Department Of Psychotherapy Research Articles

Psychiatric illness through the lifespan

Each person can be affected by mental illness, independently of his or her age or gender. Nevertheless, it has been observed that some specific diseases do appear more often in people of a particular age and that reversely the age of the person may also have an influence on the specific characteristics of the psychiatric symptoms. Moreover, the variation of symptoms of a disease through the years indicates that psychiatric illness has always to be seen in relation to the individual background of the individual. One reason for the age-specific modulation of the pathology is related to the influence of biologic and psychosocial factors that change throughout life. As a result, we are only able to comprehend mental disorders of adults if we comprehend the precursors of the illness from the beginnings of cerebral development. The annual congress of the German Association for Psychiatry and Psychotherapy (Deutsche Gesellschaft fur Psychiatrie, Psychotherapie und Nervenheilkunde, hence DGPPN) held in Berlin in November 2009 especially addressed the theme ‘‘Psychiatric illness through the lifespan’’. With this supplement, we intend to give you an overview about the major topics. We have therefore collected a series of invited contributions based on the presentations given during the Berlin congress of Psychiatry to emphasize some aspects of psychiatric illness through one’s life. Important questions, especially with regard to the ongoing demographic development in our society were addressed. A number of articles in this supplement refer to this focus: Does anticholinergic drug use enhances the risk of dementia in older ages? How do traumatic or lifethreatening experiences influence our brains and lives? How does preventive intervention in persons at risk for psychotic disorders look like? The diagnosis and therapy of psychiatric illness with regard to the individual situation of the patient was one of the key topics of the Berlin congress of Psychiatry. Furthermore, the prevention of psychiatric diseases, the examination of psychosocial and biologic influences on mental illness, as well as advances in psychoand pharmacotherapy, were topics that were focused on. We therefore also selected some more clinical articles for this supplement, reflecting actual developments, e.g. concerning therapeutic interventions in patients with affective disorders, individualized treatment of alcohol-dependent patients as well as advances of pharmacotherapy in the treatment of anxiety disorders. A special focus on our congress was also put on ethics in psychiatry, especially concerning psychiatric research. Consequently, we included a number of articles related to ethical guidelines in psychiatric research, e.g. one article dealing with conflict of interests. Another manuscript focuses on a historical perspective in ethics—the role of ethics in psychiatry in Nazi-Germany. The historical perspective and the coming to terms with the past have become an important focus of the German Association. We are convinced that the role of psychiatry and the psychiatric association in times of Nazi-Germany have not been addressed intensively up to now. This supplement comprises the major topics of the last congress; nevertheless, it is confined due to the space limits and it reflects a subjective selection. We are sorry that a lot of topics could not be included in this supplement. We hope that our selection of articles will contribute to the discussion about ‘‘Psychiatric illness through the lifespan’’ F. Schneider (&) M. Grozinger Department of Psychiatry and Psychotherapy, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany e-mail: fschneider@ukaachen.de

INSTITUTIONAL IMPACT OF SCIENTIFIC RESEARCH

The paper addresses aspects of the difficult relationship scientific research has had with psychoanalytically-informed institutions. These difficulties stem from a position of rejectionism long held by institutional psychoanalysis with regard to the role scientific research may play in the development of psychoanalysis. It is argued that the development of a solid integration between scientific research and clinical psychoanalysis can help psychoanalysis grow and contribute to resolving the theoretical fragmentation present in today's psychoanalysis. Institutional reactions to results coming from scientific studies that do not confirm assumptions, expectations, beliefs or current practices are described and discussed. Two examples of research studies carried out at the Psychotherapy Department of St Bernard's Hospital and at the Cassel Hospital, during Bob Hinshelwood's time there, that did not meet the institutional blueprint are presented.

