bluuebunny/crossref_metadata_2025 huggingface dataset:
S06-01 - Movies and Mental Health - Between Hollywood and Bollywood
Authors: Bhugra D.
Published: June 2010

The relationship between films and psychiatry remains an ambivalent one. Mentally ill patients are often portrayed unsympathetically in a comic, villainous or inaccurate manner; and film makers often see their responsibility towards financial aspects rather than educational direction. Increasingly, films are being used for training medical students and trainees in psychiatry. Films can also be used to study therapeutic relationships between therapists and patients, especially observing transference and counter-transference. The portrayal of mental illness in films can be negative for a variety of reasons: stigma, lack of knowledge and understanding with a focus on entertaining rather than on educating. The portrayal of ECT and leucotomy and associated negative connotations have increased stigma against mental illness and even led to a reduction in the prescription of these treatments. Using films to teach is relatively recent in the UK compared with the USA, where couple therapists have used films with their patients in therapy to illustrate relationship difficulties and potential solutions. ‘Cinematherapy’ as a term has been used to work with teenagers to deal with relationship and individuation issues. An advantage of using films in teaching mental illness is that their use does not involve the confidentiality of a real patient. In addition the ‘patient’ can be seen interacting with others, giving a clearer understanding of the impact of the illness on others. Unlike clinical consultations in very narrow settings focussing on symptoms and treatment which are time limited, films can be used to learn about cultures and their embedded values.
S39-01 - Epidemiology of Suicidal and Risk-Taking Behavior
Authors: Wasserman D. , Carli V. , Durkee T. , Hadlaczky G.
Published: June 2010

In EU, the latest available data estimates that some 63,000 individuals die annually due to suicide, which translates to 1 suicidal death every 40 seconds. Europe comprises seven countries that are among the top 15 countries with the highest suicide mortality rates. Statistics illustrate that the highest mortality rates for suicide (≥ 25/100,000) comprises mostly former Soviet Union Republics. Suicide rates among the age-group 15-24 years have been steadily increasing over the past few decades with statistics reporting rates up to approximately 22/100,000 among males and 4.8/100,000 among females in Europe.

Epidemiological research has demonstrated that suicide is significantly correlated with suicidal and risk behaviors. Studies have identified suicidal ideation and deliberate self-harm to be significantly correlated to both suicide and attempted suicide. Furthermore, the strongest predictor of suicide is in fact a previous suicide attempt. In Europe, there are 10-20 suicide attempts for every completed suicide. In the US, it is even higher, with estimations reporting 100-200 suicide attempts for every completed suicide. However, suicidal behavior is not an isolated act, rather is a result of a process that co-occurs with psychiatric illnesses, which can range from depressive episodes to schizophrenia. Moreover, epidemiological evidence stipulates that suicidal behavior coincides with a multitude of risk-taking behaviors that are frequently established in adolescent years. Studies have linked suicidal behavior to various types of risk-taking behaviors that include peer victimization, sexual risk behavior, delinquency, and substance abuse. Future epidemiological studies in suicide are fundamental in monitoring, identifying risks and formulating preventive interventions.
S27-03 - Sleep-Related Movement Disorders
Authors: Hornyak M.
Published: June 2010

Restless legs syndrome (RLS) as well as the periodic limb movement disorder (PLMD) are common primary disorders in the general population. They can also occur secondarily or exacerbate as a result of psychotropic medication. According to case reports or case series RLS or PLMD can aggravate due to treatment with antidepressants, antipsychotics or lithium. RLS can also occur during withdrawal from opioids. Especially the tricyclic antidepressants clomipramine and imipramine have been associated with elevated periodic limb movements as well as the tetracyclic antidepressants venlafaxine, SSRIs and SNRIs which also have been associated with RLS. RLS seems to occur mostly during treatment with mirtazapine. Amitriptyline, nortriptyline, doxepine and trazodone show neutral effects whereas bupropion has neutral to beneficial effects on PLMS/ RLS.

When withdrawn from opioid treatment, transient discontinuation effects could occur as well as an existing RLS could be unmasked.

When examining a maintaining or newly occurring insomnia, possible treatment side effects in form of RLS/ PLMS should be considered. If possible, substances should be replaced: antidepressants of other groups could be used; antipsychotic medication could be switched to antiepileptics or benzodiazepines. If the psychotropic medication cannot be changed, RLS and PLMD have to be treated on their own, if possible with dopaminergic substances which are the first-line treatment in RLS.
S25-02 - Preventive and Intensive Treatment of Psychosis for High-Risk and First-Episode Subjects
Authors: Nordentoft M. , Thorup A. , Jeppesen P. , Nordholm D. , Bertelsen M. , Petersen L.
Published: June 2010

Introduction

It is unknown if the positive effects of intensive early intervention programmes are sustainable over time. Duration of untreated psychosis (DUP) is associated with outcome of schizophrenia, and it has been proved that DUP can be shortened. Randomized clinical trials have tested possibilities for interventions in high risk groups.

