bluuebunny/crossref_metadata_2025 huggingface dataset:
Intercultural psychotherapy of depression in migrants of first and second generation
Authors: Calliess I.T. , Machleidt W.
Published: May 2011

Intercultural psychotherapeutic treatment must involve the psychological integration of different cultures within an individual as an additional developmental dimension. The literature concerning acculturation and mental health yields heterogeneous results concerning strategies of adaptive acculturation. In intercultural psychotherapy the integration strategy is usually the strategy with the highest adaptability. It is still uncertain which theoretical assumptions might be applicable to a healthy acculturation process. However, it is assumed that increased acculturative stress may lead to higher risk and susceptibility for emotional distress and depression.

Individual change during the course of migration towards a bicultural identity that includes aspects of both the culture of origin and of the host culture has often been viewed as a desirable adaptation, although the theoretical foundation of the concept of bicultural identity remains inadequate. The cultural-dynamic model presented here distinguishes between personal and social identity on the basis of the identity concept proposed by Mead (1988). We discuss implications for the intercultural psychotherapeutic process, for identity configuration in second-generation migrants, for different phases of the lifespan, and in acquiring the language of the host culture.
Culturally sensitive assessment of depression from a psychometric perspective
Authors: Qureshi A. , Collazos F. , Revollo H.-W. , Casas M.
Published: May 2011

A significant challenge in the culturally sensitive use of psychological and psychiatric instruments for depression is “bias”. Bias means that there is a lack of equivalence: Variation in the score is a result not of variation in the disorder or presence of the symptom in question but rather is due to “cultural factors”. Construct bias is perhaps the most complex of all, and is related to the very manner in which depression is understood. Psychological and psychiatric diagnostic and screening instruments delimit the very “nature” of depression, and fall prey to both false positives and false negatives when assessing individuals from cultures in which the experience and expression of depression is distinct from that found in the West. Equally complex are both method and item bias. In the former, the very method used—for example, a horizontal Likert-like scale—is responded to differentially across cultures, thus resulting in variance that is due not to variations in the presence of symptom but rather the manner of response. Item bias occurs when the item in question is understood in different ways in different cultures. Finally, there is concern about basic issues surround norms, cut-off scores and the like, in as much as the lack of equivalence indicates that results must be interpreted in accordance with population specific norms. Depression diagnostic and screening instruments and their items will be selectively reviewed to demonstrate the presence of bias, and concrete suggestions will be presented to achieve a more culturally sensitive assessment process.
Epidemiology of adult attention deficit hyperactivity disorder (ADHD) - first hungarian data
Authors: Simon V.
Published: May 2011

Introduction

Although ADHD in childhood is a well known and treated condition in Hungary, until recently there was no epidemiologic data about the prevalence of ADHD among adults.

Objective

Estimation of the prevalence of adult ADHD in Hungary.

Methods

In this study1, 3529 subjects (18 to 60 years) were screened with the Adult Self-Report Scale2 6-item version. Out of 279 positively screened subjects, 161 participated in a detailed semi-structured clinical interview.

Results

ADHD was associated with younger age and male gender [χ2=14.46; p=0.0007], however there was no significant interaction between the effect of gender and age [Estimate: –0.031, SE: 0.043, χ2=0.5124; p=0.4741]1. According to the estimates corrected for the ‘not-interviewed’ subsample and after adjusting for specificity and sensitivity data of the screener, the prevalence of ADHD was 2.3% in males, 0.91% in females; 2.02% in the ≤40 years group and 0.70% in the > 40 years group1. In our sample, 82.61% of male, and 78.94% of female ADHD subjects had at least 1 comorbid psychiatric disorder.

Conclusions

The estimated prevalence of ADHD among adults is in line with data reported in the literature.
ADHD, methylphenidate and mood instability
Authors: Asherson P. , Rosler M. , McLoughlin G. , Kuntsi J. , Skirrow C.
Published: May 2011

ADHD is a common neurodevelopmental disorder that persists into adulthood in around two-thirds of cases. Current operational definitions of ADHD focus on three core domains of inattention, overactivity and impulsivity, yet it is widely recognised that there is a wider range of psychopathology that co-occurs alongside these core symptoms. Among the most prevalent of these in adults with ADHD is mood instability, characterized by shifts in mood from ‘highs’ to ‘lows’, frustration, and chronic irritability. Mood instability may often be the main presenting symptom of ADHD and may also be one of the more impairing features of the disorder. Importantly, it has been noted that treatment for ADHD with stimulants or atomoxetine often results in improvements in mood instability symptoms in the same timescale as other core symptoms of ADHD, indicating that mood instability can be considered a symptom of ADHD just as much as inattention, impulsivity and hyperactivity. Here we report on key findings that show the very high correlation between ADHD and mood instability and the response of such symptoms to treatment with stimulant medications. Further work is aimed to clarify whether the problems with regulation of emotional responses and mood states seen in ADHD arise from the same underlying processes that lead to impaired regulation of attention and impulse control.
Stimulant treatment for children and adolescents with ADHD - An update on efficacy and safety issues
Authors: Banaschewski T.
Published: May 2011