Emergence delirium after propofol anaesthesia

Dear Editor: Propofol is a commonly used anaesthetic agent. Recent findings suggest that low-dose propofol sedation reduces the risk of delirium in the elderly [1]. In children, emergence agitation was reported [2], even with convulsions, ataxia and hallucinations [3]. In addition to the rare complication of a propofol infusion syndrome, sexual hallucinations [4, 5], epileptic seizures and seizure-like phenomena [6, 7] were reported. We report a severe delirious and aggressive state during emergence after propofol anaesthesia. A 20-year-old female patient (175 cm, 75 kg) was passed to a gastroenterological service for nausea and vomiting. She had been suffering from Crohn’s disease, continuously treated with prednisolone 5 mg and azathioprine 150 mg for 3 years, adalimumab (TNF-α antagonist) for 3 months and pantoprazole and tropisetron for 2 weeks. The past medical history was negative for drug abuse, alcohol or nicotine abuse, metabolic diseases, allergic reactions or treatment with psychiatric drugs. EEG was normal and there was no history of epilepsy or neurological disorder in the patient or among her relatives. Cranial and abdominal MRI were regular. She had already undergone two gastroscopies under propofol anaesthesia without adverse effects. Anaesthesia was prepared with propofol (1%, 100 mg bolus, 180 mg continuously over 15 min). Sedation was delayed with minimal restlessness. Continuous monitoring showed no relevant hypotonia or hypoxia. During waking, restlessness increased, but the patient was not responsive, and her eyes were closed. She did not recognise her mother, who was present during the gastroscopy, and refused body contact by beating, scratching, biting and crying not to touch her. Here agitation increased and bed rails had to be attached. The patient received prednisolone 125 mg for a coughing fit and midazolam 2 mg for sedation, but without improvement. An epileptic seizure was deemed unlikely due to the intentioned and coordinated movement pattern and the lack of response to midazolam. Finally, after 25 min she received haloperidol 5 mg, which caused a decline of the agitation and aggression within a few minutes, followed by 1 h of sleep. After waking, she was fully orientated and reported dreamless sleep for the period of anaesthesia and complete amnesia regarding the delirious state. Muscle or bone pain or muscle rigidity did not appear. The patient was observed on the normal ward until the following day. Reports of severe or prolonged agitation are sparse [8]; other findings represent the adverse effects of sexual hallucinations or seizure-like phenomena (SLP). The latter is characterised by uncoordinated and tonic–clonic muscle movements [6, 7], opisthotonus and athetoid neck and limb movements [9]. Signs of SLP or grand mal epilepsy did not occur in our patient; rather, she showed intentional, coordinated movements, a purposeful defence reaction and anxiety, whilst being unresponsive. Complete amnesia and a dreamless sleep suggest the absence of sexual hallucinations [4, 5], despite there probably being delusions and anxiety. The sudden decline of all symptoms after haloperidol medication supports the diagnosis of delirium. It has to be discussed whether the new medication was responsible for the incident. Adalimumab may cause mood U. Palm (*) :M. Lieb Department of Psychiatry and Psychotherapy, Ludwig-Maximilian University, Nussbaumstrasse 7, 80336 Munich, Germany e-mail: ulrich.palm@med.uni-muenchen.de

Detection of int1h-related inversion of the factor VIII gene

HaemophiliaVolume 17, Issue 2 p. 313-314 Detection of int1h-related inversion of the factor VIII gene S. F. PIO, S. F. PIO Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this authorC. MÜHLE, C. MÜHLE Department of Psychiatry and Psychotherapy, University of Erlangen-Nuernberg, Germany and Department of Pediatrics, Medical University of Innsbruck, AustriaSearch for more papers by this authorG. C. DE OLIVEIRA, G. C. DE OLIVEIRA CEBio and Genomics and Computational Biology Group, Centro de Pesquisa René Rachou, FIOCRUZ, Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this authorS. M. REZENDE, S. M. REZENDE Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this author S. F. PIO, S. F. PIO Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this authorC. MÜHLE, C. MÜHLE Department of Psychiatry and Psychotherapy, University of Erlangen-Nuernberg, Germany and Department of Pediatrics, Medical University of Innsbruck, AustriaSearch for more papers by this authorG. C. DE OLIVEIRA, G. C. DE OLIVEIRA CEBio and Genomics and Computational Biology Group, Centro de Pesquisa René Rachou, FIOCRUZ, Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this authorS. M. REZENDE, S. M. REZENDE Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, BrazilSearch for more papers by this author First published: 22 September 2010 https://doi.org/10.1111/j.1365-2516.2010.02392.xCitations: 2 Suely Meireles Rezende, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Alfredo Balena, 190 – 2nd floor – room 243, ZIP 30130-110, Belo Horizonte – Minas Gerais – Brazil.Tel./fax: +55 31 34099746/45;e-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume17, Issue2March 2011Pages 313-314 RelatedInformation

