bluuebunny/crossref_metadata_2025 huggingface dataset:
What Can be Learned from the Systematic Analysis of Suicides that Occur in the Healthcare System?
Authors: Wasserman D.
Published: March 2009

Many European countries have a national suicide preventive programme. In June 2008, a new national programme for suicide prevention was approved by the Swedish Parliament in Sweden. One of the nine strategies in this programme is an assignment called ‘Lex Maria’ - to report all suicides that occur within or 28 days after contact with the healthcare system to The National Board of Health and Welfare (NBHW). Lex Maria guarantees that a systematic evaluation will always occur, providing opportunities to identify components which can be improved when treating suicidal patients. All Lex Maria reports are registered in a separate database at NBHW, allowing systematic analysis at a national level. The methodology used in this analysis will be presented, with examples of individual cases.

Analysis of all suicide cases, which occurred in Sweden in 2006 within the health care system, uncovered the following areas which should be improved when working with suicidal people:

•

Better routines for suicide risk assessment;

•

Better routines for documentation of suicide risk assessment and changes in patients mood;

•

Better routines for the transfer of information within the same unit;

•

Better communication between units to ensure correct transfer of information;

•

Better routines for collaboration between care givers to ensure a continuity of care.

In order to increase the competence of psychiatric health care staff in caring for suicidal patients, an annual 2 day education programme/course is recommended. The government also has an ambition to increase awareness of suicide prevention in the population.
Cultural Bias in Psychiatric and Psychological Testing
Authors: Qureshi A. , Collazos F. , Revollo H.W. , Valero S. , Ramos M. , Delgadillo C.
Published: March 2009

Psychiatric and psychological testing are used extensively in both clinical and research contexts, with the goal of providing an objective indication of the construct being measured. At the same time, it has long been recognized that there is no such thing as a culture free or even fair test, to the extent that cultural bias-the constant and systematic statistical error due not to chance but to ethnic group membership-can seriously undermine the validity of a psychological or psychiatric test. The very construct being measured may not have a culturally compatible equivalent, or, relatedly, the behavior sampled in a given item or combination of items may not be associated with the construct in question in the same way across all cultures. In addition the means by which the behavior is sampled-the instrument construction, the sorts of questions or their structure, for example-can vary in familiarity across cultures. Finally, the individual items themselves may be poorly or ambiguously translated, may be predicated on specific cutlural norms, or, indeed, the meaning of the item can vary cross-culturally. Finally, sampling bias pertains to the representativeness of the sample, however, this is all the more complex given that constructs such as “race”, “ethnic group” and so forth are often poorly defined and ambiguous, and thus who is and who is not included in a given group may further undermine the validity of the test. Despite these difficulties, concrete steps can be taken to increase the cultural validity of the test used.
Impact of a Long Asylum Procedure on Health in Iraqi Asylum Seekers in the Netherlands; an Epidemiological Study
Authors: Laban K.
Published: March 2009

Aim:

To investigate the relationship between the length of stay in a western host country and psychiatric disorders among asylum seekers from Iraq.

Methods:

Two groups of Iraqi asylum seekers, respectively less than 6 months (n=143) and more than 2 years (n=151) in The Netherlands were interviewed The sampling was at random. The health status was measured and evaluated in relation with pre-and post-migration adverse life events. Riskfactor analyses were done and adjusted Odds Ratio's were assessed. Moreover data were collected about physical health, functional disability and quality of life and their relationship with psychopathology as well as with length of stay were assessed.

Results:

The overall prevalence of psychiatric disorders was 42% in the group that just arrived and 66.2% in the group that stayed more than 2 years in the Netherlands. On logistic regression of all relevant riskfactors, a long asylum procedure showed an odds ratio of 2.16 (CI=1.15-4.08) for psychopathology. Except for female sex, this odds ratio was higher than those from life events in Iraq. Furthermore: the ‘long stay’ group had higher scores on physical complaints and disability and lower scores on quality of life. The post migration living problems were all directly related to psychopathology. Health service use was low and inadequate.

Conclusion:

A long asylum procedure is a very important risk factor for psychiatric disorders, physical health problems, disability and low quality of life. The risk for common psychiatric problems is higher than the adverse life events in the country of origin.
Post- ECT Pharmacotherapy: An Update
Authors: Jarosch- von Schweder L.
Published: March 2009

Electroconvulsive therapy (ECT) is a very effective treatment in severe psychiatric disorders. One of the main drawbacks of ECT is the high and early relapse rate in the absence of post- ECT treatment. After a successful ECT- course, pre- ECT pharmacotherapy is often continued. There is, however, no evidence that proves this strategy effective. The research on post- ECT treatments is limited, but promising. The available studies show that relapse rates can be decreased from more than 80% to 40% or less using either imipramine (1), the combination of lithium and nortriptyline (2) or continuation- ECT (3). The question whether or not starting antidepressants during the course of ECT ca further decrease relapse rates remains unanswered. Preliminary data show that starting antidepressants medication during the ECT course has no impact on post- ECT relapse. There is an urgent need for further research on treatment strategies to decrease the unacceptable high relapse rates after recovery from ECT.
Cognitive Deficits in First Episode Schizophrenia
Authors: Galderisi S.
Published: March 2009

