bluuebunny/crossref_metadata_2025_split huggingface dataset:
The viennese psychiatric intensive care unit - therapeutic modalities
Authors: Winkler-Pjrek E. , Naderi-Heiden A. , Strnad A. , Winkler D. , Scharfetter J. , Kasper S. , Frey R. 
Published: May 2011

BackgroundIntensive care at a psychiatric intensive care unit (PICU) traditionally includes the treatment of severely ill psychiatric patients with suicidal or violent behavior [1].MethodsA chart review was performed including 100 consecutive inpatients (52% females, age: 45.7 ± 17.8 years) treated at the Viennese PICU between 2008–2009.Psychopharmacotherapy and the rate of electroconvulsive therapy (ECT) in these patients is reported here.Results87% of patients were treated with antipsychotics: 44% with quetiapine (447.7 ± 421 mg), 32% with risperidone (4.3 ± 2.3 mg), 25% with olanzapine (16.9 ± 7.5 mg), 20% with haloperidol (10.5 ± 5.4 mg), 16% with aripiprazole (15 ± 8.4 mg), 6% clozapine (416.7 ± 147.2 mg) and 3% ziprasidone (120 ± 56.6 mg). 36% of patients received treatment with mood stabilizers: 15% with valproic acid, 8% with lamotrigine, 6% with lithium, 4% with pregabaline, 3% with topiramate, 2% with gabapentine and 2% with oxcarbazepine. In 49% of patients antidepressants were prescribed: in 23% selective serotonin reuptake inhibitors, in 12% selective dual acting reuptake inhibitors, in 5% tricyclic antidepressants and in 33% other antidepressants (mostly trazodone or mirtazapine). 84% of patients were treated with benzodiazepines (30.3 ± 22.4 mg diazepam equivalents), in 17% the opioid nalbuphin was applied. Intravenous psychopharmacotherapy was used in 31% of cases. 10% of patients received ECT.ConclusionsPsychotropic compounds with sedative properties are frequently used at the Viennese PICU. However, the dosages for antipsychotics do not appear to be higher than on normal psychiatric wards.
Crisis treatments: improvements in symptomatic, defense mechanisms, recovery style and social functioning
Authors: Zanello A. , Bacchetta J.-P. , Quast S. , Merlo M. 
Published: May 2011

The challenge in crisis intervention is to seize the potential of change while giving the patients enough support and security as well as maintaining social integration. Crisis Intervention Centers (CIC) provide an alternative to psychiatric hospitalization for patients that are treated in an affiliated outpatient structure.The aim of this study was to verify the short term effects of a brief (6 weeks) intensive crisis psychodynamic oriented treatment including individual and group therapy associated with pharmacotherapy.One hundred and fourteen middle age (m = 41 years, SD = 11.7) patients were included: 68 women and 46 men with disorders like depression (75.4%), anxiety (18.4%) or others (6.2%) according to CIM-10. They were administered measures of psychopathology (BPRS 4.0 and SCL-90 R), defense mechanisms (DSQ-40), global functioning (GAF) and recovery style (RSQ) at intake and 2 weeks after discharge.At endpoint, a statistical significant reduction in the severity of symptoms was found in all variables except for hostility and phobic dimensions of SCL-90 R. This was associated with significant improvements in recovery style scores, global functioning and a shifting towards more mature defense mechanisms. None of the improvements were related to gender.These findings provide clear evidence of the effectiveness of brief psychodynamic oriented crisis interventions in specific units like CIC. Further research is needed to clarify whether the improvements remain stable on the long run and whether crisis treatments pave the way for future psychotherapeutic treatments.
SWN (subjective well-being under neuroleptics) in clinical practice
Authors: Zeppegno P. , Prosperini P. , Allera O. , Colombo M. , Lombardi A. , Gili S. , Torre E. 
Published: May 2011

