bluuebunny/crossref_metadata_2025 huggingface dataset:
Premorbid sleep, appetite, energy, and cognitive circadian profile in patients with depressive disorders
Authors: Bersani G. , Liberati D. , Rasa A. , Polli E. , Ciuffa M. , Limpido L. , Russo D. , Marconi D. , Pacitti F.
Published: June 2010

Aim

Alterations of biological rhythms are well recognized to play a crucial role in the origin and maintenance of depression, but little is known about the profile of circadian rhythms at a premorbid age in adult depressed patients. The present study was aimed at investigating the association, if any, of depressive disorders with biological and behavioural rhythm modifications both at the time of observation and at an earlier age than the clinical onset of depression. The hypothesis was that such modifications could be an early biological index of vulnerability to the illness.

Subjects and methods

One hundred and seventy-eight patients affected by DSM-IV Major Depressive Disorder were examined/observed, compared to a group of 178 matched healthy subjects. All the included subjects were asked to fill in a retrospective questionnaire reporting time of awakening and falling asleep and time of subjective peaks of appetite, energy and cognitive function during “Adolescence” (12–15 years), “Youth” (16–20 years) and “Present condition” periods.

Results

An advance of awakening time by about 20 minutes during “Adolescence” was reported in the depressed subjects as compared to the controls. Awakening is also reported as significantly (P < 0.001) advanced by about 36 minutes during “Youth” in depressed patients, while time of falling asleep at the same age in the patients group shows 19 minutes delay. Regarding “Present condition” an advance of awakening time (33 minutes) in depressed patients was reported, in association with a delay of the subjective peak of cognitive functioning (62 minutes).

Discussion

Depressed patients show clear-cut differences in sleep pattern as compared to controls, consisting in a constant and significant advance of awakening time, while the time of sleep onset never reaches any statistical difference between the groups throughout ages.

Conclusions

The results are consistent with the hypothesis that early alterations of the general circadian profile can contribute to the onset of adult life Major Depressive Disorders.
Sleep apnea in patients with oral cavity and oropharyngeal cancer after surgery and chemoradiation therapy
Authors: Qian Wei , Haight James , Poon Ian , Enepekides Dan , Higgins Kevin M.
Published: June 2010

OBJECTIVE

To determine the point prevalence of sleep apnea in patients following oral and oropharyngeal cancer treatment at a major tertiary care referral center.

STUDY DESIGN

A retrospective cross‐sectional survey.

SUBJECTS AND METHODS

Twenty‐four patients with established oral or oropharyngeal cancer were submitted to overnight polysomnography. The surgical group consisted of 15 patients (11 male, 4 female; average age 64.2 yrs) having undergone primary surgery with radial forearm free flap reconstruction. The remaining patients (5 male, 4 female; average age 54.8 yrs) were treated nonsurgically with chemoradiation therapy. The fatigue‐related daytime sleepiness was measured with the Epworth sleepiness scale (ESS).

RESULTS

Eleven patients in the surgical group and three in the nonsurgical group had a respiratory disturbance index (RDI) greater than 15 (odds ratio = 5.5, P = 0.092). Twelve patients in the surgical group and five in the nonsurgical group had significant oxygen desaturation during sleep hours (odds ratio = 3.3, P = 0.356). There was no observed significant correlation between RDI and oxygen desaturation (r2 = 0.28), nor was there any observed association between the RDI and ESS score (r2 = 0.18).

CONCLUSION

This preliminary study has suggested that surgical patients in our cohort have a higher prevalence of moderate to severe obstructive sleep apnea in the postoperative period, when tested, compared with a nonsurgical group. A small sample size and incomplete matching on important cofactors of interest, such as primary site location, body mass index, and thyroid function, limit this study. A pretreatment and post‐treatment analysis is obviously required to demonstrate any significant level of association between treatment type and sleep apnea status.

© 2010 American Academy of Otolaryngology‐Head and Neck Surgery Foundation. All rights reserved.
S14-02 - Dialectical Behavior Therapy for Borderline Patients and Comorbid Substance Addiction
Authors: Kienast T.
Published: June 2010

The treatment of patients suffering from borderline personality disorder (BPD) in combination with substance addiction requires an integrative therapeutic approach. Dialectical behavioural therapy (DBT) is well evaluated and effective for the psychotherapeutic treatment of patients with BPD. We have extended classic DBT and integrated modern elements for the treatment of substance dependency into a standardized inpatient concept. This talk will give a short overview of the efficiency of psychotherapeutical methods for the treatment of the combination of both disorders. Finally we will present a psychotherapeutic concept for patients suffering from BPS and substance addiction following DBT in line with Marsha Linehans approach.
S14-03 - Dysfunctional Reward Processing in Alcohol Addiction
Authors: Beck A. , Schlagenhauf F. , Deserno L. , Friedel E. , Wrase J. , Heinz A.
Published: June 2010

Alcohol dependence is one of the most fatal mental diseases amongst men in western industrialized nations and is the major risk factor for the development of more than 60 chronic illnesses. With no further intervention, relapse rates in detoxified alcoholics are high and usually exceed 85% of all detoxified patients. It has been suggested that stress and exposure to priming doses of alcohol and to alcohol-associated stimuli (cues) contribute to the relapse risk after detoxification.