Cognitive deficits are increasingly recognized as key features of schizophrenia, important determinants of poor psychosocial outcome and targets for treatment strategies. The huge literature on the topic made it clear that cognitive impairment is present in the majority of subjects with schizophrenia, is not an epiphenomenon of symptoms, is a risk factor for psychotic disorders and seems to contribute to poor functional outcome more than symptoms. However, relationships of cognitive impairment with symptoms, drug treatment and duration of untreated psychosis remain controversial and studies involving large cohorts of first episode schizophrenia patients are highly needed to address these topics adequately. The European First Episode Schizophrenia Trial collected demographic, clinical, psychosocial and cognitive baseline data in 498 first episode patients with schizophrenia, schizophreniform or schizoaffective disorder, with minimal or no prior exposure to antipsychotics, and in 220 healthy subjects, comparable with patients for age, sex, race and education level of parents. Z scores of the examined cognitive abilities (number of standard deviations below the comparison group means) ranged from -0.88 to -1.73. No association was found between the duration of untreated psychosis and cognitive impairment. Psychopathological dimensions were weakly correlated with cognitive impairment both at baseline evaluation and after six months of treatment.

According to EUFEST findings, cognitive impairment in patients with first-episode schizophrenia is moderate/severe, has no association with the duration of untreated psychosis, involves several domains of cognition, and is largely independent from psychopathology.
Safety First, Efficacy Second? Fear and Need of Treatment in the Absence of Controlled Data
Authors: Mohr P. , Cermak J. , Hendrychova Y. , Seifertova D.
Published: March 2009

In the clinical practice, physicians are routinely asked to make decisions whether to initiate or continue antidepressant treatment in a situation where no safety data are available. As an example can serve pregnancy and breast-feeding, where controlled clinical trials provide little guidance. Females of fertile age are rarely included in the early phases of clinical testing, the Phase IIb and III trials have a standard provision to use a reliable contraception. Pregnancy during drug trial is considered as a ‘serious adverse event’ with subsequent study discontinuation. The reasons are not just ethical and legal but also marketing, the drug manufacturers fear to have their products associated with potentially grave side effects, such as malformations. Drug treatment in pregnancy and lactation thus pose a highly relevant clinical problem that cannot be addressed in controlled trials. Excessive concerns of negative consequences could erroneously result in generalizing recommendation not to get pregnant or to abort existing pregnancy. However, fetus may be already exposed to drugs early in the first trimester during frequently unplanned pregnancies; in addition, recent epidemiological data indicate increasing consumption of psychotropics, including antidepressants, by pregnant women. Psychiatrists have to weigh the known risks of treatment discontinuation versus potential risks for the fetus and infant. They should also consider whether alternative non-pharmacological interventions (psychotherapy, ECT, rTMS) are accessible or effective. The only available safety data on antidepressants come from animal studies, epidemiological trials, drug registries, case series, anecdotal case vignettes and clinical observations.

Supported by the research project MZ0PCP2005.
Effects of Smoking, Alcohol and Illicit Drug Misuse on Maternal and Child Outcomes and Acute Management of Treatment
Authors: Havemann-Reinecke U.
Published: March 2009

Smoking, alcohol and illicit drug misuse during pregnancy lead to toxic harmful consequences for mother and especially for the fetus, neonate or child. In case of misuse of illicit substances pregnant women mostly suffer from polytoxicomania (3 substances and more) and the misuse of illicit substances is often accompanied by severe smoking and drinking of alcohol. Therefore it is often difficult to methodologically differentiate the single toxic effects. Basing on this knowledge in the presentation a view on the single toxic and /or chronic effects of addictive drugs will be given.

1.

To clarify single toxic effects of the addictive drugs diagnostic procedure about regulary and/ or ecstatical consume and the diagnose of abuse or dependence acc. to DSMIV or ICD 10 and the analysis of relapse behaviour for each substance should be done.

2.

The toxic effects of the different substances in pregnancy will be reported. Nearly al addictive substances (nicotine (+CO, +tar), alcohol, THC, psychostimulants, heroine) go into placenta and thereby have multiple toxic effects like f.e. decreased perfusion and infarct of the placenta leading f.e. to intrauterine retardation of growth, premature detaching of placenta, premature birth, to deformities, various later heavy postpartal effects (lung and breath diseases, sudden death, fetal alcohol syndrome, neurological dysdevelopment, cardial malformations, learning disturbances, ADHD etc). The toxic effects of the various substances will be differentiated so far it is possible.

3.

