bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immune activation in psychiatric and pre-psychiatric disease
Authors: Drexhage H.A. , Drexhage R.C. , Mesman E. , van Beveren N. , Hillegers M. , Nolen W.A. 
Published: May 2011

Accumulating evidence indicates an activated immune system as a vulnerability factor for the development of schizophrenia (SCZ) and bipolar disorder (BD). In support we detected:1.Monocytosis and monocyte activation (e.g. a specific gene expression signature of inflammation related genes in a coherent pattern) in naturalistically treated SCZ and BD patients, and2.T cell activation in the same patients, be it that it were Treg cells that were more numerous in BD, while in SCZ Treg and Th17 cells numbers were raised.We also tested 70–80 children at ages of 16 and 21 yrs, having1-2 parent(s) with BD. This offspring has a higher chance of developing a mood disorder and over 25% had developed a mood disorder at 21 yrs. Not only the offspring with a lifetime diagnosis of mood disorder had activated monocytes and more Treg cells (similar as BD patients), but also around 40–50% of euthymic offspring had this immune activation profile. Importantly children who were psychiatrically healthy at 16yrs, and had developed a mood disorder at 21 yrs of age, all had activated monocytes at 16yrs.Our data show that both the monocyte and T cell arm of the immune system are activated in SCZ and BD, this activation preceding the onset of first episodes in individuals at risk. Our approach opens new avenues for early detection of psychiatric disease based on the immune state of individuals at risk, enabling possible selection of those individuals who might benefit from an immune modulation treatment to prevent disease.
Cytokines and tryptophan metabolites in peripheral blood cells of patients with mood disorders: Role of antidepressants
Authors: Myint A.M. , Schwarz M. 
Published: May 2011

BackgroundMild immune activation is well documented in major depressive disorders. The imbalance in kynurenines in the plasma of patients with MDD was also reported. However, how the blood cells of the patients would respond to external challenge and what would be the effects of different antidepressants is still needed to be explored.Material and methodsAltogether 20 patients and 40 age and gender matched healthy controls are recruited. Interviews were performed with HAM-D17 and early morning blood was withdrawn. Serum was separated and whole blood culture and peripheral blood mononuclear cell culture were performed with and without stimulation with lipopolysaccharide (LPS) or PolyI:C to activate TLR-4 and TLR-3 respectively. The cytokines and kynurenines are measured in supernatants and serum.ResultsThe LPS showed clear immune activation whereas PolyI:C showed various responses. The selective serotonin reuptake inhibitor showed advantage in controlling immune activation induced by TLR-4 stimulation. The tryptophan breakdown showed higher in depressed patients.DiscussionThe immune activation is enhanced in depressed patients and SSRIs showed advantage in controlling immune activation. The details interaction between TLRs and antidepressants in depression will be discussed.
Evidence-based treatment of anxiety disorders in Europe - an update
Authors: Bandelow B. 
Published: May 2011

Anxiety disorders are chronic, disabling conditions with prevalence rates higher than the ones of schizophrenia or diabetes.Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are standard treatments for anxiety disorders. The calcium-channel modulator pregabalin is a treatment option for generalized anxiety disorder. Tricyclic antidepressants (TCAs) are as effective as modern antidepressants, but less well tolerated. For short-term treatment and in treatment-resistant cases, benzodiazepines like alprazolam may be used when the patient does not have a history of dependency and tolerance. Combining drug treatment with cognitive behaviour therapy is the most successful treatment strategy in anxiety disorders. Strategies of treatment-resistant anxiety disorders and future anxiolytics will be presented in the symposium.
Neurobiology of anxiety disorders
Authors: Den Boer J. 
Published: May 2011

In many psychotherapeutic theories the aim of therapeutic interventions is a restructuring of cognitive appraisals of past and current situations. The question is whether such a ‘dry’ and formal cognitive approach does not unjustly leave out the body. Especially in anxiety disorders brain/bodily changes appear to play an important role in the etiopathogenesis.There is now a great deal of experimental evidence that the brain does not only store mental representations, but that the brain/body is actively involved in mental operations. As an example of this I will discuss recent evidence indicating that early adverse life events not only lead to psychological (cognitive) disorders, but also leads to abnormal functioning of brain mechanisms and bodily functions.These changes occur on different levels of organization. Children who have been neglected or abused have smaller brains and a reduced complexity of neuronal dendrites, and also exhibit dysfunctions in neurotransmitter systems and the immune system.I will specifically discuss recent investigations conducted in our centre in which severely traumatized patients were studied using positron emission tomography, one of the neuroimaging techniques which yields information about brain functioning in vivo.As a final point I will discuss genetic differences that may explain differences in sensitivity for stressful life events, which may lead to the deveopment of a spectrum of anxiety disorders.
Genetics in anxiety disorders - an update
Authors: Domschke K. 
Published: May 2011

Twin studies propose a strong genetic contribution to the pathogenesis of anxiety disorders with a heritability of about 50%. The dissection of the complex-genetic underpinnings of anxiety disorders requires a multi-level approach using molecular genetic, imaging genetic, (cognitive)-behavioral genetic and pharmacogenetic techniques linking basic and clinical research.The present talk will first give an overview of results from linkage and association studies yielding support for several candidate genes contributing to the genetic risk for anxiety and panic disorder in particular such as the adenosine 2A receptor, the catechol-O-methyltransferase, the neuropeptide S receptor and the serotonin receptor 1A genes. Results from the first genome-wide association studies in the field of anxiety disorders will be discussed. Additionally, studies on gene-environment interactions between anxiety disorder risk variants and environmental factors will be presented. Imaging genetics approaches have yielded evidence for several risk genes to crucially impact activation in brain regions critical for emotional processing. Gene variation has furthermore been found to potentially confer an increased risk for panic disorder via elevated autonomic arousal and dysfunctional cognitions regarding bodily sensations. Finally, there is first evidence for genetic variants impacting treatment response to antidepressant pharmacotherapy in anxiety disorders.Thus, converging lines of evidence will be presented for several candidate genes of anxiety to exert an increased disease risk potentially via a distorted cortico-limbic interaction during emotional processing, increased physiological arousal or dysfunctional cognition. Additionally, a possible impact of genetic variants on pharmacoresponse in anxiety disorders and its potential clinical implications will be discussed.
High-risk-states for psychoses and schizophrenia
Authors: Klosterkötter J. 
Published: May 2011

Revision 5 of the diagnostic and statistical manual for mental disorders (DSM-V) has stimulated a debate about the inclusion of a risk for psychosis syndrome in order to facilitate the prevention of psychosis.The presentation critically outlines the course of this debate, focusing particularly on the question of how the inclusion of such a syndrome could be justified in DSM-V and ICD-11.Most participants in the debate have initially opposed the inclusion of a risk for a psychosis syndrome. They justified this dismissive attitude with scientific, clinical and ethical arguments. The predictive power of eligible criteria for first psychotic episodes appeared to be too low. Their use as diagnostic criteria would involve the danger of hastily treating many falsely diagnosed individuals at risk for psychosis with antipsychotics and unjustifiably putting them at risk for side effects. In general, diagnoses should be based on grounds of manifest illnesses and not include at risk states for later diseases.Meanwhile, the understanding, that the risk of disease symptoms already has a pathological significance and therefore requires treatment has by now begun to be accepted. This applies both to the risk symptoms in the early initial prodrome, as well as to the high risk symptoms in the late initial prodrome. It would therefore be reasonable to use these two sets of criteria for the definitional operationalisation of the new diagnostic category in the classification systems. This would allow the continuation of preventive efforts but also the development of evidence-based treatment within standard care.
At-risk-states for bipolar disorder
Authors: Conus P. 
Published: May 2011

Early intervention strategies have been developed over the past 20 years for psychotic disorders and recent studies have proven their efficacy. However, most of the attention has been drawn to schizophrenia, and affective psychoses have been neglected. In the recent past, new research has identified a similar need for earlier intervention in bipolar disorders, and prodrome to bipolar disorder has emerged as a key domain to investigate. Despite the complexity of this issue due to the lack of a clear consensus regarding definitions of the various stages of the disorder, some progress has been made in this domain.Two recent retrospective studies have identified a prodromal phase to first episode mania lasting between 6 and 18 months, and have identified a range of symptoms that occur during this period. It is however likely that on the basis of symptomatic profile, identification of at risk patients would be difficult, considering their low specificity. Two complementary directions have been recently proposed in order to refine such an approach. The first strategy, based on at-risk profiles inspired by the Ultra High Risk concept developed for psychosis, has yielded some promising results on a small sample of patients. The second is based on the combination of identified risk symptoms with both risk factors and markers of vulnerability into a First Episode Mania Prodrome Inventory which is currently under validation.
Trialog - concept and research
Authors: Amering M. 
Published: May 2011

The active involvement of users of services and their families and friends into mental health care and research is essential for the success of mental health services and initiatives worldwide. Also, co-operations between mental health professionals, users and carers are needed to solve methodological problems of evaluative research and generate new models of needs-orientated interventions. However, accepting each other in a working partnership for a multiperspective evidence base is still a challenge for professionals as well as for users and relatives and friends. Changes in structures as well as in forms of communication are warranted.In Trialogue-groups users, carers and mental health workers meet regularly in an open discussion forum, that is located on ‘neutral terrain’ - outside any therapeutic, familial or institutional context - with the aim of communicating about and discussing the experiences and consequences of mental health problems and ways to deal with them. This setting offers new possibilities for gaining knowledge and insight and developing new forms of communication. It also functions as a basis and starting point for trialogic activities on different levels - e.g. serving on quality control boards - and different topics - e.g. anti-stigma projects. In German speaking countries well over hundred Trialogue groups are regularly attended by altogether ∼ five thousand people. Trialogues are inexpensive and a great number of people seem to benefit from participation. Current ideas for the scientific evaluation of Trialogues regarding process as well as possible outcomes pose conceptual and methodological challenges.
World psychiatric association task force on best practice in working with service users and carers
Authors: Herrman H. 
Published: May 2011

