bluuebunny/crossref_metadata_2025 huggingface dataset:
FC30-01 - Severe mental illness is an HIV indicator disease
Authors: Ferrara M. , Solignani G. , Ferrari S. , Rigatelli M. , Guaraldi G.
Published: May 2011

Introduction

HIV testing is not yet a routine procedure in most mental health settings although adults with severe mental illness (SMI) are disproportionately affected by HIV/AIDS.

Objectives

We focused our attention to explore if the appropriate care of patients with SMI may include a routine HIV testing offering and thus contribute to diagnose HIV-infected persons earlier in the course of their infection.

Methods

We present three case histories related to primary HIV diagnosis in patients presenting with different psychiatric disorders, admitted to Modena teaching Hospital in the passed two years.

Results

Psychiatric symptoms delayed HIV diagnosis in all of the three reported cases.

Conclusions

The case histories here presented suggest that HIV testing is appropriate in the care of people with SMI, avoiding delay in HIV diagnosis with an obvious clinical benefit for the patient. Further studies are needed to assess the prevalence of HIV in those patients. These will be able to validate psychiatric diseases within a specific HIV indicator diseases list and help identifying a segment of the population in which HIV test must be routinely offered as a public health strategy, to face the burden of undiagnosed HIV infection.
FC30-02 - Common mental disorders in TB/HIV co-infected patients in Ethiopia
Authors: Deribew A. , Tesfaye M. , Michael Y.H. , Apers L. , Duchateau L. , Colebunders R.
Published: May 2011

Background

The relationship between TB/HIV co-infection and common mental disorders (CMD) has been scarcely investigated. In this study, we compared the occurrence of CMD in TB/HIV co-infected and non-co-infected HIV patients in Ethiopia.

Methods

We conducted a cross sectional study in three hospitals in Ethiopia from February to April, 2009.

The study population consisted of 155 TB/HIV co-infected and 465 non-co-infected HIV patients. CMD was assessed through face to face interviews by trained clinical nurses using the Kessler 10 scale. Several risk factors for CMD were assessed using a structured questionnaire.

Results

TB/HIV co-infected patients had significantly (p = 0.001) greater risk of CMD (63.7%) than the non-co-infected patients (46.7%). When adjusted for the effect of potential confounding variables, the odds of having CMD for TB/HIV co-infected individuals was 1.7 times the odds for non-co-infected patients [OR = 1.7, (95%CI: 1.0, 2.9)]. Individuals who had no source of income [OR = 1.7, (95%CI: 1.1, 2.8)], and day labourers [OR= 2.4, 95%CI: 1.2, 5.1)] were more likely to have CMD as compared to individuals who had a source of income and government employees respectively. Patients who perceived stigma [OR = 2.2, 95%CI: 1.5, 3.2)] and who rate their general health as “poor” [OR = 10.0, 95%CI: 2.8, 35.1)] had significantly greater risk of CMD than individual who did not perceive stigma or who perceived their general health to be “good”.

Conclusion

TB/HIV control programs should develop guidelines to screen and treat CMD among TB/HIV co-infected patients.
FC30-03 - Cognitive functioning in young, professionally active men after CABG operation
Authors: Krysta K. , Woznica A. , Krzych L.J. , Pawlak A. , Skarysz J. , Eysmontt Z. , Krupka-Matuszczyk I. , Bochenek A. , Cisowski M.
Published: May 2011

Introduction

The development of operation techniques and care of the patients treated with coronary artery bypass graft (CABG) has an influence on the reduction of mortality, the frequency of post-operation myocardial infarctions and other important side-effects. Still a certain remaining problem are cognitive dysfunctions.

Aims

The purpose of this study was to the analysis of selected cognitive functions before the operation and shortly after the operation.

Methods

120 men aged below 65 were invited to the study. Finally 50 patients were recruited to the study, who underwent CABG with extra-corporeal circulation. The examined group consisted of 50 men with a mean age of 54.4 ± 5.6. 36% of the examined patients had a myocardial infraction in the past, 76% suffered from hypertension, 60% from diabetes. The cognitive assessment was done with a standardized Vienna Test System (VTS) battery. Following cognitive functions were examined visuo-spatial short-term memory (CORSI test), precise and continuous attention (COGNITRON), psychomotor speed and co-ordination (MLS test).

Results

After the operation the visuo-spatial memory and continuous attention improved. The learning abilities did not change, and the psychomotor performance decreased. Statistically significant positive correlations were found referring to visuo-spatial memory and continuous attention before and after the operation.

Conclusions

Coronary artery bypass graft (CABG) with the use of extra-corporeal circulation in young men with no comorbid diseases aged below 65 has no significant impact on such cognitive functions like visuo-spatial memory, continuous attention and learning abilities. However the decrease of psychomotor performance was observed.
FC30-04 - Contributing factors in the occurrence of any mental disorders in pulmonary tuberculosis patients
Authors: Ginting T.T.
Published: May 2011

Introduction

Tuberculosis (TB) is one of world's health problems. Morbidity and mortality caused by the disease are increasing annually. Aspects involved in TB are individual, environmental, and bacterial. It is important to consider not only one's physical factor but also mental factor such as comprehension and perception.