The different therapeutic approach of the various addictive drugs during pregnany (withdrawl treatment, opioid substitution) will be discussed.
Metabotropic Glutamate Receptor-mediated LTD Involves two Interacting Ca2+ Sensors, NCS-1 and PICK1
Authors: Jo J. , Heon S. , Kim M.J. , Son G.H. , Park Y. , Henley J.M. , Weiss J.L. , Sheng M. , Collingridge G.L. , Cho K.
Published: March 2009

There are two major forms of long-term depression (LTD) of synaptic transmission in the central nervous system, which require activation of either N-methyl-D-aspartate receptors (NMDARs) or metabotropic glutamate receptors (mGluRs). In synapses in the perirhinal cortex we have directly compared the Ca2+ signalling mechanisms involved in NMDAR-LTD and mGluR-LTD. Whilst both forms of LTD involve Ca2+ release from intracellular stores the Ca2+ sensors involved are different; NMDAR-LTD involves calmodulin, whilst mGluR-LTD involves the neuronal Ca2+ sensor (NCS) protein NCS-1. In addition, there is a specific requirement for IP3 and PKC as well as protein interacting with C-kinase (PICK-1) in mGluR-LTD. NCS-1 binds directly to PICK1, via its BAR domain, in a Ca2+-dependent manner. Furthermore, the NCS-1-PICK1 association is stimulated by activation of mGluRs, but not NMDARs, and introduction of a PICK1 BAR domain fusion protein specifically blocks mGluR-LTD. Thus, NCS-1 is a component of a novel mechanism involved in mGluR-LTD.
Cortical Mechanisms for Emotional Fear and Chronic Pain
Authors: Zhuo M.
Published: March 2009

Investigation of molecular and cellular mechanisms of synaptic plasticity is the major focus of many neuroscientists. There are two major reasons for searching new genes and molecules contributing to central plasticity: first, it provides basic neural mechanism for learning and memory, a key function of the brain; second, it provides new targets for treating brain-related disease. Here, I propose that LTP in the anterior cingulate cortex (ACC) as a synaptic model for emotional fear and chronic pain in the brain. Integrative approaches including genetic, neurobiological and physiological methods are used to investigate the roles of cortical neurons and microglia in synaptic LTP, fear and chronic pain. We have identified several key calcium-stimulated signaling molecules including AC1, CaMKIV and FMRP for AMPA receptor mediated cingulate LTP, trace fear memory, and chronic pain. By contrast, microglia only contributes to changes in spinal dorsal horn, but not in the cortex. Our findings strongly suggest that ACC LTP may serve as a cellular model for studying central sensitization that related to fear and chronic pain, as well as pain-related cognitive emotional disorders.
Does the First Exposure to Addictive Substances Predict Future Dependence?
Authors: DiFranza J.
Published: March 2009

Aims:

The risk factors for trying a cigarette are well known, however we were interested in the factors that determine which youths become addicted to nicotine once they have tried it.

Method:

To investigate this we followed a cohort of 1246 students (mean baseline age of 12.2 years) over 4 years. Subjects underwent 11 interviews during which we assessed 45 risk factors, measured diminished autonomy over tobacco with the Hooked On Nicotine Checklist, and evaluated tobacco dependence using the International Classification of Diseases-10th revision. Cox proportional hazards models were used.

Results:

Among 217 youths who had inhaled from a cigarette, the loss of autonomy over tobacco was predicted by feeling relaxed the first time inhaling from a cigarette (adJusted Hazard Ratio (HR)=3.26; 95% CI, 1.95-5.46; P< .001) and depressed mood (HR=1.29; 1.09-1.54; P=.004). Tobacco dependence was predicted by feeling relaxed (HR=2.43; 1.27-4.65; P=.007), familiarity with Joe Camel (HR=2.19; 1.11-4.32; P=.02), novelty seeking (HR=1.56; 1.06-2.29; P=.02), and depressed mood (HR=1.17; 1.04-1.30; P=.007).

Conclusion:

Once exposure to nicotine had occurred, remarkably few risk factors for smoking consistently contributed to individual differences in susceptibility to the development of dependence. An experience of relaxation in response to the first dose of nicotine was the strongest predictor of both dependence and lost autonomy. This association was not explained by trait anxiety or many other psychosocial factors. These results are discussed in relation to the theory that addiction is initiated by the first dose of nicotine.
Dialectical Behavioral Therapy for Patients with Borderline Features and Posttraumatic Stress Disorder After Childhood Sexual Abuse (DBT-P)
Authors: Bohus M. , Priebe K. , Dyer A. , Steil R.
Published: March 2009

Several randomised clinical trials (RCT) have demonstrated the efficacy of cognitive behavioral therapy in the treatment of Posttraumatic Stress Disorder (PTSD). However, the external validity of these studies is limited with regard to PTSD related to childhood sexual abuse which often results in severe and complex sympomatology accompanied by a variety of concurrent disorders or symptoms, for example self-mutilation, suicidal ideation, or severe dissociation. Nearly 30% of patients with PTSD have a co-occuring borderline personality disorder (BPD). The prevalence rates of PTSD in patients with BPD vary between 40% and 60%.

Several RCTs have shown the efficacy of Dialectical Behavioral Therapy (DBT) in the treatment of borderline patients, who exaggerate severe behavioural dyscontrol. However specific treatment for co-occuring PTSD has been lucking.

Clinical lore suggests that exposure to trauma-relevant memories can potentially aggravate dysfunctional behaviour in patients with BPD. Empirical research however reports discrepant results with two studies documenting deleterious effects of comorbid BPD on treatment outcome, whereas one study did not find an impact.