Methods

We conducted a single-blinded randomized controlled trial of two years of specialized assertive early intervention programme (OPUS) versus standard treatment. A total of 547 first-episode patients with first episode psychosis or schizotypal disorder were included in the trial and reinterviewed after one, two and five years. OPUS treatment consisted of ACT with family involvement and social skills training.

Results

At five-year follow-up, the positive effect on psychotic and negative symptoms of the treatment seen after two years had disappeared. A significantly smaller percentage of patients from the experimental group were living in supported housing and were hospitalized fewer days during the five-year period. Among patients with schizotypal disorder, the proportion who had a transition to psychosis after one year was 8.1 vs. 28.0 percent for patients randomized to OPUS vs. standard treatment, respectively. At two-year follow-up the figures were 28.1 vs. 44.0. Duration of untreated psychosis (DUP) median was 48 weeks. Longer DUP was independently associated with more psychotic symptoms at entry and at one-year and two-year follow-up.

Discussion

Due to previous findings, we have started a new trial in which we will randomize 400 patients to two years versus five years of specialized assertive treatment.
S25-03 - At Risk Mental State for Psychosis: Clinical Features and Natural Course
Authors: Riecher-Rössler A. , Aston J. , Borgwardt S. , Gschwandtner U. , Pflüger M. , Zimmermann R.
Published: June 2010

Objectives

Despite significant advances, early detection and intervention regarding psychosis still face major obstacles. The Basel FePsy-study tries to contribute to optimising the methods for assessment of risk for psychosis, by describing individuals in an At Risk Mental State (ARMS) with and without later transition to psychosis as compared to healthy (HC) and depressive controls (DC) and by using a multidomain approach including not only psychopathology and clinical risk factors, but also neuropsychology, neurophysiology and neuroimaging.

Methods

60 ARMS subjects, 51 HC and 34 DC were investigated. 53 ARMS individuals could be followed up for up to 7 years.

Results

21 ARMS individuals made the transition to psychosis (transition rate 34%). As compared to HC, they showed significant deficits in executive functions and working memory. Predictors of transition were certain attenuated psychotic and negative symptoms and certain cognitive deficits. In an integrated model for prediction of transition using these variables, the overall predictive accuracy was 80.9%, with a sensitivity of 83.3% and a specificity of 79.3%. Specificity of prediction could be further improved by EEG analysis. Furthermore, MRI showed specific differences between ARMS with and without later transition to psychosis.

Conclusion

Individuals at risk for psychosis do not only show psychopathological prodromes and social decline, but also neuropsychological impairments and EEG- as well as MRI-abnormalities. Hopefully in the near future, a clinical staging of individuals according to their risk for psychosis will be possible with corresponding stepwise early interventions.
S31-02 - Physiopathology of Severe Refractory Hallucinations in Patients with Core Paranoid Schizophrenia (Affective Paraphrenia)
Authors: Foucher J. , Bennouna Greene M. , Bennouna Greene V.
Published: June 2010

We know from neurological diseases that there is not only one way to hallucinate. This might also be the case in the psychiatric field. During a trial on refractory verbal hallucinations, we rediscovered a subgroup described under several names in France (Délire chronique d’évolution systématique 1882, Psychose Hallucinatoire Chronique 1911-1953), England (Late Paraphrenia, 1954) and Germany (Affective Paraphrenia - AP, 1968). Roughly, AP can be viewed as the core of paranoid schizophrenia.

We compared 10 AP patients with refractory hallucinations to 35 healthy controls with structural and functional MRI (fMRI). We looked for regions that presented with both grey matter deficit relative to controls and with hallucination-related activity. The lateral orbito-frontal cortex (LOF) was bilaterally involved both anatomically and functionally.

Using fMRI, we studied whole brain functional connectivity, both as a trait factor, i.e. hallucinators vs controls, and as a state factor, i.e. ON vs OFF hallucinations in the same patient. As a trait, functional connectivity was significantly increased between left and right LOF in patients relative to controls; however as a state, functional connectivity dropped to zero between left LOF, left and right superior temporal sulcus (STS) when ON relative to OFF hallucination.

In a larger group of AP patients without ongoing hallucinations, the LOF was still disconnected from the cingulate and temporal regions, in comparison not only to controls, but also relative to non AP type schizophrenias, most of whom also hallucinate during episodes.

We will discuss the “LOF-story hypothesis” for AP patients and their hallucinations.
S31-03 - Modulation of Auditory and Visual Processing by Delta-9-Tetrahydrocannabinol and Cannabidiol: an FMRI Study
Authors: Allen P. , Winton-Brown T. , McGuire P.
Published: June 2010

Introduction

Cannabis is the world's most commonly used illicit substance. Whilst its effects on perception are well documented, little is known about the neural basis of these effects and how they are modulated by two of cannabis sativa's most abundant active ingredients, Delta-9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD).