ObjectivesTo assess the use of SWN in the acute phase of psychiatric disease as a predictor of clinical outcome.MethodsThis study started in June 2009 and at the moment we have recruited 150 patients. The patients were divided into 4 groups according to their psychiatric diagnosis (schizophrenic psychosis, mood disorders, personality disorders, acute stress reaction) and each diagnostic group into three subgroups according to length of stay (T1< 7 days, T2 = 7–14 days, T3> 14 days). The subjective well-being indicators (subscales SWN: emotional regulation; self-control; mental functioning; social integration and physical functioning) and the severity of illness (CGI-S) were evaluated at admission and discharge.ResultsAt discharge there is a statistically significant difference in the SWN subgroups among the four diagnostic groups except for social integration and total score with equal CGI-S scores. Schizophrenic patients and personality disorders show a subjective improvement at T2; mood disorders at T3; acute stress reactions T1 = T2. CGI shows a statistically improvement regardless of the length of stay.ConclusionsPreliminary data suggest that SWN represents a predictor of clinical outcome and remission and together with the clinical evaluation it can help clinician to settle therapeutic programs.
CS01-01 - Pathological gambling: impulse controle disorder or addiction?
Authors: van den Brink W. 
Published: May 2011

Gambling is a recreational activity with many participants all over the world. However, some people, especially with certain games, loose control over their gambling behavior resulting in serious problems for the person and his or her environment. The problematic nature and the underlying psychopathology is recognized by the fact that pathological gambling is an existing diagnosis in most psychiatric classification systems. In most of these systems, pathological gambling is categorized under the group of impulse control disorders. However, in DSM5, is likely to become one of the addiction and pathological become a gambling addiction.In this presentation, we discuss the similarities and differences between pathological gambling and substance use disorders in terms of the phenomenology, comorbidity, genetics, temperamental antecedents, neurochemistry, cognitive abnormalities, neurobiological substrates, course and response to psychological and pharmacological treatments. It is concluded that pathological gambling is more similar to substance use disorders than to impulse control disorders and that a move in the classification towards the category of addictions seems to be justified.
CS01-02 - Alcohol and nicotine
Authors: Gual A. 
Published: May 2011

IntroductionThe prevalence of smoking in patients presenting with alcohol problems can reach up to 80%, commonly with high nicotine dependence. Consequently, mortality and morbidity due to smoking are elevated in this population, being the first cause of mortality in recovered alcohol dependents.State of the artNicotine and alcohol have cross-tolerance, share common pathophysiological mechanisms, and are suggested to have combined effects on the reward circuit. Several studies have shown that a relevant percentage of patients with alcohol problems is willing to stop smoking and that a simultaneous treatment of smoking and alcohol do not jeopardize alcohol treatment outcomes.However, some controversy has emerged concerning the best timing to start a smoking cessation intervention, simultaneous vs. delayed, in patients attending an alcohol treatment program. Patients with past alcohol problems can benefit from both brief and intensive smoking cessation interventions while patients with short-term abstinence from alcohol may need intensive and sustained treatments and also have lower quit rates than general population.ConclusionsIt is no longer possible to ignore smoking consumption in patients with alcohol and other substance dependencies. Tobacco use should always be screened and monitored. Brief advice to all patients and intervention for smoking cessation if deemed appropriate should be offered during alcohol treatment. Future research should study new medications targeting both substances trough the understanding of shared genetic and neurobiological mechanisms, as well as the improvement of tobacco cessation treatments to prevent the high prevalence of relapses in this population.
CS02-02 - Risk and resilience markers: Use of whole-brain structural MR scans to predict familial risk and disease expression in Bipolar Disorder
Authors: Frangou S. 
Published: May 2011