In the last decades there has been substantial progress in scientific research of the neurobiological principles of alcohol-related disorders. Recent studies using multi modal imaging techniques like functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) observed dysfunctions of the mesolimbic dopaminergic brain reward system (ventral striatum including the nucleus accumbens): Functional brain activation is increased during the processing of alcohol-associated cues and decreased during the confrontation with other non-alcoholic reward-indicating stimuli. This alcohol-associated “hijacking” of the reward system is associated with craving and the prospective relapse risk.

Moreover, the reward-associated learning seems to be disturbed in alcohol-dependent patients, so that addicted persons have problems to integrate informations about positive and negative consequences of their actions and to adapt their behavior accordingly. Personality traits like impulsiveness seem to be relevant in this context as well.

These findings about the different neurobiological mechanisms of addiction and relapse raise hope for new psychotherapeutic and pharmacological treatment approaches of alcohol dependence that is adapted to individual relapse mechanisms and needs.
S16-01 - The Co-variation of Mood Variability with ADHD Symptoms
Authors: Asherson P. , Skirrow C. , McLoughlin G. , Kuntsi J.
Published: June 2010

ADHD in adults is frequently associated with unstable or irritable moods reflecting difficulties with emotion regulation. Effect sizes of drug treatments on symptoms that reflect difficulties with emotion regulation, are similar to those on core ADHD symptoms, with co-variation of around 0.8 between the two types of symptoms during the treatment response. We therefore set out to investigate whether variability in mood results from the same aetiological processes that lead to variability in behaviour and cognitive performance in ADHD. Using real-time self-monitoring of emotional states and ADHD symptoms every two hours for 3-5 days, we characterised the mood changes in ADHD. Variability in both mood and ADHD symptoms (measured as the standard deviation) were significantly correlated with self-rated ADHD symptoms of inattention and hyperactivity. Subsequent analyses will link the observed symptom changes to cognitive-electrophysiological measures which are reliable indicators of core processes that underlie cognitive deficits associated with ADHD. We previously showed that a familial reaction time (mean and variability) factor explains 70% and commission and omission errors 20%, of the familial effects on ADHD. This finding concurs with the developmental model of Halperin which postulates that ADHD is linked to an early-appearing and enduring subcortical dysfunction, reflected in reaction time variability, while persistence/desistence of ADHD is dependent on maturational changes in executive control during adolescence reflected in commission and omission errors. We propose that at a behavioural level the subcortical deficit leads to dysregulation of a number of processes, including attentional, impulsive and emotional control.
S26-01 - Antidepressant Treatment: Polypharmacy Versus Monotherapy
Authors: Kasper S. , Konstantinidis A.
Published: June 2010

Although a good selection of antidepressants is available nowadays, the pharmacotherapy of depression still represents a challenge for psychiatrists worldwide. International guidelines and textbooks advise monotherapy with a selective serotonin reuptake inhibitor as treatment of first choice in depression. However, still one third of the depressive patients do not respond to the first antidepressant treatment implicated. Furthermore, approximately 20%-30% of them prove to be treatment resistant for two different antidepressants with different mechanisms of action. For these treatment resistant patients (TRD) augmentation and combination strategies are advised.

According to AMSP surveillance data (European international pharmacovigilance program, named AMSP: Arzneimittelsicherheit für Psychiatrie) from 2007 (obtained in 54 psychiatric institutions), 1829 depressive inpatients were recorded on the two reference days. 1674 inpatients received an antidepressant medication and among them 875 were concomitantly treated with an antipsychotic medication. Although the majority of inpatients were treated with one antidepressant (72%); 28% received two or more antidepressants. The most common combination of antidepressants was Venlafaxine with Mirtazapine (5,6%) being followed from Citalopram with Mirtazapine (2,7%). Interestingly similar findings have been recently reported from an US database.

Polypharmacy, although needed in treatment resistant cases, has a greater risk for adverse drug reactions and most augmentation strategies have not been tested regarding their long term safety. A combination of antidepressants seems only to be useful if they engage different mechanisms of action. Further clinical studies addressing combination strategies are needed in order to evaluate their benefit against monotherapy.
S32-02 - Pathological Stress and the Vulnerability to Addiction
Authors: van de Wetering B.J.M. , Franzek E.J.
Published: June 2010

Stress can be defined as the subject's response - both emotionally and physically - to stimuli (stressors) from the environment. Stressors are not necessarily negative. They are, when they exceed the subject's ability to cope with them in a physiological way. This level of stress is indicated as pathological stress.

Addiction and pathological stress are strongly interrelated on several levels. Animal studies have shown that the pathological stress during the development may be the most important factor that brings the vulnerability for addiction to expression. Stress during pregnancy may have a decisive influence on brain development and the subject's ability to cope with stress during later life. Patients with post traumatic stress disorder have an increase risk for the development of substance use disorders.