Objectives

We used fMRI to assess the effects of THC and CBD on brain activation during a simple visual and auditory stimulation paradigm in healthy volunteers.

Methods

Fourteen right handed male subjects were scanned on 3 occasions. Identical 10mg THC, 600mg CBD and placebo capsules were allocated in a balanced double blinded pseudorandomised crossover design.

Results

Ingestion of THC and CBD led to reliable increases in plasma levels of each substance and for THC concomitant increases in anxiety, intoxication and positive psychotic symptoms; CBD and placebo caused no significant symptoms. Visual and auditory stimulation led to robust activations in occipital and temporal cortices respectively under placebo conditions. Administration of THC led to decreased activation in primary sensory cortices relative to placebo whilst CBD led to an increase in activation in right temporal regions during auditory stimulation and right striate cortex activation during visual stimulation. THC mediated reduction of activation in this area during auditory stimulation correlated with a concomitant rise in psychotic symptoms.

Conclusions

These data indicate that the different psychoactive constituents of cannabis have dissociable effects on sensory processing, often in opposite directions
S10-01 - The Philosophical Understanding of Schizophrenia
Authors: Stanghellini G. , Fulford B.
Published: June 2010

Schziophrenia is widely considered the most “philosophical” of all mental disorders. One main reason is that many persons with schizophrenia undergo experiences akin to what some philosophers want to attain by the suspension of common-sense attitude and beliefs. This phenomenon is quintessential to the formation of schizophrenic delusions. The typical metaphysical tinge to the contents of schizophrenic delusions is supposed to be the final configuration that this condition eventually comes to take on.

Thus, the clinical characterisation of persons’ with schizophrenia - as it commonly argued by phenomenologically-oriented clinicians - may take profit from a philosophical understanding of the symptoms of this syndrome and from a rigorous and philosophically-informed definition of concepts like ‘consciousness’, ‘self’, ‘subjectivity’, ‘intersubjectivity’ and ‘identity’. A number of recent as well as classic papers and books contributed to establish a model of schizophrenic psychoses as disorders of pre-reflexive self-awareness and other-awareness. This model is now receiving increasing consensus from clinicians as well as from philosophers, and also empirical validation. This symposium will build on and extend these ideas.
S10-03 - Hope and Personal Meaning in Schizophrenia
Authors: Schrank B.
Published: June 2010

For the individual a psychotic episode involves the profound experience of distress and identity confusion. The process of recovery includes redefining the self, understanding what has happened and finding new meaning and purpose in order to establish a personally satisfying, hopeful and contributing life.

Hope may be defined as a primarily future-orientated expectation of attaining personally valued goals that will give or restore meaning to one's own experiences. As such it may be seen as a pre-requisite for recovery but also as an important outcome of the recovery process.

This presentation will explore the connection between hope and the attribution of meaning in the process of overcoming demoralisation, resolving psychological defense and integrating the experience of severe mental illness from a psychological, philosophical, and therapeutic viewpoint. Empirical data on hope and its relation to personal explanations following a psychotic episode will be presented.
S01-01 - 5-HT4 Agonists: a Putative New Class of Antidepressants, with a Faster Onset of Action
Authors: Lucas G.
Published: June 2010

Objectives

Current antidepressants are clinically effective only after several weeks of administration. Because our previous studies indicated that both acute and sustained stimulation of serotonin4 (5-HT4) receptors facilitate central 5-HT activity, we assessed the ability of 5-HT4 agonists to induce antidepressant-like effects in the rat brain within a short (3 days) time-frame.

Methods and results

We found that 5-HT4 agonists reduce immobility in the Forced Swimming Test, displaying an antidepressant potential. Moreover, a 3-day regimen with such compounds modify rat brain parameters considered as key markers of antidepressant action, but observed only after 2-3 week treatments with classical molecules: desensitization of 5-HT1A autoreceptors, increased tonus on hippocampal postsynaptic 5-HT1A receptors, enhanced phosphorylation of the CREB protein and neurogenesis in the hippocampus. A 3-day regimen with the 5-HT4 agonist RS 67333 was also sufficient to reduce both the hyperlocomotion induced by olfactory bulbectomy, and the diminution of sucrose intake consecutive to a chronic mild stress. Moreover, the concomitant administration of a 5-HT4 receptor agonists with a classical antidepressant (SSRI) potentiated the amplitude of these effects, without altering the rapidity of action of the former.

Conclusions

These findings point out 5-HT4 receptor agonists as a putative new class of antidepressants, with a rapid onset of action.
S04-01 - Training of Medical Students in Psychiatry in England
Authors: Bughra D. , Howard R. , Agius M.
Published: June 2010

In the UK less than 4% of medical students choose psychiatry. This number has remained reasonably static but there have been an increase in the number of medical schools. There are many reasons why medical students in the UK get put off by psychiatry among these are the stresses experienced, not the right type of placement, stigma against psychiatry and psychiatrists by other disciplines and specialties. There has been massive changes in training system in the last 3 years and changes are continuing. Foe any psychiatric trainee the aim of training is to provide a doctor with an educational programme, which enables him or her to practice independently in psychiatry, whether as a consultant or as a senior member of an academic department. The Royal College of Psychiatrists has been in existence in some form since 1841 and as a body responsible for training is taking the shortfall in recruitment seriously. The report of a scoping group will be described along with lecture historical lessons which will be linked with the present and the way forward in recruiting and retaining medical students into psychiatry.
S04-02 - Teaching Medical Students Psychiatry in Central Europe
Authors: Höschl C.
Published: June 2010

Medical curricula in Central and Eastern Europe share the tradition and transformation of the university training under the strong German influence, modified by decades of communistic educational system. This tradition is characterized mainly by the classical educational formats (plenary lectures and practices), by the split of a discipline into “general” (psychopathology) and “special” (diseases) parts, and by predominating medical approach based on Kraepelinian nosological system. In recent decades, however, more problem oriented, integrated and interactive style of medical training penetrated also into this part of Europe. It was reflected by the introduction of new medical curricula with diversified teachings psychiatry in different modules including applied neuroscience, medical ethics, patient oriented approach and modern educational formats including electives in psychotherapy, biological psychiatry, psychopathology, assessment techniques, and methodology. Psychiatry becomes to be a part of modules such as pain, dyspnoea, basic medical problems and broader medical context. Neurobehavioral sciences are now more integrated and clinical rotation is more practically oriented (problem oriented). The example of a new curriculum introduced at the Third Medical School of Charles University in Prague will be presented.

Literature

Höschl C, Kozeny J. Predicting academic performance of medical students: The first three years. Am. J. Psychiatry 1997;154(6): 87-92 Höschl C. Pathways of Integrated Medical Curriculum. Surg Radiol Anat. 2007;29(6):423
S04-03 - Training Young Psychiatrists in Belgium
Authors: Zdanowicz N. , Reynaert C. , Jacques D.
Published: June 2010

Introduction

For the last dozen years, there has been a reduction of candidates for specialization in Psychiatry. Furthermore, we receive complaints from the units where they work as young psychiatrists after training. Although, five years ago the examination-selection to this specialisation became a federal contest which prioritises grades obtained during their medical studies, this does not alone account for this development.

Method

The authors teach in the Faculty of Medicine, but are also involved in the selection process, and in the process of accompanying candidates as they master Psychiatry. Based on their experiences and meetings with colleagues in other universities, they formulate hypotheses to explain this phenomenon.

Results

In addition to the reduction of numbers of candidates for specialisation, the complaints regard their competences in three domains: Pharmacotherapies, Psychoterapies, and their leadership style which is qualified as authoritarian.

We believe DSM II and subsequent versions had important effects on how psychiatry is taught. While trying to free the DSM from the influence of Psychoanalysis and not wanting to reduce training to merely learning statistical diagnostics and pharmacotherapeutic guidelines, training in Psychiatry has become «a little of everything and nothing precise». The result of this lack of content is young psychiatrists, lacking in self confidence and not sure enough of their references to establish a leadership style other than authoritarian.

Conclusion

During medical studies, we need to reinforce the courses of physio-pharmaco-therapy, Psychotherapy, and comparative psychopathologie and add training in team management.
S30-01 - Psychological Treatment of Minor Depression
Authors: Cuijpers P.
Published: June 2010

Subthreshold depression has a considerable impact on the quality of life and carries a high risk of developing major depressive disorder. Psychological treatments for subthreshold depression may be able to reduce depressive symptomatology and prevent the onset of major depression. In this presentation, an overview is given of psychotherapies that have been examined as treatments of subthreshold depression, including cognitive behavior therapy, problem-solving therapy, interpersonal psychotherapy, and internet-based guided self-help. Furthermore, the results of a meta-analysis of the effects of these psytchotherapies on subthreshold depression are presented. This meta-analysis shows that these psychological treatments have significant effects on subthreshold depression, and that these interventions may prevent the onset of major depression. After one year the effects of the psychotherapies are smaller, but still significant.
S30-03 - The MIND-Study: A Randomized Placebo-Controlled Trial on the Acute Treatment of Primary Care Patients with Mild and Minor Depressive Symptoms
Authors: Hegerl U.
Published: June 2010

Mild depressive syndromes are highly prevalent among primary care patients. Evidence based treatment recommendations need to be derived directly from this diagnostically heterogeneous group. Primary aim was to assess the efficacy of sertraline and cognitive-behavioral group therapy for treatment of depressed primary care patients, secondary aim was to evaluate if receiving treatment according to free choice is associated with a better outcome than randomization to a particular treatment. We conducted a randomized, placebo-controlled, single-center, 10-week trial with five arms: sertraline (flexible dosages up to 200 mg/day) (n=83); placebo (n=83); manual-guided cognitive-behavioral group therapy (1 individual session and 9 group sessions per 90 minutes) (n=61); guided self-help group (control condition (n=59); treatment with sertraline or cognitive-behavioral group therapy according to patients’ choice (n=82). From 1099 consecutively screened adult patients, 368 formed the intent-to-treat population with milder forms of depression. Primary outcome was a global efficacy measure combining z-converted Hamilton Depression Rating Scale and clinician-rated Inventory for Depressive Symptomatology. Sertraline was superior to placebo (p = 0.03). Outcome for guided self-help groups was worse compared to cognitive-behavioral group therapy (p = 0.002) and compared to all other treatment arms including pill placebo (secondary analyses). Outcome in the patients’ choice arm was similar to that in the sertraline and cognitive-behavioral group therapy. Overall, sertraline is efficacious in primary care patients with milder forms of depression. The superiority of cognitive-behavioral group therapy over guided self-help groups might partly be explained by “nocebo” effects of the latter.
W01-01 - (N)ever Discussed: The Normalisation of Homosexuality in German Psychiatry and Psychotherapy?
Authors: Mundle G. , Mahler D.L.
Published: June 2010

In Germany there is a scientific gap in psychiatry and psychotherapy towards specific aspects of different sexual orientations. There are only a few research studies investigating mental health in gay, lesbian and bisexual people and their special needs in the mental health care system. Non-pathologizing developmental theories and new findings about sexual orientation are hardly recognized in psychiatric textbooks, education and teaching.

Therefore in 2009 the DGPPN Referat “Sexual Orientation in Psychiatry and Psychotherapy” was founded. On the DGPPN congress 2009 the two symposia were organized. In the state of the art symposium specific aspects towards theories and mental health of gay, lesbian and bisexual people were discussed. Also the response of mental health professionals and ethical aspects of interventions aimed at changing sexual orientation were referred. In the second symposium influences of the Third Reich on the psychiatric perspectives towards homosexuality were discussed.

Future goals of the DGPPN Referat are the development of guidelines for treatment, teaching and education in Germany and the establishment of a German and European scientific network.
W04-01 - Catatonia: Differentiation, Pathophysiology and Treatment
Authors: Verhoeven W.
Published: June 2010

Catatonia is an intriguing psychopathological dimension and the discussion about the clinical relevance of catatonic symptoms in psychiatry is continuing for at least 125 years. The debate started from the original description by Kahlbaum and was further elaborated by Kraepelin and Bleuler who incorporated catatonia in their broad concept of schizophrenia. They regarded catatonic symptoms merely as an integral part of schizophrenia. In addition, periodic catatonia was described by Leonhard that has a considerable hereditary loading, shows a phasic course with alternating hyperkinesia and akinesia and can be delineated from the akinetic-hyperkinetic motility psychosis which belongs to the cycloid psychoses.

Over the past decades, the prevalence of the diagnosis of catatonia as a separate disease and as subtype of schizophrenia is decreased considerable. This phenomenon is most probably the result of changes in the diagnostic criteria as well as underrecognition of this symptom dimension.

Today's research is focussing on the pathophysiology, genetics and treatment of catatonia. As demonstrated in factor analytical studies, this disorder can be considered as a separate psychopathological dimension. Apart from the endogenous catatonias belonging to either the periodic catatonia or catatonic schizophrenia, the catatonic dimension is present in about ten percent of newly admitted patients with affective or schizophrenic psychoses.

In for different presentations, the need for a differential diagnosis of catatonias will be outlined as well as their genetic and pathophysiological backgrounds and appropriate treatment strategies, such as electroconvulsive therapy.
W04-04 - Genetics and Pathophysiology of Catatonia
Authors: Stöber G. , Schanze D. , Ekici A.B. , Reis A.
Published: June 2010

Catatonia has attracted increasing attention in relation to basic theoretical problems of psychiatry. Periodic catatonia (MIM 605419) is characterized by qualitative hyperkinetic and akinetic psychomotor disturbances through psychotic episodes, and debilitating symptoms in the long term with psychomotor weakness, grimacing facial movements, and apathy. Our aim was to identify new association loci for periodic catatonia a subphenotype of schizophrenic psychoses. We therefore performed a genome-wide association analysis using SNP Microarray and DNA pooling (SNP-MaP) with 500K Affymetrix arrays. We pooled DNA of 245 cases in three biological replicates (n=84, 84, 77) and 216 controls in two biological replicates (n=108, 108). All pools were processed in three technical replicates. Array data was analysed with a modified version of GenePool. We determined the mean relative allele signal value (RAS) of the technical replicates of each pool and compared each case pool with the combined controls. We used a 5-SNP sliding window approach and defined clusters as potentially associated loci if they overlapped in all biological replicates. We then verified pooling data at single genotype level for associated array SNPs at five selected loci using TaqMan assays in an extended cohort (344 cases, 585 controls). Two of these loci showed significant association at single marker (p=0.0002) and haplotype levels (p=0.0042), even after permutation correction (pc=0.0007; pc=0.0224). Our data show that hybridization intensities of pooled DNA correlate well with individual genotyping results. Thus DNA pooling is a useful strategy for GWAS since we were able to detect significant association loci in a complex disease.
CS03-04 - The Economic Consequences of Comorbid Diabetes and Depression
Authors: Knapp M.
Published: June 2010

