bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Aesthetics of Badness
Authors: Bernegger G. 
Published: March 2009

What are the aesthetic characteristics of badness? Is repulsion the only reaction to the wickedness, mess and disorderliness characterizing it? Or can it, depending on particular conditions, generate fascination? How does it challenge the clinical practice?One of our analyses deals with the many meanings and uses of the term, in the moral as well as in the aesthetic sphere, referring to the breaking of the rules in both fields.Besides an initial interpretation of badness, related to something which our mind cannot contain or make sense of, we also consider it as a legitimate aesthetic value. It is then the sublime and tragic categories that allow us to grasp the fascination and awe, the difficulty of judgment and the pleasure, due to the excessiveness, the disproportion, and the playing on the edge of the norms.We examined the roles that the category of badness, as well as those of the sublime and tragic, play vis-à-vis the category of madness, on both the patient's and the therapist's side, on the diagnostic front and on the therapeutic one. To this purpose, we referred to some clinical and artistic, narrative and pictorial examples.
Impact of Childhood Adversity and Premorbid Personality on the Onset and Course of Major Bipolar Disorder
Authors: Angst J. , Gamma A. , Ajdacic-Gross V. , Rössler W. 
Published: March 2009

Background:Clinical studies have demonstrated the great clinical relevance of long-term depression (LTD). Our study aims to characterise long-term bipolar disorder (LTBP) in comparison with episodic (non-chronic) bipolar major depressive episodes (EBP) on the basis of data from a community sample.Method:The Zurich Cohort Study is a prospective study of young adults followed from age 20/21 to 40/41 with six interviews. The stratified sample consisted of two thirds high scorers and one third lower scorers on the Symptom Checklist-90 R (SCL-90-R). LTBP, which was assessed from age 27/28 to 40/41, was defined as threshold or subthreshold depressive syndrome plus hypomanic symptoms, present for more days than not over the past year, plus work or social impairment.Results:The cumulative incidence of LTBP was 6.3%, and of episodic BP 15.3%. The two groups did not differ in mean age of onset (13.7 vs. 13.1 years). Age of onset was significantly earlier in subjects with a positive FH of depression and was inversely correlated with the somatisation score of the SCL-90R as assessed at age 19/20. The age of onset increased with increasing levels of childhood family problems in subjects with a positive FH, but decreased in subjects without an FH of depression. Chronic BP was associated with early childhood adversity and low self-esteem and, at a trend-level, with no family history of depression.Conclusions:The results are surprising and counter-intuitive, a genetic disposition seeming to be correlated more with periodicity than with chronicity.
Familial Risk Factors for the Course of Bipolar Disorder
Authors: Preisig M. , Ferrero F. 
Published: March 2009

Aims:The major aims of the present paper were to:1.assess associations between the course of bipolar-I disorder in probands and the presence and course characteristics of mood disorders in their relatives and2.assess associations between manic and depressive symptoms in probands and relatives.Methods:A family study including 125 bipolar-I patients and all available first-degree relatives has been conducted at two Swiss sites. All participants were evaluated using the Diagnostic Interview for Genetic Studies. Assessed course variables included the age of onset, the number of episodes and social functioning in terms of GAF scores. Among the 237 interviewed relatives of bipolar probands, 32 also exhibited bipolar disorder.Results:The occurrence of bipolar disorders in relatives was not associated with course variables in bipolar probands, whereas the occurrence of unipolar depression in relatives was associated with a more favorable course in probands in terms of higher lifetime GAF scores. Regarding the expression of symptoms during episodes, associations between disorders in probands and relatives were observed for dysphoric and psychotic rather than for typical manic symptom patterns.Conclusion:Our data did not provide support for a significant association between the course of bipolar disorder and the presence or the course characteristics of bipolar disorders in relatives. Surprisingly, the presence of unipolar depression in relatives was even associated with a better course of the bipolar disorder in probands. Nevertheless, bipolar disorder revealed some degree of similarity across family members, particularly regarding the expression of dysphoric and psychotic symptom patterns.
Diagnostic Differences Among Different Ethnic Groups Contacting Mental Health Services
Authors: Kastrup M. 
Published: March 2009

