bluuebunny/crossref_metadata_2025 huggingface dataset:
The Meanings of Psychopathology
Authors: Stanghellini G.
Published: March 2009

The term ‘psychopathology’ is used with different meanings. In the most trivial sense it refers to the object of psychiatry, i.e. pathologies of the psyche. In continental Europe Psychopathology is the formal taxonomy of the modalities of abnormal experience. We have three levels or profiles of Psychopathology. First, General Psychopathology, rooted in Jaspers’ work:

i.

sorts out, defines and differentiates abnormal psychic phenomena, actualized and sistematically described in specific terms; and

ii.

classifies groups of phenomena according to their phenomenological affinities, i.e. in terms of the patients’ self-descriptions, and the modes in which the experience comes to expression.

Second, Clinical Psychopathology, rooted in Kurt Schneider's work, aims at becoming the psychopathological doctrine linking symptoms and diagnosis. Clinical Psychopathology is essentially aimed at the identification of symptoms which are significant in view of nosographical distinctions. Third, we have Phenomenological Psychopathology, whose task is organizing different kinds of a person's abnormal experiences in theoretical constructs whose guide-line is the meaning-structures of such experiences. These meaning-organizers - i.e. psychopathological organizers - are synthesizing schemes of comprehension, conferring a unitary meaningfulness to different declinations of pathological phenomena. These constructs are descriptions of the mode of being-in-the-world of a given patient, i.e. his embeddedness in mundane, everyday activities. They are based on a holistic approach, advocating the importance of the global grasping of a phenomenon as an organising and meaningful Gestalt over a particularistic focus of attention.
Advances in the Pathophysiology of Episode-Related Cognitive Impairment in Bipolar Disorder
Authors: Kapczinski F. , Frey B.N. , Kauer-Sant'Anna M. , Andreazza A.C. , Brissos S. , Martinez-Arán A.
Published: March 2009

There have been a number of recent findings that elucidate the ways repeated episodes relate to cognitive impairment and poor functioning in Bipolar Disorder. While available treatments are undoubtedly helpful, many patients are still lacking improvement and adequate prophylaxis even when adherence to treatment is accomplished. New research point to neural glial cells resilience and connectivity as major contributors to the pathophysiology of the disorder. In this context, growth factors such as the brain-derived neurotrophic factor (BDNF) have been pointed out as potential targets for the development of new treatments. In the psychological domain, better assessment of the cognitive decline associated with the disorder is a major issue. Once cognitive disability is present, interventions with the potential to recover functioning have been put forward. In the biological domain, strategies aiming at reducing neural damage and with the potential to regenerate connectivity among brain cell are promising avenues for the development of new treatments. Another important development would be the incorporation of biological markers as a means to help staging the degree of severity of the disorder and guide the pharmacological treatment. These topics and their relationship to the clinical context will be discussed in this session.
Mitochondrial Dysfunction and Oxidative Stress in Bipolar Disorder
Authors: Andreazza A.
Published: March 2009

While we continue to refine our understanding of the pathophysiology of bipolar disorder (BD), several hypotheses have been postulated including a role for monoamines, gamma-amino butyric acid, glutamate, and second messenger signaling pathways. Recently, mitochondrial dysfunction and oxidative stress have been identified by a number of studies, as an important etiological factor in this disorder. Mitochondria play a crucial role in ATP production through oxidative phosphorylation, a process carried out by the electron transport chain (ETC) complexes. During the transfer of electrons along this ETC, the ROS can be generated, especially in complex I and III4. Growing body of evidence suggests the association of mitochondrial dysfunction and BD. Recent DNA microarray analysis in post-mortem frontal cortex and hippocampus revealed that the expression of several mRNAs coding for ETC complexes I-V subunits was decreased in subjects with BD. Supporting the key involvement of oxidative damage in BD, assays conducted with peripheral blood samples have demonstrated that BD is associated with alterations in antioxidant enzymes and increased lipid peroxidation. Recently we found that oxidative damage to lipid is present in the frontal cortex of BD subjects. A meta-analysis suggested that the levels of lipid peroxidation are elevated in BD providing support for oxidative stress hypothesis of BD. Furthermore, BD subjects showed increased DNA damage, as well as, upregulation of apoptotic genes. These data not only suggest that oxidative mechanisms may form unifying common pathogenic pathways in psychiatric disorders, but also introduce new targets for the development of therapeutic interventions.
Allostatic Load in Bipolar Disorder
Authors: Kapczinski F.
Published: March 2009