Diabetes and depression on their own are debilitating and costly diseases. Their co-existance presents further treatment and funding challenges. This session will provide an overview of the economic dimensions of this comorbid relationship and present the findings of a systematic review of evidence related to this. The review found a growing literature demonstrating: increased resource use and health care costs, unemployment and lost productivity; poorer quality of life; and a higher risk of mortality arising from the co-existance of these illnesses. While there are some good quality studies evaluating the efficacy/effectiveness of various treatments, few include an economic evaluation and the generalisability of those is unclear. Therefore, while the evidence suggests little doubt of the broad-ranging economic impacts on patients, health care systems and wider society, there is still a gap regarding the cost-effectiveness of alternative approaches to the treatment and long-term management of this comorbidity within the context of limited health care budgets.
CS04-01 - Subthreshold Eating Disorders: Diagnostic Issues, Natural Evolution and Treatment Implications
Authors: Monteleone P. , Cotrufo P. , Maj M.
Published: June 2010

Introduction

Eating disorders (EDs) exist on a continuum ranging from innocuous but persisting dieting, through subthreshold states of uncertain significance, to full-blown cases of anorexia nervosa (AN) and bulimia nervosa (BN). Subthreshold EDs resemble AN or BN, but do not meet all their diagnostic criteria. The terms “partial syndromes” and “atypical EDs” are also used to identify these conditions.Objectives. To verify whether atypical syndromes are less severe forms of EDs or represent starting phases of EDs, we designed a two-step prospective study assessing the natural outcome of those syndromes over a 4-year time period.

Methods

In the first step, we screened 495 female students attending the first year of their high school by means of ad hoc rating questionnaires. Those students identified to being at risk for an ED underwent a psychiatric diagnostic interview. In the second step, 4 years later, we reassessed 140 of those schoolgirls who had participated in the first step.

Results

In the first step, we identified 1 subject with full-blown BN, 1 with partial-syndrome BN, 2 with subclinical BN and 8 with subclinical AN. At the reassessment 4 years later, none of the girls had received any form of help. The full-blown BN case, the partial-syndrome BN case and 1 of the subclinical AN cases persisted unchanged; 1 of the subclinical BN cases shifted to subclinical AN; the remaining subclinical cases remitted spontaneously.

Conclusions

Present findings provide the evidence that subclinical AN and subclinical BN represent unstable states that can spontaneously remit over time.
Recent Developments in the Treatment of Panic Disorder (PD) and Generalized Anxiety Disorder (GAD)
Authors: Siegfried Kasper
Published: June 2010

There is a high prevalence of panic disorder (PD) in the community. The National Comorbidity Survey, a US study of over 8000 adults in the general population, found a lifetime prevalence rate of 3.5%. This is a higher prevalence than that reported in earlier epidemiological studies, which documented lifetime prevalence rates of between 1.2 and 2.4%. Panic disorder is typically a disorder of young adults, with an impact on quality of life, in terms of social, personal, and economic consequences, at least comparable to that of major depression. Benzodiazepines, as well as selective serotonine reuptake inhibitors (SSRIs) have been studied thoroughly in acute and long-term PD. However, there is a lack of data to answer the question if there is an enhanced efficacy with the combination of psychological treatments as well as to guide the clinicians what to do after non-response.

Generalized anxiety disorder (GAD) is a chronic illness with an estimated one year prevalence of approximately 3%, and a lifetime prevalence of approximately 6%. GAD (without depression comorbidity) is associated with significant impairment in quality of life and functioning which has been found to be comparable to major depressive disorder, and chronic medical illnesses such as diabetes and arthritis. At least 5 classes of drugs are available for the pharmacologic management of GAD (Bandelow et al., 2008), each acting via different mechanisms: (1) benzodiazepines (diazepam, lorazepam, alprazolam, etc) which augment inhibitory GABAergic activity; (2) monoaminergic reuptake inhibitors, consisting of SSRI drugs with serotonin selectivity (paroxetine, escitalopram, sertraline), SNRI drugs with dual serotonin/ norepinephrine activity (venlafaxine-XR, duloxetine), as well as some first generation tricyclics (imipramine); (3) azapirones (buspirone) which modulate monoaminergic transmission; and (4) pregabalin, which acts presynaptically to inhibit excitatory neurotransmission. Two other classes of medication (antihistamines such as hydroxyzine; antipsychotics such as quetiapine) and recently a herbal remedy, silexan, have also demonstrated efficacy in the treatment of GAD. Cross-study comparisons suggest that each class of drug has a different benefit-risk profile. However, relatively few double-blind, placebo-controlled head-to-head trials have been published which provide direct comparisons of the efficacy and safety profiles of drugs in each class.
Brain imaging as a Diagnostic Tool in Clinical Practice?
Authors: Siegfried Kasper
Published: June 2010