Prevalence and Treatment Outcome in Anxious Versus Nonanxious Depression

The objective of this study was to explore the prevalence of anxious depression in an inpatient population, to describe its clinical and sociodemographic correlates, and to compare treatment outcomes between patients with anxious and nonanxious depression. Furthermore, the efficacy of algorithm-guided treatment versus treatment as usual in patients with anxious versus nonanxious depression was evaluated. Data were collected on 429 inpatients with the diagnosis of a depressive episode (according to ICD-10) and a score of ≥ or = 15 on the 21-item Hamilton Depression Rating Scale (HDRS-21). The German Algorithm Project, phase 3 (GAP3), was conducted between 2000 and 2005 in 10 psychiatric departments throughout Germany. A baseline HDRS-21 anxiety/somatization factor score of ≥ or = 7 was considered indicative of anxious depression. Remission was defined as an HDRS-21 score or ≤ = 9. To evaluate the efficacy of algorithm-guided treatment, patients were randomly assigned into 3 groups: 2 different treatment algorithms or treatment as usual. The prevalence of anxious depression was 49%. Patients with anxious depression were more likely than those with nonanxious depression to be older (mean ± SD = 45.3 ± 12.8 vs 42.9 ± 12.0 years, odds ratio [OR] = 1.02 [95% CI, 1.00-1.03], P = .046), retired (70% vs 30%, OR = 3.09 [95% CI, 1.70-5.62], P = .000), without school qualification (74% vs 26%, OR = 3.11 [95% CI, 1.09-8.83], P = .035), more severely depressed (mean ± SD HDRS-21 score = 20.1 ± 5.0 vs 18.5 ± 4.4, OR = 1.08 [95% CI, 1.03-1.12], P = .001), and more likely to have a longer duration of the current episode (mean ± SD = 20.9 ± 26.2 vs 13.7 ± 14.3 weeks, OR = 1.02 [95% CI, 1.01-1.03], P = .011). Patients with anxious depression were more likely to display a variety of melancholic features. In patients with anxious depression compared to those with nonanxious depression, remission was less likely to be achieved (48.6% vs 61.5%, OR = 0.63 [95% CI, 0.42-0.92], P = .018) and took longer to occur (mean ± SD = 44 ± 3.4 vs 30 ± 2.8 days, HR = 0.65 [95% CI, 0.50-0.85], P = .001). There was no significant interaction with the treatment mode with regard to remission (Wald = 0.20, P = .890). Anxious depression is common in patients diagnosed with depression. The poorer treatment outcome in patients with anxious depression demonstrates the need to address the issue of specific treatment strategies for this subgroup. However, anxious depression has no moderating effect on the efficacy of algorithm-guided treatment. http://www.germanctr.de/ Identifier: DRKS00000161.

Trauma Exposure and Posttraumatic Stress Disorder in Primary Care Patients

Posttraumatic stress disorder (PTSD) is one of the most common but least recognized anxiety disorders in primary care. This study aimed to describe the association of PTSD and trauma exposure with somatic symptoms, psychiatric comorbidity, functional impairment, and the actual treatment of PTSD in primary care. This cross-sectional criterion standard study included 965 consecutive primary care patients from 15 civilian primary care clinics in the United States. The Structured Clinical Interview for DSM-IV (SCID) was used to establish diagnosis of PTSD and other anxiety disorders. Somatic symptoms, depression, and anxiety were measured with the Patient Health Questionnaire (PHQ), and functional impairment was measured with the Medical Outcomes Study Short-Form General Health Survey (SF-20). The study was conducted from November 2004 to June 2005. PTSD was diagnosed in 83 patients (8.6%; 95% CI, 7.0%-10.5%), and trauma exposure without fulfilling DSM-IV criteria for PTSD was reported by 169 patients (17.5%; 15.2%-20.0%). With odds ratios ranging between 2.1 (95% CI, 1.2-3.6) for headache and 9.7 (3.8-24.8) for chest pain, PTSD patients had markedly elevated somatic symptom rates compared to the reference group of patients with no PTSD or trauma exposure. PTSD was significantly associated with elevated rates of psychiatric comorbidity, pain, and impaired functioning. Patients reporting trauma but no PTSD had rates of somatic symptoms, psychiatric comorbidity, and functional impairment that were intermediate between PTSD and reference group patients. Adjusting for depression substantially attenuated the association of PTSD and trauma with somatic symptoms, suggesting that depression may be an important mediator of the PTSD-somatic symptoms relationship. The high frequency of PTSD in primary care and its association with psychiatric comorbidity and functional impairment underscore the need to better detect and treat PTSD in primary care. Recognizing the frequent somatic presentation of PTSD and appreciating the salience of comorbid depression may be especially important in optimizing PTSD care.