DBT-P was specifically tailored to treat patients with PTSD after sexual abuse during childhood. DBT-P includes training in emotion regulation and mindfulness, cognitive interventions and exposure elements, usually in combination with the use of skills. To evaluate the efficacy of DBT-P as compared to a wait list control group a RCT is currently carried out. Preliminary data, which will be presented, revealed large between effect sizes for the primary outcome measures (PDS, CAPS).
What will be the Consequences from the Changes in ICD-11/DSM-V for Decision Making in Clinical Psychopharmacotherapy?
Authors: Bitter I.
Published: March 2009

The preparations of DSM V/ICD-11 are in progress. The frustrations and limitations engendered by the categorical model in psychiatry led to the suggestion of alternative dimensional models of classification, e.g. to the suggestions for a dimensional view of psychosis. However there are strong arguments for keeping the categorical classification maybe with inclusion of new criteria, such as neurocognitive impairment for schizophrenia and even there are suggestions for new categories such as nonaffective remitting acute psychosis.

Therapeutic indications of drugs are developed by the industry and are approved by regulatory agencies (FDA, EMEA). Indications are linked to diagnostic categories as defined by DSM-IV/ICD-11, e.g. one antipsychotic is indicated for the treatment of both schizophrenia and bipolar disorder, while another is only indicated for the treatment of schizophrenia. These indications are used by the insurance industry to manage financing of drug treatment.

Changes in the criteria of a diagnostic category will result in a revision of approval which may include the obligation for new studies. Generic companies are now an important part of the major pharmaceutical markets, however many of them do not have the capacity to launch clinical studies, which may lead to the withdrawal of marketing authorization of important drugs. Clinical studies seem to be unavoidable for licensing recently available drugs for the new diagnostic categories of DSM V/ICD 11. The introduction of diagnostic categories by a dimensional approach may lead to “double book keeping”: a dimensional diagnosis used for the medical practice and a categorical one for the insurance.
Rethinking Diagnostics for the Mental Health of Populations
Authors: Weiss M.G.
Published: March 2009

The DSM and ICD diagnostic systems have developed largely in response to clinical interests, though they are used for other purposes as well. Careful attention is also needed to consider the balance of ethical and commercial interests. Public health aims of representing the burden of disease and disorder help to mobilise resources globally, nationally and locally; and relevant diagnostics and assessments guide services and programmes for the mental health of patients and populations. Like other areas of public health, the scope of community mental health extends beyond the treatment orientation of clinical services and community psychiatry. Priorities also include reducing vulnerability to prevent mental health problems and enhancing resilience to promote mental health. As the next wave proceeds in revising our psychiatric systems of classification, advancing such an agenda will help ensure that efforts to achieve the mental health of populations are effective, as they become more responsive to current developments in public health-which have recently been characterised with reference to four revolutions.
Therapeutic Drug Monitoring and Pharmacogenetic Tests in Pharmacovigilance - When and What?
Authors: Sirot E. Jaquenoud , Baumann P.
Published: March 2009

More than 80% of all adverse drug reactions are Type A reactions and dependent on drug concentrations. Therapeutic Drug Monitoring (TDM), Drug Interaction checking programs and pharmacogenetic tests are valuable instruments in elucidating or preventing Type A reactions. It stands for Quality Assurance in clinical practice. The TDMplus algorithm (Jaquenoud Sirot E et al 2006) is helpful in clinical practice and prevents unnecessary testing. This decision tree leads in several “stop/go” steps from the clinical situation of inefficacy or adverse reaction to measuring and interpreting plasma levels, checking for pharmacokinetic interactions and finally, if indicated, to pharmacogenetic tests with gentoyping and/or phenotyping. Genetic results are noted on a personal “pharmacogenetic card” for the patient's future treatments.

The interplay of genetics, drug interactions, life style and other personal vulnerabilities like comorbidity make prediction of drug response very complex. The use of TDMplus has proven useful guiding the clinicians in difficult clinical situations and helping elucidating the causality of adverse drug reactions. Its practical benefit has been shown with pharmacovigilance cases from the AMSP program (Arzneimittelsicherheit in der Psychiatrie = Drug Safety in Psychiatry).
Determination of Drug Concentrations in Serum and Dopamine Receptor Occupancy in Brain for Optimal Antipsychotic Drug Therapy
Authors: Hiemke C. , Gründer G.
Published: March 2009

Evidence has been given that antipsychotic effects of dopamine receptor antagonists are associated with 60 and 80% striatal dopamine D2 and D3 receptor occupancy. Receptor occupancy correlates well with concentrations of the antipsychotic drugs in serum or plasma, much better than the dose. The latter is consistent with weak correlations between antipsychotic dose and serum concentrations and explained by the high interindividual variabilities in drug metabolism. Using positron emission tomography (PET) for in vivo determination of dopamine receptor occupancy in conjunction with drug concentration measurements “therapeutic windows” could be calculated for the atypical antipsychotic drugs amisulpride, risperidone and ziprasidone. On the other hand, analysis of drug concentrations in serum of schizophrenic patients who were treated with these drugs and who had responded to the medication confirmed the PET derived target levels and with some modifications also those of aripiprazole and clozapine. In vivo characterisation of dopamine receptor occupancy and measurement of blood levels should therefore be part of the clinical trials during the development of new antipsychotic drugs. They provide most relevant information for the later use of therapeutic drug monitoring to optimise the treatment of individual patients.
How to Examine a Patient with Movement Disorders?
Authors: Hoek H.W. , van Harten P.N.
Published: March 2009