The brain reward system is a major target for the central and peripheral stress system. The catecholamines that mediate the stress response play an important role in the development of addiction. Addictive drugs such as stimulantia act as stressors by activating stress hormons. The process of craving is strongly associated with activated stress systems. Therefore, the adequate treatment of substance use disorders requires interventions that reduce pathological stress for the patient, either by diminishing environmental stress or by increasing the ability to cope with stress.
S32-03 - Changing Paradigms in the Treatment of Addiction - the Orpheus Project
Authors: Musalek M.
Published: June 2010

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.
S29-04 - Cognitive-Psychoeducative Group Therapy for Patients with Bipolar Disorder
Authors: Bernhard B.
Published: June 2010

Introduction

Cognitive-psychoeducative group therapy is an intervention developed in Munich to treat patients with bipolar disorder after an acute episode. First results of a prospective evaluation showed that the patients gained more knowledge after the intervention and relatives, who attended a separated group program showed less expressed emotion and burden in respect of the illness.

Objectives

We investigated the outcome of this intervention.

Aims

In a randomized controlled trial with 68 patients we analysed the days of illness, the amount of symptoms, quality of life and the knowledge about bipolar disorder.

Methods

Patients of the experimental group received a 12 week group intervention, patients of the waiting list control group received the same intervention after 6 months. Every 3 months the patients were rated for days of illness, symptoms, quality of life, knowledge and compliance.

Results

The results of 52 patients showed a significant reduction of depressive symptoms as well as an improvement of global functioning. We also showed a significant improvement of knowledge about bipolar disorder and satisfaction about the treatment. Detailed analysis showed that patients with less than 10 years of illness showed even more reduction of depressive symptoms as well as an improvement of psychological well being. Patients with more than one year of psychotherapy experience showed a reduction of manic symptoms.

Conclusions

The intervention is an important addition to pharmacological treatment, but further improvements of treatments for bipolar disorder are necessary.
S05-01 - The Body in Distress [E22]
Authors: Oyebode F.
Published: June 2010

Psychiatry deals with morbid psychological experience. This suggests that central to psychiatry's concern is the mind as opposed to the body. Yet, it is often the afflicted body rather than the mind that the patient presents to the clinician. In addiction, psychiatry classification has an underlying hierarchical bias for organic (somatic) disorders. Furthermore, many disorders such as generalised anxiety disorder and mood disorders have bodily manisfestations that are taken for granted in the consultation process or translated and relabelled as pointing towards psychological/emotional distress. This suggests that Cartesian mind-body dualism continues to significantly influence psychiatric concepts, classification and practice. In this presentation, the role of the body as model, metaphor, symbol, object and experiencing subject will be analysed with illustrative examples from clinical practice and literature. I will rely on Kafka's Letter to Father, Elfriede Jelinek's Piano Teacher, and Minkowsky's Lived Time.
S05-03 - Social Evolution of Somatization [E24]
Authors: Cimilli C.
Published: June 2010

Somatization concept should be considered in biopsychosocial integrity. This
presentation reviews the social aspects of somatization. The description of
somatization evolved in time in order to include the social aspects. The
differences of somatization between societies, somatization concept in western
and Eastern medical thought, modernist theory on the evolution of somatization,
research which confirm and which do not confirm the modernist theory were
reviewed. The pos-modern approach which constitutes a new paradigm in cultural
psychiatry, prefers to study the mental disorders through the culture, instead
of comparing them cross-culturally. In this context, first the culture-bound
somatization diagnosis of non-Western cultures, then the fashionable diagnosis
of Western culture in which the somatization is hiding were reviewed.
S15-02 - Is Emotional Dysregulation Part of the Psychopathology of Adult ADHD?
Authors: Stieglitz R.-D.
Published: June 2010

The dimensions of ADHD symptoms in adults have been discussed controversially. Beside the classical symptom domains as unattention, hyperactivity, and impulsivity, other symptom clusters as emotional dysregulation are in debate. The aim of this presentation is to update the recent discussions on this topic by reviewing current positions and empirical data as well as presenting own data. The relationship between the scales with emotional contents in the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) compared to other established ADHD rating scales was explored in a sample of 600 ADHD patients. The aim is to clarify whether the symptoms are independent of other ADHD domains.
S15-03 - The Co-Variation of Mood Variability with ADHD Symptoms
Authors: Asherson P. , Skirrow C. , McLoughlin G. , Kuntsi J.
Published: June 2010

ADHD in adults is frequently associated with unstable or irritable moods reflecting difficulties with emotion regulation. Effect sizes of drug treatments on symptoms that reflect difficulties with emotion regulation, are similar to those on core ADHD symptoms, with co-variation of around 0.8 between the two types of symptoms during the treatment response. We therefore set out to investigate whether variability in mood results from the same aetiological processes that lead to variability in behaviour and cognitive performance in ADHD. Using real-time self-monitoring of emotional states and ADHD symptoms every two hours for 3-5 days, we characterised the mood changes in ADHD. Variability in both mood and ADHD symptoms (measured as the standard deviation) were significantly correlated with self-rated ADHD symptoms of inattention and hyperactivity. Subsequent analyses will link the observed symptom changes to cognitive-electrophysiological measures which are reliable indicators of core processes that underlie cognitive deficits associated with ADHD. We previously showed that a familial reaction time (mean and variability) factor explains 70% and commission and omission errors 20%, of the familial effects on ADHD. This finding concurs with the developmental model of Halperin which postulates that ADHD is linked to an early-appearing and enduring subcortical dysfunction, reflected in reaction time variability, while persistence/desistence of ADHD is dependent on maturational changes in executive control during adolescence reflected in commission and omission errors. We propose that at a behavioural level the subcortical deficit leads to dysregulation of a number of processes, including attentional, impulsive and emotional control.
S15-04 - Do Symptoms of Emotional Dysregulation Respond to Pharmacological Treatment of Adult ADHD?
Authors: Rösler M. , Retz W.
Published: June 2010

The core psychopathology of ADHD comprises attentional deficits, hyperactivity and impulsivity. At least in subpopulations the majority of individuals suffering from ADHD present with emotional symptoms additonally. There is an ongoing and controversial debatte whether emotional symptoms belong to the disorder as further intrinsic ADHD psychopathology or may have their origin in comorbid affective disorders. There is growing evidence that emotional symptoms of ADHD as measured by the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) respond to treatment with Methylphenidate (MPH), while the classical symptoms of depression or anxiety disorder show no significant improvement.

We report on a 24-week, placebo controlled treatment study with MPH-extended release in 359 adults with ADHD. Emotional symptoms were assessed with the WRAADDS. Symptoms of depression and anxiety were endorsed by use of the Symptom Checklist-90-Revised (SCL-90-R).

As compared with placebo we found a significant treatment response in favour of MPH-ER regarding emotional symptoms like affective lability, emotional overreactivity and temper control. The psychopathology of depression and anxiety did not display a significant treatment response.
S24-02 - Phosphodiasterase 4 (PDE4) Variants: Role in Depression and Treatment
Authors: Dwivedi Y.
Published: June 2010

cAMP-specific PDE4 are a family of enzymes capable of hydrolyzing cAMP to 5’AMP. cAMP plays a major role in synaptic plasticity, neurite outgrowth, and neuronal differentiation and survival and recent studies demonstrate involvement of cAMP in pathophysiology of depression. The cAMP-specific PDE4 can be differentiated from other PDE families by sequence identity in the catalytic region of the protein and by their ability to be inhibited by a specific class of drugs, of which rolipram is the prototype. PDE4 enzymes are also unique in having ‘signature’ regions of sequence, called upstream conserved regions (UCR1 and UCR2), located in the N-terminal region of the proteins. There are four PDE4 subfamilies, encoded by separate genes (PDE4A, PDE4B, PDE4C, PDE4D), all are expressed in brain. A few studies suggest that PDE inhibitors show antidepressant-like effects in rodents. To examine the role of PDE4 in depression, we characterized various isoforms of PDE4 in human brain. Expression of PDE4A1, PDE4A4, PDE4A10, PDE4B1, PDE4B2, PDE4B3, PDE4D3, PDE4D4, PDE4D5 and PDE4D9 variants were characterized. All, except PDE4A10, PDE4B1, PDE4D4 or PDE4D5 variants, were highly expressed in human brain. When compared, we found that expression levels of PDE4A1, DE4B2, and PDE4A4 were decreased in PFC and hippocampus of depressed subjects, whereas, no change was observed in expression of PDEB3, PDE4D9, and PDED3 variants. Our study for the first time provides evidence of variant specific alterations in PDE4 in brain of depressed subjects and indicates that these variants may be used as site-specific therapeutic target(s) to develop novel antidepressants.
S24-03 - Glycogen Synthase kinase-3ß and Associated Proteins in the Phosphoinositide 3- kinase/akt Signaling Axis: Role in Major Depression
Authors: Karege F. , Perroud N. , La Harpe R. , Burkhardt S. , Ballmann E. , Malafosse A.
Published: June 2010

Objectives

Major depression disorder (MDD) is still a major public health problem and the understading of its neurobiology is still poor. We are interested in the impairment of the neuroplasticity, as hypothesis. Evidence suggest that Akt/GSK3ß axis plays a role mediating hormones actions in neuronal survival. The objective of our study was to assess, in MDD, the regulation of protein and lipid kinases involved in the signaling pathway: PI3K-Akt/PKB-GSK3α/ß-ß-catenin and a phosphatase, PTEN.

Methods

Drug-free postmortem brain cortices (VPFC) from antemortem diagnosed depressed subjects, and in few cases, neuroblastoma cells, were used. Applying the methods of western blot, enzymatic activity, we measured the activities, the levels of several proteins and their expression: Akt1 ; GSK3ß ; pGSK3ß ; PI3K ; PTEN ; ß-catenin. Statistical significance was set at p< 0.05.

Results

With respect to control subjects, the main changes observed in MDD can be summarized as follow : The PI3K enzymatic activity was decreased without changes in protein levels. The GSK3ß activity was increased, but the total activity (α+ß isoforms) was not changed, nor were the total GSKαβ protein levels. The Akt1 activity was decreased, The PTEN protein levels were decreased. The ß catenin levels and the tGSK3ß-to-pGSK3 ratio were altered.

Conclusions

The data show a major depression-associated blunting of the PI3K-Akt-GSK3 signaling pathway. The study of protein and lipid kinases and phosphatases is particularly relevant because of crucial roles played by these proteins in neuron survival, proliferation and apoptosis. It adds further support to the neuroplastic hypothesis of affective disorder.
S13-02 - Outcome in Treated Violent and Sex Offenders
Authors: Endrass J. , Rossegger A.
Published: June 2010

The aim of the “Therapy Evaluation Project” was to examine the therapy outcomes of all violent and sex offenders treated by the Zurich Criminal Justice System between January 1997 and the 31st of December 2005.

This included all the court-ordered therapies at the prisons of the Canton of Zurich as well as outpatient treatments that were carried out after release from detention (or instead of detention). The final treatment sample consisted of N=222 treated violent and sex-offenders. A representative sample of untreated violent and sex-offenders served as a control group.

After a mean time at risk of six years, the recidivism rates of the offenders were reviewed. Two types of recidivism were defined:

(1)

The listing of a new conviction in the criminal record or

(2)

offense relevant behaviour documented by the therapists, the probation services and/or other authorities.

The recidivism rate for treated violent and sex-offender was 12% compared to 20% for the untreated controls. By juxtaposing the various criteria/definitions of recidivism, the standards for evaluating the effectiveness of therapy will be debated.
S18-01 - Stress in Suicidal Persons and Genetics of the HPA Axis
Authors: Wasserman D. , Wasserman J. , Sokolowski M.
Published: June 2010

Suicidal behavior (SB) is a major burden in most nations world-wide and a major public health concern. The causes of SB are complex, in which both genetic set-up and exposure to overwhelming psychological stress (environmental factor) contribute to a person's final predisposition for SB. One candidate system reflecting this causal route to SB is the stress-modulating hypothalamic-pituitary-adrenal (HPA) axis, and dysregulation of HPA is considered to play a major role in depression and SB. The corticotrophin-releasing hormone and its main receptor (CRHR1) have key regulatory functions in the HPA axis, and we hypothesized that genetic variation in CRHR1 may be associated and linked with SB and related endophenotypes. We analyzed single nucleotide polymorphisms (SNPs) in an extended sample of family trios (n = 672) with suicide attempter offspring, by using family-based association tests. Results showed that the minor T-allele of exonic SNP rs12936511 was significantly transmitted to suicidal males with increased Beck Depression Inventory (BDI) scores (P = 0.0028). Analysis of haplotypes showed that risk alleles of three different SNPs segregated onto separate haplotypes, whereas a fourth ‘nonrisk’ haplotype (‘CGC’) was preferentially transmitted to suicidal males with lowered BDI scores (P = 0.0007). Conversely, the BDI scores of those who carried a homozygous combination of any of the three risk haplotypes were significantly increased (P = 0.000089). We concluded that depression intensity in male suicidal offspring was related to genetic variability in the 5’-end of CRHR1, while the characteristics of the suicide female attempters remained unknown.
S18-02 - Gene-Environment Interaction: 5-HT2A AA Genotype and Childhood Emotional Abuse Upturn Suicide Risk in Male Prisoners
Authors: Sarchiapone M. , Vladimir C.
Published: June 2010

Suicide is the leading cause of death in prisons. Number of studies has indicated disturbances in serotonin neurotransmission in persons displaying suicide behaviour and depression. We hypothesized that 5-HT2A -1438G/A polymorphism would modulate the influence of childhood trauma on suicide and depression among prisoners in a gene-environment-dependent manner.

Study participants were 427 male prisoners detained in jails of the District of Abruzzo-Molise in Italy. All were assessed through psychiatric interview, Hamilton Rating Scale for Depression (HRSD-21 items) and Childhood Trauma Questionnaire (CTQ). The component structure of the 21 HRSD items was determined using principal component analysis with varimax rotation and three components were extracted. We proposed a new gxe model with all components dichotomised at the median and used as dependent variables when creating logistic regression.

Significant interactions were found with the suicide/insomnia component only. The major findings were:

1)

emotional abuse during childhood interacts with 5-HT2A AA genotype to increase the risk for later-life suicide and insomnia,

2)

5-HT2A AA genotype and childhood traumas (emotional abuse and physical neglect) independently of each other increased the risk for later-life suicide and insomnia,

3)

5-HT2A AG and GG genotypes might be protective against suicide and insomnia, even when in interaction with childhood traumas.