Recurrent Episodes of Stroke-Like Symptoms Due to Accidental Intoxication With Doxepin

Back to table of contents Previous article Next article LETTERFull AccessRecurrent Episodes of Stroke-Like Symptoms Due to Accidental Intoxication With DoxepinKatrin Gade,Mathias Bähr M.D.Pawel Kermer M.D.,Katrin GadeSearch for more papers by this author,Mathias Bähr M.D.Search for more papers by this authorPawel Kermer M.D.Search for more papers by this author,Published Online:1 Apr 2010https://doi.org/10.1176/jnp.2010.22.2.247.e23AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Tricyclic antidepressants are used for treatment of mood disorders, anxiety, sleep disturbance, pain and psychosomatic symptoms. 1 Intoxication can lead to disorientation, hallucinations, unconsciousness, seizures, apnea, hypotension and conduction defects in the heart. 2 Here, we report a patient presenting repeatedly with stroke-like symptoms due to accidental doxepin intoxication underscoring the importance of a careful assessment of the patient’s drug history including hands-on examination of the actual medication. Case ReportA 64-year-old man with non-insulin-dependent diabetes mellitus was repeatedly referred to the emergency room presenting recurrent episodes of headache, dizziness, vertigo, impairment of gaze and speech, loss of balance, nausea, and muscle weakness. Neurological examination constantly revealed a somnolent patient with nystagmus, gait ataxia, dysarthria, dysmetric coordination, and general weakness without unambiguous paresis, sensory deficit, or reflex abnormalities. When the patient first presented, we suspected stroke, and he was monitored on our stroke unit for 24 hours. A peripheral vestibular disease was excluded by caloric testing. However, MRI scans showed no sign of fresh ischemia, intracerebral bleeding, or stenosis of cerebral arteries. A lumbar puncture revealed normal findings, and cardiologic examination showed no pathologies except for a patent foramen ovale without aneurysm. Since symptoms disappeared within 24 hours, the patient was diagnosed with a transitory ischemic attack and released with 100 mg/day of acetylsalicylic acid. A few days later, he returned with exactly the same symptoms, this time accompanied by mild hypoglycemia. After glucose infusion, the symptoms disappeared slowly, routine blood glucose measurements showed normal results under a reduced dose of his antidiabetic medication. Soon after being released, the patient fell into a glass door because of sudden abnormal weakness in both legs. A tentative antiepileptic treatment with levetiracetam was started suspecting epileptic seizure, although EEG and sleep deprivation EEG were normal. Unfortunately, this could not prevent reoccurrence of symptoms after hospital release. Since symptoms exclusively appeared at home and never in the hospital, we finally examined the patient’s home medication. Surprisingly, we found blisters of 100 mg doxepin tablets that had been prescribed a long time ago for sleeping disturbances and looked very similar to the patient’s antidiabetic pills. Although the patient denied doxepin intake during the last months, gas-chromatographic screening of his urine even some days after the suspected last intake revealed larger amounts of doxepin, which he obviously had taken by mistake instead of his antidiabetics.Discussion We report a case of recurrent accidental doxepin intoxication presenting with stroke-like symptoms, even though this substance was not part of the patient’s regular medication. Unexpectedly, ECG recordings never revealed extended QTc times or other signs of conduction defects in the heart. 2 Moreover, this case shows impressively that even in times of modern diagnostics, careful analysis of the patient’s drug history including hands-on examination of home medication is important and sometimes can be diagnostic. Department of Psychiatry and Psychotherapy, Medical School, University of Göttingen, Göttingen, GermanyDepartment of Neurology, Medical School, University of Göttingen, Göttingen

The spatiotemporal characteristics of the distributed network during emotional face perception

