bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suicide and Personality: Focus on Old Age
Authors: Rujescu D. 
Published: May 2011

Suicide is one of the leading causes of death worldwide, mortality from suicide being approximately 2%. Attempted suicide appears to be a major risk factor for suicide completion. Anger, aggression and impulsivity are personality traits associated with suicide attempt. We analysed anger, impulsivity and temperament/character scales as predictors of aggression and self-aggression in suicide attempters and compared this to anger- and aggression-related traits between impulsive and premeditated suicide attempts as well as between violent and non-violent suicide methods.The State-Trait Anger Expression Inventory (STAXI), the Questionnaire for Measuring Factors of Aggression (FAF), and the Temperament and Character Inventory (TCI) were assessed.Higher aggression scores, as measured by FAF, were predicted by being male, meeting criteria for borderline personality disorder and having higher angry temperament scores as assessed by STAXI. TCI dimensions associated with self-aggression were high harm avoidance, high impulsivity and low selfdirectedness.State anger, inwardly directed anger and inhibition of aggression were also predictors of self-aggression.In conclusion, impulsivity and harm avoidance have emerged as temperament dimensions independently associated with self-aggressive tendencies in personality. Such interactions could explain the correlation between temperament and suicidality but further research is needed. Anger and selfdirectedness appear to have some effects on suicide attempt.
Systematic Review of Preventing Suicide in Old Age: 2005–2010
Authors: de Mendonça Lima C.A. , Rodrigues R.M. 
Published: May 2011

Suicide is a typical phenomenon of the elderly and mainly among men. Besides the importance of suicide in terms of public health there is fewer interest to prevent suicide in old age. This can be explained by stigma, poor evaluation of the dimension of the problem and lack of politic will.Suicide prevention and the care of survivors of suicide depend on the mental health network of care. Interventions to reduce suicide can be made at individual level and at level of the development of policies and strategies. The detection of the persons at risk of suicide and the management of the suicide attempt are two main strategies to prevent suicide. Both received recently an important support from WHO with its publication mhGAP Intervention Guide which was conceived to be used 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 suicide.Our review of the literature pointed to the necessity to develop additional research to determine:•the role of somatic disorders as precipitant factor;•the role on suicide of the pre-morbid personality, cognitive functioning, social support and recent and chronic stressing events;•the participation of normal and pathological ageing on the expression of the suicide behavior;•the biological markers of suicide in old age;•the potential impact on suicide rates of educational interventions for the general public and for caregivers.
Risk for Suicide Among the Elderly: Is the Geriatric Depression Scale a Useful Screening Tool?
Authors: Wancata J. , Marquart B. , Friedrich F. , Cerny G. 
Published: May 2011

IntroductionDepression is among the main risk factors for suicide. The Geriatric Depressions Scale (GDS-30, GDS-15) is depression screening instrument specifically developed for the elderly.Objectives and aimsTo provide a systematic review of the screening accuracy of both GDS versions.MethodsAn electronic search was performed using Medline, Embase, Cinahl, Psyndex and Cochrane library. The selection and examination of papers was done by two reviewers independently. The following studies were excluded: number of depression cases less than 10, no clear case criterion, phone version, psychiatric samples.ResultsOf 173 papers which were read and examined, only 42 papers were included. For both GDS versions similar mean validity indices were found (GDS-30: sensitivity 0.753, specificity 0.770; GDS-15: sensitivity 0.805, specificity 0.750). Using pooled samples we could not find significant differences between the two versions of the GDS. Using comparative studies based on identical samples, both GDS versions showed significantly better validity indices than the “Yale-1-question” screen, but did not differ from the CES-D. Frequently, essential information about research methods was not given. When methods were reported, the differing methods (e.g. concerning blinding, cut-off values, sampling procedures) limit the comparability of primary studies.ConclusionsIn general, the GDS seems to be sufficient for depression screening. While early recognition of depression is essential for identifying persons at risk for suicide, the GDS does not explicitly focus on this problem.
Monotherapy vs combination therapy in bipolar disorder: What does the evidence say?
Authors: Fountoulakis K. 
Published: May 2011