Aim:A nationwide register study was carried out in Denmark comprising 50,877 persons aged 18-66, who were registered in 2003 in the Danish Psychiatric Register or the National Patient Register with a psychiatric ICD-10 diagnosis with the aim to compare diagnostic profiles and use of services.Method:The study is a register survey linking Psychiatric/and National Patient Register with Statistical Bureau data.Results:Of the population 87.1% were ethnic Danes, 7.8% migrants, 4.0% descendants with one Danish born parent, 0.7% descendants with both parents born outside Denmark and 0.3% foreign adoptees. Males comprised 49%, women 51% of the population. The 5 ethnic groups had significant differences in utilization of care, in diagnostic distribution and in the use of coercion. Diagnostically, contacts due to schizophrenia were significantly higher among non-Danish patients and highest among young descendant males. Personality disorders were significantly higher among women than men and highes in adopted and descendant young women. PTSD had a preponderance among migrant men. Substance abuse was higher among men in all ethnic groups, but lower among migrant groups compared to Danes. Self-mutilating behaviour was seen more frequently among female descendants from non-Western countries than among migrant women from non-Western countries as well as among young adopted women.Conclusion:Significant diagnostic differences were observed. Possible explanatory models to these findings will be discussed.
Cross-Cultural Challenges in the Diagnosis of Depression
Authors: Schouler-Ocak M. , Aichberger M. , Rapp M. , Heinz A. 
Published: March 2009

For a long time it was assumed that depressive disorders were a classic western problem specific to industrial states. However, the World Bank discovered in a study as early as 1993 that depression in Third World countries was already fifth on the list of illnesses which comprise the largest contribution to the Global Burden of Disease. Affective and behavioural disorders as well as somatic complaints represent the three central categories of symptoms in depression. In western cultures an affective disorder is seen as the main characteristic of a depression, whereas in other cultures different symptoms can be in the foreground. The increase in supraregional communication and cooperation as well as the worldwide increase in immigrant populations demand that cultural aspects are considered in the diagnosis and treatment of depression. Physicians need to consider the cultural background of their patients in order to achieve an optimal therapy. If the sociocultural aspects, which cannot always be fully appreciated, of a culturally sensitive diagnosis are not taken into consideration, this can lead to an artificial prevalence of the disorder by making false diagnoses. In order to minimize these mistakes, the guideline for judging cultural influencing factors should be used to complete the diagnosis.Not only the development of culturally adequate therapy concepts and institutions, but also the expansion of knowledge about the psychopathology and epidemiolgy of psychic disorders, e. g. of depression in immigrant groups and the examination of their use of treatment facilities, are the goals of cross-cultural psychiatry and psychotherapy.
Continuation and Maintenance ECT: An Update
Authors: Ferreira B. , Borja-Santos N. , Gamito A. , Almeida S. , Cunha I. , Parente J. , Alexandre J. , Ramos J. , Ribeiro J. , Trancas B. , Vieira C. , Luengo A. , Pereira B. 
Published: March 2009

The efficacy of electroconvulsive therapy (ECT) is widely recognized and indications are well defined for acute treatments. Surprisingly, the use of continuation and maintenance ECT (M-ECT) is uncommon after acute remission. This is partly because of the scarcity of scientific evidence. Indications are poorly defined and the practice is based on case reports and small open studies. Recent data suggest that M-ECT is a viable treatment option in severe affective and psychotic illnesses, especially in recurring, drug-resistant or medically compromised patients who suffer toxic effects with psychotropics.Studies regarding the duration and frequency of treatment sessions are laking. The time interval between sessions and duration of treatment vary according to clinical requirements, and should be individualized. The length of treatment and deciding when to stop it are still uncertain. Controversial data about the relation between the frequency of sessions and diagnostic is found. An inverse relation between good prognostic factors for each patient and the frequency of M-ECT was described. During continuation and maintenance ECT, seizure threshold increases until a plateau not being clear when the plateau is reached and if it depends on other treatment variables.The risk of cognitive dysfunction following M-ECT is one major concern. A transient memory and attention dysfunction are described after acute ECT. Recent studies seem to suggest that M-ECT is cognitively safe.
The Expectations of Practising Psychiatrists Towards New Antidepressive Drugs
Authors: Möller H.J. 
Published: March 2009

