1
|
Riederer P, Kircher T, Juckel G, Domschke K, Schneider A, