bluuebunny/crossref_metadata_2025_split huggingface dataset:
S01-01 - 5-HT4 Agonists: a Putative New Class of Antidepressants, with a Faster Onset of Action
Authors: Lucas G. 
Published: June 2010

ObjectivesCurrent antidepressants are clinically effective only after several weeks of administration. Because our previous studies indicated that both acute and sustained stimulation of serotonin4 (5-HT4) receptors facilitate central 5-HT activity, we assessed the ability of 5-HT4 agonists to induce antidepressant-like effects in the rat brain within a short (3 days) time-frame.Methods and resultsWe found that 5-HT4 agonists reduce immobility in the Forced Swimming Test, displaying an antidepressant potential. Moreover, a 3-day regimen with such compounds modify rat brain parameters considered as key markers of antidepressant action, but observed only after 2-3 week treatments with classical molecules: desensitization of 5-HT1A autoreceptors, increased tonus on hippocampal postsynaptic 5-HT1A receptors, enhanced phosphorylation of the CREB protein and neurogenesis in the hippocampus. A 3-day regimen with the 5-HT4 agonist RS 67333 was also sufficient to reduce both the hyperlocomotion induced by olfactory bulbectomy, and the diminution of sucrose intake consecutive to a chronic mild stress. Moreover, the concomitant administration of a 5-HT4 receptor agonists with a classical antidepressant (SSRI) potentiated the amplitude of these effects, without altering the rapidity of action of the former.ConclusionsThese findings point out 5-HT4 receptor agonists as a putative new class of antidepressants, with a rapid onset of action.
S04-02 - Teaching Medical Students Psychiatry in Central Europe
Authors: Höschl C. 
Published: June 2010

Medical curricula in Central and Eastern Europe share the tradition and transformation of the university training under the strong German influence, modified by decades of communistic educational system. This tradition is characterized mainly by the classical educational formats (plenary lectures and practices), by the split of a discipline into “general” (psychopathology) and “special” (diseases) parts, and by predominating medical approach based on Kraepelinian nosological system. In recent decades, however, more problem oriented, integrated and interactive style of medical training penetrated also into this part of Europe. It was reflected by the introduction of new medical curricula with diversified teachings psychiatry in different modules including applied neuroscience, medical ethics, patient oriented approach and modern educational formats including electives in psychotherapy, biological psychiatry, psychopathology, assessment techniques, and methodology. Psychiatry becomes to be a part of modules such as pain, dyspnoea, basic medical problems and broader medical context. Neurobehavioral sciences are now more integrated and clinical rotation is more practically oriented (problem oriented). The example of a new curriculum introduced at the Third Medical School of Charles University in Prague will be presented.LiteratureHöschl C, Kozeny J. Predicting academic performance of medical students: The first three years. Am. J. Psychiatry 1997;154(6): 87-92 Höschl C. Pathways of Integrated Medical Curriculum. Surg Radiol Anat. 2007;29(6):423
S04-03 - Training Young Psychiatrists in Belgium
Authors: Zdanowicz N. , Reynaert C. , Jacques D. 
Published: June 2010

IntroductionFor the last dozen years, there has been a reduction of candidates for specialization in Psychiatry. Furthermore, we receive complaints from the units where they work as young psychiatrists after training. Although, five years ago the examination-selection to this specialisation became a federal contest which prioritises grades obtained during their medical studies, this does not alone account for this development.MethodThe authors teach in the Faculty of Medicine, but are also involved in the selection process, and in the process of accompanying candidates as they master Psychiatry. Based on their experiences and meetings with colleagues in other universities, they formulate hypotheses to explain this phenomenon.ResultsIn addition to the reduction of numbers of candidates for specialisation, the complaints regard their competences in three domains: Pharmacotherapies, Psychoterapies, and their leadership style which is qualified as authoritarian.We believe DSM II and subsequent versions had important effects on how psychiatry is taught. While trying to free the DSM from the influence of Psychoanalysis and not wanting to reduce training to merely learning statistical diagnostics and pharmacotherapeutic guidelines, training in Psychiatry has become «a little of everything and nothing precise». The result of this lack of content is young psychiatrists, lacking in self confidence and not sure enough of their references to establish a leadership style other than authoritarian.ConclusionDuring medical studies, we need to reinforce the courses of physio-pharmaco-therapy, Psychotherapy, and comparative psychopathologie and add training in team management.
W01-01 - (N)ever Discussed: The Normalisation of Homosexuality in German Psychiatry and Psychotherapy?
Authors: Mundle G. , Mahler D.L. 
Published: June 2010