Pharmacological management for children and adolescents with ADHD should be part of a comprehensive treatment plan including psychological, behavioural, and educational advice and interventions. If pharmacological treatment is appropriate, stimulant medications and atomoxetine are the most effective medications for ADHD. The European ADHD Guidelines Group (a panel of ADHD experts from several European countries) has developed guidelines for the diagnosis and treatment of ADHD and published algorithms on the use of long-acting medications. Recently, the Guidelines Group has conducted a comprehensive review of the published literature on adverse effects of the drugs that are licensed in Europe, and most commonly used, for the treatment of ADHD or hyperkinetic disorder. This presentation will summarize those results and give an update on efficacy and safety issues concerning the pharmacological treatment of children and adolescents with ADHD.
International differences in the value for money provided by institutions in european countries at different stages of deinstitutionalisation and with different economies
Authors: Taylor T.L.
Published: May 2011

Background

Individuals with a diagnosis of schizophrenia or schizoaffective disorder may require longer term care. Due to the complexities of caring for this population and the high resource cost of care, it is important to ensure that mental health services are efficient and effective.

Aims

This investigation aims to examine international differences in quality of care and service user experience when compared to national health expenditure and the degree of deinstitutionalisation in 10 countries.

Methods

The quality of care provided in 213 units was measured using the Quality Indicator for Rehabilitative Care (QuIRC). Service users living in these units (N = 1750) were asked to assess the care they received. Multilevel models were used to examine the relationships between quality (QuIRC domain ratings), level of deinstitutionalisation and national health care expenditure. As no formalised assessment of deinstitutionalisation has been published, a quantitative tool was developed and validated. Percentage of gross domestic product spent on health care and per capita total health care spend was taken from World Health Organisation data to assess national health care expenditure.

Results

Multilevel models examining the relationships between deinstitutionalisation levels, health care expenditure, quality and service user experience will be presented. Results were adjusted for unit (type and size) and service user (age, gender and level of functioning) characteristics.

Conclusions

Recommendations on the best use of resources within a facility providing longer term care and how best to increase the quality of care provided without additional financial expenditure will be discussed in relation to the results.
Quality of care in longer term mental health institutions in Poland
Authors: Piotrowski P. , Ciałkowska M. , Adamowski T. , Rymaszewska J. , Kiejna A. ,   DemoB.inc
Published: May 2011

Objective

Development of Quality Indicator for Rehabilitative Care (QuIRC), experiences of Polish partner in implementation of the toolkit and preliminary assessment of care standards in longer term mental health institutions. Research constitutes a part of international project funded by European Commission.

Methods

Polish version of QuIRC has been tested in 20 psychiatric units across 3 regions in Poland. Selected facilities differed in terms of employment profile, living standards as well as location and service users turnover. Managers of participating units were interviewed using the refined tool with 145 items regarding domains indentified during previous phases of the DEMoB.inc project. Each participant was questioned by a single researcher during face-to-face meeting. Lacking answers were completed on basis of service users’ medical files and account departments’ documents when necessary.

Results

Manager of only 1 out of 21 units refused to participate in interview. The most common difficulties in data collection were in relation to the number of staff and staff training. These difficulties may be due to differences in the work patterns and training of staff in Polish units compared to other countries. In comparison to international results important differences in preliminary assessments of long term mental health care were found in several areas probably due to the early stage of deinstitutionalisation process in Eastern Europe. Development of the web based version of the toolkit will facilitate its implementation in research as well as internal assessments for units’ restructuring purposes.
Mortality in serious mental illness
Authors: Osby U.
Published: May 2011

Introduction

There is evidence that patients with bipolar disorder have an increased mortality from somatic causes of death, including coronary heart disease and myocardial infarction. However, present mortality ratios and mortality trends over time are not known.

Aim

To analyze relative mortality and mortality trends for patients with bipolar disorder in relation to the population for cerebrovascular disease, coronary heart disease and myocardial infarction.

Methods

All patients in Sweden with a clinical diagnosis of bipolar disorder from the introduction of ICD-10 (1987–2006) found in the National Swedish Patient Register were followed-up in the Cause of death register. Mortality rate ratios (MRR) for different cardiovascular diseases and different age groups were calculated, as well as numbers of excess deaths, relative to the population. Also, admission rate ratios (ARR) and yearly mortality rates for bipolar patients versus the population were calculated for the same time period.

Results

From all causes of death, there were 5,471 deaths for bipolar patients. MRR was 2.58 (95% CI: 2.51–2.65). For cerebrovascular disease MRR was 2.19 (95% CI: 2.01–2.40), and for coronary heart disease MRR was 2.10 (95% CI: 1.98–2.2.24). In the subgroup of acute myocardial infarction MRR was 1.97 (95% CI: 1.81–2.14). In cerebrovascular disease, ARR was increased to 1.47 (95% CI: 1.35–1.59), while in coronary heart disease ARR was 1.06 (95% CI: 0.98–2.24), and in acute myocardial infarction 1.09 (95% CI: 0.0.98–1.22). Yearly mortality rates for these causes of death decreased both among patients and the population, without indication of a decreasing gap.