Patients with movement disorders do not always complain about their ‘troubles with muscles’ spontaneously, and sometimes, often out of shame, they try to hide their involuntary movements. E.g. a hand tremor can be temporarily suppressed by pushing the hand against the body or sitting on it. To reveal these movement disorders, a systematic investigation of the patient is required. This investigation consists of a (hetero) anamnesis and a physical examination. The anamnesis demands knowledge of sensitive questions such as: ‘Do you notice any movements that are not under your control? Do you feel restless: an inability to keep the legs still? Do you tremble, are you slower than usual?’ Next, a physical examination is required. The investigator lets the patient execute several movements such as stretching the arms, opening the mouth and walking.

In this workshop you will learn and practice this highly sensitive examination. In clinical practice this investigation takes less than 5 minutes and will reveal all drug induced movement disorders.
Comparison of the Hypomania Check List-32 scale with the Mood Disorder Questionnaire on Spanish Sample
Authors: Vieta E. , Martinez-Aran A. , Sanchez-Moreno J.
Published: March 2009

Hypomania is perhaps the most difficult psychiatric syndrome to rule out retrospectively. However, the retrospective detection of hypomania is crucial for a correct diagnosis of bipolar disorder, and particularly bipolar II, and for the implementation of the right pharmacological treatment. Unfortunatelly, still nowadays, the misdiagnosis of bipolar II disorder as unipolar depression is very frequent, and may carry serious consequences for the patients. The availability of a good screening tool for past hypomania episodes would be extremely helpful.

The psychometric study of the development of the HCL-32 scale in Spain exhibits high internal consistency and similar stability over time, in comparison with other instruments such as the MDQ and suggests that this scale may be very useful for the detection of bipolar disorder and past hypomania.

The results of our study suggest the usefulness of the HCL-32 to screen out previous hypomanic symptoms in psychiatric patients, thus leading to better detection results than with the MDQ, although with the possibility of obtaining more false positives. HCL-32 has been shown to be a useful instrument for the detection of hypomania in patients with an affective disorder. The Spanish version exhibits good psychometric properties in relation to sensitivity and specificity. Given the difficulties involved in both the retrospective and cross-sectional diagnosis of hypomania, a key aspect of appropriate management of bipolar disorders, this questionnaire represents a potential improvement in clinicians’ ability to detect and correctly treat bipolar disorder, and in some aspects such as internal consistency, obtains better results than the MDQ.
Updateon Recent Research with the Hypomania Checklist HCL-32
Authors: Angst J. , Gamma A. , Meyer T.D.
Published: March 2009

Background:

The Hypomania Checklist HCL-32 (Angst et al. 2005) is still in development as a screening instrument for hypomania in depressed patients and as a research tool.

Update:

The original HCL-32 was slightly modified, omitting one tricky question on consequences (HCL-32 R1) and recently (HCL-32 R2) by adding two new symptoms (gambling and overeating). It is currently available in 27 languages.

New investigations include a Europe-wide GAMIAN study, individual studies in Brazil, Tunisia, Lebanon, Turkey, Korea, Taiwan and China, and the ongoing worldwide multicentre BRIDGE study.

Results:

1.

new data have been collected on the re-test reliability in China and Sweden and correlations with the Mood Disorder Questionnaire in Brazil;

2.

exploratory and confirmatory factor analysis re-confirmed a two-factor structure (elated/overactive vs. irritable/risk taking) of the self-assessed hypomanic syndrome, replicable in over 1500 subjects from the community and patients with mood disorders across all cultures so far analysed;

3.

total item scores have repeatedly been shown to be independent of the current mood state (normal, low, high);

4.

adolescents/young adults in love feel high, and score comparably to bipolar-II patients on the HCL-32 (Brand et al 2007);

5.

89% of bariatric patients were also found to be high scorers on the HCL-32 (Alciati et al. 2007);

6.

studies with the HCL-32 in subjects with alcohol use disorders (AUD) (previously shown to be strongly associated with bipolarity) are ongoing.

Future goals:

Trans-cultural comparisons and evaluation of the questions on the consequences of hypomania for case-definition.
Is there a Role for Antipsychotics in OCD?
Authors: Zohar J.
Published: March 2009

There are actually four types of situations where intervention with antipsychotics might be considered for the treatment of Obsessive compulsive disorder. Obsessive compulsive patients with poor insight (what was previously called ‘psychotic obsession’), schizophrenic patients with OCD, obsessive compulsive patients with tic disorder, and obsessive compulsive patients who did not respond to intervention with an adequate treatment of antiobsessive medication.