AimsConventional brain imaging analyses have confirmed that genetic risk and disease expression for Bipolar Disorder (BD) are associated with changes in brain structure. The current challenge is to develop new approaches to using brain imaging information to aid diagnostic classification and prediction of risk or resilience to BD.MethodsWe used a whole-brain classification approach employing a support vector machine (SVM) to the predictive value of structural MRI scans in two independent samples of BD patients and controls. Subsequently, using the same technique, we investigate whether it was possible to classify individuals at genetic risk for BD from BD patients and healthy controls.ResultsSVM correctly classified BD individuals at a specificity of 70% and a sensitivity of 81%. This approach differentiated individuals at risk for BD with a specificity of 73% and a sensitivity 64% of when compared to BD patients, and with a specificity 79% of and a sensitivity of 701% when compared to and controls.ConclusionsOur results suggest that multivariate neuroanatomical pattern classification may provide a valuable tool in diagnosing BD and differentiating between affected and unaffected individuals given the same predisposing genotype.
CS02-03 - Imaging depression
Authors: Martinot J.-l. 
Published: May 2011

ContextPET and MRI investigations performed in patient groups with major depressive disorder (MDD) by our team in Orsay searched for differences of regional brain measures during treatments.ResultsIn the patient samples investigated, thorough analysis of cortical surface and metabolism suggested marked deviations in patients with resistant depression, while abnormalities of white matter microstructure were still present in euthymic patients (1–4). Relationship with treatment response was investigated (5). Recent ALE meta-analysis of Talairach’ spatial coordinates reported in the literature on adolescent MDD confirms that imaging techniques of brain function and brain structure revealed a consistent network of frontal limbic and subcortical regions (1)ConclusionWhile the diagnosis of MDD is symptom-based by definition, brain imaging research provided a bunch of convergent information on the regions mediating the depressive syndrome, and supports a significant proportion of MDD patients have brain deviations in both regional function and regional structure measurements.
CS03-02 - Sleep and chronic pain
Authors: Hajak G. 
Published: May 2011

Recent nation-wide epidemiological data confirm the well-known clinical observation of a strong relationship between pain syndromes and disordered sleep.In experimental settings of pain patients as well as healthy subjects, pain perception shows a strong circadian pattern exhibiting significant variation over the 24-hour sleep-wake period. Several lines of scientific evidence indicate that homoeostatic components of sleep may mask circadian pain perception, which results in a two-process model of pain regulation depending on the circadian sleep-wake status.Since pain may worsen sleep, sleep deprivation increases pain, and quality of sleep not only affects nocturnal pain but influences pain during daytime hours, models of interactive pathomechanisms of pain and sleep are widely accepted.Clinical consequences include various treatment methods that consider both, pain and sleep. E.g., intake of pain medication should follow circadian aspects which assure sufficient pain reduction at early morning hours; ideal pain medication at night should have hypnotic properties, including the promotion of deep sleep; pain medication during daytime hours should activate patients to support good sleep during the following night. Psychotherapy needs to support both, the management of pain and of sleep.
CS03-03 - Sleep and sleep disorders in somatoform pain disorder
Authors: Saletu-Zyhlarz G. , Prause W. , Aigner M. , Anderer P. , Grätzhofer E. , Klug S. , Saletu B. 
Published: May 2011

IntroductionSomatoform pain disorder (SPD) is frequently associated with sleep disorders, specifically restless legs syndrome and insomnia, which in turn lowers the pain threshold and worsens pain.ObjectivesThe aim of the present study was to investigate differences in wake-EEG by low-resolution electromagnetic tomography (LORETA) and objective and subjective sleep and awakening quality in SPD patients as compared with controls and study acute and chronic effects of trazodone CR on these variables and pain measures.MethodsFifteen patients with SPD (F45.4) and co-morbid insomnia (F51.0) were compared with 15 controls and participated in a single-blind, placebo-controlled, cross-over study on the acute effect of 100 mg trazodone CR, followed by a six-week open titration period. Statistics involved clinical, EEG-LORETA, PSG and psychometry.ResultsLORETA showed reduced power, mainly in the beta band in almost all pain matrix areas (SI, SII, ACC, SMA, PFC, PPC, insula, amygdala, hippocampus). PSG demonstrated a lack of deep sleep and increased arousals and stage shifts, with opposite changes induced by trazodone after acute and chronic therapy. Improvement of sleep was associated with improvement of pain, evaluated by visual-analog scales.ConclusionOur LORETA findings demonstrate a dysfunctional pain modulation in SPD. Trazodone induced changes in subjective and objective sleep and awakening quality that were opposite to the differences between SPD patients and controls (key-lock principle) and associated with pain improvement.
CS03-04 - Concept of somatoform disorder
Authors: Kapfhammer H.-P. 
Published: May 2011

