bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex-specific Long-term Behavioral and Neuroendocrine Consequences Oftransient Peripubertal Metabolic Challenges
Authors: Patchev A. , Sousa N. , Almeida O.
Published: March 2009

Interaction between neuroendocrine stress and metabolic signals has become increasingly linked to the pathogenesis of affective and cognitive disorders. Independent evidence shows that nuclear receptors represent an essential interface of communication between these signals and the central nervous system.

On the premise that lifelong brain functions are subject to programming by stressful and metabolic signals during early life, we induced voluntary hyperphagia in prepubertal male and female rats by providing them with a cafeteria-like choice between normal chow and foods with high motivational value (palatable, high fat/high energy). The cafeteria diet was withdrawn from one subset of animals during early adulthood (postnatal day, PND 80), and several endpoints of interest were monitored until PND 200. While both sexes displayed similar metabolic outcomes during exposure to the cafeteria diet, there were substantial sex differences in the metabolic, behavioral and endocrine consequences of withdrawal of palatable food. Consistently increased food consumption and body mass gain were recorded in males, whereas females that were pre-exposed to the cafeteria diet showed clear signs of adrenocortical hyperactivity. Thus, besides verification of sex-specific mal-programming of appetitive behavior and metabolic set-points by early life events, we also demonstrate evidence for differential translation of metabolic challenges during peripubertal development into aberrations suggestive of altered neuroendocrine responsiveness to stress.
How Hormones Influence Gene Expression: Implications to the Pathophysiology of Schizophrenia
Authors: Brentani H. , Carraro D. , Mota L.D. , Maschietto M. , Mello H.B. , Torres C.H. , Gama C.S. , Goodman A.B. , Belmonte-de-Abreu P. , Palha J.A.
Published: March 2009

Schizophrenia is a complex genetic disorder. The lack of concordance on disease manifestation in monozygotic twins provides clear evidence that environmental factors are key determinants in disease aetiology. In accordance, various environmental modulators such as hormones and vitamins may well contribute to the altered expression pattern of several genes identified in post-mortem brain tissue of patients. We constructed a microarray platform containing 1,808 human genes, where 142 belong to vitamin A, thyroid hormone and estrogens’ metabolic pathways, to specifically address whether these could contribute to a molecular signature of schizophrenia in peripheral lymphocytes. We found that the genes encoding for PLP1, UGT1A6, NTRK1, THRAP1, ESR2, TRIP13, MAPK8, TGFB2, IGFBP4 are differentially expressed in lymphocytes of patients under treatment with clozapine, risperdal or haloperidol. Some of these genes have been previously reported by others to be altered in brain regions of schizophrenic patients, and all are implicated in pathways suggested to be involved in the disease. These observations further support that:

1.

studies in peripheral blood lymphocytes may contribute to reveal candidate genes in schizophrenia;

2.

transcription modulation of several genes may occur through the mediation of vitamin and hormones, therefore linking genes and environment in schizophrenia.

In order to understand the involvement of these genes in schizophrenia, future studies should investigate whether some of the observed changes are replicated in animal models of the disease, and how antipsychotic treatment interferes with their expression.
Geriatric Psychiatry and Human Rights in Romania - Involuntary Treatment
Authors: Tataru N. , Dicker A.
Published: March 2009

The protection of human rights and the dignity of persons with mental disorders has not a relatively short history in Romania. We have a short review of legislation and of conditions of hospitalization concerning involuntary commitment of the mentally ill people during our history before and after 1989, having more than 30 years experience in the field. Since 1989 it has been necessary to create committees to investigate abuse during involuntary commitment. On the other hand, before 1989 some persons with (or even without) mental disorders were committed to a psychiatry department to protect them. Generally, Romania's legislation is in keeping with principles set out by the World Health Organisation, United Nations and so on, concerning the protection of people with mental illnesses. The legislation calls for adequate treatment and respect for the human rights of the persons with mental disorders.

Standards and practice regarding involuntary commitment in a psychiatric department and also involuntary ambulatory treatment of person with mental disorders have been improved since the introduction of the new mental health law in 2002. We discuss about the assessment of competence in the elderly and ethical aspect of care and research, and about involuntary commitment of incompetent elderly patients. We also refer to the complications and difficulties when trying to apply the civil commitments compulsive hospital admission measure. Involuntary commitment of incompetent patients took in the consideration the best interest of the patient, but also the well-being of the family and the potential risk for others.
Involuntary Admissions and Guardianships: Differences and Commonalities in Germany and Switzerland
Authors: Stoppe G.
Published: March 2009