In Germany there is a scientific gap in psychiatry and psychotherapy towards specific aspects of different sexual orientations. There are only a few research studies investigating mental health in gay, lesbian and bisexual people and their special needs in the mental health care system. Non-pathologizing developmental theories and new findings about sexual orientation are hardly recognized in psychiatric textbooks, education and teaching.Therefore in 2009 the DGPPN Referat “Sexual Orientation in Psychiatry and Psychotherapy” was founded. On the DGPPN congress 2009 the two symposia were organized. In the state of the art symposium specific aspects towards theories and mental health of gay, lesbian and bisexual people were discussed. Also the response of mental health professionals and ethical aspects of interventions aimed at changing sexual orientation were referred. In the second symposium influences of the Third Reich on the psychiatric perspectives towards homosexuality were discussed.Future goals of the DGPPN Referat are the development of guidelines for treatment, teaching and education in Germany and the establishment of a German and European scientific network.
W04-01 - Catatonia: Differentiation, Pathophysiology and Treatment
Authors: Verhoeven W. 
Published: June 2010

Catatonia is an intriguing psychopathological dimension and the discussion about the clinical relevance of catatonic symptoms in psychiatry is continuing for at least 125 years. The debate started from the original description by Kahlbaum and was further elaborated by Kraepelin and Bleuler who incorporated catatonia in their broad concept of schizophrenia. They regarded catatonic symptoms merely as an integral part of schizophrenia. In addition, periodic catatonia was described by Leonhard that has a considerable hereditary loading, shows a phasic course with alternating hyperkinesia and akinesia and can be delineated from the akinetic-hyperkinetic motility psychosis which belongs to the cycloid psychoses.Over the past decades, the prevalence of the diagnosis of catatonia as a separate disease and as subtype of schizophrenia is decreased considerable. This phenomenon is most probably the result of changes in the diagnostic criteria as well as underrecognition of this symptom dimension.Today's research is focussing on the pathophysiology, genetics and treatment of catatonia. As demonstrated in factor analytical studies, this disorder can be considered as a separate psychopathological dimension. Apart from the endogenous catatonias belonging to either the periodic catatonia or catatonic schizophrenia, the catatonic dimension is present in about ten percent of newly admitted patients with affective or schizophrenic psychoses.In for different presentations, the need for a differential diagnosis of catatonias will be outlined as well as their genetic and pathophysiological backgrounds and appropriate treatment strategies, such as electroconvulsive therapy.
CS04-01 - Subthreshold Eating Disorders: Diagnostic Issues, Natural Evolution and Treatment Implications
Authors: Monteleone P. , Cotrufo P. , Maj M. 
Published: June 2010

IntroductionEating disorders (EDs) exist on a continuum ranging from innocuous but persisting dieting, through subthreshold states of uncertain significance, to full-blown cases of anorexia nervosa (AN) and bulimia nervosa (BN). Subthreshold EDs resemble AN or BN, but do not meet all their diagnostic criteria. The terms “partial syndromes” and “atypical EDs” are also used to identify these conditions.Objectives. To verify whether atypical syndromes are less severe forms of EDs or represent starting phases of EDs, we designed a two-step prospective study assessing the natural outcome of those syndromes over a 4-year time period.MethodsIn the first step, we screened 495 female students attending the first year of their high school by means of ad hoc rating questionnaires. Those students identified to being at risk for an ED underwent a psychiatric diagnostic interview. In the second step, 4 years later, we reassessed 140 of those schoolgirls who had participated in the first step.ResultsIn the first step, we identified 1 subject with full-blown BN, 1 with partial-syndrome BN, 2 with subclinical BN and 8 with subclinical AN. At the reassessment 4 years later, none of the girls had received any form of help. The full-blown BN case, the partial-syndrome BN case and 1 of the subclinical AN cases persisted unchanged; 1 of the subclinical BN cases shifted to subclinical AN; the remaining subclinical cases remitted spontaneously.ConclusionsPresent findings provide the evidence that subclinical AN and subclinical BN represent unstable states that can spontaneously remit over time.
Recent Developments in the Treatment of Panic Disorder (PD) and Generalized Anxiety Disorder (GAD)
Authors: Siegfried Kasper 
Published: June 2010