The WPA has invited service users and family carers to join in its work as members of a taskforce, recognising their essential contribution to improving mental health in any country. WPA President Prof. Mario Maj established the project within the WPA Action Plan 2008 to 2011. The taskforce has prepared recommendations for the international mental health community on best practices in working with service users and carers. It has also worked with the WPA Standing Committee on Ethics to prepare a new paragraph for the WPA Declaration of Madrid. The WHO Department of Mental Health has offered its experience and advice.Ten recommendations are ready for dissemination after extensive consultation. Each country will need specific guidelines to apply these recommendations. The recommendations begin by declaration that respecting human rights is the basis of successful partnerships for mental health. The second recommendation is that legislation, policy and clinical practice relevant to the lives and care of people with mental disorders need to be developed in collaboration with users and carers. The series continues with a recommendation that the best clinical care of any person in acute or rehabilitation situations is done in collaboration between the user, the carers and the clinicians. Education, research and quality improvement in mental health care also require this collaboration. The next step is developing a series of projects to apply these broad principles in each country and local communities. The WPA hopes to support partnership and participatory developments worldwide, and learn from these experiences.
The effectiveness of schema focused therapy; Indirect, experimental measures of emotional change in forensic patients
Authors: Nentjes L. , Bernstein D. 
Published: May 2011

According to recent literature, 50 to 90 percent of criminal offenders have personality disorders (PDs), with cluster B PDs being the most prevalent in forensic settings. The latter type of PD is associated with an increased risk of violence and recidivism. Among forensic patients with a cluster B diagnosis, psychopathic offenders are at particularly high risk for re-offending. Psychopaths are believed to be untreatable, but evidence for this view is weak.The current study aims at determining the effectiveness of Schema Focused Therapy (SFT) versus ‘treatment as usual’ in male forensic patients (including psychopaths) with Antisocial, Borderline, Narcissistic, and Paranoid PDs, within a 3-year multi-center randomized clinical trial. SFT is an integrative form of psychotherapy combining cognitive, behavioral, psychodynamic object relations, and humanistic/existential approaches, and was developed as a treatment for PDs and other longstanding problems. SFT aims at changing early maladaptive schema modes, thereby producing changes on a structural, emotional level.The goal of a second study that runs within the same project is to objectively determine the nature of the emotional deficiencies that are thought to be central to psychopathy. By administering forensic patients an extensive test battery that assesses various affective capacities (e.g., moral emotion, emotional expressive behavior, cognitive and emotional empathy), we aim at constructing an integrative picture of psychopaths’ emotional functioning. Within the SFT effectiveness study, patients are tested twice (with a one year interval), to see whether these affective capacities are subject to change in the context of therapy.
Detection of dementia
Authors: Stoppe G. 
Published: May 2011

Detection of dementia is usually a two-step procedure, consisting of screening and application of diagnostic instruments. Screening has to be done on the background of fears for stigma and loss of autonomy.There are many screening instruments available for the detection of dementia. However, they were not tested in very old age and often not in the primary care setting for which they are developed. We present results of a study in primary care, where we tested which elements of common tests (MMSE, TFDD, DEMTECT, Clock Test…) would be best for this age group. All available screenings showed a good effect size of >0.70.For the application of further diagnostic tools an update of the current guidelines is given and compared to the available evidence regarding guideline implementation. As far as possible, results of an ongoing study in Switzerland will be presented.
Issues in pharmacological management of behavioural and psychological symptoms of dementia: English ministerial review of the use of antipsychotic drugs for people with dementia
Authors: Banerjee S. 
Published: May 2011