Conclusions

In patients with bipolar disorder, mortality from cerebrovascular disease and coronary heart disease with its subgroup acute myocardial infarction was doubled during 1987–2006. In contrast, admission rates for coronary heart disease and acute myocardial infarction were not increased. Yearly mortality rates decreased both for the patients and the population, but there were no indications of a decreasing gap.

Keywords

Bipolar disorder; Register study; Cerebrovascular disease; Coronary heart disease; Acute myocardial infarction; Mortality rate ratios; Admission rate ratios.
The impact study - motivating a change in health behaviour
Authors: Smith S. , Greenwood K. , Atakan Z. , Sood P. , Ohlsen R. , Papanastasiou E. , Featherman A. , Todd G. , Eberhard J. , Ismail K. , Murray R. , Gaughran F.
Published: May 2011

IMPaCT is a five-year project funded by the Department of Health, UK. Running in the UK and now Sweden, the IMPACT Project aims to target the poor physical health and excessive substance use seen in people with SMI. There is evidence that behavioural interventions may be associated with an improvement in physical health and substance use in this population.

IMPaCT is a randomised controlled trial of a health promotion intervention which consists of a manualised modular approach to working with people with severe mental illness to empower them to improve their physical health and substance use habits. It consists of The Manual, The Reference Guide and The Better Health Handbook which make up a therapy package to support clients to become healthier.

The therapy is provided by care coordinators (mental health practitioners) over a 6–9 month period and combines Cognitive Behavioural Therapy (CBT) with Motivational Interviewing (MI) principles. The aim is to work with clients to help them identify their own problem health behaviours, e.g. smoking, diet, exercise, drug and alcohol use. Realistic goals are set and revised with the client, and individual and group sessions are used to develop personal motivation to change. Information, workbooks and diaries are provided to record progress and give helpful hints, while meaningful alternative activities are introduced to replace problem health behaviours.
Physical health in schizophrenia - what's cognition got to do with it?
Authors: Gallhofer B. , Sammer G. , Hanewald B. ,   Cognitive Neuroscience Unit Giessen
Published: May 2011

Patients suffering from schizophrenia are usually treated with antipsychotic agents posing a threat both to their cognitive and physical skills. Anticholinergic and antihistaminic side effects are well known to have a negative impact on mental as well as physical health and pose a major hazard regarding progress in reintegration.

Strategies changing the fate of patients have moved away from just dampening dopaminergic noise in the limbic system. Nowadays, the new focus is on cognitive remediation. The centre of these efforts is to enhance strategic and executive skills and thereby alter patients' motivation to take their life into their own hands again.

The present report aims at presenting evidence from both physical treatment strategies with the power to enhance hippocampal circuit capacity as well as cognitive remediation tools with the the aim of augmenting executive skills by rewiring cognitive circuitry in the brain.

Preliminary results demonstrate not only improved processing of mental load found with fMRI measured circuitry connectivity, but they also point to the improvement of physical parameters taken in a continuous clinical context.

The reasons for these favourable findings are not straight forward and trivial, but they seem to be the result of complex interaction between various factors. The latter are to be pursued in a large cohort and presented at a later point in time.
Neural correlates of cognitive behavioural therapy in patients with schizophrenia
Authors: Kicher T. , Krug A. , Cabanis M. , Walter H. , Winterer G. , Müller B. , Herrlich J. , Wiedemann G. , Vogeley K. , Wittorf A. , Rapp A. , Klingberg S.
Published: May 2011

Cognitive behavioural therapy (CBT) is an important treatment in conjunction with psychopharmacotherapy in schizophrenia. However, there is only very little research on the effects of such interventions on brain function.

Recent studies have suggested that jumping to conclusions and a specific attributional bias is a predominant cognitive style in patients which might lead to the development of delusions. In this multi-centre fMRI trial, we investigated the effect of nine months of CBT on neural correlates of “jumping to conclusions” and the “attributional style” in patients with psychosis. Eighty patients and 80 control subjects were recruited in six centres and measured with 3-Tesla functional magnetic imaging (fMRI) before and after CBT.

It could be shown that CBT ameliorates differences in brain activations between patients and controls after nine months.

These results support the feasibility of fMRI multicenter trials and sheds further light into the mechanisms relating psychotherapy to brain function in Schizophrenia.
Social cognition in schizophrenia: Impairments and treatment approaches
Authors: Wölwer W.
Published: May 2011

Impairments in cognitive processes underlying social interaction (i.e. “social cognition”) have increasingly attracted interest in schizophrenia research during the last years. These impairments concern various components of social cognition, exist relatively independent from impairments in basic cognition and from clinical psychopathology, are already present at the onset of the disorder, and can even be detected in persons at high risk of developing schizophrenia. As social cognitive impairments are closely related to poor functional outcome, and because longitudinal studies have proven the stability of social cognitive impairments across the course of the disorder despite clinically efficacious traditional treatment, various specialized treatment and rehabilitation programs targeting social cognitive impairments have been developed during the last years. These programs differ significantly with regard to the conceptualization of the impairments and the required treatment strategies, i.e. whether the impairments are suggested to be represent cognitive “deficits” or cognitive “biases” requiring remediation vs. debiasing approaches. Moreover the programs differ with regard to the scope of cognitive subcomponents addressed, i.e. whether the program focuses on only one social cognitive subcomponent like affect recognition or whether several subcomponents are addressed in parallel. As the evaluation of such programs is still in an infant stage there is still debate about the most efficacious approach.