Germany and Switzerland are neighbour countries and have a long history of exchanging cultural and scientific issues especially - because of the common language - with the German speaking part of Switzerland (about 66% of the population). Both are federal states and laws for psychiatric patients are mainly task of the member cantons / states. However, large differences regarding the “liberal” history between both countries may be the reason for differing attitudes and regulations to involuntary admissions and guardianships. Examples will be given, especially concerning demented patients.
Compulsory Hospitalization, Involuntary Treatment and Guardianship in Czech Republic
Authors: Mohr P. , Tuma I.
Published: March 2009

The Czech law related to compulsory hospitalization dates back to 1966, but it has been revised several times. Besides having mental illness as a criterion for compulsory admission, the law requires the criterion that the patient may only be committed to the hospital, if he is an acute danger to himself and/or others. The Czech law does not accept the criterion that patient may be committed, if there is a danger to his health or if his behavior is not accepted to the community. The law does not specify the type of psychiatric illness required for a person to be committed. A patient admitted voluntarily to a psychiatric ward can be subsequently detained if he fulfilled the criteria of the law. The psychiatrist must examine the patient, decide and apply for commitment. The court has to be notified of compulsory admission in period of 24 hours. The detention is decided by judge in seven days. The detention could last up to 3 months then should be reevaluated by court. Appeals or complaints regarding compulsory acts are referred to the court by guardian or patient himself. A competence proceeding and the appointment of a guardian is considered in the case of demented, retarded, and in some cases of psychotic people. At issue is whether such people are capable of managing their own affairs, to make sound judgment-to weigh, to reason, and to make reasonable decision. Incompetence is decided by judge. Expert psychiatric witnesses play a role in determining the level of incompetence. The court appoints a guardian.
The European Alliance Against Depression (EAAD): An Evidence Based Cost-effective Approach to Improve Depressed Patients Care and Prevent Suicidality
Authors: Hegerl U. , Network E.A.A.D.
Published: March 2009

The European Alliance Against Depression (EAAD) is a 4-level, community-based intervention programme to improve the care of depressed patients and prevent suicidality in Europe (1).

In 2001, a pilot project, the ‘Nuremberg Alliance Against Depression’, was initiated. This community based intervention program comprised a 4-level action programme, implemented in the city of Nuremberg (500,000 inhabitants) (2). Careful evaluation has provided evidence that this program is effective: the number of suicidal acts was reduced by 24% during the two year intervention compared to a baseline year and a control region (2).

Based on these positive results 18 international partners representing 16 different European countries established the ‘European Alliance Against Depression’ in 2004. The EAAD partners initiated respective regional intervention programmes addressing depression and suicidality. Evaluation of the activities takes place on regional and international level.

The European Commission listed EAAD as a ‘best practice’ model in its Green Paper (European Commission 2005).
Religion and Spiritual Advice as Surrogate Care Provision for Mental Health Problems in the ESEMED Survey
Authors: Kovess V. , de Graaf R. , Haro J.M. , Bruffaerts R. , Gilbert F. , Briffault X. , Coldony J. , Alonso J.
Published: March 2009

Objective:

To complete missing information on the influence of spiritual and religious advisors as informal providers for mental health problems in Europe.

Methods:

Recourse to religious practice or belief when coping with mental health problems was evaluated using data from the ESEMED survey. This was a stratified, multistage, clustered-area probability sample survey of mental health carried out in six European countries which included 8796 subjects. Between countries differences in sociodemographic characteristics, religious affiliation, and prevalence of mental disorders and management of mental disorders were evaluated.

Results:

Religion appears to play a limited role in coping with mental health problems in Europe. Only 7.9% of individuals seeking help for such problems turned to a religious advisor. This proportion differed between countries from 13% in Italy, 12.5% in Germany, 10.5% in the Netherlands, 5.8% in France, 4.7% in Belgium to 4% in Spain. In addition, seeking help exclusively from religion was reported by only 1.3% of subjects. Practicing religion at least once a week and considering religion as important in daily life were predictors of using religion versus conventional health care only. Use of religion was not influenced by gender and age. Non-Christian respondents and individuals with alcohol disorders were more likely to use religion. In Spain, the use of religion is much lower than average.

Conclusions:

Unlike the situation in the United States, organised religion does not provide alternative informal mental health care in Europe. At best, it could be considered as an adjunct to conventional care.
Development of a European Measure of Best Practice for People with Long Term Mental Illness in Institutional Care (DEMoBinc)
Authors: Killaspy H.
Published: March 2009

This presentation will give an overview of the aims and progress of the DEMoBinc study. The project aims to develop a toolkit for assessing the living conditions, care and human rights of people with long term mental illness in psychiatric and social care institutions in European countries. The study has been funded for 36 months by the European Commission and started in March 2007. It involves eleven centres across ten countries: UK; Germany; Spain; Czech Republic; Bulgaria; Italy; Netherlands; Poland; Greece; Portugal.

