bluuebunny/crossref_metadata_2025_split huggingface dataset:
FC31-05 - Mental disorder and moral responsibility
Authors: Meynen G. 
Published: May 2011

IntroductionMental disorders are often considered to be able to undermine a person's moral responsibility, at least in some respect. Yet, it is unclear exactly how mental disorders would be capable of compromising a person's responsibility. Sometimes, it is suggested that mental disorders undermine responsibility via some detrimental effect on free will.ObjectivesEstablishing to what extent the effect of mental disorder on moral responsibility might be due to an effect on free will, and to what extent other factors might play a role.AimsProviding an analysis of the concept of free will and assessing the relevance of the elements of this concept with respect to mental disorders. Second, establishing what other - not free will related - factors might be relevant to the intuition that mental disorders can undermine responsibility.MethodsConceptual analysis with respect to free will and moral responsibility on the one hand and specific features of mental disorders on the other.ResultsSome of the responsibility-undermining features of mental disorders could have to do primarily with free will related issues. However, for some other aspects it is less clear. In fact, they might be more epistemic in nature instead of having to do with free will.ConclusionsThe possible effects of mental disorders on moral responsibility are likely to involve also other than free will related factors.
FC31-06 - Recurrent health issues and missed vaccines (immunization) affect the cognitive function in general public primary school children
Authors: Shaheen A. , Ullah S. 
Published: May 2011

ObjectivesThe study was aimed to assess the relationship of general health and cognitive function of primary school children in Pakistan.MethodProspective observational study conducted in 2 state and 2 private schools in a small district.ResultsTwo hundred children age 7-12 years class 3, 4 and 5 were assessed using McCarthy scale of child cognition. 11(5.5%) children stated missing some immunization whereas 15(7.5%) found to have recurrent health issues.Healthy children demonstrated better verbal and linguistic skills. (Mean score 3.94 ± 0.85 vs 3.27 ± 1.03, P = 0.004).Similarly children receiving full immunization demonstrated better verbal and linguistic skills (score 3.91 ± 0.87 vs 3.18 ± 0.87, P = 0.01).Mathematical ability was assessed by 3 tests and was scored 1–3. Children with no recurrent health issues demonstrated better mathematical ability (2.56±0.62 vs. 1.93± 0.70, P=< 0.000). Similarly children compliant with immunization demonstrated better mathematical ability (P = 0.02).Reasoning in conversation was assessed on scale of 1-7. Immunization compliant group expressed better reasoning score (P = 0.03).There was no statistical difference between the group with recurrent health issues and the healthy group (P = 0.51).Memory was assessed on a scale of 1–4. Better memory was observed in the immunization compliant group (P = 0.006) whereas no significant difference observed between the healthy group and the group with recurrent health issues (P = 0.51).Gross movements were assessed on a scale of 1–5. The Immunisation compliant and the healthy group demonstrated better performance (P = 0.03 and 0.07) respectively.ResultsThis study demonstrates that missing immunisation and recurrent health problems result in poor cognitive function and school performance.
Depression and Suicide in Early Onset Schizophrenia
Authors: Zalsman G. 
Published: May 2011

PurposeSuicide is a major cause of death in adolescents with first-episode schizophrenia (FES). We compared suicide-related traits between subjects with FES and with other psychopathologies in order to evaluate risk factors for suicidal behavior.Subjects and methodsTwenty-five inpatient adolescents with FES and a control group of 28 psychiatric inpatients matched for gender and age were assessed for depression, anger, criminal behavior, aggression, and suicidal ideation, risk and potential.ResultsThe adolescents with FES had significantly lower depression (p=0.003) anger (p=0.025) and criminal behavior (p=0.022) than did the controls. However, while suicide ideation was greater in the subjects with FES (p=0.003), suicide risk was significantly lower than controls (p=0.004).DiscussionDecreased levels of both depression and anger as part of affective constriction in the schizophrenia group could explain why the increased suicide ideation did not lead to a higher suicide risk in these inpatients.ConclusionThis study highlights the importance of distinguishing between suicidal ideation and actual suicide risk. We demonstrated that thoughts of suicide do not necessarily translate into an actual risk of suicidal behavior in adolescents with schizophrenia.
Treatment resistance in Schizophrenia
Authors: Fleischhacker W. 
Published: May 2011