The data supporting the role of antipsychotic medication in obsessive compulsives with poor insight are not convincing. However, at times the treatment dilemma (antipsychotic or antiobsessive) actually derives from diagnostic ambiguity; many of the very severe ego-syntonic obsessive compulsive patients may be erroneously diagnosed as schizophrenic, while they are actually severe OCD that should be treated with antiobsessive medication and not antipsychotic.

The prevalence of OCD amongst schizophrenic patients ranges from 10-25% and has a negative effect on the prognosis for those substantial proportion of schizophrenic patients. Preliminary data implies that for this subset of patient (the schizo-obsessive patients) a combination of antipsychotic and antiobsessive medication might be useful.

It is crucial to screen for tic disorder in patients with, OCD as this subset of patients responds (both in terms of obsession and tics) to a combination of typical antipsychotic and antiobsessive medication.

Data in regard to augmentation of OCD patients who did not respond to treatment with SSRI suggest that risperidone might have a specific therapeutic potential in this subset of patients. The role of antipsychotics with 5HT1D properties like ziprasidone need to be studied.
An Introduction to Social Cognition and its Relationship to Mental Disorders
Authors: Lahera G.
Published: March 2009

A capital issue in human psychology is how individuals understand the actions and emotions of others. But the field of social cognition includes different concepts: the mirror system (that allows us to understand other people’s motor actions and action intentions), “theory of mind” (that allows us to understand more abstract concepts such as beliefs or wishes in others) and empathy (that allows us to understand and share emotions and sensations with others). It is known the difficulties of people with schizophrenia in interpreting social information or the “theory of mind” severe deficit in autist children, but nowdays social cognition can be a new point of view in understanding different psychopathologies, such as social phobia, pure delusional disorder or personality disorders. In regard to schizophrenia, the association between ToM deficit and negative symptoms and disorganization has been shown, whereas the association with paranoid symptomatology seems to be more controversial. A supplementary line for debate has been whether a ToM deficit is a state marker or a trait marker in relation to psychosis. In this workshop we will review the importance of this approach and the main -verbal and non-verbal- instruments used to asses social cognition in clinical practice.
Social Cognition in Bipolar Illness
Authors: Lahera G.
Published: March 2009

Theory of Mind (ToM) is defined as the cognitive ability to infer mental states to oneself and to others, in terms of thought, emotion and intention. There are many studies about ToM in schizophrenia, but a paucity of them about ToM in bipolar disorder, despite the suggesting relationship between ToM and emotions. Some affective patients were included as control group in schizophrenia studies, but these samples were small and heterogeneous. Some authors have found ToM deficit in manic and depressed patients, but there is also some evidence of a ToM deficit even in a state of euthymia, associated to other cognitive deficits, mainly in executive function. Multiple factors could be involved in this ToM deficit, but these studies open the way for a line of research about the cognitive mechanisms underlying the psychosocial disadjustment that these patients present. Mentalization skills could be more decisive for keeping a job or a social network than other neurocognitive variables, and BD remains a very important cause of psychosocial disadvantage. In this workshop we will debate the relevance of these findings in BD and the potential therapeutic consecuences.
Leadership in a Changing Europe
Authors: Höschl C.
Published: March 2009

Psychiatry as a medical discipline plays an important role in mental health care (MHC). Hand in hand with increasing demand for MHC transformation toward more individualized, personalized, and patient oriented service, the integrity of psychiatry, the role of psychiatric staff, the stigma, and identity of psychiatry become important questions to be tackled. These questions are related to the leadership role of coming generation of psychiatrists. Is it a challenge or just a myth? We should not deny the fact that in important documents of global importance (e.g., Green paper and other WHO/EU MH documents) there is almost zero occurrence of the word “psychiatry”. So it seems psychiatry is rather marginalized than promoted to be the leading force in MHC policy. EPA YPP program could become a suitable platform to prevent such an undesired process and to formulate ways how to increase motivation, skills and chances of psychiatrists to take control of their own destiny.
Neuroimaging Findings and Diagnosis
Authors: Kasper S.
Published: March 2009

There is a lack of a precise and biologically verifiable definition of illness, which in turn contributes to the inconsistencies published in the literature on the topic of neurobiological abnormalities within psychiatric diseases. Among the available neuroimaging tools, positron emission tomography (PET) and functional magnetic resonance tomography (fMRI) are the most promising tools. For affective disorders, volumetric and functional dysregulations have been shown in the prefrontal cortex, basal ganglia, amgydala and hippocampus and receptor imaging revealed differences to healthy controls for the serotonin transporter as well as the 5HT1A and 5HT2 receptor. For schizophrenia the volumetric and functional dysregulations have also be obtained in the prefrontal cortex, however, different to affective disorders, in ventricular volume, striatal volume, activity in temporal lobe and changes in receptor imaging with dopamine release as well as dopamine 1 and 2 receptors. Anxiety disorders have been related to volumetric and functional dysregulation in amgydala, prefrontal cortex and hippocampus and the receptor imaging was related to changes in serotonin 5HT1A receptor as well as dopamine 1 receptors. Given the high comorbidity between depression and the different anxiety disorders, it seems to be unlikely that these disorders result in a different biological characteristic. Future research will focus on subgroup analysis encompassing both neuroimaging techniques and molecular changes leading to specific subgroups, which hopefully lead to specific treatment modalities. Specific biomarkers are likely to be characteristic for illness subtypes associated with specific treatment outcomes.
Destination of Mental Disorders Through Biochemical and Neuropathological Analysis?
Authors: Falkai P.
Published: March 2009