Although there is no doubt about its efficiency, pharmacotherapy of depression still faces several problems that have to be focused upon and hopefully solved. Besides the problem of drug-resistance and delayed response, the need to achieve remission has become increasingly important.As for the near future, there is great hope that new mechanisms of action can overcome the limitations of the traditional and current antidepressant medications. Unfortunately, some of the recent developments that raised the most interest either turned out to be less effective than hoped, such as the substance P antagonists, or did not yet lead to a drug likely to be marketed in the near future, such as CRF antagonists, for example. On the other hand the first melatonergic antidepressant, agomelatine, is seen as a successful new development.Drug development can currently be based on improved brain imaging techniques, better animal models, and an increased knowledge of genetic markers. Hopefully this will result in a change in the pharmacotherapy of depression and psychiatric diseases in general. From a clinical point of view, new antidepressants should target the following unmet needs: early onset of action; increased proportion of remission; broad spectrum of efficacy including physical symptoms, pain, sleep disorders, circadian rhythm disorders, etc; good efficacy in subtypes of depression, such as atypical depression; efficacy in bipolar depression without inducing switches to mania; lack of side effects of TCAs and modern antidepressants, especially lack of cardiac side effects, anticholinergic side effects, sedation, weight gain, sexual side effects, etc.
Clinical Development of Antidepressive Drugs - the Viewpoint of the Industry
Authors: de Bodinat C. , Delalleau B. 
Published: March 2009

The clinical development program strategy of a new treatment of depression to be registered in Europe must be built in agreement with recommendations of the CHMP guidance.Demonstration that an antidepressant is effective in treatment of major depressive disorders requires consideration of specific recommendations notably regarding the use of placebo and reference drugs, efficacy assessment, designs features and safety aspects.In the field of depression, comparisons between test medicinal product and reference drugs are difficult to interpretate since the level of placebo response is high and variable. An adequate evaluation of antidepressant efficacy is firstly based on randomised double blind comparison versus placebo. For short term efficacy, studies with 6 week-treatment period are required and three arm trials including placebo and active control are recommended. Regarding the long term efficacy, relapse prevention study is the design recommended for demonstrating that the short term effect can be maintained over time.Assessment of efficacy criteria includes both clinical relevance and statisitical significance, particularly:Improvement expressed as difference between baseline and post-treatment score in symptomatology and as proportion of responders.Remission, defined as a condition where no or only few signs remained, with a justified cut-off on a validated rating-scale.In randomised withdrawal trials, efficacy is expressed as number of patients relapsing and/or time to relapse.The acceptable scales for use as primary endpoint include the HAM-D17 scale, the MADRS scale. Cautions regarding designs features, safety assessment and the global methodological issues faced in conducting such program will be detailed in the presentation.
First Experience and Later Risk of Alcohol Dependence: An Epidemiological and Genetic Approach on a Large Sample of Young Adults
Authors: Le Strat Y. , Gorwood P. 
Published: March 2009