Repeated stress induces structural remodeling in brain regions involved with memory and emotions, such as hippocampus, amygdala and prefrontal cortex. Under chronic stress, hippocampal and prefrontal volumes are frequently diminished, whereas the size of the amygdala is increased. Related anatomical changes have been described in patients with bipolar disorder. New data indicate that episodes of depression and mania are associated with decreases neurotrophic and increases in proapoptotic pathways. Such stress- and episode-induced alterations in emotional circuitry may lead to a dysfunctional processing of information, which may render BD patients more vulnerable to subsequent environmental stressors, episodes, and substances of abuse. Allostasis means literally keeping stability through change. Allostatic load refers to the bodily wear and tear that emerges with sustained allostatic states. This concept provides an explanatory link to apparently unrelated findings such as cognitive impairment and higher rates of physical co-morbidity and mortality that occur in the course of bipolar disorder and further highlight the importance of effective long-term prophylaxis.
Introducing the Pharmacology Behind Treatments to Understand Treatment Challenges
Authors: Nutt D.
Published: March 2009

Receptor-binding profiles of antipsychotics differ, with important implications for treatment efficacy and tolerability. Receptors implicated in clinical response and adverse effects include dopamine D2, serotonin 5HT1A and 5HT2A, as well as H1 histamine, M1 muscarinic and alpha1 adrenergic receptors. Varying receptor affinities can explain the clinical profile specific to each compound, including adverse events such as weight gain, metabolic disturbance, hypotension, hyperprolactinaemia and extrapyramidal symptoms.

Receptor profiles also play a role when switching between antipsychotics. Consideration of the differences between agents being withdrawn and introduced can minimise adverse events and ensure efficacy is maintained. Using strategies such as cross-titration, the consequences of receptor upregulation, and amplified or muted treatment effects can be minimised. Pharmacokinetic profiles of the agents should also be considered, as withdrawing an agent with a long half-life may lead to hangover effects.

In all patients, a pharmacological basis should be used to select agents with minimal drug-related adverse events. Patients at risk of metabolic syndrome, for example, may benefit from an agent with a low risk of weight gain, such as aripiprazole or ziprasidone, while agents associated with hypotension, such as clozapine, risperidone or quetiapine, should be avoided in elderly patients to reduce the risk of falls. The route of administration also impacts treatment decisions and appropriate use of co-medications needs to be considered carefully.

By paying attention to the pharmacology of antipsychotic agents, physicians can balance good efficacy and a low incidence of adverse events, thereby optimising treatment for their patients with schizophrenia and bipolar disorder.
Recent Developments in Decoding Neurobiological Pathways and Treatment Targets in Alcohol Dependence
Authors: Kiefer F. , Mann K.
Published: March 2009

Multiple neurochemical pathways have been identified to be involved in mediating craving and relapse to alcohol and, further, animal models greatly assist in investigating pharmacological interventions of relapse behaviour. Opioidergic and glutamatergic systems play a key role in alcoholism as demonstrated by the clinically effective compounds naltrexone and acamprosate acting through these systems. Although the dopaminergic system has been in the focus of alcohol research for many years, clinical trials interfering with several components of this system displayed rather disappointing results. This situation, however, could change in light of the discovery that dopamine D3 receptor antagonism produces very consistent and robust results in preclinical studies. Corticotropin-releasing factor signalling and the endocannabinoid system integrate stress-related events and thereby mediate relapse behaviour. Thus, many new targets have been identified and several new compounds are currently undergoing clinical testing. However, given the heterogeneity in treatment response, genetic and protein markers as well as endophenotypes are currently characterised for individualised pharmacotherapy.
Treatment Innovations of Opiate Dependence Treatment
Authors: van den Brink W.
Published: March 2009

Opiate dependence is a serious psychiatric disorder with substantial suffering for the patient, his environment and society as a whole. Currently available treatments include abstinence oriented treatment with naltrexone and substitutian treatments with methadone and buprenorphine. However, treatment compliance with naltrexone is very low resulting in low effectiveness. In addition, existing substituation treatments only show moderate effectiveness resulting in a large number of patients showing continued drug use and serious psychological, somatic and functional impairment.

New treatment strategies involve:

a.

the development of long acting opiate antagonists (naltrexone) and partial agonist (buprenorphine) to improve treatment compliance and treatment retention,

b.

new substitution options such as slow release oral morphine (SROM), oral diacetylmorphine (heroin) and inhalable and injectable diacetyl morphine (heroin assisted treatment: HAT).

Recently, a new approach using neurosurgical and neuromodulatory techniques has been advocated to help treatment refractory opiate dependent patients. Finally, certain combinations of farmacotherapy and psychosocial interventions have shown promise for future improvements.

This presentation reviews the evidence of existing treatments for opiate dependence and explores the new treatment options for patients not fully responsive to the existing treatment modalities.
Treating Chronic Depression with Cognitive Behavioural Analysis System of Psychotherapy (CBASP)
Authors: Hull A. , Swan J. , McVicar R.
Published: March 2009

Background:

Patients with Chronic Depression present particular challenges to psychological therapists and the evidence base for CBT with this disorder is weak. However, a large multi-centre clinical trial has demonstrated that Cognitive Behavioural Analysis System of Psychotherapy (CBASP) can be an effective therapy for chronic depression. In CBASP, patients learn how their cognitive and behavioural patterns produce and perpetuate interpersonal problems and how to alter maladaptive patterns of interpersonal behaviour. CBASP focuses primarily on problematic interpersonal situations in the everyday lives of people with chronic depression using a structured intervention called situational analysis. In addition, it places considerable emphasis on the therapeutic relationship as a vehicle for change using a methodology termed disciplined personal involvement. Clinical experience to date suggests that CBASP can be a very effective approach for a difficult to treat disorder.