Event Abstract Back to Event The spatiotemporal characteristics of the distributed network during emotional face perception Yu-Han Chen1*, Jürgen Dammers1, Frank Boers1, Susanne Leiberg2 and Klaus Mathiak1 1 University Hospital Aachen, Department of Psychiatry and Psychotherapy, Germany 2 University of Zurich, Center for the Study of Social and Neural Systems, Switzerland The neural process of emotional face encoding is a complex interconnected network. This study applied MEG and Magnetic Field Tomography (MFT) to explore the dynamics of the neural network during emotional face perception. Thirteen subjects participated in the study. Emotional faces (disgust, happy, neutral) were randomly presented for 1000 ms and participants were asked to press a button whenever the facial expressions were the same as in the previous image (one-back task). Group statistics of MFT solutions from 0 to 600 ms post-stimulus were analyzed in SPM5 for 3 contrasts (disgust vs. happy, disgust vs. neutral, happy vs. neutral). Time courses of significant brain activations were extracted. For all contrasts, early activity started to emerge in caudal structures such as primary visual cortex (0-200ms), to fusiform area (FFA), insula, and supplemental motor area (SMA) (200-300 ms), and finally to more rostral areas such as inferior frontal gyrus (IFG) and middle frontal gyrus (MFG) (300-600ms). Interestingly, increased FFA activation was only observed in emotional vs. non-emotional faces, but not between the emotional faces. The later responses (>300 ms) in prefrontal area were observed stronger in disgust than happy faces. The emotional modulation of brain activation in response to faces showed a sequential pattern from primary visual cortex, to tempo-parietal cortex, and connected to the frontal cortex across different latencies. Early activation in primary sensory cortices reflects the sensory encoding of faces, and the later activations in temporal and frontal area may reflect emotional classification. Our results demonstrate the temporal profile of different structures engaged in emotion face processes. Emotional valence or arousal may modulate face processing at all levels in a dynamic fashion. Conceivably only higher-order cortical areas such as medio-frontal structures are differentially influenced by the valence of emotion. Conference: Biomag 2010 - 17th International Conference on Biomagnetism , Dubrovnik, Croatia, 28 Mar - 1 Apr, 2010. Presentation Type: Poster Presentation Topic: Neurocognition and Functional Connectivity Citation: Chen Y, Dammers J, Boers F, Leiberg S and Mathiak K (2010). The spatiotemporal characteristics of the distributed network during emotional face perception. Front. Neurosci. Conference Abstract: Biomag 2010 - 17th International Conference on Biomagnetism . doi: 10.3389/conf.fnins.2010.06.00320 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 06 Apr 2010; Published Online: 06 Apr 2010. * Correspondence: Yu-Han Chen, University Hospital Aachen, Department of Psychiatry and Psychotherapy, Aachen, Germany, yuhanmc@gmail.com Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Yu-Han Chen Jürgen Dammers Frank Boers Susanne Leiberg Klaus Mathiak Google Yu-Han Chen Jürgen Dammers Frank Boers Susanne Leiberg Klaus Mathiak Google Scholar Yu-Han Chen Jürgen Dammers Frank Boers Susanne Leiberg Klaus Mathiak PubMed Yu-Han Chen Jürgen Dammers Frank Boers Susanne Leiberg Klaus Mathiak Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

S11-04 - Integrated care of depressive disorders - the freiburg model

A carefully planned comprehensive and integrated care model of in- and outpatient depression treatment is a promising way to achieve improvements in care. Within the framework of the Freiburg Model of integrated care for depressive disorders a network of psychiatrists and primary care physicians offers in collaboration with the Department of Psychiatry and Psychotherapy of the University of Freiburg a coordinated treatment for patients with depressive disorders. Complementary to an evidence-based outpatient treatment the department of Psychiatry and Psychotherapy offers a complex treatment where patients can use the different inpatient measures during their outpatient treatment. In addition patients with a chronic depression can make use of a specific treatment program.

The impact of sleep-related attentional bias on polysomnographically measured sleep in primary insomnia.

Although sleep-related attentional bias has been shown to be evident in primary insomnia, the association with objectively measured sleep has not been investigated. In the present study, we used polysomnography (PSG) to fill this void. Patients with primary insomnia and healthy controls were studied using a visual dot probe task (VDP) and an emotional Stroop task (EST). Additionally, polysomnography was carried out in a sub-sample (n = 22) of patients in the subsequent night. Department of Psychiatry and Psychotherapy of the University of Freiburg Medical Center. Thirty patients with primary insomnia and 30 matched healthy controls. N/A. Patients with primary insomnia demonstrated a significant sleep-related attentional bias compared to controls in the EST but no significant group effects were found for the VDP. VDP attentional bias scores were positively correlated with measures of sleep pressure, including total sleep time, sleep efficiency, and the amount of slow wave sleep. EST attentional bias scores were not correlated with subsequent PSG parameters, and we did not observe a correlation between attentional bias scores on the two tasks. The unexpected relationship between increased attentional bias, in the VDP task, and improved markers of sleep duration and continuity, may be indicative of a homeostatic craving for sleep in those with high attentional bias. This awaits further testing in multiple night studies, to shed light on the mechanisms and implications of sleep-related attentional bias.