There is a high prevalence of panic disorder (PD) in the community. The National Comorbidity Survey, a US study of over 8000 adults in the general population, found a lifetime prevalence rate of 3.5%. This is a higher prevalence than that reported in earlier epidemiological studies, which documented lifetime prevalence rates of between 1.2 and 2.4%. Panic disorder is typically a disorder of young adults, with an impact on quality of life, in terms of social, personal, and economic consequences, at least comparable to that of major depression. Benzodiazepines, as well as selective serotonine reuptake inhibitors (SSRIs) have been studied thoroughly in acute and long-term PD. However, there is a lack of data to answer the question if there is an enhanced efficacy with the combination of psychological treatments as well as to guide the clinicians what to do after non-response.Generalized anxiety disorder (GAD) is a chronic illness with an estimated one year prevalence of approximately 3%, and a lifetime prevalence of approximately 6%. GAD (without depression comorbidity) is associated with significant impairment in quality of life and functioning which has been found to be comparable to major depressive disorder, and chronic medical illnesses such as diabetes and arthritis. At least 5 classes of drugs are available for the pharmacologic management of GAD (Bandelow et al., 2008), each acting via different mechanisms: (1) benzodiazepines (diazepam, lorazepam, alprazolam, etc) which augment inhibitory GABAergic activity; (2) monoaminergic reuptake inhibitors, consisting of SSRI drugs with serotonin selectivity (paroxetine, escitalopram, sertraline), SNRI drugs with dual serotonin/ norepinephrine activity (venlafaxine-XR, duloxetine), as well as some first generation tricyclics (imipramine); (3) azapirones (buspirone) which modulate monoaminergic transmission; and (4) pregabalin, which acts presynaptically to inhibit excitatory neurotransmission. Two other classes of medication (antihistamines such as hydroxyzine; antipsychotics such as quetiapine) and recently a herbal remedy, silexan, have also demonstrated efficacy in the treatment of GAD. Cross-study comparisons suggest that each class of drug has a different benefit-risk profile. However, relatively few double-blind, placebo-controlled head-to-head trials have been published which provide direct comparisons of the efficacy and safety profiles of drugs in each class.
Rating Scales and Standardised Diagnostics in Daily Routine
Authors: Bandelow Borwin 
Published: June 2010

To assess the efficacy of psychiatric treatments, rating scales are essential. In this presentation, methodological and statistical problems associated with the use of rating scales in psychiatry are discussed, by taking the anxiety disorders as an example.Not only standard symptom-specific rating scales, such as the Hamilton Anxiety Scale (HAMA), but also global measures such as the Clinical Global Impression Scale (CGI) and Quality of Life scales are used, as not only improvement of single symptoms, but also an overall increase of a patient's well-being should be the focus of a clinical trial. However, due to high placebo response rates in anxiety disorders, the use of rating scales is determined by the need for an instrument, which is sensitive enough to detect differences between active drugs and placebo (or between a certain psychological treatment and a psychological placebo). Quality of Life scales often do not detect such differences, as domains such as partnership or employment do not show rapid changes within the 8-12 weeks of a clinical study. Moreover, when using too many different scales, problems of multiple testing occur.The outcome of a clinical study is often described by the number of patients who responded or remitted, as these endpoints are easily understood by patients. “Response” is commonly defined as a ≥ 50% reduction on these standard scales. However, this definition is arbitrary, and cut-off points should rather be founded on empirical data than on a thumb rule. The definition of “remission” on standard scale scores varies from study to study and is also very subjective. An analysis of available treatment studies in patients with anxiety disorders revealed that these definitions do not necessarily reflect clinical reality. Also, “number needed to treat” is an endpoint, which may lead to inaccurate assessments from a statistical point of view, because it is based on a subjective definition of remission. The adequate use of rating scales also touches ethical questions.
Psychiatry for Dermatologists: An Update
Authors: Sambhi Rajvinder , Lepping Peter 
Published: June 2010