DiagnosisThe diagnosis of treatment resistant schizophrenia generally follows two not always consistent lines of thinking: one is based on research strategies, the other one on every day clinical practice. Both require a failure to respond to at least two (sometimes three) treatment attempts of adequate duration with an adequate dose of an antipsychotic.In research, one needs to define clearly operationalized criteria which can be applied and reproduced in different settings. Response data are usually operationalized using rating scales scores. Under routine treatment conditions physicians often have to rely upon poor drug response histories or less than perfect chart notes. A more general view of the patient's condition, often including social functioning and quality of life, will then be amalgamated for the clinical diagnosis of treatment resistant schizophrenia.ManagementOnce the diagnosis has been established, alternative treatment strategies can be discussed. The treatment option which is substantiated by the largest research base is clozapine.If a trial with clozapine is unsuccessful, various alternatives are currently discussed. These range from adding another antipsychotic, mood stabilizers, benzodiazepines, serotonin antagonists, serotonin reuptake-inhibitors, glutamatergic drugs to dopaminergic agents and electroconvulsive therapy. None of these have proved unequivocally efficacious in sufficiently large patient samples. There is some evidence, that treatment resistant patients need more time until they show a positive response. Although this evidence is tentative, for practical matters last resort trials will be extended anyway since very little treatment options remain after these have failed.
Longitudinal neuropsychological findings in the at-risk mental state for psychosis
Authors: Linszen D. 
Published: May 2011

BackgroundCognitive impairment is considered to be a core characteristic of schizophrenia. The relationship between psychosis and cognitive deterioration, however, remains unclear. This longitudinal study investigated the neuropsychological functioning of patients before and after their first psychotic episode. Cognitive functioning of participants who later developed a psychosis was compared to that of people at ultra-high risk (UHR) for psychosis who did not develop psychosis at follow-up and healthy controls.MethodsParticipants were 41 persons at UHR for psychosis (the UHR group), of whom 17 developed psychosis between the first and second assessment. Seventeen healthy controls were included in the study. Cognitive performance was assessed at intake (T0) and again after 18 months (T1). The areas of cognitive functioning assessed include verbal memory and learning, visuo-spatial working memory, executive function, sustained attention and motor speed.ResultsThe transition group did not perform significantly worse at the second assessment than at the first on any of the outcome measures. The UHR group performed better on a verbal learning and memory test at T1 compared to T0. At T0, the control group scored significantly better than the UHR group and the transition group on the verbal learning and memory test and the verbal fluency test.ConclusionsThe results indicate that no cognitive deterioration occurs during the first psychotic episode. Problems in verbal memory may be present before the first episode of psychosis.
Subjective quality of life and its changes in patients at-risk for psychosis results of the EPOS study
Authors: Salokangas R. , Svirskis T. , Heinimaa M. , Klosterkötter J. , Ruhrmann S. , Graf von Reventlow H. , Linszen D. , Dingemans P. , Birchwood M. , Patterson P. 
Published: May 2011