P02-273 - Religion in psychiatry? The pilot study in Freiburg, Germany: the meaning of religion / spirituality in psychiatry from staff's perspective

ObjectivesIn the context of a growing body of international research though not in German-speaking countries, this study examines1)the extent of spirituality of staff in a psychiatric hospital,2)their relationship to staff's attitudes towards religion / spirituality (ReS) of patients3)and the integration of religious and spiritual contents to the patient's therapy.MethodsAn anonymous survey distributed to the staff in the department of psychiatry and psychotherapy of the Freiburg university hospital in 2009. Main predictor variable was the extent of spirituality using DRI. Main criterion variables were the relevance of ReS of patients and staff's attitudes towards ReS during their therapies using the questionnaire of Curlin et al.(2007).ResultsThe response rate was 44.16% (n=197). The extent of spirituality of staff is 6.89 on a scale of 12.0. Although there is no significant relationship between the extent of spirituality and staff's attitudes towards ReS as well as their integration of religious and spiritual contents to therapies, staff regard the influence of ReS generally positive to patients. 95.4% endorse ReS as coping strategy. However staff do not integrate religious and spiritual practices in their therapies. The most frequent reasons are insufficient time/occasion, insufficient knowledge and concern about offending patients.ConclusionsReligious and spiritual contents have not been integrated yet in psychiatric therapy methods, although they are regarded as important for patients. Further studies and discussion about religious and spiritual matters are essential for their integration into psychiatric therapies to overcome these problems for patients and staff.

Influence of Anesthetic Drugs and Concurrent Psychiatric Medication on Seizure Adequacy During Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is performed under anesthesia and muscle relaxation. Only well-generalized seizures seem to have the high "adequacy" or "quality" that have been claimed to reflect positive predictive power for the outcome of an ECT course. The induction of well-generalized seizures can be potentially influenced by several variables. One major variable is concurrent medication including anesthetic drugs, since most anesthetic drugs are potent anticonvulsives. We hypothesized a negative influence of anesthetics and benzodiazepines but a positive effect of antidepressants and antipsychotics concurrently applied during ECT on seizure adequacy. We included inpatients (n = 41) with a DSM-IV-diagnosed major depressive episode treated with ECT (411 ECT sessions) during a period of 20 months (May 2005 to December 2006) in an open label and noncontrolled study. A repeated measurement regression analysis was performed with 8 seizure adequacy parameters as dependent variables. We indirectly quantified narcotic agent influence with bispectral index monitoring. In contrast to the impact of psychiatric comedication, this measure of "depth of narcosis" prior stimulation turned out to influence most seizure adequacy parameters in a highly significant manner. Thus, we concluded that the anticonvulsive properties of narcotic agents have much higher influence than concomitant psychotropic medication. Our data support the view that a significant influence of concurrent psychotropic drugs on seizure adequacy markers is missing, especially when directly compared with other confounders like stimulation energy, age, and depth of narcosis. The latter suggests to further prove the idea that lighter anesthesia is indeed an important tool to get patients faster into remission.

The relationship between alcohol intake and cellular immune activity in systemic lupus erythematosus may change from inhibitory to stimulatory within 2 months of study: findings from an integrative single-case study