The treatment of bipolar disorder is complex and the overall results of monotherapy are not satisfactory. Combination and add-on studies suggest that in acutely manic patients who are partial responders to lithium, valproate or carbamazepine, a good strategy would be to add haloperidol, risperidone, olanzapine, quetiapine or aripiprazole. Adding oxcarbazepine to lithium is also a choice. For patients with refractory bipolar depression the only positive data concern adding lamotrigine to lithium. During the maintenance phase the combination of quetiapine plus mood stabilizer is superior to monotherapy in the prevention of manic and depressive recurrences in either manic, depressive, or mixed index episode over a period of 2-years. These combination studies appear to be the first to report prevention on both depression and mania regardless of the type of index episode.Discontinuation studies suggest that patients stabilized on combination therapy (olanzapine plus lithium/valproate or mood stabilizer plus ziprasidone) do worse when the antipsychotic is discontinued. The recently published BALANCE could neither reliably confirm nor refute a benefit of combination therapy compared with lithium monotherapy. Add on studies suggest that at least some strategies could be useful in patients with inadequate response to monotherapy. Overall, although there is no compelling data that combination treatment does better than monotherapy, the data suggest that those patients stabilized on combination treatment might do worse if shifted from combination, and patients refractory to monotherapy could benefit with add on treatment with olanzapine, valproate, an antidepressant or lamotrigine, depending on the index acute phase.
Bipolar treatment in everyday practice - the European perspective; data from the international AMSP program
Authors: Konstantinidis A. , Grohmann R. , Friedrich M.E. , Greil W. , Kasper S. 
Published: May 2011

In the last decade new psychotropic agents have been licensed for the treatment of bipolar depression and mania. We wanted to evaluate if this led to changes in psychotropic prescriptions for bipolar-inpatients over the time-period from 2000 to 2007.On two reference-days per hospital and per year, the following data are recorded for all patients on the wards under AMSP surveillance: all drugs applied on that day with the daily dosage for psychotropic drugs, ICD-diagnosis, age, and sex. In our analysis we evaluated data from 2000 (N = 210) and 2007 (N = 383).We found a decrease of psychotropic monotherapy from 13.8% in 2000 to 4.7% in 2007. The percentage of inpatients receiving 5 or more psychotropics increased significantly from 10.95% in 2000 to 22.19% in 2007 (chi2: 11.199, df:1, p < 0.001). Furthermore we found a significant decrease of prescriptions for one or two psychotropics (38.89% to 16.38%) in bipolar-depressed-inpatients, but not in bipolar-hypo/manic-inpatients (chi2: 17.929, df:1, p < 0.001). The most frequently prescribed psychotropic in bipolar depression in 2000 was lithium-carbonate (median-dosage: 675 mg/day) and in 2007 valproic-acid (median-dosage: 1000 mg/day). In bipolar hypo-/mania the most commonly prescribed psychotropic in 2000 was again lithium-carbonate (median-dosage: 675 mg/day) and in 2007 valproic-acid (median-dosage: 1500 mg/day). The most frequently prescribed combinations were those of cbamazepine with lithium-carbonate (4.76%) in 2000 and of valproic-acid with quetiapine (8.88%) in 2007.In our bipolar sample polypharmacy increased over the years. Further studies evaluating the safety of this polypharmacy, as well as putative effects of psychotropic combination-treatment in bipolar disorder are needed.
Drug interactions in the treatment of Bipolar disorder
Authors: Baumann P. 
Published: May 2011

Bipolar disorders are characterized by many different forms and episodes, which require specific pharmacological treatments. For the treatment or prevention of manic episodes, lithium salts, some atypical antipsychotic drugs and some anticonvulsants were introduced. Antidepressant drugs but also a very limited number of anticonvulsants (lamotrigine) and antipsychotic drugs (quetiapine) are recommended for the treatment of depressive episodes. In addition, benzodiazepines or related compounds may be useful as comedications for sleep problems or for their sedative properties. Polypharmacy is therefore rather common, also in case of insufficient response to a single drug, when the administration of a combination of active agents appears to be promising.Most of these drugs are substrates of cytochrome P-450, and many of them are also either inducers or inhibitors of some of its isozymes. Interactions may also occur at the level of conjugating enzymes. Increasingly, knowledge about the underlying mechanisms of drug transport from intestine to the blood, and from the blood to the brain helps to predict interactions at this level. Indeed, many drugs are transported by P-glycoprotein, and inhibitors and inducers, respectively, may modify the transport of psychotropic drugs. Therefore, it is recommended to consider the interaction profile of each drug before initiating a combined treatment and adapt medication. Sometimes, despite it is known that interactions may occur with pharmacodynamic consequences, some risky combined treatments may nevertheless be useful. In such situations, careful titration of the drug doses and therapeutic drug monitoring are recommended.
Chronotherapeutics: Fulfilling the unmet needs for faster, better, and longer-lasting antidepressant response
Authors: Wirz-Justice A. 
Published: May 2011