Our results add evidence to the fact that suicide and insomnia are both complex traits shaped by interactions between genetic and environmental factors. These factors might interact dynamically throughout prenatal and postnatal periods, thus shaping the brain development and leaving long-term consequences on adult behaviour.
S23-01 - Lithium Treatment and the Risk of Suicide in Affective Disorders
Authors: Rihmer Z.
Published: June 2010

In spite of the fact that suicidal behaviour is very complex, multicausal human behaviour, untreated current major Axis I affective disorder (bipolar and unipolar major depressive episode: 56-87%) is the most powerful predictor of suicide, particularly in the case of prior suicide attempt. Prospective and retrospective follow-up studies clearly support the eivedent clinical observation that if patients with unipolar or bipolar mood disorder committ or attempt suicide, they do it mostly during the major depressive episode (78-89%) and less frequently in dysphoric mania or mixed affective episode (11-20%) but very rearly during euphoric mania or euthymia, indicating that suicidal behaviour in mood disorder patients is a state-dependent phenomenon. Consequently, effective treatment of acute major mood episodes and successful long-term management is very important part of suicide prevention of patients with affective disorders. Indeed, it has been repeatedly demonstrated that long-term lithium treatment of bipolar disorder and unipolar depression reduces the risk of completed and attempted suicide markedly, even in this high-risk population. The marked anti-suicidal potential of lithium seems to be more than the simple reflexion of its phase-prophylactic effect, as it has been demonstrated that during the long-term prophylaxis of recurrent unipolar and bipolar affective disorder patients with at least one prior suicide attempt, a significant reduction in the number of suicide attempts was found not only in the excellent responders (93%), but also in moderate responders (83%) and in poor responders (49%).
S23-02 - In Search of Optimal Lithium Levels in the Long-Term Treatment of Bipolar Disorders
Authors: Severus E.
Published: June 2010

Introduction

Lithium is generally regarded as a first-line option for the long-term treatment (ie, maintenance treatment, prophylactic treatment) of bipolar disorders. However, there is a substantial amount of uncertainty regarding the most efficacious plasma concentration of this drug for this indication.

Aims

To allow clinical psychiatrists to practice evidence-based medicine when it comes to decide which lithium levels to target in the long-term treatment of their patients with bipolar disorders.

Methods

We will present the available evidence from randomized controlled trials (RCTs) explicitly addressing the issue of optimal lithium levels, show new data from post-hoc analyses of more recent approval-seeking RCTs including lithium as a comparator drug, discuss the methodological limitations and pitfalls inherent in all these studies and address open questions still waiting to be answered.

Results

The available evidence suggests that lithium levels ≥0.6 mmol/L will be necessary for optimal protection against both manic/mixed and depressive episodes. For most patients an increase in lithium levels beyond 0.8 mmol/L will not be associated with superior efficacy against either manic/mixed or depressive episodes. In contrast, lithium levels between 0.4 - 0.6 mmol/L may be sufficient, at least for some patients, for optimal protection against pure depressive episodes.

Conclusion

Lithium levels between 0.6 - 0.8 mmol/L seem to be associated with optimal protection against both manic/mixed and depressive episodes in the long-term treatment of bipolar disorders.
S19-04 - Current Findings of Suicidality and Migration
Authors: Schouler-Ocak M. , Yesil R. , Temur-Erman S. , Aichberger M.C. , Heredia-Montesinos A. , Bromand Z. , Rapp M.A. , Heinz A.
Published: June 2010

The process of migration can be a risk factor for suicidal behaviour. Factors such as circumstances of the migration and individual characteristics like age, education, and his offspring play an important role. The empiric evidence of today's suicide prevention therapy strategies - following a suicidal crisis or a suicide attempt - in order to prevent prospective crises are limited. There are not enough protective therapy recommendations. Psychotherapeutic interventions and antidepressants are not proven to be better than a standard treatment. An appropriate treatment of depression (antidepressant, psychotherapy, psychoeducation, self-help) seems to be preventive. In this contribution the current state of epidemiology, ethiopathogenesis, models of suicidal behaviour and suicide prevention will be discussed.
S33-02 - Role of P-Glycoprotein for the Actions of Antidepressants
Authors: Carvalho L.
Published: June 2010

Clinical studies have demonstrated an impairment of glucocorticoid receptor (GR)-mediated negative feedback on the hypothalamic-pituitary-adrenal (HPA) axis in patients with major depression (GR resistance), and its resolution by antidepressant treatment. This GR impairment is driven by different pathophysiological mechanisms, including the effects of inflammatory mediators, changes in GR-associated proteins, reduction of intracellular access of glucocorticoid hormones, and GR gene variants. Our research has looked at the multitude of pathways affecting GR and MR function, using both clinical models and experimental systems, including most recently the use of prednisolone as a new neuroendocrine test, the in vitro evaluation of GR function in peripheral blood cells from depressed patients, the use of mice with knockout glucocorticoid transporter (p-glycoprotein) genes, and the examination of polymorphisms in inflammatory genes. This presentation will review our most important recent findings in this field, including:

1)

that GR in peripheral blood mononuclear cells is resistant to the modulating effects of antidepressants in the context of increased activation and production of interleukin (IL)-6;

2)

that p-glycoprotein knockout animals have normal entry of corticosterone into the brain but do not show the effects of antidepressants on the HPA axis;

3)

that polymorphisms in the IL-6, IL-10, phospholipase A2 (PLA2) and cyclooxygenase-2 (COX-2) genes regulate the interaction between stress, inflammatory challenges and the development of mood and somatic symptoms; and

4)

that, in contrast to the GR, the mineralocorticoid receptor (MR) function remains intact in depression, except in a subgroup of individuals who do not respond to treatment.
S33-03 - Involvement of Cytoskeletal Microtubules in the Action of Antidepressant Drugs
Authors: Bianchi M.
Published: June 2010

Growing evidence suggests that alterations in cytoskeletal microtubules dynamics may be involved in the effects of antidepressant drugs on brain structural neuronal plasticity phenomena such as remodelling of axons and dendrites. The speaker will review the most recent data in the field obtained in either naïve animals or in animal models of stress/depression. These results were gathered using a multidisciplinary approach, ranging from behavioural tests to neurochemistry and molecular analyses of specific markers of microtubule dynamics and synaptic remodelling. Several classes of antidepressant drugs have been shown to differentially modulate the expression of microtubular proteins and synaptic markers in specific rat brain regions depending from the dose and length of administration. Importantly, such antidepressant-induced effects on microtubular and synaptic proteins showed a very different pattern of changes in environmental (social isolation from weaning) or genetic (Flinders Sensitive Line) rat models of depression, which were not always accompanied by recover of the “depressive-like” behavioural phenotypes. Therefore, antidepressant drugs can modulate brain cytoskeletal and synaptic remodelling, but the pattern of these phenomena seems related to a complex gene-environment interaction. These data may be considered of translational human relevance when put in the context of partial- or non responders to antidepressant therapy. Finally, MAPREG developed new molecules specifically targeting neuronal microtubules and promoting structural neuronal plasticity, which may represent novel tools for the therapy of depressive disorders. Novel data on the antidepressant efficacy of one of these promising molecules in rat models of depression will be presented.
S02-01 - Prevalence Rate and Comorbidity of Computer Addiction of Children in a German Psychiatry
Authors: Ammerschläger M. , Müller K. , Wölfling K.
Published: June 2010

Objectives

At present, limited quantitative data about computer addiction of young people are available. The study was designed to obtain the prevalence rate of computer addiction of children. A further objective was to increase the know-how about cyber-related addictions and their comorbidity of mental disorders.

Methods

Survey among children/young people and their parents using questionnaires CBCL, YSR, CSVK, OSV and View. The children answered the questions of CSVK and OSV, adolescents over the age of 11 further filled in YSR. The parents were interviewed using CBCL and View.

Data collection was in the paediatric psychiatry in Munich, data analysis in the University of Mainz.

100 patients between 8 and 18 years of age, who asked for an outpatient or inpatient treatment of various mental disorders, filled in the questionnaires from July to November 2009 (63% male and 37% female).

Results

The prevalence of computer addiction was 3%. The prevalence of computer abuse was 7%.

The study exhibited a significant difference in gender: boys showed to be mainly addicted, girls mainly improper users.

It was further observed that the young cyber junkies use games, chats, emails and communities more frequently than average users.

In accordance with other studies it was determined that possible comorbidities are depression, anxiety disorders and aggressive behaviour.

Conclusions

In addition to other mental disorders, 3-6% of the patients in a German psychiatry were found to be computer addicted. It is important to do research for a better diagnostic and therapeutic treatment or implementation of preventive interventions.
S07-02 - Maternal Perinatal Depression: Impact on Infant Emotion Regulation and Later Toddler Behavior Problems
Authors: Muzik M.
Published: June 2010

Introduction

Pre-and Post-natal maternal stress and/or psychopathology can have negative effects on infant temperament and later toddler behavior (Buitelaar, Huizink, Mulder, Robles de Medina, & Visser, 2003; Gutteling et al., 2005; Whitaker, Orzol, & Kahn, 2006). Infant temperamental difficulties, such as shyness or emotional lability, have been associated with later behaviors problems as children develop (Olson, Bates, Sandy, & Lanthier, 2000; Olson, Bates, Sandy, & Schilling, 2002). In particular, infant emotionality and emotional reactivity has been suggested as an early precursor to externalizing problems in children (Crockenberg, 2005).

Objectives/aims

The goal of this research study is to explore the links and potential pathways between maternal perinatal depression and adverse infant and toddler behavior problems.

Methods

The present study utilizes data from a high-risk community sample and explores the links between maternal stress and depression during pregnancy and postpartum predicting to their infants’ emotion regulation problems at 7 months of age. On a smaller subset we further explore the associations between early emotion regulation problems and subsequent development of pre-school behavior problems.