Alcoholic beverages such as beer and wine contain several compounds (e.g. ethanol and antioxidants) that potentially counteract inflammatory diseases such as systemic lupus erythematosus (SLE) [1]. However, evidence on the association between alcohol consumption and SLE disease activity is equivocal. While meta-analyses by Wang et al. revealed that alcohol drinking might be protective in SLE [2], their own most recent empirical work did not support this observation [3]. This inconsistency may arise from the inability of conventional group studies to appropriately handle the subjective and temporal qualities characterizing the association between drinking alcohol and physiological response [4]. In order to better deal with complex psychosomatic features, we have developed an integrative research approach based on extensive single-case studies [5]. Using this approach, it was shown in a 40-year-old patient with SLE that daily alcohol consumption was associated with a decline in levels of urinary neopterin, an immune activation marker and indicator of SLE activity [6], within 24 h after intake [5]. In our second integrative single-case study on a 52-year-old woman with SLE, we investigated—among other topics—the dynamic relations between drinking alcohol, emotional states (mental activity, irritation and mood) and urinary neopterin concentrations [7]. In this study, the patient collected her entire urine and filled out questionnaires for 56 days in 12-h intervals (total of 112 consecutive measurements). Urinary neopterin was analyzed applying HPLC. The patient noted type and quantity of alcohol intake, which was then converted into gram alcohol consumed. Emotional states (mental activity, irritation and mood) were determined using the short form of the Eigenschaftsworterliste [8]. Time series analysis consisted of autoregressive moving average modelling—to control for serial dependencies—and adjusted crosscorrelational analysis [9]. Cross-correlational analyses revealed that the effect that moderate alcohol consumption (sparkling wine, wine and schnapps) had on urinary neopterin levels differed depending on which time series period was statistically analyzed, i.e. the period before or the period after the occurrence of an inflammatory event (acute paranasal sinusitis) which took place halfway through the study period (12-h units 45– 54). Before sinusitis occurred (1–44), increases in alcohol intake were paralleled by decreases in urinary neopterin levels (lag0: r=−0.371; p<0.05), whereas after sinusitis (55–112) increases in alcohol consumption were followed by increases in urinary neopterin concentrations with a temporal delay of 12 h (lag1 : r 1⁄4 þ0:308; p<0.05). Analyses further demonstrated that none of the emotional states measured in this study (i.e. mental activity, irritation and mood) interfered with the associations between alcohol consumption and neopterin. This integrative single-case study showed that the relationship between alcohol intake and cellular immune activity in SLE can change from inhibitory to stimulatory C. Schubert (*) Clinic of Medical Psychology, Department of Psychiatry and Psychotherapy, Innsbruck Medical University, Innsbruck, Austria e-mail: christian.schubert@i-med.ac.at

Models of mental health care in psychiatry across sectoral borders

Since 2004, article 140 of the fifth German Social Code Book (SGB V) provides the opportunity for developing and implementing models of Integrated Care (IC). The main aim of integrated care projects is to improve the quality and efficiency of health care in Germany by ameliorating the cooperation between the different sectors hospitals, ambulatory and rehabilitative care. As an example of implementing an integrated care network in the psychiatric sector, the first local network for integrated care in psychiatry in Aachen is described. It was founded in 2006 by the department of Psychiatry and Psychotherapy of the University Hospital Aachen, the DGPPN (German Association of Psychiatry and Psychotherapy) and the BVDN (Professional Association of German Neuropsychiatrists). The present interface problem between the separated sectors of medical care in Germany is being solved by evidence-based therapy, coordinated treatment between the different sectors, a standardised documentation and advanced training for all clinical participants. Early diagnosis and treatment of depression are improved by integrating clinical diagnostics, acute therapy, maintenance therapy, prophylaxis of relapse and after-care within one network. By the end of 2008, 1,081 patients have been treated within the integrated care network in Aachen by 56 ambulant general practitioners and psychiatrists and by 3 local psychiatric hospitals. Currently the network is going to be enlarged by integrating the diagnosis of schizophrenia. Following this, other mental illnesses should be integrated. The aim is to create a nationwide integrated care network across all diagnostic borders of mental illnesses.

Predicting BCI performance to study BCI illiteracy

a Berlin Institute of Technology, Machine Learning Laboratory, Berlin, Germany b Fraunhofer FIRST IDA, Berlin, Germany c Dept. of Neurology, Campus Benjamin Franklin, Charite University Medicine Berlin, Germany d Institute of Medical Psychology and Behavioral Neurobiology, Universitat Tubingen, Germany e Department of Biological Psychology, Clinical Psychology and Psychotherapy, University of Wurzburg, Germany

Von der Angst, den Zucker in die Zelle zu lassen – Fall 05/2009

An 19-year-old female patient was admitted to our department of psychosomatic medicine and psychotherapy for the treatment of her metabolically deranged type 1 diabetes mellitus. Exploration and assessment revealed a typical eating disorder symptomatology. The body mass index at time of admission was 18.7 kg/m (2). Episodes of binge eating were followed by purging behaviour (insulin purging, vomiting). After diagnosis of bulimia nervosa, the patient was treated with a structured dual treatment regime consisting of psychosomatic/psychotherapeutic interventions and endocrinological support. The existing complex bio-psycho-social conditions were considered carefully. In the treatment course typical eating disorder behaviour (i. e. insulin purging) decreased and mood stabilised. Adolescent women with diabetes mellitus are at an increased risk of developing an eating disorder. This comorbidity is associated with a markedly increased mortality. Therefore, diagnosis of an eating disorder should be made as soon as possible in order to provide adequate treatment not only for the metabolic disturbances but also for the coexisting psychosomatic disorder.