Chronotherapeutics (light, darkness, sleep manipulations, melatonin) offer a new synthesis of non-pharmacologic interventions designed to accelerate remission in patients with depression and bipolar disorder. Combinations of light and wake therapy achieve fast results and, by reducing residual symptoms, also minimise relapse over many months. In addition, chronotherapeutics seem to be a major facilitator of drug response, and, in combination with antidepressants, a promising method to stabilise patients over the long term. The above treatments fulfil the unmet needs for a new antidepressant drug - short latency of action, fewer residual symptoms, lack of side effects, shorter hospital stays, and less relapse, as well as WHO criteria for interventions that are effective, affordable and sustainable. Yet, despite the growing evidence for their efficacy, and more than thirty years of implementation, it is surprising how limited their use still remains. Is it an image problem (alternative medicine, too simple) or a marketing problem (not patentable, therefore not profitable)? One important factor is lack of insurance reimbursement, because of not being a listed treatment (because they do not go through official clinical trial registration at federal regulatory agencies). Perhaps it is the patients who will spearhead the transition, together with a younger generation of psychiatrists curious to find biologically active alternatives to medication.See: the nonprofit, multilingual patients’ website www.cet.org and clinicians’ website www.chronotherapeutics.org
Neuroimaging and genetics of antidepressant response to sleep deprivation: Implications for drug development
Authors: Benedetti F. 
Published: May 2011

Despite confirmed evidences about some neurochemical effects of antidepressant treatments, there is still an high level of uncertainty about which biological changes are needed to recover from a major depressive episode. Changes of monoaminergic neurotransmission are paralleled by profound changes in brain metabolism, neural responses to stimuli, sleep architecture, biological rhythms, and, at the intracellular level, neuronal signaling pathways regulating gene expression, neuroplasticity, and neurotrophic mechanisms.Sleep deprivation targets the biological mechanisms which are responsible of the possibility, unique to mood disorders, of rapid switching between depression, euthymia, and mania. The rapidity of action of sleep deprivation enables the study of the correlates of antidepressant response at close time points, providing a good model to study the biological basis of the antidepressant response and of the patophysiology of affective illness.Current knowledge suggests that multiple neurobiological effects of sleep deprivation are responsible for the clinical mood amelioration, suggesting a multi-target mechanism of action. An impressive group of brain imaging studies using different brain imaging techniques (positron emission tomography, single photon emission tomography, functional magnetic resonance imaging, proton spectroscopy, arterial spin labeling) showed that clinical response is associated with changes in the functioning of specific brain areas. The combination of these new methodological acquisitions with the classical neurobiological and pharmacogenetic perspective provides an evolving knowledge about brain changes associated with antidepressant response, and will then help to identify the real targets of antidepressant treatment.
Wake therapy yields sustained response and remission. A rater-blind 9 weeks controlled study using a chronotherapeutic intervention compared to exercise
Authors: Martiny K. , Refsgaard E. , Lund V. , Lunde M. , Bech P. 
Published: May 2011

IntroductionWake therapy (sleep deprivation) is known to induce a rapid amelioration of depressive symptoms. Recently, techniques using bright light therapy and sleep time control have been developed to sustain the acute response of wake therapy.ObjectivesThe aim of this study was to establish the efficacy of these new methods and to control for the placebo response by incorporating an active control group.MethodsPatients with an actual diagnosis of unipolar or bipolar major depression were randomized to either a wake group or an exercise group and followed for 9 weeks. All patient were treated with duloxetine 60 mg daily. After a one week medication run-in phase, all patient were admitted to an open ward for six days: The wake group had 3 wake nights during their stay in combination with daily bright light treatment and sleep time control and the exercise-group started their exercise program. Bright light and exercise were continued for the whole study period.ResultsPatients in the wake group had a statistically significant larger improvement from immediately after wake therapy and maintained for the rest of the study period. At end of study the Wake group achieved a response / remission rate of 70.2 % and 45.6 %. The exercise group had a response/remission rate of 42.2 % and 23.1 %ConclusionThe chronotherapeutic intervention induced a rapid and sustained response superior to the response seen in the exercise group.
Relationship between fast-acting antidepressant properties of total sleep deprivation and serum BDNF levels
Authors: Caliyurt O. 
Published: May 2011

Sleep deprivation therapy is a treatment option for major depressive disorder. Total sleep deprivation for one night improves depressive symptoms in 40–60% of treatments. Recent reports have suggested that brain-derived neurotrophic factor (BDNF) levels are reduced in individuals suffering major depressive disorder and these levels normalize following antidepressant treatment.In a recent study we have shown that the effects of total sleep deprivation therapy on BDNF levels in major depression. Results were compared between depressive patients that were treated with sertraline and healthy volunteers who experienced single total sleep deprivation. The baseline BDNF levels were significantly lower in both patient groups than the controls. Single sleep deprivation therapy was shown to decrease HAM-D scores and increase BDNF levels significantly in depressive patients. Effects of single sleep deprivation therapy on HAM-D scores was correlated with changes in BDNF levels. A series of three sleep deprivation therapies in a week accelerated the treatment response and increased the BDNF levels rapidly compared to the patients treated with sertraline alone. Better treatment response in the TSD group was also correlated with the statistically significant increase of BDNF levels in the 7th day compared to the sertraline group.In conclusion, our results support the BDNF reduction in major depression. Rapid antidepressant effects of sleep deprivation therapy appear to relate to the rapid BDNF increase in major depressive patients. These results give an opportunity to explore the relationship between fast antidepressant response and BDNF changes in major depression.
Advances in male and female sex therapy: Expectations and disappointments
Authors: Zemishlany Z. 
Published: May 2011