Objectives:

In this didactic workshop combining opportunities to hear/see actual CBASP therapy carried out individuals will learn about the model and therapy process and key mechanisms of change will be discussed with role-play used where appropriate to illustrate specific techniques. The theoretical model underpinning CBASP and the empirical evidence will be outlined.
A Pre-Post Comparison of a Multidimensional Treatment Program for Acutely Suicidal Borderline Patients
Authors: Ohlendorf P. , Di Clemente T. , Gaudry-Maire D. , Burnand Y.
Published: March 2009

Over the last few years, a new comprehensive program for acutely suicidal borderline patients has been developed in the Geneva area (careful description is provided in a distinct section of this workshop). The present work will report the results of a service research oriented study aimed at evaluating the impact of the implementation of such multidimensional intervention on a system of psychiatric services in a 500.000 inhabitant catchment area. Specifically, a pre-post design has been utilized to compare two distinct patient cohorts meeting criteria for borderline personality disorder who had bee referred to medical emergency room with suicidal attempt. Both cohorts had follow-up at 3-month and 1 year to assess treatment failure, repetition, hospitalization and direct costs. The results indicate that the program is feasible and may be associated with improved outcome and substantial costs savings among acutely suicidal borderline patients.
Psychodynamically Oriented Crisis Hospitalisation and Ambulatory Combination Treatement for Borderline Patients: An Introduction
Authors: Andreoli A.
Published: March 2009

The following educational topics will be carefully addressed:

a.

to establish a coherent model of the borderline syndrome as a complex, heterogeneous reaction resulting from the interaction of psychobiological vulnerabilities, psychosocial stressors and abnormal mental processes;

b.

to teach how new data from recent investigations of the clinical course of the borderline crisis are changing our view of both the scopes and the limitations of mental health policies for borderline patients;

c.

to review the several issues associated with adequate acute service provision for borderline patients in order to define a set of well structured recommendations for good quality, comprehensive emergency services organisation and acute treatment delivery;

d.

to teach a well structured, simple, cost-effective, easy to implement psychodynamic crisis intervention program with specific accent on: case management, risk management, facilitating an alliance, inactivating pathological personality traits triggered from acute traumatic experiences, empathic exploration of distressing feelings, conveying insight on repetitive patterns of ego syntonic masochistic behaviour, active support for problem solving;

e.

to teach the main aspects of an innovative brief psychodynamic psychotherapy program (mourning focused psychodynamic psychotherapy) model and its relevance to increased cost-effectiveness of psychiatric treatment among acute patients with borderline emotional crisis triggered from traumatic abandonment and other stressful life events.

The course is intended for people with an experience in the field of personality disorders and an interest in combining psychobiological science and psychotherapeutic wisdom to improve acute treatment and psychiatric services.
Telepsychiatry - When Resources are Short
Authors: Mucic D.
Published: March 2009

“Telepsychiatry” refers to video conferencing (interactive audio-video link in real-time where patient and doctor can both see and hear each other at the same time). Limited access to clinicians that have similar cultural and ethnic background decrease speed and accuracy of diagnosis and treatment (especially psychotherapeutic intervention). One solution to this problem is to give refugees, migrants and asylum seekers access to ethnic specialists by using Telepsychiatry.

4 stations have been established in Denmark during pilot project in periode 2005-2007. The equipment has been installed in two hospitals, one asylum seekers centre and one social rehabilitation institution.

Participants were mentally ill refugees, migrants and asylum seekers. 61 participants were involved in the assessment and/or treatment through 318 telepsychiatry provided remote consultations. They received mental health care by video-conferencing from providers who spoke participants ‘own language, i.e. without the assistance of interpreters.

All participants were asked to fulfil 10-items satisfaction questionnaire after the end of Telepsychiatry contact. The most of participants would prefer treatment via Telepsychiatry than via interpreter.

Aside from cross cultural patient population, Telepsychiatry can be used in order to provide mental health care towards domestic population in rural and remote areas with resource shortage.
The Ethnopsychiatric Logic and Methodology in the Context of Migration
Authors: Ulman A.-M. , Zajde-Nathan N.
Published: March 2009