ObjectivesIn the European Prediction of Psychosis Study (EPOS) a large sample of young patients at high risk of psychosis (HR) were examined and their conversion rate to psychosis during 18 months follow-up was estimated. This presentation describes quality of life (QoL) and its changes in patients at risk of psychosis who did or did not convert to psychosis.MethodsIn all, 245 young HR patients were recruited and followed for 9 and 18 months. Risk of psychosis was defined by occurrence of basic symptoms (BS), attenuated psychotic symptoms (ATP), brief, limited or intermittent psychotic symptoms (BLIPS) or familial risk plus reduced functioning (FR-RF). QoL was assessed at baseline and at 9 and 18 months’ follow-ups, and analysed in the HR-patients who converted (HR-P; n = 40) or did not converted to psychosis (HR-NP; n = 205).ResultsThere were no differences in the course of QoL between the HR-P and HR-NP patients. Of the inclusion criteria, only BS associated with poor QoL at baseline. Among HR-NP subjects, depressive symptoms associated with QoL at baseline and predicted poor QoL at 9 and 18 month follow-ups.ConclusionsQoL of the HR-NP patients is as poor as that of the HR-P. From the QoL point of view, all HR patients require intensive treatment intervention from the first contact on. Especially, depressive disorders need to be treated vigorously.
Pre- and postnatal factors in child mental health: The importance of prospective longitudinal studies
Authors: Rodriguez A. 
Published: May 2011

IntroductionDoes the prenatal environment contribute to subsequent mental health in childhood? --A question that has been around since antiquity, but still remains difficult to answer. Compelling evidence from epidemiological studies and animal experiments support the concept of developmental origins of health and disease whereby risk is conferred via early environmental influences rather than genetic transmission. However, it is difficult to disentangle the effect of confounding factors.ObjectivesTo critically explore biologically plausible mechanisms and potential postnatal moderators in child mental health using evidence from epidemiological studies. Examples are drawn from work on Attention Deficit Hyperactivity Disorder (ADHD) symptoms.MethodsData come from prospective pregnancy cohorts primarily gathered in Sweden as well as in other Northern European countries. The research is based on longitudinal design and emphasizes the critical role that development plays in the manifestation of behavior problems.ResultsLongitudinal modeling reveals that both prenatal and postnatal environmental factors have an impact on child mental health problems.ConclusionsExposure to adverse environmental factors related to maternal lifestyle during prenatal development have a lasting impact on child development. Therefore, the time of pregnancy offers a critical window of opportunity for prevention.
Neuroimaging and neurogenesis of depression
Authors: Frodl T. 
Published: May 2011

IntroductionUntil only a few years ago, the adult brain was considered to be an organ with a fixed structure, unable to remodel or repair itself. Today, neuroscientists and neurobiologists use the term “neuroplasticity” to indicate an ability of some nervous system regions to change their structure, eventually altering their overall functionality.AimThe presentation reviews the implication for the conceptualization of and investigation of depression arising from neuroplastic change and neurogenesis in the brain.ResultsAnimal experimental and human studies have shown the effects of stress and depression to affect brain structure and function, e.g. of the hippocampus. Exercise, learning and antidepressant treatment was shown to have beneficial neuroplastic effects.DiscussionLong-term interventions should also target the molecular mechanisms linked with neuroplastic adaptive dysfunctions in the brain. Possibilities how psychotherapy and pharmacotherapy could achieve this aim will be discussed.
Delirium in the general hospital: Why and how cl-psychiatry must tackle a major health care problem
Authors: Diefenbacher A. 
Published: May 2011

Delirium in patients older than 70 years is a frequnet problem on somatic wards in the general hospital, leading to adverse events such as falls, and/or prolonged length of hospitals stay.Albeit c-l-psychiatrists and geriatricians since long have advocated the necessitiy to improve this situation, nothing really happens.This lecture discusses problems, perils and pitfalls of this unsatisfying situation and tries to answer questions such as whether guidelines could be of help here, and whether pilot projects could be useful to lead the field further. The latter issue will be illustrated with two examples from Germany.
The assessment of self experiences in patients with primary negative symptoms
Authors: Bitter I. 
Published: May 2011

