bluuebunny/crossref_metadata_2025_split huggingface dataset:
ECP02-04 - Implications for training. Relevance of transcultural psychiatry for European early career psychiatrists and trainees
Authors: Kastrup M.C. 
Published: May 2011

During the last decades, the field of psychiatry has grown tremendously, but despite prevailing optimism we are faced with many challenges. A major challenge is that psychiatric services in many European countries are faced with increasing immigrant populations. Here there is a need to integrate knowledge hereof in the undergraduate, graduate and postgraduate training curriculum.A main educational goal is to construct the core elements of a graduate training curriculum in psychiatry regarding cultural aspects to ensure high quality of psychiatric services via the creation of competent psychiatrists in all areas of Europe and promote the standard of training for cultural psychiatry by providing recommendations for training agreed upon by all stakeholders.No explicit health policy has been formulated in many countries with respect to immigrants of which a large proportion has a traumatized background with a variety of problems linked to this.Till now, the psychiatric curriculum in most areas comprises little training on cultural issues. On both under- and post-graduate level, the curriculum should comprise training in transcultural aspects of psychiatry.With increased globalization there is a need to pay more attention to cultural aspects at all levels and develop strategies to increase the cultural competence of mental health professionals.Consensus statements on psychiatric training and related issues related to cultural issues should be produced.The paper will discuss the content of a culture sensitive curriculum and strategies to implement it.
ECP09-05 - Psychiatric training in europe: the opinions of early career psychiatrists
Authors: Giacco D. 
Published: May 2011

IntroductionThe recent reforms of mental health legislation occurred in most European countries, together with the continuous advances of technologies and the development of research in all the domains of psychiatry have deeply modified the role of mental health professionals with consequent changes in training needs for early career psychiatrists. The competencies required to psychiatrists today include not only the knowledge of the advances in neuroscience, psychopharmacology, psychotherapy and social psychiatry, but also the ability to understand the different clinical and social needs of the patients. Young psychiatrists report a gap between their knowledge and the skills required during the first years of their job.AimsThe European Psychiatric Association-Early Career Psychiatrists Committee, in cooperation with the European Federation of Psychiatric Trainees, conducted a survey among European young psychiatrists and psychiatric trainees, aimed at evaluating difficulties and perspectives related to psychiatric training residency.Methods86 respondents completed the Psychiatric Training Questionnaire, a multiple-choice and self-reported questionnaire, which evaluates: 1) satisfaction with training received; 2) self-confidence in theoretical and practical skills included in psychiatric training curriculum; 3) educational opportunities received during training.ResultsRespondents were almost equally split between trainees (54%) and young psychiatrists (46%). Seventy per cent of them were completely or partially satisfied with training received. Early Career Psychiatrists reported higher levels of self-confidence in clinical psychiatry (98%), psychopharmacology (69%) and emergency psychiatry (61%), whereas the most problematic areas were forensic psychiatry (64%) psychotherapy (61%) and child and adolescent psychiatry (57%). 41% of respondents was not assigned a tutor for clinical activities, 73% of them could not rely on a dedicated supervisor for training in psychotherapy and 58% had not the possibility to use a log-book to record the competencies acquired during training. Only 37% participated in exchange programs; all early career psychiatrists who had this opportunity found this experience very useful for their professional growth.ConclusionsStandards of training in psychiatry in Europe are generally satisfactory. However, our results highlight the need to:1)upgrade training in some areas, such as psychotherapy, forensic psychiatry and child and adolescent psychiatry;2)guarantee an adequate clinical supervision;3)spread the use of log-book;4)improve the opportunities for exchange programs.
FC05-04 - The gamse (grodberg autism mental status examination). Preliminary development of a standardized autism-focused exam
Authors: Grodberg D. , Weinger P. , Kolevzon A. , Soorya L. , Buxbaum J. 
Published: May 2011