In today's world of globalization and immigration, mental health workers are required to adapt their practice and develop new skills in order to treat immigrant populations. Ethnopsychiatry is a field created by Georges Devereux at the beginning of the 20th century. Devereux's unique psychoanalytic approach resides in reference to the relationship existing between psychic troubles and social norms in a given cultural context. During his multiple stays predominantly among North American Mohave Indians, Devereux structured knowledge and created concepts including anxiety observer counter-transference, schizophrenia as an “ethnic disorder”, the ethnic personality etc. Since the early 80's, the French psychologist and psychoanalyst Tobie Nathan, Devereux's student and follower, further developed his master's theories. He conceptualized a methodology with implementation in the French immigrant population. He thus shaped contemporary Ethnopsychiatry, as currently practiced in the Georges Devereux center, (Paris 8 University) in France and in many other clinics internationally. The ethnopsychiatric setting conceived by Tobie Nathan imparts a crucial and authentic role to cultural diversity. Tobie Nathan proposes to study with equal respect and seriousness theories and practices related to unhappiness and disease, irrespective of culture or civilization. Ethnopsychiatric setting helps to overcome the deleterious consequences of the split existing between the two cultural referents (host and origin) in which our patients live. During the presentation, principles of Ethnopsychiatric practice will be introduced accompanied by a case report of an Ethiopian patient from the Beer-Yaacov Mental Health Center Ethnopsychiatric clinic for illustrative purposes.
Alcohol Addiction and Bipolar Disorders
Authors: Musalek M.
Published: March 2009

In the last decades a large number of co-morbidity studies were published indicating a strong relationship between affective disorders and alcohol addiction. Patients with affective disorders suffer also from dependence disorders at about 6 times more often than the rest of the population. In 30 to 60 percent of patients with alcohol addiction also affective disorders are present. In this context authors emphasized that depressive states observed in the course of alcohol addiction may be reactions to problems occurring in the frame of dependence disorders. In contrast to that depressive mood disorders in general (and above all states of anxiety and increased tension often connected with depressive states) can also be considered as starting points of addictive behaviour. Furthermore alcohol itself may induce and catalyze depressive mood. Less attention has been paid to the role of manic or hypomanic states in dependence disorders. The few studies indicate an increased co-morbidity rate between bipolar II disorders and alcohol addiction. In a psychopathological study carried out on 200 alcohol addicts in the Anton Proksch Institute Vienna we focused on the co-morbidity with bipolar II as well as on the pathogenetic role of hypomanic states in the frame of constellations of conditions of alcohol dependence using among other scales and a standardized interview, the Hypomania Self Rating Scale (HSRS, Angst). Preliminary results underline a strong relationship between Bipolar II Disorders and Alcohol Addiction: hypomanic states induce high risk behaviours which may become responsible for relapse and increased alcohol consumption.
Cannabis and Psychosis
Authors: Crome I.B.
Published: March 2009

Aim:

This contribution will explore UK-based research developments in substance misuse and mental illness over the last 20 years.

Methods:

The main body of work revolves around research largely, but not only, funded by the Department of Health from the late 1990s. Early research revolved around alcohol, especially alcoholic hallucinosis: the relationship with schizophrenia-like illness was examined and the conclusion at that time on the basis of twin, family and clinical studies, was that very few cases did develop into schizophrenia. More recently, large general population epidemiological, and medium or small scale clinical studies, have been undertaken on the relationship between substance misuse (sometime specifically on cannabis) and the later development of mental illness especially psychosis.

Results:

The presentation will aim to draw parallels with the current debate around the link between cannabis and psychosis and urges caution in too rapid an assertion that cannabis is necessarily ‘causal’ and the clinical and policy implications of the misinterpretation of evidence. A proposal will be put forward that the genesis of psychotic illness in alcohol misuse is revisited using more sophisticated research methodologies.

Conclusions:

Given the changing landscape of substance use in the UK, particularly the fashion of polysubstance use and the recognition that this may be associated with psychotic illness, other drugs that are associated with psychotic illness should be similarly investigated to determine whether there is a common mechanism that might throw light on understanding the relationship between substance use and psychotic illness or schizophrenia.
Comorbidity and Comortality
Authors: Baldacchino A. , Crome I.
Published: March 2009

Aims:

To analyse the nature and extent of data extracted from case files of deceased individuals in contact with health, social care and criminal justice services six months prior to their drug deaths in Scotland during 2003.

Methods:

A cross-sectional descriptive analysis of 317 case notes of 237 individuals who had drug related deaths, using a data linkage process, was undertaken. All contacts made with services in the six months prior to death were identified. Information on clinical and social circumstances obtained from case records of social care services, specialist drug treatment, mental health and non-statutory services and the Scottish Prison Service and Criminal Records Office were collated using the Centre for Addiction Research and Education Scotland (CARES) Clinical and Social Circumstances Data Collection Form.

Findings:

More than 50% (n=237) were seen six months prior to their drug death. Sociodemographic details were reported much more frequently than medical problems. While there was information available on ethnicity (49%), living accommodation (66%), education and income (52%), and dependent children (73%), medical and psychiatric history was recorded in only 12%, blood-borne viral status in 17%, and life events in 26%. This paucity of information was also a feature of the treatment plans and progress recorded for these individuals.