This presentation highlights the need for a close link between the psychiatrists and the dermatologists. There is undoubtedly a high prevalence of psychiatric conditions amongst both the dermatology outpatients and the inpatients. The psychiatric symptoms can be either a manifestation of distress secondary to the primary dermatological pathology or a primary psychiatric condition presenting as dermatological pathology. In both the cases, the risk has to be recognised as the distress can lead to a suicide attempt and therefore, it can be challenging to both the treating dermatologist and the psychiatrist as the patient can actively refuse treatment because of the stigma associated with the label of having a psychiatric ailment. This presentation mentions various psychiatric conditions with regard to dermatology and specific issues about the psychotropic and dermatological medications.Mental disorders which can present in the dermatology clinics are anxiety, depression, obsessive-compulsive disorder, body dysmorphic disorder, delusional parasitosis or delusional infestation and dermatitis artefacta. It can be quite helpful for the dermatologist to be aware of the symptoms of these disorders whether primarily psychiatric or secondary to the dermatological pathology. The issues regarding medication are specifically with regard to Isotretinoin and combination treatments. An association had been reported between oral isotretinoin and mood changes, particularly depression and suicide but a recent systematic review did not find any conclusive evidence for such an association. Combination of cytotoxic agents with clozapine can exacerbate the risk of reduction in white blood cell counts. There is an increased risk of ventricular arrhythmias with the combination of erythromycin and antipsychotics. An increased risk of convulsions with a combination of erythromycin and clozapine has been mentioned. There are particular concerns about the over the counter use of St. John's wort, used in mild and moderate depressions with regard to interaction with various dermatological agents.In summary, a close liaison between dermatologists and psychiatrists is essential to provide holistic care for patients presenting with dermatological pathology.
Rethinking Subthreshold Bipolarity: The Rebirth of Kahlbaum-Hecker Syndrome
Authors: Hantouche Elie G. , Erfurth Andreas 
Published: June 2010

Bipolarity might be underdiagnosed by the DSM-IV. This could particularly pertain for young adults, when the disorder is in early stages and the manifestations of hypomania are not typical. Additionally, the current DSM-IV-based instruments are not sufficiently sensitive for detecting hypomania. Support comes from epidemiological and clinical studies, which showed that subthreshold BPD is common and clinically significant. In the National-Comorbidity-Survey-Replication (NCS-R) the overall prevalence of BPD increased from 2.1% up to 4.4% if subthreshold BPD was considered. Role impairment, comorbidity (alcohol abuse, panic disorder, impulse control), and family history of mania are the validators of subthreshold bipolarity. In the small prospective Zurich Study a stepwise broadening of the criteria for hypomania allocated almost half of the subjects with MDE to a broadly defined bipolar group. In bigger samples, such as 2300 patients presenting recurrent or resistant depressions, the hypomania rate, when dimensionnaly rated (by using the hypomania checklist) was more than 60%.DSM-IV “Bipolar II disorder” and “Cyclothymia” are still ill defined with a great confusion among the territory of “Soft Bipolar Spectrum”, and clinicians need a more practical approach.The Kahlbaum-Hecker syndrome of cyclothymia includes depressive (dysthymia), hypomanic (hyperthymia), and mixed hypomanic-depressive phases. According to French experts, Deny and Kahn (1909) supported the hypothesis that Cyclothymia represents a special constitution, which can be considered nowadays as particular affective temperament with close continuum with subtrheshold bipolarity.The great idea of Kahlbaum, Hecker, Deny is to combine the following variables: 1) premorbid temperament; 2) age of onset, 3) time course of an illness (cyclicity / intermittence). Applying this combination, bipolar spectrum could be currently divided into 2 categories: “Typical BP-I/II” (episodic mania or hypomania with free intervals) versus “Cyclothymia” (radically instable form with continuous ups and downs). This intra-bipolar dichotomy seems to be closer to the clinical reality of mood disturbances. Cyclothymia is probably the most frequent expression of bipolar disorder (more than 30% of major depressions). Repeated brief swings with high mood instability and rapid switching seemed to be a distinct entity with early onset, irritable (“dark”) hypomania and high suicide risk. This condition emerged as the most prevalent and severe expression of the bipolar spectrum.
FC01-01 - Does Stress-Related Major Depression Differ from Non-Stress Related Major Depression in Primary Care? Results from the PredictD-Spain Study
Authors: Motrico E. , Moreno B. , Bellón J.A. , Monton-Franco C. , Sánchez-Celaya M. , Vicens C. , Sánchez-Artiaga M.S. , Muñoz-Garcia M.M. 
Published: June 2010