The toolkit will assess domains considered most important for service users’ recovery and is designed for use in a face to face interview with the institution manager. The domains have been identified through an international literature review and Delphi exercises in each country with mental health professionals, clients, carers and advocates and agreed by the research partners and an international panel of experts in rehabilitation and recovery. The toolkit will be refined through the course of the study to maximise:

a.

its reliability;

b.

its usability;

c.

its ability

to deliver assessments that can be used within each country's established systems of change at local, regional and national level. The toolkit assessment will also be compared against clients’ quality of life, autonomy and markers of recovery to test whether it can deliver a proxy-measure of the promotion of individuals’ human rights and recovery. In addition, a health economic component will assess the institution's “value for money”.
The DEMoBinc Study in Portugal: Development and First Results
Authors: Cardoso G. , Coelho C. , Caldas de Almeida J.
Published: March 2009

The DEMoBinc study's main objective is to develop an instrument for assessing the living conditions, the quality of care, and the human rights of long-term mentally ill patients in psychiatric and social residential care. It started on March 2007, with 11 centres and 10 countries participating.

The Portuguese centre has carried out a national literature review of mental health legislation, standards of care related with residential care for mental patients, and mandatory procedures for physical restraint and seclusion.

A three-round Delphi exercise with four groups of experts - advocates, mental health professionals, service users, and carers - was also developed. In the first round the participants were asked to state the ten more important components of care helping recovery in institutional care for the long-term mentally ill. The results were sent back to be rated for their importance on a 5-point scale. Finally, the participants were asked to confirm or change their own scores in comparison with the calculated group median. Between twelve and 18 participants by group were contacted, and the overall rate of participation was 73%.

A pilot study using the first draft of the DEMoBinc instrument was done, and refinement of the instrument is being carried out in twenty institutions and will be completed during the next months.

The results of the Portuguese centre on the national literature review, the Delphi exercise, and the first phase refinement of the DEMoBinc instrument will be presented and discussed.
The Relationship Between Streptococcal Antibodies and the Course of OCD and Tics in a Pediatric Population
Authors: Murphy T. , Storch E.
Published: March 2009

The clinical phenotype of pediatric OCD and tic disorders in relation to streptococcal antibody patterns will be discussed. Also, cellular and other immune findings will be presented on a group of children with OCD and tic disorders taking into account clinical phenotype data.
European Portal for High Quality Links Selected by Colleagues: www.psychiatrynet.eu
Authors: Hoek H.W. , van Harten P.N.
Published: March 2009

The internet makes it possible to search in an endless variety of information. However, not all information is valid and reliable. Googling the term schizophrenia gives over 10 million hits. Among these hits there are some high quality websites, but also many sites with useless or even misleading or false information. With this workshop the editors-in-chief of the website www.psychiatrynet.eu will present search strategies for the participants, which they can apply in their daily practice. In June 2008 the English version of www.psychiatrynet.eu has been launched modelled after the Dutch website www.psychiatrienet.nl (launched in 2001). The lead of the website is ‘An independent selection of high quality links by your colleagues’. Independency is a basic value and the financial support comes from the Foundation of the Netherlands and Flemish Journal of Psychiatry. The current editorial board consists of over 50 mainly Dutch and Flemish psychiatrists, who select links and provide a short description of the links. In the forthcoming years members from different European countries will be selected to join the European editorial board. The goal is to become a key website for psychiatrists in Europe.
Searching www.psychiatrynet.eu
Authors: Harten P.N. van , Hoek H.W.
Published: March 2009

The European portal www.psychiatrynet.eu offers a selection of high quality links for the practising psychiatrist, but also for researchers in psychiatry. The editorial board has selected websites for 16 categories of psychiatric disorders, following the DSM system. There are also links related to treatment, specific areas of interest and more general categories.

For example, if your are looking for guidelines for the treatment of schizophrenia, you will find a brief (3-6 lines) description of the NICE and APA guidelines and a link to these guidelines (in PDF) in the category psychotic disorders. You can search on a wide variety of relevant and checked information, like what are the international organisations on eating disorders or on specific substance abuse. If you want to know the names of the members of the DSM-V workgroups or the journal impact factors 2007, you can find it under general categories or by using the search function of www.psychiatrynet.eu.
Challenges in the Diagnostic Process of Deaf and Hard of Hearing Patients with Mental Health Problems
Authors: Sleeboom-van Raaij C.J.
Published: March 2009