In the first half of the last century researchers believed that severe mental disorders like schizophrenia have a neuropathological basis. Up to now it has been difficult to prove any consistent core finding for this disorder. Reason for this might be that it is a network disorder and therefore regional specific findings will unlikely be found. Parallel to that describing the dopamine hypothesis of schizophrenia and the catechol amine deficit hypothesis of depression were very helpful for understanding the mechanisms of antipsychotics and antidepressants working in these disorders. Especially the introduction of the positron emission tomography has helped to link symptoms with the transmitter systems. However, none of these findings are specific for schizophrenia or depression. During the talk it will be discussed when the combination of core clinical symptoms, imaging findings and genetic variables are helpful for a future classification of psychiatric disorders.
Could Brain Imaging be a Biological Validator of Mental Illness?
Authors: Lawrie S.
Published: March 2009

Case-control differences at the voxel or regional level in structural brain imaging assessments tend to be subtle and non-specific, but these could still be sensitive diagnostic assays in certain situations e.g. in a population at genetic or other risk for a particular disorder. More sophisticated pattern classification methods, such as support vector machines, which use more of the available information, have been applied to distinguish established cases from controls, and to distinguish people at high symptomatic risk of developing schizophrenia who do and do not make the transition. Functional brain imaging techniques are likely to be generally more sensitive and examples of our work will demonstrate this for both high risk and established schizophrenia versus bipolar contrasts.
The Role of Arts and Humanities in undergraduate Medical Curricula
Authors: Sukhanova E.
Published: March 2009

This paper will explore possible ways of integrating humanities disciplines in medical education.

In today's world, medical students have to learn to understand the social and cultural environment in which medicine is practiced. The humanities have long since have been the principal site of diversity in the academy. Now they can help medical students come to terms with diversity that is the context ot today's medicine.

Studies in arts and humanities help recognize the limitations of purely biotechnical approach to patient care, in complex and paradigm-changing ways. Such studies also pave the way for understanding how social assumptions and values play out in healthcare policies. In sum, the humanities provide an additional insight into the human condition, allowing students “to consider human beings in their totality,” in the words of Jean Delay, a pioneer of psychopharmacology who also maintained a literary career throughout his life.

Furthermore, humanities contribute to the development of complex interpretive skills, embracing affective aspects of intelligence as much as they embrace conventional rationalist forms of inquiry such as logic, analysis, deconstruction and critique. There is some evidence that medical students who have an additional background in the humanities are less vulnerable to burnout while studying and go on to perform better in important areas of practice. Approaches to developing specific learning outcomes and curricular guidelines will be discussed.
Epidemiology and Risk Factors of Bipolar Disorder and Schizophrenia in the Conceptualization of the Disease Spectrum
Authors: Höschl C. , Stopková P.
Published: March 2009

Both disorders are worldwide, lifelong, and recurrent illnesses with periods of exacerbation and partial or full remissions. Lifetime prevalence of schizophrenia and bipolar disorder type I is around 1%. Women and men are affected at proximately equal rates and the typical age of onset is similar. Both disorders also share risk factors showing evidence for impaired prenatal development, such as birth seasonality, abnormal dermatoglyphs and higher incidence of perinatal complications. However, there is evidence for differences in prevalence in geographical isolates, in presence of minor physical abnormalities and possibly also in influence of psychosocial factors, urbanicity and use of cannabis. However, based only on similar epidemiological parameters, it is not possible to assume any degree of continuity between bipolar disorder and schizophrenia. The main evidence for partially shared pathophysiology is given by genetic studies.
Genome-wide Search for Genes Associated with Memory-related Brain Activation Patterns
Authors: Papassotiropoulos A. , de Quervain D.J.-F.
Published: March 2009

Background:

Human memory is a polygenic trait. Heritability estimates of ~50% suggest that genetic factors have an important impact on this fundamental brain function.

Objectives:

1.

To identify genes and gene-clusters related to memory capacity and to brain activation during memory tasks;

2.

To translate the findings to memory-related disorders.

Methods:

A combination of genome-wide association studies (GWAS), candidate gene studies (gene clustering) and functional MRI (fMRI) in independent populations which were carefully tested for episodic memory performance and for the presence or absence of Alzheimer’s disease.

Conclusions:

Variability of human memory performance is related to variability in genes encoding proteins of important signaling cascades, including NMDA receptor, metabotrobic glutamate receptor, adenylyl cyclase, CAMKII, PKA and PKC. Functional magnetic resonance imaging reveals that this genetic profile correlates with activations in memory-related brain regions. GWAS reveal the existence of novel genes significantly related to human memory performance, brain activation and to the risk for developing Alzheimer’s disease.
Patients with First Episode Psychosis Take More and Stronger Cannabis than Controls
Authors: Di Forti M.
Published: March 2009

Epidemiological studies have reported that the increased risk of developing psychosis in cannabis users is dose related. In addition, experimental research has shown that the active constituent of cannabis responsible for its psychotogenic effect is Delta-9-Tetrahydrocannabinol (THC) (Murray et al, 2007). Recent evidence has suggested an increased in potency (% TCH) in the cannabis seized in the UK (Potter et al, 2007). We predicted that first episode psychosis patients are more likely to use higher potency cannabis and more frequently than controls.