This presentation will give an overview on social cognitive impairments and on respective treatment strategies, before the subsequent presentations will exemplify three treatment programs, which may help schizophrenia patients to overcome their impairments in social cognition and social functioning.
A targeted remediation approach: The training of affect recognition (TAR)
Authors: Sachs G. , Winklbaur B. , Jagsch R. , Frommann N. , Kryspin-Exner I. , Wölwer W.
Published: May 2011

Introduction

An increasing number of studies is focusing on general deficits in patients with schizophrenia in identifying, differentiating and recalling facial emotions which significantly impairs the patient's psychosocial functioning and quality of life.

Objectives

These impairments seem not to be affected by conventional treatment. According to preliminary results antipsychotics alone show only little effects on social cognition.

Aims

The present study investigated the efficacy of a computer based training focussing on facial affect recognition (Training of Affect recognition TAR, Wölwer et al. 2005) for the remediation of social cognitive dysfunctions.

Methods

Effects on social cognition were tested with the Vienna Emotion Recognition Task (VERT-K, Pawelak 2004). Neurocognitive performance was assessed by the Wisconsin Card Sorting Test (WCST Heaton et al. 1993). Additional assessments were tests of alertness, vigilance and working memory (TAP Zimmermann and Fimm 2002), positive and negative symptoms (PANSS Kay et al. 1987), Beck Depression Scale (BDI Beck 1964) and Quality of Life (WHOQOL-Bref WHOQOL Group 1998).

Results

In comparison to the TAU group, the TAR group achieved significant improvements in affect recognition in general as well as in recognizing sad faces (p < 0.01) (Fig.2). In addition, we found significant improvements for the TAR group in regard to vigilance and Quality of Life (p < 0.05).

Conclusions

Treatment with new antipsychotics alone leads only to limited effects on social cognition and functioning. A specific combined treatment of new antipsychotics and TAR leads to improved cognition and emotional performance with additional positive effects on functional outcome.
A broad-based remediation approach: The integrated neurocognitive therapy (INT)
Authors: Roder V. , Mueller D.R. , Schmidt S.J.
Published: May 2011

Objective

Cognitive functions have a decisive influence and prognostic value for functional recovery. The NIMH MATRICS initiative established a consensus on neuro-cognitive and social cognitive domains relevant for the treatment of schizophrenia. Against this background we developed the Integrated Neurocognitive Therapy (INT) covering all MATRICS domains. INT is strongly based on therapeutic principles of the Integrated Psychological Therapy (IPT) designed by our research team several years ago. INT is partly computer based and intends to restitute and compensate neuro-cognitive and social cognitive functions.

Methods

INT was evaluated in an international multi-cite RCT with centers in Switzerland, Germany, and Austria. The Swiss National Science Foundation supported this study. INT was compared with a treatment as usual control condition (TAU). INT patients received 30 therapy sessions twice a week. 169 schizophrenia outpatients participated in the study.

Results

Using an ANOVA model, INT groups show superior effects after therapy and 1-year follow-up in proximal outcomes of neuro- and social cognition. Significant effects are evident in most of the MATRICS-domains. Additionally, significant effects in more distal outcomes are evident for INT patients in psychosocial functioning and negative symptoms after therapy and at follow-up. A low drop-out rate of 12% of the INT patients indicates a high acceptance by the patients.

Conclusions

Results support evidence for the efficacy of INT in proximal and distal outcome dimensions. Further evaluations on INT have to investigate its relevance for different psychotic populations such as young early psychotics and more chronic older patients.
A bias-oriented treatment approach: The metacognitive training for schizophrenia patients (MCT)
Authors: Moritz S. , Woodward T.S.
Published: May 2011

Until recently, psychological therapy for schizophrenia was considered inefficient or even harmful by many clinicians. The reservation against psychotherapy is partly rooted in the assumption that delusions are not amenable to psychological understanding. However, meta-analyses suggest that cognitive intervention is effective in ameliorating schizophrenia symptoms. In addition, evidence has accumulated that cognitive biases, such as jumping to conclusions (JTC), are involved in the pathogenesis of schizophrenia positive symptoms, particularly delusions. A recently developed group program, called metacognitive training (MCT), is presented targeting cognitive biases. The MCT is a hybrid of psychoeducation, cognitive remediation and cognitive-behavioural therapy. Patients are taught strategies how to identify and defuse “cognitive traps”. The program can be downloaded at no cost at www.uke.de/mkt and is currently available in more than 20 languages. New evidence on the feasibility and efficacy of the MCT is presented. At the end, a novel individualized variant entitled MCT+ is demonstrated targeting individual delusional ideas. A random-controlled study asserts the efficacy of the MCT+ to reduce JTC as well as delusion severity and conviction.
Childhood abuse and the genetic variants of the HPA and serotonin systems
Authors: Wasserman D.
Published: May 2011

According to a stress diathesis model, genes and environment, as well as possible interactions in-between (GxE), may result in vulnerability towards suicidal behaviors (SB), characterized by behavioral trigger endophenotypes such as increased depression-intensity and aggression/anger/impulsivity.