Mental health services in many countries undervalue the special needs of people with auditive disorders. The diagnosis and treatment of mental health issues in this group of people, however, requires special skills in communication and knowledge of language and, relevant medical, psychosocial and cultural issues related to the auditive disorder. The great variation between these aspects complicates the psychiatric diagnostic process. In addition, there is a remarkable diversity of psychiatric syndromes and special target groups; these include deaf and hard of hearing patients, deaf-blind patients, mentally retarded patients, patients with brain damage, immigrants, forensic patients, patients with special medical problems and patients who have been physically and sexually abused.In several European countries specialised services have been developed with multidisciplinary teams. These teams observed difficulties in the diagnostic process and classification. Neither were psychiatric and psychological scales reliable nor validated, because they needed to be adapted to the language skills of the patients. Symptoms such as auditive hallucinations presented differently. In special causes of deafness such as prenatal Rubella, special symptoms occurred.In this lecture, an overview of these diagnostic problems will be presented illustrated with case-histories. A research project into the validity of screening lists for mental disorders and autism in mentally retarded deaf people will be discussed.
Drugs Treatment for Deaf People
Authors: Menguiano C. Moreno
Published: March 2009

The resources for deaf persons’ mental health and the studies in the field of the psychopharmacology are nowadays inadequate to meet the specific needs of this population. The indications or the way of using the medication do not differ between deaf and hearing persons, but it is not well-known among professionals that during the psychopharmacologic treatment of deaf patients it is possible to observe the presence of intense and unexpected side effects of the medication, so that it does turn out to be indispensable to give special attention to the prescription of psychoactive drugs in deaf persons. This ignorance is partly due to the fact that the research in this area is deficient. The above mentioned side effects are more prevailing and intense in deaf persons than in hearings and often interfere with basic aspects of a person's daily life as it is his system of communication, the language of signs that becomes affected, for example, due to alterations in the vision or the movement, which means in practice (at the same time) a decrease in the quality of life. Therefore, our aim is to emphasize that the indications for pharmacological treatment in deaf persons are the same than in hearings and at the same time to emphasize the importance of knowing the specific needs.
Netrin-1 Receptor Deficient Mice: A Phenotype Resistant to Psychopathology?
Authors: Flores C.
Published: March 2009

Dysfunctions of the midbrain dopaminergic system are implicated in the psychopathology of schizophrenia and other disorders including drug addiction. Abnormalities in brain development play an etiological role in schizophrenia leading to altered dopaminergic function in adulthood and increased vulnerability to the effects of stimulant drugs. Netrins are proteins that organize neuronal connectivity during development and their receptors are highly expressed in dopaminergic neurons. We find that adult netrin-1 receptor deficient mice exhibit altered dopamine-related behaviors and show profound molecular and anatomical changes in dopamine systems that appear opposite to those observed in developmental animal models of schizophrenia or following chronic use of drugs of abuse. Significantly, the signs of this apparently ‘protective’ phenotype are not evident in pre-pubertal mice. We propose that variations in netrin-1 receptor function at critical periods in development could contribute to individual differences in susceptibility to psychopathology.
Elderly Abuse in Turkey
Authors: Icelli I.
Published: March 2009

In Turkey, in the families who moved from rural settlements into city, the young peoples go to work and the grand parents take care of the little children at home. When the grand parents become old, there will be no one who can take care of them. This situation shows two solutions: to move back to their native environment or to be settled in a nursing home. If they have no where to go, these nursing homes are their only chance.

The private nursing and caring homes, from the point of quality, are not in the same equality. The low-quality institutions are more familiar to the abuse. The residents of these institutions expect kindness, affection and warmth, but they never receive these expectations.

A new kind of elderly abuse in Turkey is the Automatic Transfer Machines thefts. On the paydays the thief comes next to the machine, offers help to the elderly who came to take his retirement salary from the machine; the thief takes the ATM card, put in the hole, ask the password, enter it and take the money and run with a high speed. The poor old person looks after.

There are no criminal codes yet which cover the elderly abuse in Turkey. Those kinds of incidents are taken as ordinary police incidents. The administration is now in preparation of a new program and a new regulation.
Interepisode Functioning of Bipolar Disorder
Authors: Aydemir O.
Published: March 2009

Even though bipolar disorder is suggested to have a benign course with episodes and remissions, it has been shown that interepisode functioning of bipolar disorder is not so good. Subclinical residual mood symptoms are found to be in 24% of bipolar patients during remission. Furthermore, it appears that 30-60% of individuals with bipolar disorder fail to regain full functioning in occupational and social domains. In cognitive domain, euthymic bipolar patients demonstrate relatively marked impairment in aspects of executive function such as processing speed and verbal fluency, sustained attention, and verbal memory.

It is estimated that 30-50% of largely remitted patients fail to attain premorbid levels of psychosocial functioning due to their cognitive impairment. It is also suggested that the subsyndromal residual depressive symptoms have substantial effect on the persistence of cognitive and psychosocial impairment after remission. Thus, residual symptoms play an important role in the inter-episode functioning of the bipolar patients.