Conclusions:

The 237 drug deaths were not a population unknown to services. Highly relevant data about the six-month period prior to death were missing. Improved training to promote in-depth recording, and effective monitoring may result in better understanding and reduction of drug deaths.
Cocaine Use and Liability to Psychotic Symptoms
Authors: Franzek E.J.
Published: March 2009

In a pilot study with 55 inpatients, primarily admitted for cocaine addiction, the following hypotheses were found: Patients with cocaine addiction and comorbide core schizophrenia (according to Kreapelin, n=17) respond completely different on cocaine use than all other groups of patients including a schizophrenia spectrum group (without core schizophrenia according to Kraepelin). When using cocaine the schizophrenic patients do not experience new psychotic symptoms and existing symptoms do not get worse. Most of them are less bothered of negative symptoms and some of them are, even more, less bothered of positive symptoms. In all other patients with various comorbidity (n=28) and without comorbide psychiatric disorders (n=10) positive psychotic symptoms occur dependent on the dosage of cocaine. In some of them the positive symptoms are also triggered by stress alone. The symptoms occurred in a dosage dependent hierarchical structure: mistrust - delusions of reference with fear - delusions of persecution and illusions with anxiety or panic - threatening voices and noises - disorganized and catatonic behavior.

The psychopathology induced by cocaine prooved to be similar to one of the core symptoms of cycloid psychoses.

The hypothesis is raised that there is an individual genetically and/or environmentally caused liability to the developing of positive psychotic symptoms under various stress factors including drugs. These reactive psychoses have to be distinguished from schizophrenia. Their relationship to the spectrum of cycloid psychoses is discussed.
Exploring the Causal Relationship Between Cannabis and Schizophrenia: What is the Role of Genes and Environment?
Authors: Kuepper R. , Myin-Germeys I. , Konings M. , van Winkel R. , van Os J. , Henquet C.
Published: March 2009

Frequent use of cannabis has been associated with poor outcome in patients with psychosis or schizophrenia, and research has become more and more interested in the question whether cannabis may actually cause psychosis or schizophrenia. Since only a minority of cannabis users eventually develops psychosis or schizophrenia, cannabis is suggested to be a component cause, potentially interacting with environmental as well as genetic factors. However, little is known about this putative interaction. Recent research in our group has therefore focused on differential sensitivity to cannabis and its psychosis-inducing effects. Experimental and observational work for instance showed that a functional polymorphism within the COMT gene moderates the acute effects of cannabis on psychosis outcome. In this presentation new evidence from epidemiological work is presented, showing gene-environment interactions within the cannabis-psychosis association. These results point to a moderating role for both age of onset of cannabis use and childhood trauma. Also a certain haplotype within the COMT gene was found to increase the risk of developing schizophrenia after adolescent cannabis use. Complex gene-environment interactions as well as interactions between cannabis and other environmental risk factors seem to underlie the cannabis-psychosis relationship. Possible biological mechanisms such as sensitization processes that may underlie these interactions will be discussed.
Controversy Over the Diagnosis of ‘Cannabis-Induced Psychosis’
Authors: Arendt M.
Published: March 2009

Background:

Both the ICD-10 and the DSM-IV operate with a diagnosis of cannabis-induced psychotic disorder. Despite this, the diagnosis is controversial.

A number of studies have shown that cannabis can induce short-lived psychotic symptoms, and that this could depend on factors such as genetic predisposition. To qualify for a diagnosis of ‘cannabis-induced psychosis’, however, the symptoms must last for at least 48 hours according to the ICD-10. This diagnosis has traditionally been regarded as benign, but this is based on a very limited number of studies.

Methods:

We have conducted two studies based on Danish treatment registers. Firstly, all patients who had received psychiatric treatment for cannabis-induced psychosis were followed for at least 3 years to determine the rate of subsequent treatment for schizophrenia-spectrum disorders. Secondly, familial predisposition for psychiatric disorders among subjects treated for cannabis-induced psychosis and schizophrenia was compared using competing risk analyses.

Results:

Schizophrenia spectrum disorders were diagnosed in 44.5% of the 535 subjects included in the first study. New psychotic episodes of any type were diagnosed in 77.2% and 47.1% received a diagnosis of schizophrenia spectrum disorders more than a year after the cannabis-induced psychosis.

Those who develop cannabis-induced psychosis and schizophrenia spectrum disorders both show elevated levels of predisposition for schizophrenia, other psychotic conditions, and other psychiatric disorders in first-degree relatives. In general, the level of predisposition is of similar magnitude in individuals treated for cannabis-induced psychosis and schizophrenia.

Conclusion:

Cannabis-induced psychosis could be an early sign of schizophrenia rather than a distinct clinical entity.
Skunk and psychosis in South East London
Authors: Di Forti M. , Morgan C. , Mondelli V. , Gittens L. , Handley R. , Hepgul N. , Luzi S. , Marques T. , Aas M. , Masson S. , Prescott C. , Russo M. , Sood P. , Wiffen B. , Papili P. , Dazzan P. , Pariante C. , Aitchison K. , Powell J. , Murray R.
Published: March 2009

Background:

Epidemiological studies have reported that the increased risk of developing psychosis in cannabis users is dose related. In addition, experimental research has shown that the active constituent of cannabis responsible for its psychotogenic effect is Delta-9-Tetrahydrocannabinol (THC) (Murray et al, 2007). Recent evidence has suggested an increased in potency (% TCH) in the cannabis seized in the UK (Potter et al, 2007).