IntroductionIn response to increasing concerns about the use of anti-psychotic drugs in dementia, the Department of Health in England commissioned an independent ministerial review.Aims and methodsThe report was based upon an expert review of policy and publications; systematic review of the benefits and harms; and new pharmacoepidemiology.ResultsThis review finds that these drugs are used too often in dementia and potential benefits are outweighed by their risks overall. It estimates 180,000 people with dementia receive antipsychotic medication in the UK per year. Of these, 20% (36,000) will derive some benefit. Negative effects directly attributable to antipsychotics equates to an additional 1,620 cerebrovascular adverse events (around half severe), and an additional 1,800 deaths per year. The report's analysis is that this overuse is a specific symptom of a general cumulative failure over the years in health and social care systems to develop an effective response to dementia.ConclusionsThe report contains 11 recommendations to reduce the use of these drugs to the level where benefit will outweigh risk. These include: making reduction a clinical governance priority; audit to drive down the level and up the quality of use of these drugs; specialist services to support primary care in its work in care homes and the community; research on alternatives to antipsychotic medication. The report estimates that, if this is implemented then we can reduce the rate of use of antipsychotic medication to a third of its current level safely over a 36 months.
Stress reactivity in patients with drug dependence and personality disorders
Authors: Walter M. , Gerber H. , Wiesbeck G.A. , Riecher-Rössler A. , Borgwardt S.J. 
Published: May 2011

Drug dependence is defined as a chronic relapsing brain disorder that is defined by a compulsion to seek and use drugs despite negative consequences. Drug-related cues and stress are known to be key factors for drug use. It has been argued that drug use could be seen as self-medication in patients with drug dependence and co-occurring personality disorders. However, the relevance of co-occurring personality disorders for stress reactivity after drug use is not clear.Thirty drug-dependent patients on stable opioid maintenance treatment with and without personality disorders were examined in a randomized placebo-controlled crossover study to investigate the effects of diacetylmorphine (DAM = heroin) on stress reactivity. They were compared with 20 healthy volunteers receiving saline. The drug-dependent patients administered either their individual prescribed DAM dose or saline. Afterwards they completed four emotional tasks while brain responses were measured with functional magnetic resonance imaging (fMRI). Before and after the fMRI investigation, adrenocorticotropic hormone (ACTH), cortisol, DAM blood levels, and psychological stress parameters, such as anxiety, anger, and craving were measured.The findings of DAM effects on stress reactivity in patients with drug dependence and co-occurring personality disorders will be reported and clinical implications regarding specific psychosocial interventions will be discussed.
The nosological role of comorbidity in patients with internet and video-game addiction
Authors: te Wildt B.T. , Putzig I. , Vukicevic A. , Wedegärtner F. 
Published: May 2011

Background and ObjectivesWith the Cyberspace's exponential growth of influence questions arise about its mental impacts. The presented study examines the question whether the dependent use of the Internet can be understood as an impulse control disorder, an addiction or as a symptom of other psychiatric conditions.MethodsInternet dependent patients seeking for psychiatric assistance and fulfilling the criteria for pathological Internet use (PIU) were examined with the Structured Clinical Interview according to DSM-IV (SCID), and a variety of questionnaires including the Barratt Impulsiveness Scale (BIS), the Beck Depression Inventory (BDI) and the Dissociative Experience Scale (DES). The patient group was compared to a matched group of healthy controls.ResultsThe adult patient-group consisted of 25 subjects, 76% male, with a mean age of 29.36 years. Average time spent in Cyberspace was 6.47 h/d, mostly in online-role-playing games. According to SCID I and BDI, 19 patients (76%) suffered from a depressive syndrome, with 10 cases of major depressive disorder (40%) and 8 cases of adjustment disorder with depression (32%). Six patients (24%) suffered from a comorbid anxiety disorder. Compared to controls, the patient group presented significantly higher levels of depression (BDI), impulsivity (BIS) and dissociation (DES).ConclusionsPIU shares common psychopathological features and comorbidities with substance related disorders. Therefore, it might be seen as a diagnostic entity in itself within a spectrum of behavioral and substance dependencies. Especially Internet role play may contain an addictive potential for adolescents and adults with subclinical psychopathology.
Mental health and european big cities: London
Authors: Priebe S. ,   PROMO Study
Published: May 2011

Big cities in Europe are characterised by social factors that can influence mental health and impact on the provision of mental health care. These factors include social inequalities, social marginalisation and fragmentation, large scale immigration, and a high proportion of mobile populations. Big cities tend to have higher levels of morbidity and higher costs of service provision than other parts of the same country. This leads to specific challenges, particularly in inner city areas. The paper summarises how mh services in London approach these challenges, how they are organised and how they have changed over the last 10 years. Services are provided by the NHS with an emphasis on care in the community. Whilst there have been large investments in mental health care and the establishment of a range of new teams with specialised functions over the last 10 years, recently funding has come under pressure and service provision may need to be reduced. There has also been a stronger focus on risk issues and the introduction of compulsory treatment in the community.Taking the example of East London as the most deprived area in London, the paper will illustrate how traditional principles of sectorisation, catchment area responsibility and continuity of care have been put into question with potentially new solutions to old problems. The paper will also briefly describe how mental health care for socially marginalised groups is provided and compare the situation in London against that in other European capitals as investigated in the EC funded PROMO Study.