Excessive stress has the potential to induce unfavorable effects in a variety of higher brain-functions, incurred as side effects to maladaptive responses in the genetically controlled stress-responsive neurosystems eg. in the hypo- thalamic-pituitary-adrenal(HPA) axis. Childhood traumatic experiences are particularly relevant as stressful experiences are they frequently occur in the early childhood, when susceptibility to external stressors is higher. Childhood abuse has been found in several study as directly associated with suicidal behavior, independently from other psychological or psychopathological risk factors.

HPA-axis dysregulation is regarded as an endo- phenotype of depression-, anxiety- and alcohol abuse disorders, commonly found also in suicide behaviors. Various neurobiological alterations, suggesting abnormal HPA-axis activity and reactivity, have also been demonstrated to occur in suicidal behaviors including completed suicides.

The HPA axis is a major systemic stress-modulator being mainly controlled by the regulatory corticotropin releasing hormone receptor 1 (CRHR1) gene. An overview will be presented of the role of the HPA axis in suicidal behaviors with a focus on CRHR1 gene. and on interactions with childhood traumatic experiences.
Stressful life events in early life and suicidal behaviour
Authors: Saiz P.A.
Published: May 2011

There is robust evidence that stressful life events (SLE) are associated with an increase in risk of developing depression. However, humans display wide variation in response to adversity. Caspi et al (2003) reported that a functional length polymorphism (5-HTTLPR) in the promoter of the serotonin transporter gene moderated the influence of SLE on depressive symptoms, major depression, and suicidality, suggesting evidences of a gene-by-environment interaction.

Neuroimage data from healthy, non-depressed, s allele carriers of the 5-HTTLPR show an exaggerated amygdale response to threatening visual stimuli as well as reduced gray matter volume in limbic regions critical for processing of negative emotion compared with individuals with the LL genotype. These data suggest a potent modulatory effect of the 5-HTTLPR on amygdala reactivity to environmental threat.

In recent years, a growing number of molecular genetic studies have focused on the serotonin system, suggesting that this system may be involved in the pathogenesis of suicidal behaviour. Meta-analytic evidences support a link between the s allele of the 5-HTTLPR and the risk of suicidal behaviour. However, several case-control association studies show an association between the short allele and the violence, the number, and the medical lethality of the attempts.

On the other hand, recent data suggest that biological stress reactivity, mediated by the hypothalamic-pituitary-adrenocortical axis, might be a plausible mechanism underlying the association between the 5-HTTLPR genotype and exposure to life stress in predicting psychopathology.

In this presentation we discuss data regarding the complex relationship between the above mentioned systems, stress, and suicidal behaviour.
GXE interaction as a protective factor: 5HTTR and bad environment
Authors: Carli V. , Mandelli L. , Zaninotto L. , Gatta V. , Stuppia L. , Serretti A. , Sarchiapone M.
Published: May 2011

Early traumatic experiences have been consistently associated with a higher risk to develop psychopathological symptoms in adulthood. Resilience, a trait reflecting tolerance of negative affect, positive acceptance of change and an action-oriented approach to problem solving, has been hypothesized to be a protective factor against stressors. Genetic aspects have been also hypothesized influencing resilience to stress and risk to develop psychopathological symptoms in response to both early and recent adverse events. In particular, a common polymorphism within the gene coding for serotonin transporter (5-HTTLPR s/l) has been consistently associated to the risk to develop depressive-anxious symptoms in response to stressful life events. In the present study we aimed to investigate the role of childhood traumas and 5-HTTLPR on measures of resilience and depression in a sample of individuals at a high risk for psychological distress.A large sample of male prisoners was investigated (n = 1516). 5-HTTLPR genotype was available for 762 individuals. Overall, childhood traumas were significantly correlated to poor resilience and more severe depressive symptoms. 5-HTTLPR genotype did not influence resilience and depressive severity. However, a significant interaction was observed between 5-HTTLPR and childhood traumas on both resilience and depressive severity. Contrary to expectations, s/s individuals exposed to a high number of early traumas had a current higher resilience and less depressive symptoms than l-allele carriers. Present data did not confirm the 5-HTTLPR s-allele as the genetic risk variant for psychopathology in individuals exposed to stressors.
Decision making and vulnerability to suicidal behaviour in elderly
Authors: Courtet P. , Wyart M. , Jaussent I. , Ritchie K. , Jollant F.
Published: May 2011