Patients presenting with bodily symptoms and complaints that are not sufficiently explained by organic pathology or well known pathophysiological mechanisms present a major challenge to any health delivery system. From a perspective of psychiatric classification these medically unexplained somatic symptoms may be diagnosed as primary psychiatric disorders such as depressive and anxiety disorders on the one hand, as somatoform disorders on the other. Among medical specialties a separate diagnostic approach is taken to conceptualize functional somatic syndromes. Unfortunately, both diagnostic systems do not conform to each other very well.The concept of somatoform disorders as outlined in DSM-III to DSM-IV-TR and in ICD-10 refers to a group of heterogeneous disorders with prominent somatic symptoms or special body-focussed anxieties, or convictions of illness. These disorders seem to indicate medical conditions that cannot, however, fully be explained either in terms of medical diagnostics or of other primary psychiatric disorders. There is one major conceptual assumption that postulates a decisive impact of psychosocial stress on the origin, onset and/or course of these somatic symptoms and complaints. And there is one major path of diagnostic steps to be taken, i.e. just to count the number of medically unexplained somatic symptoms, to determine their reference to any main organ system, to prove that they are not self-induced, to put special stress on prevailing pain symptoms and to separately assess dominant health anxieties or illness convictions.Since introduction of the diagnostic concept of somatoform disorders there have been arising many critical issues regarding the soundness of this diagnostic category. These issues, among other things, refer to a problematic mind-body dichotomy overemphasizing psychosocial and psychological factors and neglecting major neurobiological processes, to the impracticable criterion of “medically unexplained”, to the demand of conceptual clarity and coherence of this diagnostic category, to the rather trivial diagnostic procedure of just counting the number of medically unexplained somatic symptoms whereas not assessing typical dimensions of illness behaviour in a corresponding way, to the major overlap between subgroups of somatoform disorders on the one hand and factitious disorders, anxiety disorders and depressive disorders on the other, to a principal focus on the epidemiologically rare condition of somatisation disorder as core disorder thereby undervaluing much more prevalent subthreshold conditions, to the difficult communication of the whole diagnostic group to medical colleagues dealing with the same problems by using a different conceptual approach, however.These critical issues surrounding the concept of somatoform disorder will be reflected in respect of some major revisions projected in future diagnostic classification systems of DSM-V and ICD-11.
CS04-03 - New developments in the classification of personality disorders
Authors: Simonsen E. 
Published: May 2011

Personality disorders are regarded as being among the more important categories within the DSM-IV diagnostic nomenclature, because they have the unique distinction of being placed on a separate diagnostic axis. However, empirical data have pointed out a number of disadvantages and concerns with the categorical system: excessive co-occurrence, inadequate coverage, heterogeneity within diagnoses, arbitrary and unstable diagnostic boundaries and inadequate scientific basis.Alternative dimensional approaches have been considered. There is a surprising consistency over the number and descriptions of the main factors or dimensions both in normal population and among psychiatric patients, at least the following four: an externalizing factor aggression (antagonism), an internalizing anxious-emotional unstable second factor, an inhibited and constraint third factor and fourth factor of compulsivity and perfectionism. Beside this, severity of functional deficits, a number of trait domains and disturbances of self and identity are considered to be included as additional descriptors of personality pathology. It is proposed that only 5 or 6 of the current categories with highest clinical validity will be kept in the system. The aim is to maximize clinical utility, but the current suggestions seem to be too complex for the average clinician to follow.
CS04-04 - Subtreshold states in psychiatry: clinical and theoretical implications
Authors: Küey L. 
Published: May 2011