BackgroundThe traditional mental status examination, used universally in psychiatry, does not provide flexibility to accommodate the developmental perspective necessary for the examination of patients with Autism Spectrum Disorder (ASD). The Grodberg Autism Mental Status Examination (GAMSE), developed at the Seaver Autism Center for Research and Treatment, prompts the observation and recording of social, communicative and behavioral functioning in patients with ASD. The GAMSE contains 8 items, which produce a total score ranging from 0 to 16.Objectives1. To determine the validity of the GAMSE in accurately predicting diagnostic classification based on a gold standard observational assessment.2. To establish inter-rater reliability.MethodsEighty consecutive patients receiving autism diagnostic evaluations at the Seaver Autism Center were administered the GAMSE and the Autism Diagnostic Observation Schedule (ADOS) as part of standard intake procedures. The classification accuracy of the GAMSE was assessed using the ADOS as the gold standard. Inter-rater reliability on the GAMSE was also examined (n = 44).ResultsA receiver-operating characteristic (ROC) curve analysis was used to determine a cut-off score based on the 8 items of the GAMSE. The most effective cut-off score of greater than or equal to 5 predicted outcome on the ADOS with a sensitivity of 0.94 and a specificity of 0.81. Co-rating of 44 participants on the AMSE resulted in an average measures intra-class correlation of 0.85.ConclusionsPreliminary results indicate excellent classification accuracy and suggest that the GAMSE may act as a useful standardized autism assessment tool for clinical and research endeavors.
FC10-02 - Ghrelin affects sleep, secretion of cortisol and growth hormone and psychopathology in patients with major depression
Authors: Kluge M. , Schüssler P. , Dresler M. , Schmidt D. , Yassouridis A. , Uhr M. , Steiger A. 
Published: May 2011

IntroductionGhrelin showed antidepressant-like effects in mice. Furthermore, ghrelin influences sleep and the activity of hypothalamic-pituitary-adrenal (HPA) and somatotropic axis in healthy humans as indicated by increased cortisol and growth hormone (GH) plasma levels. Both sleep and the activity of these endocrine axes are disturbed in depression.ObjectiveTo study the effect of ghrelin on psychopathology, sleep and secretion of cortisol and GH in patients with major depression.MethodsDepressive symptoms as assessed by a validated self rating scale (’Befindlichkeits-Skala’, [well-being scale]), secretion profiles of cortisol and GH and sleep-EEGs were determined in 14 unmedicated patients with major depression (7 women) twice, receiving 50 μg ghrelin or placebo at 2200, 2300, 0000, and 0100 hours.ResultsOverall, depressive symptoms did not change significantly after ghrelin administration (placebo: 37 ± 8; ghrelin: 33 ± 10, p = 0.178). However, there was an improvement at trend level in men (placebo: 36 ± 9 to ghrelin: 30 ± 9, p = 0.093) but not in women. In men, ghrelin was associated with less time awake (placebo: 149.0 ± 11.1; ghrelin: 88.0±12.2 min, p = 0.029) and more non-REM sleep (placebo: 263.2 ± 24.1; ghrelin: 304.9 ± 14.1 min, p = 0.027), in women with less REM sleep (placebo: 108.6 ± 15.7; ghrelin: 74.1 ± 13.8 min, p = 0.031) and longer REM latency (placebo: 49.9 ± 6.5; ghrelin: 85.6 ± 14.1 min, p = 0.019). In both sexes, ghrelin caused strong transient increases of GH and cortisol.ConclusionOur study may provide an initial indication that ghrelin can exert antidepressant effects in patients with major depression. Ghrelin strongly affected sleep and secretion of GH and cortisol in a partly different way as previously reported in healthy subjects.
FC13-02 - Karolinska interpersonal violence scale predicts suicide in suicide attempters
Authors: Jokinen J. , Åsberg M. , Nordström P. 
Published: May 2011