Hypothesis:

We predicted that first episode psychosis patients are more likely to use higher potency cannabis and more frequently than controls.

Methods:

We collected information concerning socio-demographic, clinical characteristics and cannabis use (age at first use, frequency, length of use, type of cannabis used) from a sample of 191 first-episode psychosis patients and 120 matched healthy volunteers. All were recruited as part of the Genetic and Psychosis (GAP) study which studied all patients who presented to the South London and Maudsley Trust.

Results:

There was no significant difference in the life-time prevalence of cannabis use or age at first use between cases and controls. However, cases were more likely to be regular users (p=0.05), to be current users (p=0.04) and to have smoked cannabis for longer (p=0.01). Among cannabis users, 86.8% of 1st Episode Psychosis Patients preferentially used Skunk/Sinsemilla compared to 27.7% of Controls. Only 13.2 % of 1st Episode psychosis Patients chose to use Resin/Hash compared to 76.3% of controls. The concentration of TCH in these in South East London, ranges between 8.5 and 14 % (Potter et al, 2007). Controls (47%) were more likely to use Hash (Resin) whose average TCH concentration is 3.4% (Potter et al, 2007).

Conclusions:

Patients with first episode psychosis have smoked higher potency cannabis, for longer and with greater frequency, than healthy controls.
Differential Effects of THC and CBD in Cannabis Smokers
Authors: Morgan C.
Published: March 2009

Cannabis contains a myriad of different chemicals, more than 60 of which are unique to the plant and called cannabinoids. The main psychoactive ingredient is delta9-tetrahydrocannabinol (THC) and this produces the effects that users seek (Curran et al., 2002 Psychopharmacology 164: 61-70). When given intravenously to healthy humans, THC produces psychotic-like and anxiogenic effects (D’Souza et al., 2004 Neuropsychopharmacology 29: 1558-1572). In contrast, cannabidiol (CBD), another major constituent of most strains of cannabis, appears to have anti-psychotic properties, is anxiolytic (Guimares et al., 1990 Psychopharmacology 100: 558-559)and may be neuroprotective in humans (Hermann et al., 2007 Biol. Psychiatry 61: 1281-1289). The relative THC/CBD ratio of cannabis varies greatly. Although high THC cannabis has become increasingly available over recent years, little is known on changes in levels of other cannabinoids as these are seldom measured. One study in the U.S. however found that the THC content of cannabis trebled in resin and doubled in leaf, whilst the average level of other cannabinoids, including CBD, remained unchanged. We recently found that users with high levels of THC in hair and little CBD demonstrated greater levels of schizophrenia like symptoms than users with higher levels of CBD (Morgan & Curran, 2008, Br J. Psychiatry, 192: 306-307). We are currently exploring the relationship between cannabinoids in naturalistically smoked cannabis and the acute and chronic effects of the drug. This presentation will focus on the implications of the increased ratio of THC/CBD and the different effects of CBD and THC in cannabis smokers.
Clinical and Epidemiological Data on Eating Disorders NOS
Authors: Machado P.
Published: March 2009

Eating Disorders Not Otherwise Specified (EDNOS) represent the most common eating disorder diagnosed in specialized treatment settings. The purpose of the current presentation is to review epidemiological data on this residual diagnostic category. Namely we will present data on the prevalence of EDNOS in a nationwide community sample. In this study, participants were 2028 female students, aged 12 to 23, attending public schools in the 9th to 12th grades in Portugal. Participants completed the Eating Disorder Examination Questionnaire in Stage 1 of the study. In Stage 2, we selected all the participants who met any of these criteria:

1.

BMI ≤17.5,

2.

scores ≥4 on any of the four EDE-Q Subscales,

3.

a total EDE-Q score ≥4, or,

4.

the presence of dysfunctional eating behaviors.

In Stage 2, eating disorder experts interviewed 901 participants using the Eating Disorder Examination. The prevalence of all eating disorders was 3.06% among young females. Prevalence for anorexia nervosa was 0.39%, for bulimia nervosa 0.30%, EDNOS 2.37%. EDNOS was a very common eating disorder and accounts for three-quarters of all community cases with eating disorders. Implications for research and treatment will be presented.
Psychiatric Comorbidity in Eating Disorders Not Otherwise Specified (EDNOS)
Authors: Milos G.
Published: March 2009

This study aimed to analyse the course of eating disorders (ED) over thirty months emphasizing comorbidity and stability of the ED diagnoses. Particularly attention was given to the eating disorders not otherwise specified (EDNOS) subjects in comparison with anorexia nervosa (AN) and bulimia nervosa (BN) patients.