Objective

Stigma and social isolation may occur and precipitate any psychopathology and thus co morbidity of mental disorders in tuberculosis patients.

Aim

The aim of this research is to identify any contributing factors in the occurrence of any mental disorders in pulmonary tuberculosis patients.

Methods

Qualitative method of analysis was used; begin with determining the frequency of mental disorders in pulmonary tuberculosis, followed by interview and observation of the samples that mentally disordered.

Results

The frequency of any mental disorders in pulmonary tuberculosis was 20%. From qualitative analysis, themes such as comprehension, treatment seeking behavior, psychological impacts, stigma, financial, occupational impacts, and other stressors were obtained. Respondents’ comprehension to the disease was not satisfying; treatment seeking behavior includes visiting public health services and hospitals; psychological impacts include Kubler-Ross’ response and depression as the most prevalent; financial impact includes financial difficulties; occupational impacts include occupational problems and unemployment; and other stressors.

Conclusions

Respondents’ comprehension to tuberculosis was not satisfying so thus worsen their perception of illness and of treatment seeking behavior. Their false perception will result in behavioral changes and social consequences like self-withdrawal, and together with stigma and any stressors will precipitate mental disorders.
FC30-05 - Psychiatric co-morbidities in patients with pemphigus: An issue to be considered
Authors: Arbabi M. , Mahdanian A. , Ghodsi Z. , Noormohammadi N. , Parsafar H. , Shams S.
Published: May 2011

Background and objectives

There exists a high prevalence of psychiatric disorders in dermatological patients. However, investigators have so far evaluated psychiatric aspects of the patients suffering from several specific skin diseases, there are a few studies concerning mental health in pemphigus patients. Our objective was to evaluate mental health status, quality of life and psychological well-being of newly diagnosed pemphigus patients.

Methods

Between April 2007 and February 2008, all newly-diagnosed pemphigus patients attending the pemphigus outpatient clinic of a dermatological hospital were given a questionnaire comprising the GHQ-28 and DLQI to fill out.

Results

Out of 283 patients, 212 complete forms were returned and analyzed. The bimodal score of GHQ ranged from 0 to 26 (Mean = 9.4) and the Likert score of GHQ ranged from 6 to 68 (Mean = 31.9). The DLQI score ranged between 0 and 30 (Mean of 13.8). A total of 157 patients (73.7%) were yielded to be possible cases of mental disorder considering GHQ-28 bimodal scores. Significant correlation between the DLQI score and bimodal and Likert scoring of GHQ-28 was detected.

Conclusion

Our study has depicted the prevalence of psychiatric morbidity in pemphigus patients. It underlines the fact that physicians, who are in charge of care for these patients, are in an exceptional position to distinguish the psychiatric morbidity and to take appropriate measures.
FC30-06 - Prevalence of depressive - anxiety disorders of gastroenterology outpatients in five cities cross China
Authors: Zhang L. , He Y.-L. , Ma H. , Liu Z.-N. , Jia F.-J. , Zhang M.-Y.
Published: May 2011

Introduction

Depression and anxiety disorders are prevalent mental disorders in China. But some those patients do not seek help from psychiatrists firstly but see internists first.

Objectives and aims

This study aimed to investigate the prevalence of depressive - anxiety disorders in gastroenterology outpatients and assess the detection rate provided by physicians in China.

Methods

A multicenter, hospital-based cross-sectional study was carried on in the 15 large general hospitals of five cities cross China. A total of 1995 gastroenterological outpatients were screened by Hospital Anxiety and Depression Scale (HADS). Subjects whose HADS scores ≥ 8 were interviewed by psychiatrists, using Mini International Neuropsychiatric Interview (M.I.N.I) to make further diagnoses. Physicians’ diagnoses and treatment were recorded.

Results

The adjusted prevalence of depressive disorder and anxiety disorders was 14.39% and 9.42% respectively.

Conclusions

The prevalence of depressive-anxiety disorder is high in gastroenterology outpatients in China, which suggests the related training of detecting these mental disorders is needed to gastroenterologists.
FC31-01 - Psychiatric advance directives: From a single document to a complex and multistage intervention, realist review
Authors: Dubois V.
Published: May 2011

Introduction

Psychiatric Advance Directives (PADs) are documents that allow severe and chronic mentally ill users notifying preferences of treatment and appointing a surrogate decision-maker for crisis relapses. Despite many expected benefits at the intrapersonal, interpersonal and organisational levels of the mental health system, PADs take-up rate remains low and many barriers to their use were identified. Moreover, a recent Cochrane systematic review provided little evidence on these benefits.

Aim

A realist review was carried out to clarify the theoretical frameworks underlying PADs, examine data evidencing these frameworks and determine the conditions in which PADs may have an effect, on what issues, and how.

Method

After a selection process, 38 references were retrieved from health and social sciences databases containing empirical data on PADs. Papers were thematically coded along identified theoretical frameworks and levels of effects, and populated with empirical data. Results were reported within a multistage process including the PAD definition, completion, registration, access, and honouring.

Results

Three theoretical frameworks were identified: users' autonomy, therapeutic alliance and health providers' networking. Although PADs were set up in a user's autonomy approach, they produce better results within a therapeutic alliance framework. Networking is determining on access and honouring stages. However, the literature mainly focused on definition and completion stages. Very little is known about their actual honouring.

Conclusion

PAD is a complex intervention with effects and barriers at each step of the process and levels of action. Their take-up rate and evaluation could be improved assessing these levels and stages separately.
FC31-02 - Is it ethical not to prescribe placebo? the patient's perspective on the usage of placebo for the treatment of depression - a comparative study
Authors: Feffer K. , Nitzan U. , Lichtenberg P. , Lev-Ran S. , Fennig S.
Published: May 2011

Introduction

The current stands of the medical establishment exclude usage of placebo in the clinical setting on ethical grounds. No attempt has been made to clarify the viewpoint of the psychiatric patient regarding the matter.

Objective

To compare the viewpoint of healthy subjects to that of patients who suffered from depressive episode.

Aims

1)

Investigate the willingness of subjects in both groups to receive placebo for the treatment of depression, and

2)

compare both groups’ views regarding the ethical aspect of placebo usage (e.g. doctor-patient relationship, patient's autonomy, etc).

Method

We enrolled 81 patients and 107 healthy subjects. Patients were recruited from an out-patient clinic and were diagnosed, in the past or present, as suffering from a depressive episode. All subjects were briefed thoroughly about the efficacy, potential benefits and limitations of placebo in treating depression and then completed a self-report questionnaire.

Results

64% of the patients (N = 50) expressed consent to use placebo in case they suffer again from depressive symptoms, compared to 79% (N = 85) of healthy subjects (p< 0.05). In both groups over 70% of the subjects do not perceive prescribing placebo as a deceit or as an act that diminishes the patients' autonomy (p>0.05).

Conclusions

The majority of patients agreed to receive placebo medication as a first line treatment, and do not feel that it will negatively affect their sense of autonomy or doctor-patient relationship. These findings question some of the ethical justification of excluding placebo from the clinical practice and call for further discussion in the subject.
FC31-04 - Outside the questionnaire a preliminary of the essence of differential diagnostics in ethical psychiatric practice: The conners as paradigm
Authors: Brand Flu R.L.
Published: May 2011

Introduction

Misdiagnoses can have profound implications on treatment outcome; in children also risks of continuation in adulthood, including forensic repercussions.The Conners questionnaire, an international tool to rule in ADHD poses like any structured assessment tool a ceiling effect of optimum sensitivity/specificity. This gap in certainty of diagnosis can be bridged by clinical astuteness on applicable differential diagnoses, an exercise which resulted in transformational treatments in complex ‘ADHD’. This instigated an analysis of the Conners parent questionnaire in relation to common differential diagnoses or problems.

Aims

To explore alternative explanations and differential diagnoses in the abbreviated Parent - Conners questionnaire.

Objective

To establish common ADHD differential explanations and diagnoses from this questionnaire to inform on more comprehensive diagnostic schedules and algorithms.

Method

Every item of the questionnaire is appraised in relation to its assigned index i.e. ‘oppositional, cognitive problems/inattention, hyperactivity’ and ‘ADHD’. Differential explanations of ADHD symptoms are explored in terms of diagnoses or specific significant impairment according to established psychiatric diagnostic and neurocognitive criteria.

Results

Hyperarousal i.e. anxiety symptoms i.e. correlate with all indices of the questionnaire. The oppositional index can be indicative of anger or social and communication problems. Hyperactivity can also be explained by sensory processing difficulties. The Cognitive/inattention index may reflect (specific) learning difficulties. The ADHD index can reflect learning and communication problems.

Conclusion

Above named alternative explanations for an ADHD diagnosis using the Conners questionnaire need to be further studied to inform on enhanced clinically effective medication and non-medication interventions.
JS01-01 - Pharmacokinetics of psychotropic drugs - keys for treatments’ improvements
Authors: Baumann P.
Published: May 2011

Non-response, adverse effects and pharmacokinetic interactions with clinical consequences are frequent manifestations observed in psychiatric patients treated with psychotropic drugs. These risks are increased in patients belonging to the category of “special populations”: elderly patients, children and adolescents, patients with a genetic particularity of metabolism or suffering from somatic or psychic comorbidities. Increasingly, the use of generics has been shown to represent a source of unexpected treatment outcomes. Therapeutic drug monitoring (TDM) is not only recommended in these situations, but especially also in patients who are suspected to be non-compliant. In addition, the increasing knowledge of the metabolism of psychotropic drugs allows the use of phenotyping and/or genotyping techniques (e.g. cytochrome P-450, P-glycoprotein) in patients and to adapt their medication considering their pharmacogenetic status. Pharmacokinetic (TDM) and pharmacogenetic tests are therefore useful to solve problems in psychopharmacotherapy and thus improve efficacy and safety of the drugs. An earlier developed Consensus guideline on TDM (Baumann et al., 2004) has recently been updated (Hiemke et al., 2011).
JS01-03 - Improved anti-addiction therapeutic programmes based on pharmacogenetic criteria
Authors: van den Brink W.
Published: May 2011

Addictions are frequently occurring mental health problems that are associated with serious morbidity and excessive mortality, suffering of family and friends, societal damage, criminality, public nuisance and in some instances destabilization of certain regions or even countries. In the last decades, effective pharmacological treatments have become available for the treatment of nicotine, alcohol and opioid dependence, whereas new medications are developed and tested for cannabis, cocaine and amphetamine dependence. Unfortunately, the effect of most of the currently available medications is moderate at best. Different strategies have been tested to improve the response to these medications, e.g. combination of different pharmacological treatments, combinations of pharmacological and psychosocial interventions, and patient-treatment matching based on clinical characteristics. So far, these strategies have not been very successful. A promising direction is a better matching of patients and treatments based on differences between patients in their genetic make-up. In this presentation we provide an overview of the pharmacological and genetic background of addiction and the promising findings with regard to recent attempts to improve outcomes by a better matching of treatments and patients based on genetic information.
JS01-04 - Rational optimization of bipolar disorders’ treatment
Authors: Vieta E.
Published: May 2011

Bipolar disorder is difficult to treat. There are several options to treat acute mania, but combination of two or more drugs is the rule rather than the exception, indicating the limitations of currently available therapies. The evidence base for the treatment of bipolar depression is much weaker, and again combination is the rule. Although patients with bipolar disorder may experience resolution of symptoms with acute treatment, many will continue to experience impaired functioning due to the episodic, chronic, and progressive nature of the illness. Maintenance therapy is needed for a variety of reasons, including prevention of relapse, reduction of subthreshold symptoms, decreasing the risk of suicide, and reducing the frequency of rapid cycling and mood instability. Although long-term therapy is usually required to maintain or improve functioning and quality of life, it has been a significant challenge to identify clinically effective treatments for long-term management. There are few currently-available, well-tolerated treatment options that are effective in all phases of bipolar disorder and which prevent recurrence of manic and/or depressive episodes. Questions concerning when to discontinue one of the drugs when two or more are used, or how to switch from one mood stabilizer to another, have not been addressed in clinical trials. Electroconvulsive therapy may be effective in treatment resistant cases and can be used as maintenance when pharmacotherapy is not enough. Psychoeducation may help to enhance treatment adherence and healthy lifestyle. A rational combination of the above mentioned strategies may help to optimize the outcome of this challenging condition.
JS02-01 - Psychiatric intensive care
Authors: Frey R. , Winkler D. , Naderi-Heiden A. , Strnad S. , Winkler-Pjrek E. , Scharfetter J. , Kasper S.
Published: May 2011

Psychiatric disorders per se or treatment resistance can cause life-threatening conditions. More than 25 years have passed since the term “psychiatric intensive care unit” (PICU) was introduced in the United Kingdom. This system is comprised of security units for psychiatric patients with suicidal or violent behaviour, providing a locked environment with more resources regarding personnel and care. The PICU concept at the Department of Psychiatry and Psychotherapy in Vienna, Austria, represents a progress towards optimal care of patients with serious psychiatric illnesses who also have critical somatic illnesses. One third of the patients are transferred from inpatient facilities of medical departments such as internal medicine, emergency medicine, trauma surgery or anesthesiology. Our PICU is dedicated to somatically, critically ill patients who have psychiatric symptoms (e.g., agition, aggression, impulsivity, delusions, catatonia, confusion, reduced consciousness, impaired self-reliance) complicating recovery from their critical, somatic condition. Generally, the dosages for antipsychotics are not higher than those at normal psychiatric wards. Benzodiazepine dosages of about 30mg diazepam equivalents per day are frequently used. In the years 2008 and 2009, 10% of all patients at the Viennese PICU were treated with electroconvulsive therapy. Delirium requires immediate therapy of underlying intracerebral pathologies, extracerebral illnesses or toxic features. Involuntary commitment, physical restraints and urinary catheterization were applied in approximately 50% of the patients, nasogastric tube or central venous catheter in 20%. In every case, intensive care nursing, monitoring of vital functions and specific experience at the interface between psychiatry and somatic medicine are required.
JS02-03 - Suicidology and suicide prevention
Authors: Haring C.
Published: May 2011

Suicide is in Austria one of the most causes of death in the age group 15–54. World wide every year 1.000.000 of people die by suicide, in Europe the number of total suicide per year is 40.000, approxymately 13.500 young man and women aged 15–24 years die by suicide. Suicidology is a science which automatically leads to active work in prevention. Preventive strategies of the last two decades results in a marked decrease of Suicide rates in most countries of the world. However different preventive concepts seems to show similar results in reducing suicide rates. So it is not easy to identify the right way in suicide prevention. We analyzed the publications of the last years and tried to find out what are the characteristics approaches of the the countries with a successful suicide prevention. It seems that countries which istitutionalized suicide prevention by creating institutes on an university level had a good fundament for research and applied research is the best groundwork for establishing preventive projects. Applied research is as well the best ground base for establishing educational programs which are the start in all well functioning national suicide prevention programs.
JS02-04 - The organisation of emergency psychiatry in The Netherlands
Authors: Mulder C. , de Leeuw R.
Published: May 2011

Introduction

The organisation of emergency psychiatry varies between European countries. Our aim is to describe the organisation of emergency psychiatry in the Netherlands, including relevant epidemiological data.

Methods

The organisation of emergency psychiatry in the Netherlands was assessed using written material, official statistics and a recent study about the organisation of outpatient crisis services.

Results

In the Netherlands, most psychiatric emergency services are being delivered by three levels of care: primary care physicians, outpatient crisis services and inpatient admission units. The outpatient psychiatric crisis services constitute the key factor in the emergency psychiatric care, as they do most assessments (triage), short term crisis interventions and referral. Outpatient crisis services are available 24/7, and are mainly staffed by physicians (including psychiatrists) and psychiatric nurses. Usually, patients first consult a primary care physician in case of a psychiatric crisis situation, which can be followed by a referral to an outpatient emergency crisis service in the local region. Patients can also be referred by mental health clinicians (for example for triage for involuntary admission), the police or emergency departments of general hospitals. The outpatient crisis services perform diagnostic and risk assessments (triage), short term crisis interventions, and decide on referral to other services. These can be specialized outpatient programs or (in)voluntary admission to a psychiatric hospital. The number of crisis contacts per 100.000 inhabitants varies between regions, depending e.g. on population density. For example 400 crisis contacts per 100.000 inhabitants were registered in 2003 in the urban region of The Hague, versus 200 per 100.000 in a surrounding rural area. As a mean 20% of patients are being referred to a psychiatric hospital, half of them involuntarily. The number of crisis contacts, voluntary admissions, as well as involuntary admissions rises steadily in The Netherlands. In 1978, 17 per 100.000 inhabitants were admitted involuntarily, as compared to 50 in 2009. Reasons for involuntary admission include self harm, harm to others and severe self neglect. Involuntary admission for reason of severe self neglect is increasing over the last ten years. As a seperate phenomenon, ethnic minority groups, especially from Antillean, Surinam and Moroccan descent, are over-representated in outpatient as well as inpatient emergency services in the urban areas.

Conclusion

Outpatient crisis services constitute the key factor in the organisation of emergency psychiatric services in The Netherlands. The last decade, the number of crisiscontacts, as well as the number of (in)voluntary admissions did rise.
JS03-01 - Diagnosis and Treatment of Depression in Europe
Authors: Kasper S.
Published: May 2011

During the past years substanial knowledge has been obtained both in diagnostics and pharmacotherapy of unipolar depression. Today it is well-established that perturbation of the monoaminergic neurotransmission pathway is implicated in the development of depressive states, and that all currently existing antidepressants act on depressive symptoms by controlling monoamine availability at the synaptic level. According to the data obtained in Europe, it is apparent that these treatments are efficient in only 60–70% of depressed patients and their onset of action is partly delayed by 4–5 weeks. With novel pharmacological approaches recently being introduced, these figures can be improved. With the introduction of agomelatine, for instance, which affects the melatonergic as well as serotonergic pathways, higher response rates than with conventional antidepressants have been demonstrated. Furthermore, treatment of therapy resistance has been advanced with the introduction of atypical antipsychotics. For treatment refractory patients, brain stimulation as well as vagus nerve stimulation showed promising results although the later two methods are only possible in specific treatment centers. The advances in pharmacogenomics and sequencing of the human genome promise for the future to have molecular targets which have not as yet reached the daily practice. The search for new antidepressants based on these considerations has not been completed and the recent findings are promising for the future in regards to research and treatment. The lecture will include data on the neuropsychopharmacological understanding furthermore the future perspectives of treatment approaches will be discussed.
JS03-02 - Diagnostic and Treatment Procedures of Depression in India
Authors: Sheth A.
Published: May 2011

Depression in Indian Perspective is a major psychiatric problem. India is diverse country having many sociocultural factors, gender issues, Poverty and lack of appropriate psychiatric care. It is observe that patients use other modalities like yoga, satsang, Social support to deal with minor to moderate Depression. Severe problems are handled by about 4,000 psychiatrist for a total of hundred billon population and this facility are mainly centered around metropolitan cities. This paper discusses the relative merits and demerits of diagnostic problems and the management of depressive states.
JS03-03 - Prevalence and Impact of Common Mental Disorders: International Similarities & Differences. Results of the Who World Mental Health (WMH) Surveys Initiative
Authors: Alonso J. ,   on behalf of WHO World Mental Health (WMH) Consortium
Published: May 2011

Introduction A number of studies have shown that there is international variation in the prevalence of common mental disorders. Several factors have been suggested to explain such differences. Methodological challenges to comparability include: differences in settings, samples, assessment methods, and reporting practices. Also, cultural differences have been pointed out as possible cause of differential recognition and reporting of mental health issues. There is still uncertainty about the degree of international variation in the prevalence of mental disorders, and the lack of comparability of results is still an issue.

Objectives We assessed the prevalence and impact of mental disorders in the WHO World Mental Health (WMH) Survey Initiative, using common survey, assessment and reporting methods.

Methods The WMH surveys were completed in 24 countries from Africa, the Americas, Asia, Europe, the Middle-East and the Pacific. Representative samples of the adult, non-institutionalizes population were interviewed face-to-face, with the aim of estimating the prevalence, burden and unmet need for treatment of common mental disorders. The Composite International Diagnostic Interview (CIDI, 3.0) was used in all surveys to assess mental health status. Common mental disorders assessed included: anxiety, mood, disruptive behaviour, and substance disorders. Several standard measures of disability, both generic and disorder-specific, and role impairment were administered.

Results Results show that the mental disorders are commonly occurring in all participating countries. The inter-quartile range (IQR: 25th–75th percentiles) of lifetime DSM-IV disorder prevalence estimates (combining anxiety, mood, disruptive behaviour, and substance disorders) is 18.1–31.1%. The IQR of 12 month prevalence estimates is 9.8–19.1%. Prevalence estimates of 12-month Serious Mental Illness (SMI) are 4–6.8% in half of the countries, 2.3–3.6% in one-fourth and 0.8–1.9% in one-fourth. Possible causes of international variation will be addressed. Analysis of age-of-onset reports shows that many mental disorders begin in childhood-adolescence and have significant adverse effects on subsequent role transitions. Mental disorders are found in the WMH data to be associated with high levels of role impairment.

Conclusions Despite this burden, the majority of mental disorders go untreated. Although these results suggest that expansion of treatment could be cost-effective form both the employer perspective and the societal perspective, treatment effectiveness trials are needed to confirm this suspicion. The WMH results regarding impairments are being used to target several of these interventions.

Additional information about the WMH Surveys Initiative and the funing of the project can be found at: http://www.hcp.med.harvard.edu/wmh/
JS03-04 - How to Integrate Cultural Beliefs and Attitudes in Diagnosis and Treatment
Authors: Malhotra S.
Published: May 2011

Culture forms a part of one's identity. Cultural beliefs are intricately interwoven not only in conflicts and psychopathology but also in conflict resolution. With classificatory systems, now understanding and emphasizing on a ‘person-centred’ approach, the need to integrate cultural beliefs and attitudes can not be understated. With globalization, awareness and understanding of cultural beliefs, values, scriptures, practices, rituals and festivities, can help in personal growth, understanding psychopathology, establishing trust and rapport, aid in the help-seeking process, holistic management of the patient in a more acceptable, sensitive and compliant manner. Revisiting scriptures and trying to understand the insights gained in the past era can add on to the knowledge and skills used in the practice of Psychotherapy. Models of cultural integration that can be utilized in the teaching and practice of psychiatry, in understanding preventive psychiatry and stress-management shall be presented. Such integration shall be a definite step forward to a ‘person-centred’ approach and in addressing the soul of science.
PL01-01 - Genetic Reseach: Promises and Pitfalls for Clinical Treatment of Depression
Authors: Mendlewicz J.
Published: May 2011

The lifetime prevalence of mood disorders is estimated around 20% in the general population leading to a main cause of disability worldwide and a major public health issue.1 The ethiology of mood disorders is still unknown, but its various phenotypes are believed to be caused by multiple genetic variants interacting in a complex way with environmental vulnerability factors. Therefore, the identification of biomarkers and environmental markers is crucial to improve our understanding and diagnosis as well as our treatments. Despite intensive and costly research for more than two decades to unravel suceptibility genes, although pathophysiological pathways of interest have been recongnized, results have not been consistant so far and not a single genetic biomarker of depression has been identified and replicated. More recent systematic genome-wide association studies (GWAS) have reported weak associations of some genetic variants in large samples, but multiple rare variants may concur to confer only part of the suceptibility to depression. Structural variations may also be considered to be promising as is the case for copy-number-variations (CNVs). Methodological issues and limitations will also be critically discussed in light of the complexity of gene-evironment interactions (epigenetic modulation of gene expression)2 and in relation to future prospects for individualized pharmacotherapy of depressive illness.
PL02-01 - Why are there so Few New Drug Treatments in European Psychiatry?
Authors: Montgomery S.
Published: May 2011

Those with psychiatric disorders have long suffered from prejudice, their illnesses and suffering often trivialised by journalists in their columns and by government agencies. Tougher regulations appear to be imposed on the licensing of new treatments in psychiatry and harsher criteria for their reimbursement by government agencies compared with other therapeutic areas despite clear evidence that these disorders are associated with the highest levels of suffering and disability according to the WHO.

