous for the C variant. In a series of studies, we investigated the possible effect of CLOCK variants in mood disorders and drug response.

Taken together, this evidence suggests that CLOCK gene variants modulate mood disorders in a subtle but consistent way, causing liability to a shorter and disrupted sleep, which is reflected in poorer sleep improvement during antidepressant therapy and eventually in a higher frequency of episodes. This also suggests the clinical usefulness of social rhythm therapy particularly in this subgroup of patients.
Teaching about depression in different cultures: Experience gained in the use of the WPA educational programme on depressive disorders
Authors: Sartorius N.
Published: May 2011

Aware of the huge and growing public health importance of depressive disorders the World Psychiatric Association developed an educational programme that brought together materials that psychiatrists could use in teaching other medical staff - for example general practitioners - about depression and its management. The programme was translated in many languages and widely used. Reports about the usefulness of the programme were very positive and usually drew attention to the fact that the programme contained a large amount of data that could be used in composing teaching curricula appropriate for the different settings in which the training was to take place. The experience gained in the use of the programme guided the development of the updated version of the programme released in 2009. As in the first edition, information was made available so that teachers could use in composing their educational activities. In addition however, a special chapter has been added to the programme addressing the role of culture in the presentation of depression and in its management. The presentation will describe the programme and its development. It will in particular describe the parts of the programme dealing with cultural issues and with the methods of education of general practitioners.