Many risk factors for alcohol dependence have been pointed out on the basis of large cohort analyses, including antisocial personality disorder, familial history of substance abuse and initial effect of the first consumption of alcohol, these factors having large overlaps. In addition, a low level of response to first alcohol drink has been reported to increase the risk of future alcohol-dependence. This response to first dinks is a genetically influenced characteristic, but the genes involved remain unknown.The Susceptibility Addiction Gene Environment (SAGE) cohort was designed to assess addictions and psychiatric disorders in a cohort of young adults. All 3.895 college students of the French region “Champagne Ardennes” were eligible. Of them, 3.056 (1.834 males and 1.224 females; mean age 20.42 years, s.d 1.4) were enrolled on their campus during a single day and completed an intake assessment. The final sample was based on 2.730 subjects (70.08%) who fulfilled the inclusion criteria, namely having ever drink at least once in their lifetime. The level of response to alcohol during early consumption was assessed, as well as the DSM criteria for alcohol dependence at the time of interview. DNA was also collected.Our results confirm the strong association between low level of response to alcohol and the risk of dependence. Furthermore, the genotyping of several candidate genes allowed disentangling the potential intermediate factors between the first consumption and the development of later dependence. These findings emphasize the utility of the endophenotype approach in the genetic study of addictive disorders
Dialectical Behavior Therapy for Inpatients with Borderline Personality Disorder and Concomitant Alcohol Dependence: Results of a Pilot Study
Authors: Kienast T. , von Hoerner H. , Reiske S. , Renneberg B. , Wrase J. , Heinz A. 
Published: March 2009

Purpose of study:Psychotherapy with patients suffering from borderline personality disorder (BPD) and concomitant alcoholism requires an integrative approach. Dialectical Behavioral Therapy (DBT) is an evaluated and effective program for patients with BPD, whereas behavior therapy, commitment therapy and self-help groups have all been found to be effective in the treatment of alcoholism. In this pilot study, we give an initial report of the concept and efficacy of an eight week inpatient therapy program integrating an evaluated therapy of alcoholism with standard DBT. The changes of symptoms were evaluated using the Borderline Symptom List (BSL), the European Addiction Severity Index (EuropASI), Lifetime Parasuicide Count (LPC), and Beck-Depression-Inventory.Findings:Five case reports were included. All show improvements in various subscores of BSL and EuropASI, and had a decrease in the LPC score.Summary:With this pilot study we test the efficacy of an extended DBT program for inpatients with BPD and alcoholism who failed outpatient treatment, and found significant improvements in the study in all outcome measures. This promising result points to the necessity for clinical trials that compare standard care with extended DBT in larger cohorts.
Psychoanalytic Psychotherapy and Venlafaxine Among Acutely sSuicidal Borderline Patients: A Randomized Clinical Study
Authors: Andreoli A. , Burnand Y. , Cochennec M.F. , Marie D. , Di Clemente T. , Ohlendorf P. 
Published: March 2009

Background:Psychoanalytic psychotherapy was found superior to usual treatment among borderline patients and should be further investigated in subject samples with adequate adherence to effective treatment and careful evaluation of psychotherapy process and its relationship to outcome. According to this rationale we tested the comparative cost-effectiveness of an innovative model of time limited psychoanalytic psychotherapy aimed at working-out conflicting mourning process associated with traumatic abandonment from a romantic partner.Methods:Eighty patients aged 18-60, who had been referred to medical emergency room with self-intoxication, DSMIV-R major depression and DSMIV-R borderline personality disorder were investigated in a 3-month randomized clinical trial. At general hospital discharge consecutive subjects were allocated to time-limited mourning focused psychoanalytic psychotherapy and venlafaxine and psychodynamic crisis intervention and venlafaxine. Reliable evaluations were conducted at intake, treatment discharge and 6-month follow-up on a battery of standardized instruments. Service consume was assessed via the computerized case register of the Geneva state health services system.Results:Intensive psychoanalytic psychotherapy was found a cost-effective treatment choice among borderline patients in a suicidal crisis.Comment:A combination of ambulatory psychoanalytic psychotherapy and venlafaxine protocol is a feasible, safe and cost-effective treatment for acutely suicidal borderline patients.
Schema Focused Therapy for Forensic Patients with Personality Disorders: New Research Findings
Authors: Bernstein D. , Arntz A. 
Published: March 2009