Suicide is a major public health concern, especially for older adults, who have higher rates of completed suicide than any other age group in most countries of the world. However, understanding suicidal behaviour remains a challenging task particularly among the elders who have been poorly studied. Decision making has been recently found to be altered in suicide attempters under 65.To test wether decision making would be a neuropsychological trait of vulnerability to suicidal behaviours, the authors used the Iowa Gambling Task to investigate normothymic non demented elders with a history of suicidal behaviour (N = 35) and compared it to decision making in non suicide attempters with a past history of depression (N = 52) and comparison subjects (N = 43). The data also were compared to those of similar groups of younger normothymic subjects. Moreover, the old suicidal patients were assessed according to the age at the onset of suicidal behaviour (before or after 60).Old suicide attempters did not significantly differ from the other aged groups and according to the age of first suicidal behaviour. Old suicide attempters presented better performances than that of younger suicidal patients.Vulnerability to suicidal behaviour in older people may proceed from cognitive processes which are different from the ones involved in suicidal vulnerability of younger subjects. These results are preliminary and further studies are needed to explore vulnerability cognitive patterns to suicide among elders.
Neural, cognitive and behavioral correlates of CBASP- effects
Authors: Schnell K.
Published: May 2011

To test the validity of two different social cognitive mechanisms as mediators of CBASP-treatment effects, we conducted fMRI-studies in

i) healthy and

ii) healthy compared to chronically depressed subjects.

The first fMRI experiment included in these studies explored the neural representations and behavioral correlates of causal contingencies between action and response in social interaction and the regulatory effect of successful/erroneous affective response prediction on the limbic system. In the second experiment we examined the ability to infer on the affective states of another person and the correlated activation of the neural “Theory of Mind” (ToM)-Network comprising superior temporal and dorsomedial prefrontal cortices.

In the first experiment we demonstrated for the first time, that the probability of an interaction partner's contingent response to an action is inversely correlated with the activation of a network of medial, ventrolateral prefrontal and inferior-parietal cortices in healthy controls. The congruence of predicted and actual responses modulated activations of amygdala (aversive responses) and ventral striatum (positive responses). The Second experiment actually replicated previous observations, that mentalizing of affective states predominantly activates anterior parts of the ToM-network.

Preliminary results of the comparison between healthy and chronically depressed individuals indicate dysfunctional differentiation of social partners’ predictability in chronic depression as well as altered neural representations of contingencies. For the second experiment we found altered activation within the Theory of Mind network in the patient group.

Finally we will demonstrate pre-post measurements of neural and behavioral changes in both systems of social cognition after 12 CBASP sessions.
Cbasp for chronic depression: impact of co-morbidities and learning acquisition
Authors: Penberthy J.K.
Published: May 2011

Depression and other co-morbidities, such as alcoholism, frequently co-occur and make effective treatment more complex and challenging. There is a growing interest in the co-occurrence of substance use disorders and mood and anxiety disorders, but knowledge about effective behavioral treatment options is far from complete. Research supports the hypothesis that an integrated therapy such as CBASP, which possesses components of motivational, cognitive, behavioral therapy, as well as management of interpersonal reinforcements, to target co-occurring depression and alcoholism may be most effective for chronic depression and co-occurring disorders. CBASP has been shown to be effective in treating chronically depressed individuals and is a promising behavioral approach for use with chronically depressed patients who may report treatment resistance, traumatic developmental histories, manifest impoverished interpersonal relations, interactions, and coping skills, and demonstrate additional chronic under-functioning similar to alcohol dependent individuals with chronic depression. We review the application and research findings regarding the use of CBASP in chronically depressed individuals with co-occurring alcoholism. In addition, we explore the relationship between acquisition learning of the two primary skills in CBASP and treatment outcome. Learning acquisition is assessed in order to capture increases in felt emotional safety with the therapist, as well as perceived functionality on the part of the patient. We hypothesize that patients receiving CBASP will demonstrate an improvement in both symptoms of depression and their co-morbid disorders and that the amount of learning will be proportionally related to improvement in symptoms. We also explore patient characteristics that predict outcome.
Theoretical considerations and clinical implementations of the somatoform disorders concept
Authors: Bobrova M.A. , Bobrov A.E.
Published: May 2011

The existing ICD-10 typology of somatoform disorders is often criticized. The alternative approach to pseudo-somatic complaints as an expression of anxiety-affective disorders still deserves much recognition among practicing psychiatrists.

To evaluate the validity of these views a group of 53 patients (24 men and 29 women) was studied with the help of clinical interview, symptomatic scales, personality and neuropsychological tests. Results of statistical analysis demonstrate that there are four relatively independent "core" variants of somatoform syndromes, which closely resemble ICD disorders: anxiety-depressive, psychovegenative, dissociative, and paranoid hypochondriac. These variants differ in symptomatology, levels of disturbance and prognosis.