Both childhood trauma and violent behaviour are important risk factors for suicidal behaviour. The aim of the present study was to construct and to validate a clinical rating scale that could measure both the exposure to and the expression of violence in childhood and during adult life and to study the ability of the Karolinska Interpersonal Violence Scale to predict ultimate suicide in suicide attempters.161 suicide attempters and 95 healthy volunteers were assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to violence and expressed violent behaviour in childhood (between 6-14 years of age) and during adult life (15 years or older). The Buss-Durkee Hostility Inventory (BDHI), “Urge to act out hostility” subscale from the Hostility and Direction of Hostility Questionnaire (HDHQ) and the “Early Experience Questionnaire” (EEQ) were used for validation. All patients were followed up for cause of death and a minimum of fours years from entering in the study.Patients who committed suicide had significantly higher scores in exposure to violence as a child, in expressed violent behaviour as an adult and in KIV total score compared to survivors. Suicide attempters scored significantly higher compared to healthy volunteers in three of the four KIV scales. There were significant correlations between the KIVS subscales, BDHI, Urge to act out hostility and EEQ.Exposure to violence in childhood and violent behaviour in adulthood are risk factors for suicide in suicide attempters. The KIVS is a valuable new tool in suicide risk assessment.
FC13-10 - Frequency of prolonged qtc in children and adolescents hospitalized for psychiatric disorders: a nested case-control study
Authors: Manu P. , Figen V. , Harris J. , Kane J.M. , Correll C.U. 
Published: May 2011

BackgroundThe rate-corrected Q-T interval (QTc) prolongation is a risk factor for sudden death and may be produced by antipsychotic drugs.ObjectiveTo determined the frequency and psychopharmacological correlates of baseline prolongation of QTc in a large pediatric cohort.MethodsThe QTc was measured on the electrocardiograms obtained on 811 children and adolescents (404 males and 407 females, mean age: 15.5 ± 2.4 years) consecutively evaluated in the admissions unit of a psychiatric hospital. Each patient with QTc > 440 msec was age- and gender-matched with 5 patients with QTc< 420 msec. The psychiatric diagnoses and psychotropic treatment of patients with prolonged QTc and control subjects were compared in univariate and logistic analyses.ResultsQTc duration was > 440 msec (mean 454 ± 10 msec, range 442–481 msec) in 16 patients (1.97%; 95% confidence interval (CI): 1.17%–3.25%). The 80 control subjects had a mean QTc of 391 ± 21 msec. The groups were similar with regard to the proportion of patients on antipsychotics (43.8% vs. 40.8%, p = 0.78) and chlorpromazine equivalents (165.5 ± 109.7 mg vs. 167.6 ± 217.8 mg, p = 0.98). Logistic regression identified schizophrenia as the only psychiatric predictor of baseline QTc prolongation (odds-ratio: 6.17, 95% CI: 1.24–30.69, p = 0.042).ConclusionsIn a large cohort of children and adolescents with psychiatric disorders, baseline QTc prolongation was infrequent and, at most, of moderate severity. The findings argue against performing electrocardiograms prior to the initiation of antipsychotics in all patients from this age group.
FC14-01 - Internal losses and the creation of “Nowhere land”: psychodynamic themes of adults with ADHD discovered during drama-therapy
Authors: Manor I. , Yazpan G. 
Published: May 2011

ADHD is a well-known, chronic disorder that persists in adulthood. During the past 20 years its existence in adults is becoming clearer, yet its dynamic aspects are rarely discussed. The treatment of adults is vital, as much as that of children; however the literature discussing it, especially its non-pharmacological aspect, is scarce.We describe the results of our treatment with drama-therapy of two groups of adults with ADHD. These groups included 11 adults (from both groups), men and women, from most socioeconomic strata, aged ≥ 60 yrs., who were diagnosed as suffering from ADHD and were treated for it for the first time in their life. Drama-therapy was selected as we believed it to be a useful method with associative, distracted ADHD patients, since it enabled the use of transitional space through non-verbal images and acts.This presentation discusses the basic themes with which patients began therapy. Interestingly, all patients, however different, shared the same themes that were built on self doubt and the pre-presumption of disappointment. The impairment related to ADHD, that was felt, but not understood, led to a strong experience of heavy losses, which we tried to define separately: of a clear path, of control, of the inner perception of borders and of the loss of an integrative inner self. All these losses were accumulated in the transitional space in a place we named “Nowhere land”.We would like to present these themes of losses and of becoming lost and to discuss their meaning.
FC25-04 - Comorbid mood and anxiety disorders in adult ADHD patients
Authors: Meshkat D. , Kutzelnigg A. , Eckert C. , Konstantinidis A. , Kasper S. 
Published: May 2011