Based on the sound knowledge of clinical psychiatry neuroscientists embark since over 20 years to discover the biological bases of mental disorders. Whereas the “window to the brain” was firstly dominated by neuroendocrine and biochemical models, we now have the possibility to use sophisticated brain imaging techniques which span from electrophysiology to techniques derived from nuclear medicine. Furthermore, the combination of brain imaging techniques with genetic variables promises to have a close insight into brain-environment interactions. For treatment of psychiatric diseases, multidimensional criteria for selection of a psychotropic medication is necessary to not only judge the clinical phenotype but also the functional phenotype and finally the genotype. Whereas the clinical phenotype is characterized by psychiatric syndromes including psychiatric and somatic comorbidity, the functional phenotype can be uncovered with neuroendocrine measurements, sleep physiology, imaging techniques as well as proteomics. Finally, the genotype can be characterized by single nucleotid polymorphisms (SNP), coupling as well as the determination of candidate genes. Imaging genetics is a new way to achieve insight in the genetic variables of changes on a cellular level which thereafter influence information processing and finally are represented in complex functional interaction of human behavior. Based on this knowledge it is evident that psychiatrists not only should be determined to the clinical symptomatology of their patients but also on the underlying biological processes which can in turn be influenced to various degress with pharmacological as well as non-pharmacological treatment modalities, since the brain has a specified way to get better.
Rating Scales and Standardised Diagnostics in Daily Routine
Authors: Bandelow Borwin
Published: June 2010

To assess the efficacy of psychiatric treatments, rating scales are essential. In this presentation, methodological and statistical problems associated with the use of rating scales in psychiatry are discussed, by taking the anxiety disorders as an example.

Not only standard symptom-specific rating scales, such as the Hamilton Anxiety Scale (HAMA), but also global measures such as the Clinical Global Impression Scale (CGI) and Quality of Life scales are used, as not only improvement of single symptoms, but also an overall increase of a patient's well-being should be the focus of a clinical trial. However, due to high placebo response rates in anxiety disorders, the use of rating scales is determined by the need for an instrument, which is sensitive enough to detect differences between active drugs and placebo (or between a certain psychological treatment and a psychological placebo). Quality of Life scales often do not detect such differences, as domains such as partnership or employment do not show rapid changes within the 8-12 weeks of a clinical study. Moreover, when using too many different scales, problems of multiple testing occur.

The outcome of a clinical study is often described by the number of patients who responded or remitted, as these endpoints are easily understood by patients. “Response” is commonly defined as a ≥ 50% reduction on these standard scales. However, this definition is arbitrary, and cut-off points should rather be founded on empirical data than on a thumb rule. The definition of “remission” on standard scale scores varies from study to study and is also very subjective. An analysis of available treatment studies in patients with anxiety disorders revealed that these definitions do not necessarily reflect clinical reality. Also, “number needed to treat” is an endpoint, which may lead to inaccurate assessments from a statistical point of view, because it is based on a subjective definition of remission. The adequate use of rating scales also touches ethical questions.
Psychiatry for Dermatologists: An Update
Authors: Sambhi Rajvinder , Lepping Peter
Published: June 2010

This presentation highlights the need for a close link between the psychiatrists and the dermatologists. There is undoubtedly a high prevalence of psychiatric conditions amongst both the dermatology outpatients and the inpatients. The psychiatric symptoms can be either a manifestation of distress secondary to the primary dermatological pathology or a primary psychiatric condition presenting as dermatological pathology. In both the cases, the risk has to be recognised as the distress can lead to a suicide attempt and therefore, it can be challenging to both the treating dermatologist and the psychiatrist as the patient can actively refuse treatment because of the stigma associated with the label of having a psychiatric ailment. This presentation mentions various psychiatric conditions with regard to dermatology and specific issues about the psychotropic and dermatological medications.

Mental disorders which can present in the dermatology clinics are anxiety, depression, obsessive-compulsive disorder, body dysmorphic disorder, delusional parasitosis or delusional infestation and dermatitis artefacta. It can be quite helpful for the dermatologist to be aware of the symptoms of these disorders whether primarily psychiatric or secondary to the dermatological pathology. The issues regarding medication are specifically with regard to Isotretinoin and combination treatments. An association had been reported between oral isotretinoin and mood changes, particularly depression and suicide but a recent systematic review did not find any conclusive evidence for such an association. Combination of cytotoxic agents with clozapine can exacerbate the risk of reduction in white blood cell counts. There is an increased risk of ventricular arrhythmias with the combination of erythromycin and antipsychotics. An increased risk of convulsions with a combination of erythromycin and clozapine has been mentioned. There are particular concerns about the over the counter use of St. John's wort, used in mild and moderate depressions with regard to interaction with various dermatological agents.