We collected information concerning socio-demographic, clinical characteristics and cannabis use (age at first use, frequency, length of use, type of cannabis used) from a sample of 191 first-episode psychosis patients and 120 matched healthy volunteers. Cases were more likely to be regular users (p=0.05), to be current users (p=0.04) and to have smoked cannabis for longer (p=0.01). Among cannabis users, 86.8% of 1st Episode Psychosis Patients preferentially used Skunk/Sinsemilla compared to 27.7% of Controls. Only 13.2 % of 1st Episode psychosis Patients chose to use Resin/Hash compared to 76.3% of controls (OR*= 7.4 95% CI 3.4- 17.2, Adjusted for age, gender, ethnicity, level of Education and employment status).The concentration of TCH in these in South East London, ranges between 8.5 and 14 % (Potter et al, 2007). Controls (47%) were more likely to use Hash (Resin) whose average TCH concentration is 3.4% (Potter et al, 2007).

Patients with first episode psychosis have smoked higher potency cannabis, for longer and with greater frequency, than healthy controls.
Cannabis Abuse at First Episode Psychosis (FEP): Data from Mental Health Centres in Modena and Bologna, Italy
Authors: Tarricone I. , Rossi E. , Pecile D. , Castellani A. , Paparelli A. , Bandieri V. , Ferrari S. , Pingani L. , Di Lorenzo R. , Rigatelli M. , Berardi D.
Published: March 2009

Aims:

To evaluate the clinical and functional effects of cannabis abuse in patients at First Episode Psychosis (FEP) referring to Community Mental Health Centre (CMHC) “Bologna Ovest” and in patients admitted with a diagnosis of psychosis at the Modena Emergency Psychiatry Ward (EPW).

Method:

All FEP patients, aged 18-35, referring to CMCH “Bologna Ovest” in a 6-years period were evaluated and followed-up at 3 and 12 months. Of the 1559 psychiatric admissions at the Modena EPW in a 3-year period, those with a positive history for substance abuse were selected.

Results:

Among the 88 Bologna Ovest FEPs, 32% were cannabis abusers (FEP-c). In Bologna, FEP-c were more frequently natives (23.39% vs 31.13%; c sq=5.1; p=0.02) single (26.38% vs 0,0% c sq=7.3, p=0.007) and unemployed (13.50% vs 18.32%, c sq=2.4, p=0.1). Non FEP-c did not use any other drug (0.0% vs 26.1%, c sq=77.5; p< 0.001). A trend towards higher prevalence of hospital admission at follow-up was found for FEP-c (4.20% vs 2.4%, c sq=3.8, p=0.07). 22.0% of patients admitted at the Modena EPW had a positive history for substance abuse: of these, 7% were diagnosed with paranoid schizophrenia, which significantly correlated with the use of cannabinoids (alone or in association).

Discussion:

Our results enlighten that cannabis use is frequent among psychotic patients admitted to hospital and worsens clinical course of FEP patients, consistently with previous evidence (Hambrecht & Hafner, 1996; Hafner et al., 2004).
Calibration of Forensic Risk Assessment Instruments
Authors: Endrass J. , Rossegger A.
Published: March 2009

Risk assessment instruments have been the subject of validation studies which have primarily investigated the properties known from psychometrics (objectivity, reliability and validity). Validation of forensic risk assessment instruments is confronted with a whole row of methodical challenges, which differ considerably from the topics addressed in psychological test development. Risk assessments instruments state the probability of a particular offense to occur. To disregard the probabilistic nature of risk calculations leads to methodically faulty assumptions on the predictive validity of an instrument. Furthermore, test developers will use questionable statistical methods to assess the validity of the instruments such as ROC analyses. This analysis strategy is considered to be state of the art even though this method does not take into account the probabilistic nature of prognoses. Its results can thus be interpreted only to a limited degree. ROC analyses for example disregard certain aspects of an instrument’s calibration, which might lead in an instrument’s validation to high ROC values while demonstrating only low validity.
Inner Speech-based Models of Auditory Verbal Hallucinations: What Can they Explain?
Authors: Jones S.
Published: March 2009

The term auditory verbal hallucination (AVH) covers a diverse phenomenological experience. One model of AVHs proposes they result from self-monitoring deficits causing inner speech to be experienced as alien. The experimental evidence for such a model is briefly summarised. The fit of inner speech models with the phenomenology of AVHs is then critically examined. The form, function, and development of private and inner speech is discussed, and contrasted with the phenomenology of a range of AVHs. It is argued that only a subset of AVHs are phenomenologically consistent with inner speech models. Implications for the study of AVHs are discussed.