For a new treatment for a psychiatric disorder to be licensed in the EU more studies meeting stricter conditions are required than is the case with equivalent licensing authorities such as the FDA. For example, in the EU a comparator arm is required in clinical trials in addition to the more scientific placebo control. There is no adequate justification for this demand which appears to confound the demonstration of efficacy and safety versus placebo with pricing issues. A further hurdle in the EU is the requirement that long term efficacy compared to placebo is established before a treatment can be licensed which causes delay in bringing the drug to the market and adds to the cost of development. The process might be eased if access to specialist advice by the licensing agencies, strictly limited in the CHMP in contrast to other agencies, were improved.

Difficulties in the licensing process and delays following the granting of a licence inevitably have a negative effect on the viability of developing new treatments. Even when a licence is granted transparency/pricing commissions are the source of serious delays before clinicians are allowed to prescribe the treatment. Delays in allowing access to treatment by EU citizens can be so long that medications become available only after they have come off patent. These issues have led some pharmaceutical companies to withdraw from the development of treatments in psychiatry for the EU market and to close their neuroscience laboratories. The resulting loss of expertise in neuroscience will not be easily reversed. Psychiatric patients in the EU will find that the options for new treatments of their serious disorders are declining compared with other countries.
Early Detection in Psychosis: 5 year Outcome in the Scandinavian Tips-Study
Authors: Larsen T.K. , Melle I. , Auestad B. , Haahr U. , Joa I. , Johannessen J.O. , Opjordsmoen S. , Rishovd-Rund B. , Rossberg J.I. , Simonsen E. , Vaglum P. , Friis S. , McGlashan T.
Published: May 2011

Background

During the last decades we have seen a new focus on early treatment of psychosis. Several reviews have shown that duration of untreated psychosis (DUP) is correlated to better outcome. However, it is still unknown whether early treatment will lead to a better long term outcome. This study reports the effects of reducing DUP on 5-year course and outcome.

Methods

During 1997-2000 a total of 281 consecutive patients aged > 17 years with first episode non-affective psychosis were recruited of which 192 participated in the 5-year follow-up. A comprehensive early detection (ED) program with public information campaigns and low-threshold psychosis detection teams was established in one health-care area (ED-area), but not in a comparable area (No-ED area). Both areas ran equivalent treatment programs during the first 2 years and need-adapted treatment thereafter.

Results

At the start of treatment ED-patients had shorter DUP and less symptoms than No-ED-patients. There were no significant differences in treatment (psychotherapy and medication) for the 5 years. Mixed-effects modeling showed better scores for the ED-group on PANSS negative, depressive and cognitive factors and for GAF social functioning at 5 year follow-up. The ED-group also had more contacts with friends. Regression analysis did not find that these differences could be explained by confounders.

Conclusions

Early treatment had positive effects on clinical and functional status at 5 year follow-up in first episode psychosis.
The Beauty of Delusions
Authors: Musalek M.
Published: May 2011

As cosmopoets we create our world - but we do not create our world independently from our surroundings. What we are doing is not a poetry work in the sense of arbitrary inventions, but an attempt to transfer extensively and intensively psychical processes into communicable events. Patients suffering from delusions are also cosmopoets, they also create their world. It is a more or less understandable world, it is a world which is more or less similar to the world of the non-deluded, and it is a world which on the one hand terrorizes the patient but on the other hand attracts the patient by its sublime beauty. In this context W.Janzarik spoke from an ‘enemy/partnership’ of patients with delusions of persecution. The deluded world is a non-contingent terrifying but also in any case at least to some extent a beautiful and attractive world. Thrown in the risky and ugly world of mental disorders characterized by ambiguity and precariousness, patients are looking for islands of safety and sublime beauty; such islands may represent delusional convictions. As meanings of the disorder and the resulting ambivalence between attractiveness and suffering represent important disorder maintaining factors, knowledge about them provide the indispensable basis for effective treatment strategies (in particular psychotherapy) of delusional syndromes.
Reward-Related Learning in Alcoholism
Authors: Heinz A. , Beck A. , Park S.Q. , Deserno L. , Schlagenhauf F.
Published: May 2011

The disposition and maintenance of alcohol addiction has been associated with dysfunctional learning, particularly with increased salience attribution to alcohol-associated stimuli and Pavlovian-to-instrumental transfer, which establishes an effect of alcohol-associated cues on operant alcohol seeking and consumption. Previous imaging studies showed that dopamine dysfunction in the ventral striatum is associated with increased brain activation elicited by alcohol-associated cues in brain areas associated with attention. Furthermore, brain activation elicited by non-alcohol (e.g. monetary) reward was decreased in detoxified alcohol-dependent patients. Neuroadaptation following addiction therefore seems to augment neuronal responses to well-established, drug-associated stimuli while interfering with the learning of new, reward-seeking behaviour patterns. Using functional magnetic resonance imaging (fMRI) we showed that in detoxified alcoholics, reward-dependent reversal learning is impaired compared to healthy controls, and that this impairment correlates with reduced functional connectivity between the ventral striatum and the dorsolateral prefrontal cortex. Furthermore, we will present first data from a multimodal imaging study combining fMRI and positron-emission-tomography (PET) to measure the association between dopamine synthesis reduction and impaired functional brain activation during reversal learning in detoxified alcohol-dependent patients compared with healthy controls.
The Effects of Malnutrition in a Human Population on Addictive Behavior and Sex Ratio at Birth
Authors: Franzek E.J. , Roozen H.G.
Published: May 2011