IntroductionNegative symptoms in schizophrenia are present both in behavior and in the subjective experiences of the patients. However the latter are not represented in most rating instruments.ObjectivesTo review assessment methods for the subjective experiences of primary negative and related symptoms in schizophrenia.MethodsLiterature review and comparison of negative symptoms as judged by the rater with reports of self experiences.ResultsThe Scale for Assessment of Negative Symptoms (SANS) is an instrument concerning the positive-negative distinction in schizophrenia. The SANS is based on the judgment of the rater about the behavior of the patient. Items reflecting subjective experiences of the patients were initially included in the SANS, buy they were not significantly correlated with the behavioral items, and were therefore excluded from this scale by its author.Huber's group emphasized subjective experiences in schizophrenia. According to this concept the lack of behavioral negative symptoms does not exclude subjective experiences of deficiencies (part of „basic symptoms”, „pure defect”). Nineteen such symptoms were included in the Subjective Deficit Syndrome Scale (SDSS).We compared negatives symptoms measured by SANS with the corresponding subjective experiences measured by SDSS in patients with the diagnosis of schizophrenia and schizoaffective disorder (n = 122).D2 receptor occupancy during antipsychotic treatment was found to be associated with subjective experiences/well being, which can be assessed with specific rating scales (e.g.: Drug Attitude Inventory and Subjective Well-Being under Neuroleptic Treatment).ConclusionsBehavioral symptoms and the subjective experiences of the negative syndrome are not correlated with each other.
Manifesto for a European anxiety disorders research network
Authors: Baldwin D. 
Published: May 2011

Anxiety disorders are common, have an early onset, run a long course, cause substantial distress, impair overall function, reduce quality of life and impose a major economic burden, and therefore represent an important public health problem. Many patients do not present or are not recognized, the standard of care is often sub-optimal, and the effectiveness of interventions in real-world practice can be disappointing: there is considerable room for improvement in recognition, care and treatment.The causes remain largely unknown and this hinders accurate diagnosis, prediction of prognosis, and development of refined treatment approaches. There is much co-morbidity between the disorders and with conditions such as bipolar disorder, depressive illness and physical illness. Research findings in patient samples without co-morbidity may have limited applicability to wider practice, and there is a need to undertake research in fully representative groups. Little is known about determinants of non-response, or next steps in management after the failure of first-line interventions, and there is a clear need for research in the substantial proportion with ‘treatment-resistant’ conditions.The unmet public health, clinical and research needs could therefore be addressed by developing an independent collaborative European Anxiety Disorders Research Network. This would facilitate harmonization of research and clinical databases and refinement of research methodologies. It should contribute to greater accuracy when predicting clinical outcome, and encourage the evaluation of innovative interventions, particularly in important groups such as in the early stages of illness, those with comorbid disorders, and those who have not responded to initial treatment approaches.
Pharmacotherapy in patients with cluster a personality disorders
Authors: Völlm B.A. , Farooq S. , Ferriter M. , Jones H. , Smailagic N. , Khalifa N. , Huband N. , Gibbon S. , Stoffers J. , Duggan C. , Lieb K. 
Published: May 2011

BackgroundAmong the 10 categories of personality disorders (PDs), interventions for antisocial and borderline personality disorder are best studied. However, the remaining PDs also pose major problems in everyday health care settings. People affected often additionally present with Axis-I disorders such as substance-related, mood or anxiety disorders, and are among those most difficult to treat. Cluster A PDs (paranoid, schizoid, schizotypal) are of particular significance as some authors argue that they may be part of a continuum of mental disorders and be considered as sub-syndrome of schizophreniaMethodsIn the context of Cochrane Collaboration reviews for Cluster A, B and C PDs, exhaustive literature searches were completed to identify the current RCT evidence for PD treatments. Retrievals were assessed and evaluated by two reviewers independently and trials for Cluster A PD were identified.ResultsOnly very few (under five) RCTs specifically for Cluster A PDs were identified. Some studies reported on mixed PD samples but it was not always possible to extract data specifically for Cluster A disorders. Participants mostly also suffered from Axis-I disorders. Reported outcomes also focus on Axis-I disorder outcomes or general measures such as overall functioning rather than specific PD symptoms.ConclusionsThe current evidence for psychpathological treatment of Cluster A PD is sparse and does not allow for distinct treatment recommendations. Symptom-driven treatment regimes as suggested by several guidelines are not supported by current evidence.
Diagnosis and differential diagnosis of dementia
Authors: de Mendonça Lima C.A. 
Published: May 2011