In the assessment of interepisode functioning, subjective QOL in bipolar patients may not accurately reflect objective functional outcome status. Especially, in the subjective assessment of cognitive functions, bipolar patients tend to over-estimate themselves. There is only weak to moderate correlation between subjective cognitive complains and objective cognitive tests. Therefore, it would be more accurate to assess the inter-episode functioning of the bipolar patients via objective tests and ratings.
Consultation Liason Issues in the Training of Psychiatry Residents in Portugal
Authors: Castro L.C.
Published: March 2009

Background:

It is widely recognized the importance of Consultation Liaison (C-L) training for general psychiatry residents. The present International and European panorama is diverse among countries which reflect different cultural, historical and political backgrounds.

Aim:

To present the postgraduate training in C-L Psychiatry during Psychiatry Residency in Portugal and discuss it in a trans-european perspective.

Methods:

Review of the literature. MEDLINE and PubMed databases searches, using combinations of the Medline Subject Heading terms consultation-liaison psychiatry and training, residency, internship.

Results:

In Portugal, during postgraduate training, rotation to a C-L psychiatry service is mandatory, with a minimal duration of three months. It is possible to prolong the duration of the stage for several months as an optional rotation training. National psychiatric directives define generally the core competencies and skills to acquire during the C-L Psychiatry training. There are no specific national guidelines for C-L Psychiatry training. There is no C-L Psychiatry speciality or sub-speciality. Liaison Psychiatry is practised in general hospitals where there is a psychiatric unit.

Conclusions:

Portuguese psychiatry residents are exposed to C-L work as part of their clinical experience in general psychiatry as the national psychiatry residency training program include three months minimum of compulsory training in C-L Psychiatry in a general hospital. It is crucial to reflect on training issues in C-L Psychiatry in Portugal and Europe, since it is a step to a common path of higher quality and homogeneity of training across european countries.
New Developments in Classification of Sexual Dysfunctions
Authors: Segraves K. , Segraves R.
Published: March 2009

The diagnostic system for the sexual dysfunctions in the Diagnostic and Statistical Manual was originally developed by expert opinion, literature review and from feedback from experts in the field of human sexuality. In spite of considerable research in the area of human sexuality over the intervening years, there have been minimal changes to the diagnostic criteira for the sexual dysfunctions since their description in DSM III. These critieria sets lack precison. Progress within the field requires precise defintions to select homogenous groups for clinical research,. Current data suggests that many of the sexual dysfunction diagnoses can be updated with severity and duration criteria. This presentation will suggest revision to the diagnositc criteria based on recent clinical research.
The perspective of German-speaking Countries for the Future work to Develop ICD-11
Authors: Gaebel W.
Published: March 2009

In the course of the revision of the International Classification of Mental Disorders (currently 10th revision, hence ICD-10), an international scientific partnership network group was founded by the World Health Organisation (Chair: N. Sartorius, Geneva) in order to review the international scientific evidence of putative significance for the revision of ICD-10 in different language areas.

In the course of this project we reviewed several areas of activity that may be of importance for the review process to develop ICD-11. First of all, general questions arise about how a psychiatric classification system should be organized. Will it still depend on classical psychopathological information with additional information from imaging, genetic and laboratory studies, and finally the patient history? An alternative approach is based on functional psychopathology be based on functional neural modules which represent functional activities of the human brain and their disturbances in mental disorders. Another area of debate is whether dimensions rather than categories shall lay a new foundation for the classification of mental disorders. A further issue arises when considering narrative elements of psychiatric history taking. In how far can or should such factors be integrated? All these questions are interwoven with the classical German contributions to psychiatric nosology by Kraepelin and Bleuler, which will be reassessed on the background of these current topics in revising ICD-10.
Psychotherapy Training. How Can Skills be Assessed?
Authors: Lindhardt A.
Published: March 2009

Aims:

Psychotherapy training is a sensitive treatment based upon the confidence between therapist and patient. And a specific focus on ethical conduct is needed because of the dependencey relation which to a certain degree is a therapeutic tool.

Different types of psychjotherapy requires different assement and evaluation techniques. from listenng to auditapes, the use of video tapes, and supervion based on process notes.

The advantages and draw back of different techniqes will be discussed and the recommendations from UEMS on psychotheraoy training will be included in the presentation
Influence of the Mother’s Emotional State on Infant Irritability is Moderated by the 5-HTTLPR Polymorphism
Authors: Sanjuan J. , Ivorra J.L. , Jover M. , Carot J.M. , de Frutos R. , Molto M.D.
Published: March 2009

The serotonin transporter gene-linked polymorphic region (5-HTTLPR) may moderate an individual's response to stress. This study analyzes how the infant 5-HTTLPR may interact with the level of their mother's emotional state to affect infant irritability.

A prospective study was carried out with 314 newborns and their mothers. Infant irritability and the mother emotional state were evaluated at 8 and 32 weeks after childbirth. These variables were correlated with the 5-HTTLPR genotypes of both the infants and their mothers. The irritability score of infants with the s allele of 5-HTTLPR showed a linear relationship with their mother's anxiety at both 8 (P= 0.009) and 32 weeks (P= 0.008). In Infants carrying the ll genotype irritability was independent of their mother's anxiety.