IntroductionADHD is a highly heritable neurodevelopmental syndrome with significant lifetime risk for psychiatric comorbidities. Several psychiatric conditions are significantly more common in patients with ADHD than in control subjects.MethodsTo evaluate the incidence of comorbid affective disorders, patients with adult ADHD who were first seen at the outpatient clinic of the Department of Psychiatry and Psychotherapy were evaluated for symptoms of major depression, brief recurrent depression, bipolar depression and anxiety disorders. Patients aged between 18 and 75 years were included into the study. All patients were evaluated according to DSM IV TR criteria. So far, from February 2007 until May 2010, 330 patients (192 males and 138 females) were included into the study.ResultsThe mean age of the patients at diagnosis was 33, 7 years for males (range: 18-75) and 35, 9 years for females (range: 18–64). Affective disorders were most frequently diagnosed as comorbid conditions in our patients and occurred in 26% of the patients in our sample. 13% had a minor depressive episode, 7% a major depressive episode and 6% were diagnosed with bipolar disorder. 21% of our patients were diagnosed with one or several comorbid anxiety disorders.ConclusionMost adults with ADHD are not diagnosed properly and therefore remain untreated although they are usually diagnosed and treated for comorbid psychiatric disorders. In the present study, we systematically analyzed comorbid anxiety and depression in a sample of adult ADHD outpatients in order to estimate the incidence of these disorders in an undiagnosed patient population.
JS01-02 - Pharmacogenetics in psychiatry: how far from clinical practice?
Authors: Serretti A. 
Published: May 2011

The practical application of pharmacogenetics is not as straightforward as expected, particularly in psychiatric disorders. Despite the large benefit expected, only a very small numbers of clinical applications are available. The reasons for this are many, in particular the key questions are: Is science robust enough for routine application? Are physicians and patients ready? Are stakeholders (e.g. Government, insurance industry, etc) ready to pay and implementing? What is the position of the pharmaceutical industry?The presentation will cover such aspects offering a coverage of present status and realistic expectations in the field.
Prediction and Prevention of Suicide in Elderly Depressives
Authors: Rihmer Z. , Gonda X. 
Published: May 2011

In the majority of countries, suicide rates increase progressively with age, the highest suicide rates occurring in men above 75 years. Given the progressive aging of population in industrialized countries, old age suicide is one of the greatest public health problems. Although suicide attempt, and particularly completed suicide are relatively rare events in the community, they are very common among older psychiatric patients who contact different levels of health care system, particularly some weeks or months before the suicide event. More than one-third of suicide victims have at least one prior suicide attempt, which significantly increases the risk of future attempts and completed suicide. However, the rate of attempted to completed suicide decreases with increasing age indicating that the lethality of suicidal behaviour is much higher in older persons. Suicide is a very complex, multifactorial human behaviour with several biological and psychosocial components, associated with a number of
1/ Psychiatric (e.g., major mental disorders),2/ Psycho-social (e.g., adverse life situations), and3/ Demographic (e.g., male gender) suicide risk factors.Although depressive disorders and substance-use disorders are the two most common diagnoses among suicide victims, depression is more common and substance abuse is less prevalent in later-life suicide victims. Beside depression and prior suicide attempt, social isolation, loss of relatives/friends and physical illnesses are the most important risk factors for suicide in this age-range. Available studies suggest that appropriate acute and long-term treatment of depression in combination with psychosocial interventions reduces suicide mortality even in this very high-risk population.
Twenty years of forensic aftercare in Hessen, Germany
Authors: Freese R. 
Published: May 2011