If one of the major current challenges in the classification and diagnosis of mental disorders is the issue of multi-morbidities, a further one is the subtreshold states. These challenges could be partially considered as the by-products of the prevailing current categorical approaches in our classification systems.The categorical approach needs and is based on vertical and horizontal boundaries to differentiate different states of human behavior. While, at a horizontal level the boundaries between mental disorders are elicited by strict diagnostic criteria, the issue of drawing a threshold at a vertical level requests some dimensional approaches. These thresholds in the description of many mental disorders in our current categorical approaches are defined by a combination of some dimensions; i.e., the duration of the symptoms, the severity of the symptoms, and the effects of the symptoms on social functioning and abilities.Another problem in defining the thresholds for mental disorders is the consequence of the cross-sectional approach. Since, the clinical pattern of many mental disorders change in time, the cross-sectional approach does not reply to the requirements of a historical perspective from which the variation of a mental disorder over and under a given cut-off line in due course could be understood. It is a widely shared opinion that the necessity of defining thresholds for mental disorders is not only taking the clinical, scientific and research motives into consideration, but also the forensic and administrative grounds.This presentation will mainly discuss the phenomenon of threshold and subtreshold states in the context of psychopathology, clinical practice and classification systems.
CS05-01 - Interpersonal therapy
Authors: Aldenhoff J. 
Published: May 2011

Interpersonal therapy of depression was created and established in American psychiatry in the 80ties. At that time european and especially german psychiatry was still dominated by the concept of endogenous depression, which suggested a somehow biologically determined aetiology which was not very likely to be influenced by psychotherapeutic access.However, the empiric approach to evaluate therapy regardless of aetiology, which is very typical for IPT, produced strong evidence for the effectiveness of IPT in unipolar depression and many other psychiatric disorders.On this basis, a diversity of biological studies became possible which aimed to the elucidation of neurobiological mechanisms of psychotherapy.The first data indicate that biological state markers change when the patient responds, regardless if he received Psycho- or pharmacotherapy. However, no empirical findings suggested, how IPT might be linked to neurobiological phenomena.We followed the suggestion by E. Kandel, that the phosphorylation of cAMP-responsive-binding-protein (pCREB) could be a crucial factor in the process of psychic improvement. Therefore we studied pCREB in human T-lymphocytes under different treatment conditions in unipolar depression. The results will be presented.
CS05-04 - Cognitive behavioral analysis system of psychotherapy (CBASP)
Authors: Berger M. , Brakemeier E.-L. , Schramm E. 
Published: May 2011

Chronic depression accounts for roughly a third of all mood disorders. It is a particularly disabling disorder, which is associated with greater comorbidity and suicidality, more significant impairments in functioning, and increased health care utilization than acute major depressive episodes. In the past, chronic depression was often considered as treatment-resistant since traditional pharmacological and psychological treatment approaches show at most modest success. In addition, relatively few psychotherapy studies have focused on chronic (mostly dysthymia) forms of depression. However, in chronic Major Depression a specific form of psychotherapy, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), proved to be equally effective than medication; the combination of CBASP and medication revealed significant superiority over both monotherapies.CBASP-developed by James McCullough-is the only psychotherapeutic intervention specifically designed for chronic depression. The approach integrates behavioral, cognitive, psychodynamic, and interpersonal strategies. It focuses on problems resulting from an inhibition of maturation in early childhood often caused by early traumatization by using the therapeutic relationship in a disciplined personal way. In addition, other interpersonal strategies are applied to overcome preoperational thinking. By means of a specific behavioral technique, the Situation Analysis, patients learn to focus on the consequences of their behavior and to use efficient social problem-solving. The techniques of CBASP will be demonstrated.Results of two pilot studies will be presentedFirst, a randomized pilot outpatient study comparing CBASP with the interpersonal psychotherapy (IPT) in early onset chronically depressives was conducted showing significant superiority of CBASP against IPT. Second, a first open pilot study in the inpatient setting investigated a new modified multidisciplinary CBASP inpatient program. The data of the first patients suggest that the three-month CBASP inpatient program is a feasible and effective treatment for severely chronically depressed patients with severly to extreme traumatization.