This study provided evidence that the promoter 5-HTTLPR polymorphism could moderate the influence of the mother's anxiety on infant irritability.
Essential Features in Outpatient Care of Severely Mentally Individuals
Authors: Burns T.
Published: March 2009

Aims:

Most community mental health services have evolved in response to the downsizing and closing of mental hospitals. Their form varies in different health care settings and their evolution was rarely subjected to formal evaluation. The introduction of Assertive Community Treatment in 1980 lead to a flurry of research activity which yielded conflicting results. Examination of these results provides the opportunity to distinguish essential from redundant components of care.

Methods:

Two separate studies were conducted - a systematic review followed by cluster and regression analysis of reported components of care and a secondly a meta-regression analysis of published studies.

Results:

The meta-regression demonstrated that most of the variation in hospitalization outcome was due to differences in baseline hospital usage. Staffing levels (e.g. caseloads) were not found to be crucial but multi-disciplinary working and integrated psychiatrists were. The systematic review indicated the importance of integration of health and social care and outreach.

Conclusions:

Multidisciplinary teams which include both social workers and psychiatrists and which focus on visiting patients at home are highly successful in managing severely ill patients in the community. Many of the detailed requirements proposed for ACT teams are probably superfluous.
Drug Interactions with Antidementia Drugs: Clinical Consequences
Authors: de Mendonça Lima C.A.
Published: March 2009

Alzheimer" disease (AD) is a major public health problem, and it is at the origin of a significant burden: 15% of direct costs in dementia are attributed to pharmacological treatment. Persons with dementia often have comorbidities and receive multiple medications. Both factors increase the risk of drug-drug interactions (DDIs) which can result in adverse drug reactions (ADRs). In a study, a total of 1058 spontaneous reports were identified that involved cholinesterase inhibitors (ChEIs) in the French Pharmacovigilance Database; 35.5% contained at least one DDI; 118 of them (31.4%) were the cause of ADRs. Pharmacodynamic interactions play a far greater role than pharmacokinetic interactions in the significance of DDIs. Some known interactions with ChEIs are:

1.

atropinic drugs aggravate cognitive disorders;

2.

combinations of ChEIs and antipsychotics are associated with an increased risk of extrapyramidal adverse effects;

3.

combining ChEIs with drugs that reduce the heart rate, depress cardiac conduction, or induce torsades de pointes increases the risk of arrhythmias and cardiac conduction disorders.

Recent studies suggest that the therapeutic response in Alzheimer"s disease is genotype specific, depending on genes associated with AD pathogenesis and/or genes responsible for drug metabolism. APOEe4/e4 genotype carriers are the poorest responders to treatments. Some ChEIs are metabolized via CYP-related enzymes and can interact with other drugs that are substrates, inhibitors or inducers of the CYP system. Health professionals should be aware of the potential adverse effects of ChEIs, including the possible DDIs and antagonist effects with other drugs.
Posttraumatic Disorders in Patients with Substance Use Disorders: A German Multi-center Study
Authors: Schäfer I.
Published: March 2009

Aims:

This multi-center study examined the prevalence of posttraumatic stress disorder (PTSD) and the level of dissociative symptoms in a German population of patients with different substance use disorders (SUD).

Method:

A total of 459 participants (59.7% male) were recruited in 14 study centers. Of these, 182 (39.7%) were alcohol dependent (A), 154 (33.6%) were drug-dependent (D), and 123 (26.8%) were dependent on both, alcohol and drugs (AD). Diagnostic measures included the Addiction Severity Index (ASI), the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Scale (DES), and the Posttraumatic diagnostic scale (PDS). The International Diagnostic Checklists (IDCL) were used to confirm DSM-IV diagnoses of PTSD and SUD.

Results:

25.3% of the subjects had PTSD confirmed by both IDCL and PDS. Higher rates were found in the AD (34.1%) and D (29.9%) groups as compared to group A (15.4%, p < .001). Similarly, rates of dissociative symptoms as measured by the DES differed significantly between the different subgroups (AD: M=15.1±11.3; D: M=12.9±11.7; A: M=9.9±8.8; p < .001). In a stepwise linear regression model, childhood trauma severity was associated with dissociation independent from current PTSD. The relationships between SUD group and dissociation ceased to be statistically significant when age and gender were included in the model.