Results

We found that both maternal postpartum depression and problematic bonding uniquely predict problematic infant temperament at 7-months, and that in turn, infant emotion regulation problems were predictive of higher scores of toddler behavior problems 12 months later.

Conclusions

Our preliminary data confirms that infant emotionality (in the context of maternal psychopathology and problematic bonding) may be an early precursor to the development of later toddler behavior problems.
S28-02 - Impact of Gene Polymorphisms on Pharmacokinetics and Pharmacodynamics of Olanzapine and Clozapine
Authors: Dahl M.-L.
Published: June 2010

Treatment with antipsychotic drugs is, despite the introduction of many new compounds, far from optimal in a large proportion of patients. Apart from lack of or insufficient response, various adverse drug reactions often limit the use of otherwise efficient drugs, and increase the risk of non-compliance and poor treatment outcome. Thus, there is considerable need for individualized treatment in order to maximize the therapeutic outcome. This variability in drug response may be related to both pharmacokinetic and pharmacodynamic factors, many of which are genetically regulated. In the presentation, the contribution of allelic variability in genes coding for drug metabolic enzymes (CYP2D6, CYP1A2 and others) and transport proteins (ABCB1), as well as drug targets, to the pharmacokinetics and clinical effects of atypical antipsychotics will be discussed, using olanzapine and clozapine as model drugs. While CYP2D6 had no influence, carriage of two CYP1A2 allelic variants was associated with higher dose-adjusted plasma concentrations of clozapine and its metabolite desmethylclozapine. Patients with elevated insulin levels more frequently carried the *1C and *1D alleles, had higher plasma drug levels, higher blood lipids and HOMA-IR compared to patients with normal insulin levels. Associations were found between HTR2C and HTR2A haplotypes and increased BMI and C-peptide levels. A HTR2C haplotype was also shown to be significantly more frequent among obese than non-obese patients on long-term clozapine treatment. The data illustrate the need of an integrated approach involving both pharmacokinetic and -dynamic aspects in pharmacogenetic studies aiming at personalized antipsychotic treatment.
S35-02 - Pharmacogenetic Studies of Treatment Response in First-Episode Psychosis
Authors: Reynolds G.P.
Published: June 2010

Introduction

Antipsychotic drugs are limited in their efficacy by the relatively poor response of negative and cognitive symptoms of schizophrenia as well as by the substantial variability in response between patients. Although there is a substantial number of pharmacogenetic studies of antipsychotic drug response, relatively few have studied response in first-episode patients. Still fewer have separated effects on positive and negative symptoms, despite the established differences in response to drug treatment between these syndromes.

Objectives

To identify genetic polymorphisms contributing to individual variability in the response of different symptoms to antipsychotic drug treatment of first-episode psychosis.

Methods

Functional polymorphisms in several candidate genes implicated in antipsychotic drug mechanisms have been investigated in first-episode psychosis patients and assessed for their association with response of different symptom subgroups.

Results

We have identified the importance of a common functional polymorphism in the 5-HT1A receptor gene on response of negative and depressive symptoms in initially drug-naive psychotic patients; a longer term (one year) study of first-episode subjects demonstrated an association of the 5-HT transporter gene on negative symptom outcome. Despite the discrepancy between these and other reports, most findings are consistent with the conclusion that dopamine D2 and D3 receptor polymorphisms appear to relate to positive symptom response, while negative symptom improvement relates to polymorphisms of genes influencing 5-HT neurotransmission.

Conclusions

Identifying the genetic factors influencing initial symptom response to antipsychotic drugs may provide both an understanding of the underlying neurotransmitter mechanisms and an indication of the clinical utility of genetic testing.
S06-03 - Schizophrenia, Epiphany and Kafka's “the Trial”
Authors: Handest P.
Published: June 2010

Schizophrenia, epiphany and Kafka's “The Trial”K. Conrad wrote Die beginnende Schizophrenie in 1958, but his description of the psychopathology of schizophrenia and his concepts of schizophrenia are still very enligthning to contemporary readers. One of several important concepts described is that of epiphany. In his description he stressed that this was a way of experiencing the whole world, perceptions, emotions, notions, etc. The schizophrenic patient not only experiences that every thing has a certain meaning attached to it, also this meaning has something to do with the patient. Nothing seems to be coincidential, but on the contrary seems to be specifically important for the patient. This sudden, intuitive perception of or insight into reality or essential meaning of the world resembles the experience of a revelation (=epiphany from ancient Greek). This way of experiencing/living in the world feels so “natural” to the patient, that he never questionswhat is obvious discrepancies and incompatibilities to others.Frans Kafka has been called the best descriptor of the schizophrenic world. His novel The Trial (Der Prozess) is commonly viewed as a description of bureaucracy, but can also be seen as a matchlessly description of the schizophrenic world. In the film the spectator sees every thing through the eyes of Joseph K and thereby has the opportunity to a first person experience of the self-reference, oddness and inconsistencies of the schizophrenic world. This brings the notion of epiphany to the lived world of the spectator.