In Germany, the Forensic Hospital in Haina/Germany has a tradition of more than two decades of continuously outpatient treatment of mentally ill offenders. In our system, patients were conditionally released after a successful hospital order treatment. Time under parole for these patients normally spread between two to five years. In nower days, after a reform of penal law, time under parole can be unlimited.Since 1988 far more than 1000 patients were released from the forensic hospital and treated under parole conditions in the community.The paper will describe the careers of these patients, demonstrate rates of success and failure, and explain our treatment and risk-management approach.
Reality in psychosis
Authors: Figueira M.L. , Madeira L. 
Published: May 2011

The medical model approach in Psychiatry brought up pressure for clear descriptors in diagnostic procedures. This presentation will address two particular psychopathological phenomena, described from the viewpoint of the observer and considered to be key psychotic features: patients’ “loss of contact with reality” and “bizarre” attribute of the content of the delusional phenomena. Challenges seem to occur from present hermeneutical, epistemological and conceptual limitations. Relevant to this is the practical impossibility to fully access a patient frame of reference and our (psychiatrists) subjective knowledge of the world, leading to a value-laden analysis of patients. We’ll be analyzing the historical, cultural and linguistic background and stressing the relevant links to the current psychiatric phenomenology.The validity of both descriptors, used in classification systems, seems questionable as we find a practical impossible to represent those ways of experiencing, and something remaining unsurpassable, not understandable and inapprehensible. But if we find no consistent judgment in these psychopathological signs and remain confortable with frequent biases in clinical findings that do occur, then the weakness of both descriptors raises ethical problems. This presentation aims to suggest clues to an unbiased use and conceptualization of both. But a vital conclusion is that the gap between inner/subjective reality and objectively valuable and classifiable experience is perhaps beyond epistemic and constituent of personhood.
Effects of genetic variants on neural circuits in major depression
Authors: Frodl T. 
Published: May 2011

IntroductionThe underlying neurobiology of major depressive disorder (MDD) is likely to represent an interaction between genetic susceptibility and environmental factors like stress. There is growing evidence that epigenetic processes might mediate the effects of the social environment during childhood on gene expression.ObjectivesWe investigated in multimodal high-resolution MRI-genetic studies whether microstructural and functional brain changes are the result of gene-environment interactions.MethodsPatients with major depressive disorder (MDD), high-risk subjects for developing MDD and healthy participants were investigated using high-resolution magnetic resonance imaging (MRI), high angular resolution diffusion imaging (HARDI) and functional MRI. Furthermore, we assessed early life adversity and measured the serotonin transporter polymorphisms (5-HTTLPR).ResultsWe demonstrated that patients with MDD have smaller hippocampal and frontal cortex volumes associated with gen-environment interactions. Healthy Subjects at risk for developing depression, who manage to stay healthy, show better activation of the frontal cognitive control system. Those who had stronger fibre connections between frontal and temporal brain regions also better managed incidences of adversity in early life.ConclusionsStress x gene interactions seem to account for at least some of the structural brain changes. Resilience against environmental stressors might be associated with stronger neural fibre connections and more effective cognitive control networks.
Empowerment and mental health
Authors: Sartorius N.H. 
Published: May 2011

The word empowerment has been used to describe the efforts to give disadvantaged groups in the population a better chance to state their opinion and influence decisions affecting the population as a whole as well as themselves. In psychiatry the word is used both when talking about the process of raising self-confidence of an individual and in speaking about the need to increase the role of people with a mental illness and of their families in the shaping of the services which are to serve them.In these and other instances it would be possible to expect two positive outcomes if empowerment were to happen: firstly, disadvantaged individuals (including people with mental illness) who were empowered would feel better and be more likely to participate in the work of the group that has helped them to gain or regain self-confidence; and secondly, if given a chance people who were empowered would help to shape services that are to help them in harmony with their needs and the environment in which they are to work. The presentation will exemplify some of these points by a description of the experience gained in programmes that fought stigma and consequent discrimination.