Conclusion:

The findings support significant rates of PTSD and dissociative symptoms in patients with SUD and marked differences between the different SUD subgroups. The complex relationship between childhood trauma, dissociation, and PTSD in patients with SUD requires more research.
Complex Posttraumatic Stress Disorders in Patients with Substance Abuse
Authors: Langeland W.
Published: March 2009

The author will review the published data on complex posttraumatic stress disorder (Complex PTSD) in patients with substance abuse. Especially after interpersonal traumatization in childhood PTSD symptoms may be complicated by personality changes suchs as disturbed affect regulation, memory, self-image and relational problems. This syndrome has been labelled "PTSD with associated features" in DSM-IV-TR and is known by clinicians as "complex PTSD" or "Disorders of Extreme Stress NOS". The recognition of the range of interrelated problems associated with a history of early severe interpersonal trauma is an important development with much relevance for the field of substance abuse. Despite the evidence that a majority of women who are seeking treatment for addictions have been exposed to early and multiple traumatic experiences, standard treatment programs do not typically assess or target these associated impairments, which greatly complicates the prognosis. In practice, integrating interventions that specifically target the associated features are often recommended for these patients. Suggestions will be given for furture research.
Developing Services for Schizophrenia in Croatia, Slovenia, and Bosnia
Authors: Agius M. , Blinc-Pesek M. , Ivezic S. , Martic-Biocina S. , Svab V. , Gruber E. , Kulenovic A. Dzubur
Published: March 2009

Along the coast of the Adriatic, several small projects have developed to improve treatment of patients with Schizophrenia. All these projects have benefited from links with the Department of Psychiatry in Cambridge.

In Ljubljana, The Ljubljana Prodrome Project has developed a system of early intervention and treatment which has a strong research arm. It has contributed knowledge about how psychosis develops, and shown that treatment in the prodromal phase of illness gives patients significant advantages.

The Assertive Outreach Team in Ljubljana Psychiatric Hospital has reduced readmissions for the chronic patients it deals with. Case Management in the Community has also been established at Vrapce Hospital Zagreb, where there has also been established a ward for first episodes of Psychosis. Non Governmental Organisations have been working with patients and their families in Central Croatia, using group interventions for carers.

In Sarajevo, one doctor is working with identifying psychosis early.

All of these projects are successful and amount to a major contribution in improving treatment for schizophrenia for patients in these countries.

Staff from Croatia and Slovenia have visited the UK to learn Early Detection and Intervention techniques and case management.

Further development nationally of these techniques for delivery of Mental Health Care in the Community is now awaited.
Proposals for a New Identity of Young Psychiatrists in Europe
Authors: Fiorillo A. , Volpe U.
Published: March 2009

The professional identity of psychiatrists is recently generating controversies and uncertainty, which are reflected in psychiatric education and training throughout Europe.

In Europe, the organization of psychiatric education and training mostly depends on the range of mental health services available at individual sites. It has been recently proposed residents to rotate compulsory in different settings, such as hospital wards, outpatient clinics and community services, in order to learn how to provide different interventions for the different mental disorders. Moreover, while young psychiatrists are skilled in several pharmacological and psychosocial interventions to be provided in the community, they seem to be less experienced in providing these interventions within an hospital framework. The need for “balancing” community- and hospital-based mental health care needs to be specifically addressed during psychiatric training.

The shortage of funds for research projects is one of the major challenges for young researchers. In most European countries, it is becoming more and more difficult to have access to independent funds. National and international networks, as well as exchange programmes involving residents and young researchers, should be promoted.

Finally, it has been documented that residents in psychiatry are at a high-risk of “professional isolation”, which may contribute to the development of burn-out symptoms, particularly frequent among young colleagues.

Difficulties faced by young psychiatrists in the above-mentioned domains of psychiatry are illustrated and possible solutions discussed on the basis of recent results from European research networks involving young psychiatrists.
European Psychiatry Trainees on Fire - Results from “the International Psychiatry Trainee Burnout Syndrome Study BOSS 2008”
Authors: Jovanovic N. , Beezhold J.
Published: March 2009

Psychiatric training is designed to educate psychiatrists to the highest standards of competence in prevention, diagnosis, treatment and rehabilitation of persons with mental disorders. At the same time, it may be an extremely stressful period characterized by intensive work demands, lack of job autonomy, poor salary, high degree of work-home interference and severe dilemmas regarding one's clinical skills. Trainees may be at increased risk of burnout syndrome and associated mental and physical health problems. Burnout syndrome is defined as a psychopathological reaction to prolonged occupational stress. Most recently, a unique international study - "The International Psychiatry Trainee Burnout Syndrome Study: Europe BOSS 2008” - was introduced across Europe in order to evaluate the prevalence and degree of burnout syndrome among psychiatry trainees. The aim is to use the study findings to improve the professional status and the working environment of young psychiatrists. The study itself is run through the national trainee associations in collaboration with the European Federation of Psychiatric Trainees. At this point, fifteen countries are engaged - Austria, Czech Republic, Croatia, Denmark, France, Germany, Greece, Hungary, Italy, Netherlands, Romania, Russia, Slovenia, Turkey and UK. The sample comprises all trainees in the country. They are asked to complete the questionnaire, translated into their native language, by entering data directly into anonymised online database. The study has already started in France and Croatia, and next two countries are Hungary and Romania. Results from the study, as well as detailed study design and methodology will be presented and discussed.
How to Develop and Implement Recommended Guidance for European Psychiatry?
Authors: Gaebel W.
Published: March 2009