Patients' Language Proficiency and Inpatient Depression Treatment in Baden-Württemberg (South Germany)

Patients' Language Proficiency and Inpatient Depression Treatment in Baden-Württemberg (South Germany)

Opera‐hallucinosis

International Journal of Geriatric PsychiatryVolume 24, Issue 4 p. 432-433 Letter to the Editor Opera-hallucinosis M. Rentrop, M. Rentrop Department of Psychiatry and Psychotherapy, Technical University of Munich, GermanySearch for more papers by this authorC. Knebel, C. Knebel Department of Surgery, Technical University of Munich, GermanySearch for more papers by this authorH. Förstl, H. Förstl Department of Psychiatry and Psychotherapy, Technical University of Munich, GermanySearch for more papers by this author M. Rentrop, M. Rentrop Department of Psychiatry and Psychotherapy, Technical University of Munich, GermanySearch for more papers by this authorC. Knebel, C. Knebel Department of Surgery, Technical University of Munich, GermanySearch for more papers by this authorH. Förstl, H. Förstl Department of Psychiatry and Psychotherapy, Technical University of Munich, GermanySearch for more papers by this author First published: 19 March 2009 https://doi.org/10.1002/gps.2124Citations: 4AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume24, Issue4April 2009Pages 432-433 RelatedInformation

The German version of the Toronto Structured Interview for Alexithymia: factor structure, reliability, and concurrent validity in a psychiatric patient sample

Background Recently, the Toronto Structured Interview for Alexithymia (TSIA) was developed to supplement the self-assessment of alexithymia and/or offer a different method of measuring the alexithymia construct. The aim of this study was to evaluate the psychometric properties of a German language translation of the TSIA in a psychiatric patient sample. Methods Translation and back-translation were performed until a high agreement of cross-language equivalence was obtained between the German and the original English language version of the TSIA. The TSIA and the German language version of the 20-Item Toronto Alexithymia Scale were administered to 237 psychiatric patients at the departments of psychiatry and psychotherapy in Germany and Switzerland. Videotapes of some of the interviews were recorded for the assessment of interrater reliability. Results The German version of the TSIA and its 4 scales correlated significantly with the German version of the 20-Item Toronto Alexithymia Scale and its 3 factor scales, providing support for concurrent validity of the interview. Confirmatory factor analyses supported the hierarchical, 4-factor structure obtained with the original English version, with 4 lower-order factors nested within 2 higher-order latent factors. Acceptable levels of internal reliability and interrater reliability were also demonstrated. Conclusion The TSIA is a valid and reliable measure for assessing alexithymia, at least in clinical samples. The TSIA, together with a self-report alexithymia scale, allow for a multimethod approach to assessing alexithymia.

Generalized deficit in all core components of empathy in schizophrenia

Empathy is a multidimensional construct composed of several components such as emotion recognition, emotional perspective taking and affective responsiveness. Patients with schizophrenia demonstrate deficits in several domains of emotion processing and perspective taking, thus suggesting a dysfunctional emotional competence.We assessed empathic abilities via three paradigms measuring emotion recognition, perspective taking and affective responsiveness as well as self-report empathy questionnaires in 24 (12 females, 12 males) schizophrenia patients meeting the DSM-IV criteria for schizophrenia and 24 matched healthy volunteers. Patients were recruited from the Department of Psychiatry and Psychotherapy, RWTH Aachen University and healthy volunteers were recruited via advertisement. Groups were matched for age, gender and parental education.Data analysis indicates a significant empathic deficit in patients, reflected in worse performance in all three domains. This deficit was only partly reflected in the self-report empathy questionnaires. Comparing the different tasks, emotional perspective taking was the most difficult task for all subjects and symptomatology worsened affective responsiveness.Schizophrenia patients not only struggle to correctly identify emotions, but also have difficulties in spontaneously simulating another person's subjective world (perspective taking) and might not be able to respond adequately in terms of their own emotional experience (affective responsiveness), which are not caused by emotion perception deficits. The results suggest that all domains of empathy are affected in schizophrenia and have to be addressed independently in behavioral therapies, thereby offering a possibility to improve socio-occupational life.