IntroductionResearch has consistently documented the significance of severe life events for the onset and course of major depression. However, no research has been done on whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to those who have not.ObjectivesWe investigated whether social and clinical characteristics differ in depressed primary care attendees who have experienced stressful life events compared to depressed primary care attendees who have not.MethodsWe undertook a prospective cohort study involving 5,442 consecutive primary care attendees with evaluations at baseline and at 6 months. Patients aged 18-75 years were recruited in six Spanish provinces between October 2005 and February 2006. The incidence of major depression was assessed at 6 months with the Depression Section of the Composite International Diagnostic Interview (CIDI). Stressful life events were measured with the List of Threatening Experiences (LTE).Results3,804 (70%) were interviewed at 6 months of follow-up. Among 200 attendees with a first episode of major depression, 24.5% had experienced no stressful life events, 30.5% had suffered one, 20.5% had experienced two and 24% had suffered three or more in the 6 months prior to the onset of depression. Depressed primary care attendees who had experienced three or more stressful life events differed from depressed patients with no stressful life events in the following variables: economic difficulties, dissatisfaction with unpaid work, relational variables, psychiatric co-morbidity and family history.ConclusionsStress-related major depression differs from non-stress-related depression in primary care.
FC01-06 - The DTNBP1 (Dysbindin-1) Gene Variant rs2619522 is Sssociated with Variation of Hippocampal Grey Matter Volume in Humans
Authors: Gruber O. , Trost S. , Platz B. , Scherk H. , Wobrock T. , Reith W. , Meyer J. , Falkai P. 
Published: June 2010

Background and aimsDTNBP1, which encodes dysbindin-1, is one of the best-supported susceptibility genes for schizophrenia, and hippocampal volume reduction is one of the major neuropathological findings in schizophrenia. Consistent with these findings, dysbindin-1 has been shown to be diminished in glutamatergic hippocampal neurons in schizophrenic patients. The aim of this study was to directly investigate the effects of two single nucleotide polymorphisms of the DTNBP1 gene on regional brain volumes in human subjects.Methods128 subjects participated in the study. All subjects were genotyped with respect to two single nucleotide polymorphisms of the DTNBP1 gene (rs2619522 and rs1018381) and underwent structural magnetic resonance imaging (MRI). MRI data were preprocessed and statistically analyzed using standard procedures as implemented in SPM5, in particular the voxel-based morphometry (VBM) toolbox.ResultsWe found significant effects of the DTNBP1-SNP rs2619522 on regional brain volumes bilaterally in the hippocampus as well as in the anterior middle frontal gyrus and the intraparietal cortex. T/T homozygotes showed significantly lower grey matter volumes in these brain regions than carriers of the G allele.ConclusionsCompatible with previous findings on a role of the dysbindin-1 gene in hippocampal functions as well as in major psychoses, the present study provides first direct in-vivo evidence that the DTNBP1-SNP rs2619522 is associated with variation of grey matter volumes bilaterally in the human hippocampus.