One of the concrete projects resolved at the 2nd EPA European Platform of Psychiatrists meeting in Nice 2008 concerns the development and implementation of evidence-based treatment recommendations in psychiatry with an European dimension named "Recommended Guidance". The major objective is to improve quality of mental health care in Europe by providing evidence-based information and advice regarding core clinical questions and to identify and minimize health care gaps. As following steps it was targeted to establish a steering committee, to obtain clinical core priorities by contacting national psychiatric societies, to provide examples of good practice based on existing information, and to develop (first) "recommended guidance" for selected topics as pilot work. To promote this process, information regarding existing guidelines in psychiatry, methodological aspects of their development and evaluation as well as implementation strategies will be provided.
Cultural and Economic Factors in European Psychiatry Guidance
Authors: Christodoulou G.
Published: March 2009

Europe can hardly be considered as homogeneous. There are gross historical, climatological, cultural, developmental, religious, political and economic differences that render generalizations inappropriate and European “globalization” a mission impossible (and, by and large, undesirable).

Psychiatry is no exception to the above and in the historical evolution of our discipline, psychiatric practice has varied. Because this evolution has followed a different course and has occurred at a different pace in the various parts of Europe, the present situation reflects all these developmental stages, thus rendering homogeneity questionable.

In spite of these differences, however, there is a degree of consensus regarding the basic requirements for the practice of our discipline and the desired competencies of its practitioners. The development of a common language through the modern classification systems, the organizations of specialist psychiatrists (e.g. the UEMS) the WPA and the European Psychiatric Associations have played a useful role in the harmonization of psychiatric practices and are expected to play a more useful role in the future.

In conclusion, what is required (and what can be realistically achieved) is consensus on some basic clinical, research, administrative and teaching requirements, in association with agreement on the basic ethical principles of our profession and, basically, the beneficence and non maleficence principles. European Psychiatry Guidance should involve these basic requirements that can be achieved by all European countries.
Theory and Characteristics of IPT. IPT in Spain
Authors: Solé-Puig J.
Published: March 2009

Gerald Klerman, Myrna Weissman and colleagues (Basic Books, New York, 1984) created IPT as a psychotherapeutical agent, analogous to a psychopharmacological one, antidepressants. With psychodynamic roots, IPT shows cognitive behavioral aspects: therapeutic stance, problem-solving attitude and the encouraging role of the therapist; he/she does not give homework to the patient. IPT overlaps with family therapy, but is mainly individual, although other formats (couple, groups) exist. As an eclectic formalization of procedures often used by psychiatrists, IPT is a semistructured way to guide the patient over a few months. It is user-friendly, confortable and well-accepted. IPT shows a solid ground based more on empiric knowledge and less on belief systems. So, school faithes should not obstacle IPT to improve with research and even be a model for it in the field. Psychotherapeutic training should include at least the psychodynamic, the cognitiv-behavioral and the interpersonal approach.

I translated the original manual's Part II included in “Psicoterapia Interpersonal” (Elsevier, Barcelona, 1998), the only Spanish IPT textbook in use. In the Comprehensive Guide to IPT (Weissman, Markowitz & Klerman, 2000) I am quoted as its introducer in Spain. Members of the Sociedad Española de Terapia Interpersonal -psychiatrists and psychologists, mainly- have given presentations and imparted courses in Spain and abroad (Portugal, Latin America). Since my seminal 1995 paper “Qué es y donde está la psicoterapia interpersonal” (Revista de Psiquiatría, 6:141-159), a number of Spanish papers have been produced. Spanish research programmes on IPT are still lacking, although promising initiatives have been published in local journals.
The Cycle of Violence - an Outdated Concept for Forensic Psychiatry?
Authors: Laubacher A.
Published: March 2009

The cycle of violence theory proposed in the early sixties suggested that children growing up exposed to violence would themselves become violent.

Testing this theory incidence studies found elevated levels of child abuse in offender populations compared to the general public, whereas prospective studies found significant associations between child abuse and subsequent adult criminality. However, prospective studies also showed that a large proportion of children exposed to violence did not grow up to become violent or criminal, which in turn lead to the assumption that the cycle of violence theory was to be rejected.

Recent studies have found indications of more specific relationships between early traumata and subsequent adult criminality. For example elevated levels of both risky sexual behavior as well as adult sexual victimization experiences have been found in persons having suffered childhood sexual abuse (CSA). These findings have raised the question if a specific association exists between the experience of CSA and subsequent adult sex offending.