The European prevalence of dementias will increase of 40% during the next 40 years, with serious effects on families, communities and healthcare systems (1).A correct diagnosis of dementia is the first step to plan treatment, care and support. There is no single test to identify the cause of dementia. The diagnostic process involves, medical history, mental status exam, physical exam, laboratory tests, psychiatric and (neuro)psychological tests and assessment of individual's functioning. An image of brain is suitable.There is an idea that this diagnostic process can only be realized by highly specialized staff. WHO has recently published the mhGAP Intervention Guide for use in non-specialized health-care settings by health-care providers working at first- and second-level facilities. It includes guidance on evidence-based interventions to make the diagnosis and manage a number of priority conditions, including dementia (2).The recent progress in pathological process understanding of Alzheimer's disease (AD), may help to the proposal of new research criteria that reconceptualise the diagnosis around both a specific pattern of cognitive changes and structural/biological evidence of Alzheimer's pathology (3).These two recent developments are significant contributions to increase the accessibility to a proper diagnosis and care of dementia around the world.
Social factors in mental disorders - update on the evidence
Authors: Amering M. 
Published: May 2011

ContextSocial determinants of mental health and mental illness are classic topics of social psychiatric research and practice.ObjectivesThe broad range as well as specific examples of different areas of this field of interest will be presented and discussed with a focus on current research needs.Key messagesThe field of social determinants of mental health and illness ranges from traditional sociological concepts such as social class and gender to recently emerging concepts such as empowerment, social capital and Amartya Sen's capabilities approach.There is ample evidence that contextual factors on the micro level, such as the role of the family, as well as those on a macro-level such as stigma and dicrimination play a vital role with regard to psychiatric disorders, their treatment and course. Also, internationally emerging policies and research into mental health promotion and prevention clearly show that interventions rely on and vary with social structures and policy strategies in different cultural and economical situations. Current special interest fields in psychiatry such as migration, urbanicity and childhood experiences renew interest into gene x environment interactions as do the dynamic and complex concepts of recovery and resilience.ConclusionsThe large existing evidence base as well as urgent current research efforts such as those into epigenetic mechanisms warrant new vigor in developing and researching variables for further research into the social determinants of mental health and illness.
Manifestation and symptomatology of depression in refugees and asylum seekers
Authors: Kastrup M.C. 
Published: May 2011

WHO has predicted that in 2020 depression will be the second most important cause of disability.Studies focusing on cross- cultural aspects of depression have increased during the last decade, and depression has been studied cross-culturally regarding their prevalence and symptomatology.The WHO study assessing depression across cultures reported a core symptomatology across the participating centres, but with certain differences in the ranking of problems in e.g. patients from non -industrialised nations somatic symptoms often dominate.Furthermore, there is increasing focus on the impact of migration on depressive illness. Depressive syndromes are clearly very common in migrants, and are probably the most frequent mental disorders in people who move to other countries. Refugees and asylum seekers are subjected to significant social and psychological stress and are more vulnerable. For scientific purposes it is vital though to differentiate between the different aspects of influence, for example the frequency of disorders and problems in treatment. Results of studies on increased psychological morbidity in migrants do not indicate whether increased vulnerability is associated with a migration background, or with acculturation problems in the host country due to cultural differences, or a combination of both factors. Both culture and migration-specific factors, as well as the level of integration into the host country, determine the conflicting arguments.The presentation will provide an overview of the burden of depression in relation to culture, differences in symptomatology, the role of migration and other circumstantial factors having an impact on the appearance and outcome of the disorder.