The obtained data evidence that differences in clinical features of somatoform disorders are determined by specificity of cognitive styles, changes in sensory levels, dysfunction of brain antinociceptive system, higher integrative brain functions and personality/behavioral patterns. It also means that contradiction between empirically and operationally based approaches to somatoform disorders reflects the consecutive transition from phenomenological to descriptive and then - to bio-psycho-social paradigm in modern psychiatry.
Chronic stress and anxiety-depressive spectrum disorders in patients of phoniatric practice
Authors: Veltishchev D. , Stukalo A. , Romanenko S. , Kovalevskaya O. , Seravina O.
Published: May 2011

Objectives

To research the influence of stress factors on the development and circuit of voice disorders in their relation to anxiety and depressive spectrum.

Aimes

To analyze the extent to which the anxiety and depressive disorders are spreading among the patients with voice dysfunctions, to determine the variety of factors for psychological traumatic experience, and to distinguish the variety of anxiety and depressive disorders.

Methods

The Hospital Anxiety and Depression Rating Scale (HADS), the projective psychological tests.

Preliminary HADS screening was conducted among 180 patients. More than half of the patients (57.5%) had high risk of anxiety and depressive disorders. 55 patients (44 women, 13 men, age of 18–70) with voice disorders and the positive results of screening were included to the study. Patients underwent a complete otolaryngologic examination and were grouped into organic voice pathology (34.5%) and non-organic voice pathology (65.5%). In accordance with ICD-10, anxiety and depressive disorders were diagnosed in 48 (87%) patients. In most cases (98.7%) the phoniatric pathology developed in chronic stress conditions. The prevailed chronic stress factors that provoked both anxiety-depressive spectrum disorders and voice pathology were inability to reach pre-set social goal (65.4%), ethical conflict (18.2%) and lack of external control factors (16.4%). Professional factor was also important as 38.2% of the group claimed heavy voice load at work.

Chronic stress factors play significant provoking role in the development of voice and anxiety-depressive spectrum disorders, which should be taken into account to design diagnostic and therapeutic tactics for patients with voice pathology.
Insomnia and brain function
Authors: Van Someren E.J.
Published: May 2011

Affecting 6-11% of the population, insomnia is the most common complaint in general practice. While insomnia is a major risk factor for health problems, its brain mechanisms have hardly been explored (Front Neurosci 2009;3:436). We applied brain imaging to find causes and consequences of insomnia. While some deviations recover after therapy, e.g. increased complexity cost in response times and attenuated prefrontal BOLD activation during word fluency (J Sleep Res 2008;17:335; Sleep 2008;31:1271), others don’t and may be heritable traits involved in the risk of developing insomnia. Using TMS, we found an abnormal intracortical excitability and facilitation (ICF) that did not recover after treatment (Biol Psychiatry 2010;68:950). This finding may be the first endophenotype allowing for genotyping, because ICF is among the most heritable human traits (J Neurosci 2009;29:8897). MRI voxel based morphometry (VBM) showed a lower volume of gray matter in areas that are part of the default mode network including the orbitofrontal cortex, where volume showed a strong negative correlation with insomnia severity (Biol Psychiatry 2010;67:182). This area seems involved in disturbed hedonic evaluation, which we indeed found to be disturbed (Sleep 2008;31:1301). Concertedly, we found new angles on mechanisms of vulnerability. We now look for research partners and volunteers for extensive web-based characterization of phenotypes of good and poor sleepers (www.sleepregistry.eu).
Objective versus subjective sleep in patients with insomnia related to generalized anxiety disorder and apnea as compared with normals
Authors: Saletu B. , Anderer P. , Gruber G. , Parapatics S. , Dorffner G. , Saletu-Zyhlarz G.M.
Published: May 2011

Introduction

Earlier studies reported that subjective sleep quality correlates with objective polysomnographically measured sleep initiation and continuity, but less with sleep architecture.

Aims

This study aimed to investigate relations between subjective and objective sleep in normals (N), insomnia comorbid with generalized anxiety disorder (G) and apnea (A).

Methods

One hundred and seventy-seven normals (50.9±19.6a), 100 insomniac G patients (37.9±10.6a) and 51 A patients (51.3±9.7a) completed the self-rating scale for sleep and awakening quality (Saletu et al. 1997) regarding two polysomnographic nights analyzed by the Somnolyzer (Anderer et al. 2005). Correlations were calculated based on changes between the first (adaptation) and second polysomnographic night to diminish inter-individual variances of sleep perception.

Results

In N, subjective sleep quality (S-QUA) demonstrated correlations (p < 0.01) with sleep efficiency (EFF), wake after sleep onset (WASO), S2, S1%, REM, S1, frequency of awakenings (FW), latency to continuous sleep (L-CONT), sleep latency (S-LAT) and slow-wave sleep, while awakening quality (A-QUA) showed weak (p < 0.05) correlations with EFF and WASO. Somatic complaints (S-COM) correlated (p < 0.05) with WASO and REM. In G, correlations (p < 0.01) were obtained between S-QUA and EFF, WASO, S2, L-CONT and S-LAT (p < 0.05), while A-QUA correlated with S2, WASO and EFF. In A, S-QUA correlated (p < 0.01) with EFF, S2, S1%, S2%, L-CONT, WASO and less (p < 0.05) with S-LAT and S1. A-QUA correlated with S2, S2% (p < 0.01), L-CONT and EFF (p < 0.05). S-COM correlated with S-CONT (p < 0.01) and S-LAT (p < 0.05).