192 women with a DSM IV eating disorder diagnosis - 55 AN, 108 BN, 29 EDNOS - was assessed with the structured interview (SCID I) at the baseline, one year and thirty months after the first assessment.

83.3% of the total sample had in addition to the ED diagnosis one or more lifetime axis I diagnoses. We found no significant differences between the most common axis diagnoses - anxiety and affective disorders, or dependence disorders - in the three diagnostic groups, excepted for social phobia, in fact this disorder was significantly often present in AN. The distribution of the lifetime suicidal attempt was very similar in the three diagnostic groups.

The stability of the ED diagnoses was low, but EDNOS was the most instable ED diagnosis with a tendency to remission.

The axis I comorbidity of ED was very high, and the EDNOS subjects showed a very similar axis I comorbidity compared with subjects with AN and BN. The stability of the ED diagnoses was low and the EDNOS group showed the highest ED diagnosis instability and tendency to remission. The relationship between axis I comorbidity, and ED instability is unclear, further studies in these fields are needed.
Progress in the Development of ICD-11 and DSM-V Classifications of Mental Disorders
Authors: Sartorius N.
Published: March 2009

The International classification of diseases - which includes a chapter dealing with mental disorders - will be revised and its 11th Revision will be published in 2014.

A special unit within the World Health Organization coordinates the process of revision and the numerous tasks that have to be undertaken to ensure full participation of the WHO member states in the process of revision as well as the consideration of evidence on which the classification is to be based.

The Department of Mental Health and Substance Abuse Control of the WHO has created a special advisory group that should help it in considering the evidence and proposals made by scientists, governments, organizations and interested individuals and in producing the draft of the classification of mental disorders for inclusion into the 11th Revision of the ICD: This group has, in turn, developed several structures that will deal with the tasks that will arise in the revision process. At the same time the American Psychiatric Association has created a DSM 5 Task Force that should develop proposals for the 5th Revision of the Diagnostic and Statistical Manual that will be published in 2012.

The lecture will describe the processes and structures that have been put in place by the two organizations and refer to the issues that have arisen or are likely to arise in the course of work that should lead to the proposals for the ICD 11 and the DSM 5.
State of the Art “Personality Disorders”
Authors: Herpertz S.
Published: March 2009

Personality disorders have high prevalence rates of approx. 8% in the general population and up to 40% among psychiatric patients. The increasing amount of empirical and experimental research within the last ten years challenges our concept of personality disorders (PDs) with the following most prominent findings:

•

Longitudinal studies indicate much less stability than expected.

•

The DSM classification system hypothesis of a fundamental difference between axis I and axis II disorders has not been empirically affirmed.

•

Some of the current categories of disorders cover highly heterogeneous individuals and have low therapeutic implications.

•

The detection of neurobiological underpinnings of personality dysfunctioning points to a close interaction between nature and nurture in etiology.

•

Psychotherapeutic approaches developed for specific disorders have been proven to be efficacious; they rather favour a limited focus on maladaptive behaviors and attitudes instead of targeting a fundamental change of personality structure.

•

There is no empirical basis for polypharmacy; classes of psychotropic agents act on a rather broad spectrum of symptoms with no convincing database to suggest the combination of several drugs with respect to different targets.
Psychotherapy in Emergency Psychiatry: Between Myths and Evidence Based Medicine
Authors: Damsa C. , Freymann J.-R.
Published: March 2009

The aim of this communication is to debate between two seemingly contradictory epistemological approaches in emergency psychiatry: Psychotherapy and Pharmacotherapy. Even if many international experts consider the interest of combining psychotherapy and pharmacotherapy in emergency, clinicians often find a conflict between psychotherapeutic and pharmacological skills. The question of the transference will be discussed in the emergency psychiatric settings. The newest literature data about the interest of the combining treatments (psychotherapy and pharmacology) in emergency psychiatry will be discussed by the experts from our international emergency network [1]. Then, the presentation of some preliminary research experiences of our group [2, 3], will be followed by the discussion of new unpublished data from around 10000 patients admitted consecutively in four emergency psychiatry rooms (Switzerland, Belgium, France, Romania). The clinical heterogeneity of the emergency psychiatry situations often stimulate clinicians to become creative and search for “symbiosis” between psychotherapeutic and pharmacologic treatments, as well as for clinical practice and evidence based medicine.
The Interest of an International Research Network Focusing on Emergency Psychiatry for Improving the Quality of Care
Authors: Damsa C. , Lazignac C. , Brousse G. , Adam E. , Llorca P.-M.
Published: March 2009

This communication focus on the critical points about the quality of care in emergency psychiatry: rapid diagnose, management of the psychotherapeutic and pharmacologic treatments effective in emergency. The interest of an international research network in emergency psychiatry is emphasized starting from several clinical experiences (United States, Switzerland, Belgium, France, Luxembourg, Romania).
Unjustly Neglected: Siblings of People with a Schizophrenic Psychosis
Authors: Schrank B. , Sibitz I. , Schaffer M. , Amering M.
Published: March 2009

Objective:

Siblings of individuals suffering from schizophrenia are often overseen as relatives in need in clinical practice and they are an underrepresented group in research focussing on the needs of carers and relatives of psychiatric patients. We investigated differences between siblings and parents as well as spouses, in regards to help seeking, utilisation of an open group for relatives, their subjective burden and quality of life.