In summary, a close liaison between dermatologists and psychiatrists is essential to provide holistic care for patients presenting with dermatological pathology.
Rethinking Subthreshold Bipolarity: The Rebirth of Kahlbaum-Hecker Syndrome
Authors: Hantouche Elie G. , Erfurth Andreas
Published: June 2010

Bipolarity might be underdiagnosed by the DSM-IV. This could particularly pertain for young adults, when the disorder is in early stages and the manifestations of hypomania are not typical. Additionally, the current DSM-IV-based instruments are not sufficiently sensitive for detecting hypomania. Support comes from epidemiological and clinical studies, which showed that subthreshold BPD is common and clinically significant. In the National-Comorbidity-Survey-Replication (NCS-R) the overall prevalence of BPD increased from 2.1% up to 4.4% if subthreshold BPD was considered. Role impairment, comorbidity (alcohol abuse, panic disorder, impulse control), and family history of mania are the validators of subthreshold bipolarity. In the small prospective Zurich Study a stepwise broadening of the criteria for hypomania allocated almost half of the subjects with MDE to a broadly defined bipolar group. In bigger samples, such as 2300 patients presenting recurrent or resistant depressions, the hypomania rate, when dimensionnaly rated (by using the hypomania checklist) was more than 60%.

DSM-IV “Bipolar II disorder” and “Cyclothymia” are still ill defined with a great confusion among the territory of “Soft Bipolar Spectrum”, and clinicians need a more practical approach.

The Kahlbaum-Hecker syndrome of cyclothymia includes depressive (dysthymia), hypomanic (hyperthymia), and mixed hypomanic-depressive phases. According to French experts, Deny and Kahn (1909) supported the hypothesis that Cyclothymia represents a special constitution, which can be considered nowadays as particular affective temperament with close continuum with subtrheshold bipolarity.

The great idea of Kahlbaum, Hecker, Deny is to combine the following variables: 1) premorbid temperament; 2) age of onset, 3) time course of an illness (cyclicity / intermittence). Applying this combination, bipolar spectrum could be currently divided into 2 categories: “Typical BP-I/II” (episodic mania or hypomania with free intervals) versus “Cyclothymia” (radically instable form with continuous ups and downs). This intra-bipolar dichotomy seems to be closer to the clinical reality of mood disturbances. Cyclothymia is probably the most frequent expression of bipolar disorder (more than 30% of major depressions). Repeated brief swings with high mood instability and rapid switching seemed to be a distinct entity with early onset, irritable (“dark”) hypomania and high suicide risk. This condition emerged as the most prevalent and severe expression of the bipolar spectrum.
Mechanisms of gene-environment interaction in schizophrenia
Authors: Meyer-Lindenberg Andreas
Published: June 2010

Environmental factors and both common and rare genetic variants increasing risk for schizophrenia are being discovered, but the neural mechanisms that mediate their impact are only now coming into focus. We discuss work from a translational genetics approach, with a focus on neuroimaging, delineating mechanisms of genetic risk through interaction of prefrontal cortex with striatum, midbrain and hippocampus. Using social status as an example, we identify dissociable neural responses to perceived social rank using functional magnetic resonance imaging (fMRI) in an interactive, simulated social context. In both stable and unstable social hierarchies, viewing a superior individual differentially engaged perceptual-attentional, saliency, and cognitive systems, notably dorsolateral prefrontal cortex. In the unstable hierarchy setting, additional regions related to emotional processing (amygdala), social cognition (medial prefrontal cortex), and behavioral readiness were recruited. Furthermore, social hierarchical consequences of performance were neurally dissociable and of comparable salience to monetary reward, providing a neural basis for the high motivational value of status. Finally, we discuss GEI impacting on these circuits, with a focus on validating epidemiologically identified GEI on the neural circuit level.
PF01-01 - Mental Health and the European Big Cities
Authors: Bassi M.
Published: June 2010

In 1900 only 15% of world population lived in urban areas. In 2030 this percentage will rise to 60%. On May 23, 2007, according to data published by North Carolina State University and Georgia University, the overtaking took place: for the first time the urban population exceeded the rural. Over the last few years research on urban mental health has flourished, as significant contribution have been made in this expanding field. In this update we will summarize the latest developments in the field. First we will discuss the most important research approaches in urban mental health and then will discuss environmental as well as social determinants of urban mental health. The three most commonly cited approaches are the rural vs. urban approach, the intercity comparisons approach and the multilevel contextual model. More recently, Vlahov et als (Vlahov et als, 2005) summarized them as follows: the: urban health penalty, the urban sprawl model, the urban health advantage model and the urban living conditions model.The urban health penalty model posits that urban areas, due to unhealthy environments create the conditions for poor health. Thus, penalty stands foor higher rates of of medical problems, mental illness and substance abuse.For example, a recent German study found that higher levels of urbanization were linked to higher 12 month prevalence for almost all major psychiatric disorders (Dekker et als, 2008) Similarly, in the Netherlands five levels of increasing urbanization were significantly associated with increasing prevalence of psychiatric disorders. (Penn et als, 2007).