Rationale:Schema Focused Therapy (SFT) has proven effective in outpatients with Borderline Personality Disorder (PD)(Giesen-Bloo et al., 2006). To test the effectiveness of SFT with forensic patients, we have begun a multi-center randomized clinical trial of SFT for male forensic patients with Antisocial, Borderline, Narcissistic, or Paranoid PDs.Methods:One hundred twenty patients will be enrolled from 7 high security forensic hospitals (“TBS clinics”) in The Netherlands. Patients are randomly assigned to receive either SFT or usual forensic treatment. Patients receive 3 years of therapy, and are assessed every 6 months for changes in PD symptoms, recidivism risk, and other outcomes. Following treatment completion, patients will be followed an additional 3 years to assess actual recidivism.Results:Since 2007, 39 patients (mean PCL-R score = 25.0, SD = 6.6) have been enrolled in the study, 22 have completed their 12-month assessments, and 11 their 18-month assessments. Only 3 have dropped out. Recruitment is ongoing, with expected completion of the project in 2012. Pilot data on a different sample of N = 18 forensic PD inpatients treated in SFT for a mean of 1.9 years (SD = 0.8) is encouraging. Nine of the 18 patients showed reliable improvement, and only one showed reliable deterioration (mean d-score = 0.84, SD = 0.95, p < .01).Conclusions:SFT appears to be a promising treatment for forensic patients with Antisocial and other Cluster B PDs.
Is Decision Making in Clinical Psychopharmacotherapy Depending on Syndromes or Nosological Entities or Both?
Authors: Moeller H.-J. 
Published: March 2009

The basis for decision making in pharmacopsychiatry is not as trivial as one might think. There was a tradition to believe that we have more or less specific drugs with a more or less specific mode of pharmacological mode of action for special indications, such as schizophrenia depression etc. However, the situation is apparently much more complex and the clinical decision making is far from being that trivial. The current development of new psychopharmaca is heading for different directions: either broadening the indication for one compound, or looking for subtypes of a more general indication. Some of these main aspects shall be discussed in the presentation.The decision making in pharmacopsychiatry is rather complex, involving nosological and syndromatological aspects. We have to understand that the pharmacological mechanism of a psychopharmacon is not directly associated with only one psychiatric disorder but often with several. This is already true for psychopharmaca, which have only one mechanism, such as SSRIs, but even more so for drugs like the modern antipsychotics, which have a wide spectrum of receptor interactions and can therefore be effective in quite a variety of psychiatric disorders. Apart from broadening the indication of a psychopharmacon, a development in the direction of exceeding specification and, amongst others, of involving new mechanisms of action can be observed.
Ethical Issues Arising in Revising Classifications of Mental Disorders
Authors: Sartorius N. 
Published: March 2009

The classification of mental disorders in the International Classification of Diseases (ICD) will be revised in the course of the next three years and its publication (as the 11th Revision of the ICD) will be published, after the approval of the World Health Assembly in 2014. In parallel, the American Psychiatric Association created a Task Force which has begun work on the proposals for the revision of its Diagnostic and Statistical Manual which is to be published as the DSM 5th Revision, in 2012. The World Health Organization has established a special advisory group that should assist it in developing proposals for the classification of mental disorders for the 11th Revision of the ICD and this group collaborates closely with the APA Task Force creating the DSM5 proposals.Numerous ethical issues arise in this process and need to be discussed now so as to inform the process of agreeing on the proposals for the new classifications. They include the importance of an internationally accepted classification as a protection against abuses of psychiatric patients; the need to set the threshold for the diagnosis of a mental disorder at a level ensuring that people with such disorders receive help, the need to avoid imposition of diagnostic systems or categories without sufficient evidence and others. The presentation will briefly discuss the process of constructing the proposals for the new classifications and ways in which the groups established by the WHO and the APA handle these ethical questions.