The introduction of the PDE-5 inhibitors for male erectile dysfunction (ED) evolved expectations for 70–80% of efficacy as has been shown in short term studies. Ten years later, we are aware of their limitation: PDE-5 inhibitors are not efficient when desire is lacking, as well as in severe ED. Also, long term studies showed a lesser degree of efficacy.The new pharmacological treatment for premature ejaculation, Dapoxetine, has been developed as a short acting SSRI. It has been shown to increase the time for ejaculation by three folds but has some adverse effects including nausea and fainting (due to hypotension).Low desire is the most common sexual complaint in females. New pharmacological treatments include Bupropion 150 mg/day and Flibanserin 150 mg/day, although the evidence for efficacy is not conclusive. Their proposed mechanism is an increase in dopamine and norepinephrine activity. Flibanserin is an antagonist at the serotonin 2A receptor and an agonist of the serotonin 1A and dopamine D4 receptors.Estrogen and/or testosterone replacement may be beneficial in appropriate cases.There is a growing awareness in the last decade that low sexual desire in women is associated with age, relationship duration, relationship distress and complaints of anxiety and depression. Those psycho-social factors might limit the role of pharmacological agents.Sex therapy should always consider and relate to these key issues
Course of psychopathology in the at-risk mental state - outcomes beyond transition to psychosis
Authors: Ruhrmann S. , Schultze-Lutter F. , Salokangas R.K.R. , Linszen D. , Birchwood M. , Juckel G. , Heinz A. , Lewis S. , Klosterkötter J. ,   EPOS Group
Published: May 2011

IntroductionResearch on at-risk states of psychosis has mainly aimed to predict conversion. Yet as a considerable number of patients does not to progress to this outcome during the investigated observation periods, the course of these non-converters (NC) is of major interest, particularly with regard to preventive interventions and treatment.AimsTo analyze the psychopathological and functional in 18-month non-converters.MethodsData were derived from the prospective multicenter European Prediction of Psychosis Study with an 18-month follow-up period. Participants had to fulfill ultra-high risk criteria and/or the COGDIS criterion, which is based on a set of cognitive basic symptoms. Psychopathology was assessed with the Structure Interview for Prodromal Syndromes (SIPS), including the Global Assessment of Functioning Scale (GAF) and a short version of the Schizophrenia Proneness Instrument (SPI-A).ResultsAll total and subscale scores improved significantly during follow-up. However, a more detailed analysis revealed that a considerable part of the patients showed no improvement or even a worsening of psychopathology and function.ConclusionsOur first analysis of course on non-converters shows that a high proportion of patients improved. In the light of results from retrospective studies, however, this improvement has to be interpreted with caution, as the observation period does not allow to determine the proportion of outpost syndromes, i.e. precursors of a later prodrome. Furthermore, a considerable portion of our sample worsened functionally and/or symptomatically. With regard to retrospective schizophrenia related results, very long observation periods may be needed to characterize the patterns of course in subpsychotic syndromes.
Discharge planning, an intervention study - and where to go next?
Authors: Becker T. , Steffen S. , Puschner B. ,   NODPAM
Published: May 2011

BackgroundProcess evaluation should be an integral part of randomised controlled trials (RCTs), and this is important in examining complex interventions with a number of active ingredients.ObjectiveTo analyse effectiveness and effect moderators in a multi-centre RCT of needs-oriented discharge planning vs. treatment as usual (TAU) for high utilisers of mental health care.MethodFrom April 2006 to July 2007, 491 adults with high utilisation of mental health care for psychotic disorders gave informed consent to participate in a multi-site RCT at five German psychiatric inpatient services. Subjects allocated to the intervention group were offered a manualised needs-led discharge planning intervention of two 45 minute sessions delivered by a trained study worker. Outcomes (service use, needs, psychopathology, depression, quality of life, direct costs) were assessed at four measurement points during 18-month follow-up. Latent class modelling was used to scrutinise differential effectiveness. Characteristics of subgroups of participants showing variable treatment response will be described.ResultsThere was improvement both in the intervention and (TAU) control group but no differential effectiveness of the discharge planning intervention. Only few variables significantly moderated effects. Effect moderators pertained to quality of delivery and intervention dose.ConclusionsStudy results could help to tailor interventions to local conditions and guide future implementation of discharge planning in routine care. Further research should focus on scrutinising study process, ensuring ecological suitability of interventions and on head-to-head comparison studies.