The objective and aim of this case-control study was to replicate an earlier finding of a significant relationship between prenatal exposure to famine and substance use disorders later in life and to examine the sex ratio at birth in the study populations. We compared the number of addicted individuals in a population prenatally exposed to a severe hunger period with matched individuals in a non-exposed population. The gender distribution of patients with substance use disorders and healthy controls were calculated and all data were quantified as odds ratios. The findings confirm that prenatal exposure to famine is a risk factor to develop substance use disorder later in life. Men are at risk in particular by exposure to famine during the first trimester, women by exposure during the third trimester. The sex ratio men to women at birth was 3 : 1 in the patient groups compared to 1:1 in the healthy controls. The results were discussed in the light of the possible disastrious future consequences for the hunger regions in our world.
Individualised Pharmacotherapy of Alcoholism
Authors: Mann K.
Published: May 2011

Treatment of alcoholism is successful but effect sizes are in the low to moderate range. Heterogeneity of patients entering treatment trials could be one potential explanation. Several attempts have been made to subgroup patient for specific treatment approaches (“matching”). A new approach includes biological data such as pharmacogenetics and neuroimaging for treatment-patient matching.

In the PREDICT study (Mann et al., 2009) 426 alcohol-dependent patients were randomized either to placebo, naltrexone or acamprosate. Design and questionnaires were similar to the US COMBINE Study (Anton et al., 2006). Extending Project MATCH and the COMBINE Study we used biological and psychopathological characteristics of patients in order to test their response to naltrexone or acamprosate. In pharmacogenetics 14 SNPs from an own genome-wide association and follow-up study (Treutlein et al., 2009) were tested for differential treatment outcome. Indeed, one SNP showed a significant gene dose effect under acamprosate. Using neuroimaging we confirmed that an increase in brain activity in the ventral striatum is related to time to relapse. We also found support for our hypothesis concerning the rewarding characteristics of alcohol in a certain subgroup of patients. Here f-MRI BOLD response in the ventral striatum predicted a positive naltrexone response. Furthermore, new opioid receptors in alcoholics and normal controls were assessed using carfentanil PET.

Analyses are still underway.

In conclusion the treatment of alcoholism is moving towards a personalised approach. This holds the potential for a significant increase in effect sizes of our treatment trials and thus for better treatment options for our patients.
Ressource-Oriented Treatment of Addiction - the Orpheus Programme
Authors: Musalek M.
Published: May 2011

Major problems in treating patients suffering from addictions derive from the fact that the diagnostic category dependence syndrome covers a highly inhomogeneous patient group. Therefore uniform therapeutic approaches inflexibly following treatment guidelines have not fulfilled prognostic expectations. This was the starting point for developing a new modular resource-oriented treatment program in the Anton Proksch Institute Vienna.

Changing paradigms in the treatment of addiction, the Orpheus Programme offers a host of different modules designed to help patients to discover their own aims, objectives, values, and resources. The main task of the Orpheus modules is an increasing autonomous and joyful life. Abstinence represents no longer the only final goal of therapy, but is an important step to offer space and possibilities for the patients’ new life. When life becomes once again beautiful and filled with joy and meaning, addictive substances lose their seductive power: The more beautiful and attractive the patient's life, the less the drugs attractiveness. As illustrated by Orpheus, who defeated the sirens (as a symbol for addictive agents) by making the better, louder, and more attractive music, it becomes the patients’ main task to make a better “music of life”; the Orpheus modules are not training programs telling the patients how the better life looks like (as in former moral therapy); they intend to provide places, spaces and atmospheres encouraging and promoting the patients to make possible the possible.
Suicide and Personality: Focus on Old Age
Authors: Rujescu D.
Published: May 2011

Suicide is one of the leading causes of death worldwide, mortality from suicide being approximately 2%. Attempted suicide appears to be a major risk factor for suicide completion. Anger, aggression and impulsivity are personality traits associated with suicide attempt. We analysed anger, impulsivity and temperament/character scales as predictors of aggression and self-aggression in suicide attempters and compared this to anger- and aggression-related traits between impulsive and premeditated suicide attempts as well as between violent and non-violent suicide methods.

The State-Trait Anger Expression Inventory (STAXI), the Questionnaire for Measuring Factors of Aggression (FAF), and the Temperament and Character Inventory (TCI) were assessed.

Higher aggression scores, as measured by FAF, were predicted by being male, meeting criteria for borderline personality disorder and having higher angry temperament scores as assessed by STAXI. TCI dimensions associated with self-aggression were high harm avoidance, high impulsivity and low selfdirectedness.

State anger, inwardly directed anger and inhibition of aggression were also predictors of self-aggression.

In conclusion, impulsivity and harm avoidance have emerged as temperament dimensions independently associated with self-aggressive tendencies in personality. Such interactions could explain the correlation between temperament and suicidality but further research is needed. Anger and selfdirectedness appear to have some effects on suicide attempt.