Methods:

147 relatives of in-patients and patients attending a day hospital where assessed using the General Health Questionnaire (GHQ), Family Problem Questionnaire (FPQ), WHO Quality of Life-BREF (WHOQOL-BREF) and a questionnaire inquiring about their utilisation of various sources of information and help throughout the course of the illness.

Results:

Siblings had less contact with patients compared to both parents and spouses, and their quality of life showed less impairment than that of the other groups. However, siblings’ subjective burden was comparable to that of spouses. Still, compared to the other groups, they reported significantly less utilisation of any source of information and help and were far less likely to be invited to support offers specifically aimed at relatives.

Conclusions:

Siblings of patients with schizophrenia are a particularly neglected group regarding support aimed at relatives. They are heavily distressed, yet there is little offer of professional support for them.
Family Needs, Children and Parenthood in People with Mental Illness
Authors: Becker T. , Kilian S. , Kilian R. , Lahmeyer C. , Krumm S.
Published: March 2009

Objective:

Given that parental mental diseases affect the whole family system, a family centered support and help system seems appropriate for families with a mentally ill mother/father. However, the majority of mental health services do not integrate interventions for the family system into psychiatric treatment programs.

Aims:

To introduce a counselling and support service for families with a mentally ill parent (FIPS) that has been established at a psychiatric hospital serving a large catchments area. Preliminary results of a qualitative study that focused on the clients’ family background as well as on their reasons for utilising the service and service satisfaction will be presented.

Methods:

Factors that impact the family system are considered and brought to a concept for counselling and support service for families with a mentally ill parent. Problem-focused interviews with 14 clients (mentally ill parents and relatives) of the counselling service for families were subjected to content analysis.

Results:

Most clients came to the counselling centre because of worries that the parent's mental illness might negatively affect children's well-being. Mentally ill mothers described their daily lives as utterly burdensome and also reported strong feelings of guilt towards their children. The concept of FIPS includes psychoeducation, social therapy, case management and family therapy. Clients assessed the counselling service as helpful and reported some significant changes.
Development of Aculturally Informed Therapy for Schizophrenia
Authors: de Mamani A. Weisman
Published: March 2009

This speaker will serve as chair ofthis workshop. Background informationabout schizophrenia will be presented, including how cultural variables impactvarious aspects of the illness. Ofparticular interest is the fact that patients from more traditional societiesappear to have a vastly better course of illness (World Health Organization, 1960, 1992). The speaker will present results fromnumerous studies, both from her own research and from colleagues, demonstratingthe possible reasons why patients from these cultures have better prognoses. Main ideas include attributions for thecause/controllability of the illness, use of religion/spirituality, greaterfamily cohesion, and less critical/hostile emotional climate of the family(commonly referred to as Expressed Emotion). Dr. Weisman de Mamani will describe how these studies have shaped a newfamily therapy for schizophrenia, titled Culturally Informed Therapy forSchizophrenia (CIT-S). This new therapyis being pilot tested at the University of Miami and incorporates elements frompreviously-established therapies as well as new, culturally-informedtechniques. CIT-S consists of 15sessions broken into five modules: Family Collectivism, Education, SpiritualCoping, Problem-Solving, and Communication Training. CIT-S is offered in English and in Spanish.
Family Cohesion, Psychoeducation, and Insight in Schizophrenia
Authors: Aldebot S.
Published: March 2009

The speaker will describe the first two modules of the culturally informed family therapy for schizophrenia, as well as some of her own research on insight in severe mental illness. The first module of the treatment is Family Collectivism. This module is based on strong research linking perceptions of family cohesion to decreased psychiatric symptoms and less general emotional distress (Weisman, Rosales, Kymalainen, & Armesto,2005). This module is aimed at fortifying a strong sense of family unity and helping members to view themselves as a team working towards a mutual goal with the objective of tapping into the protective effects of experiencing a cohesive family unit. A demonstration of this module will beconducted using volunteers from the audience.

The second module, Education, is based on earlier psycho-educational programs of Falloonet al. (1984) and Miklowitz and Goldstein (1997). The Education module discusses the known causes of schizophrenia, the exacerbating factors, and ways in which family might influence the patient's mood, thoughts, and behaviors. This speaker will discuss patients' insight into having a mental illness, which is an important variable when conducting psychoeducational programs. Many individuals suffering from schizophrenia have limited or no insight into the fact that they have a mental illness. This speaker will explore possible mediators and moderators of the relationship between insight and distress and discuss how these factors may be important during treatment, particularly in the psychoeducation module.