Conclusion

EFF, WASO, S2 and less S-LAT determine good S-QUA in all groups.
Insomnia and nocturnal movement disorders
Authors: Wetter T.C.
Published: May 2011

Little is known about the prevalence of nocturnal movement disorders in patients with insomnia or psychiatric disorders. However, it is well established that sleep-related motor disorders (movement disorders, parasomnias) are associated with psychopharmacological treatment. In a recent prospective study it has been shown that second-generation antidepressants may induce or worsen symptoms of restless legs syndrome (RLS) which is often associated with insomnia. While pure SSRIs and SNRIs carried an average risk of about 5% for triggering RLS, reboxetine did not seem to induce this syndrome. By contrast, mirtazapine caused or worsened RLS in almost 30% of the patients surveyed (Rottach et al., 2009). Other studies using polysomnography have reported an increased risk of periodic leg movement disorder with antidepressant treatment. It was reported that SSRIs and venlafaxine, but not bupropion, increased the risk of periodic leg movements during sleep (PLMS), suggesting that PLM activity seen in association with antidepressant administration might be serotonergically mediated (Yang et al., 2004). Sleep-related movement disorders may also occur under treatment with first- or second-generation neuroleptics (Cohrs et al., 2008). Administration of antidepressants may also induce the occurence of rapid eye movment (REM) sleep parasomnias such as REM sleep behaviour disorder (RBD) (Thomas et al., 2007). Own preliminary data of an ongoing study revealed that sleep-disordered patients with comorbid psychiatric disorders are more likely to report a variety of nocturnal movement disorders using the Munich Parasomnia Screening Questionnaire. However, whether this result is due to the psychopharmacological medication remains to be determined.
SS05-01 - The place of agomelatine in the antidepressant armamentarium
Authors: Boyer P.
Published: May 2011

The choice of an antidepressant is tailored according to patient factors (age, sex, severity, diagnostic subtype, comorbid disorders, past response) and to drug characteristics (efficacy, tolerability, safety, simplicity of use, discontinuation syndrome).

A wide range of antidepressants are available nowadays, with mode of action mainly based on the monoamine hypothesis of depression, but all have limitations: still too many nonresponding patients, late onset of action, and poor tolerability profile, resulting in low adherence. The challenges for a new antidepressant are first to provide all patients with rapid and sustained antidepressant efficacy in relieving all symptoms, second to lead patients out of depression by achieving complete remission, and third to ensure that patients are compliant throughout treatment.

Agomelatine is a new antidepressant with an innovative mode of action acting as an agonist of melatonergic MT1 and MT2 receptors as well as an antagonist of serotonergic 5-HT2C receptors. These receptors play a major role in circadian rhythms, which are dysregulated in depression. Recent data suggest that the distinctive antidepressant efficacy of agomelatine results from the potential synergy between these receptors.

Agomelatine rapidly improves depressive symptoms in most subtypes of depression, particularly in patients with anxiety symptoms, known as factor of resistance. Moreover, agomelatine shows greater antidepressant efficacy than fluoxetine in severely depressed patients (HAM-D total score difference over 8 weeks: 1.49; P = 0.024).

Thanks to its unique impact on mechanisms at the core of depressive dysregulation, agomelatine provides doctors and patients with an innovative approach to depression treatment.
SS05-02 - Management of depression with agomelatine: A different perception
Authors: Hajak G.
Published: May 2011

Agomelatine is a completely new approach to the treatment of depression thanks to its innovative mode of action. Acting as melatonergic agonist and 5-HT2C antagonist, it provides depressed patients with a distinctive antidepressant efficacy that perfectly suits patients’ needs and addresses all symptoms at each step of depression. Two years after the first launch in Europe, now is the time for an update from doctors and patients alike.

The patient/doctor relation is key when initiating depression treatment, because patients are reluctant to start, fearing withdrawal symptoms, serious unwanted side effects, and “addiction”. It is important therefore that they understand that agomelatine has none of these effects.

The benefits perceived by patients right from the first days of treatment are influential, because patients are reluctant to continue with classic antidepressants (delayed onset of perceived benefit, early side effects). The early improvement reported by patients on agomelatine supplements data on clinical benefits seen in clinical trials from the first week versus venlafaxine (CGI-I, rate of response, daytime alertness, feeling good) and after two weeks versus sertraline (twice as many HAM-D responders to agomelatine as to sertraline).

Finally, patients are reluctant to maintain antidepressant treatment because of later side effects (weight gain, sexual dysfunction, emotional blunting). Patients on agomelatine confirm the absence of the classic side effects of antidepressants and are more likely to continue treatment than they are with other drugs. Both the antidepressant efficacy and the tolerability were confirmed in a large non-interventional study in a real-life setting in daily practice.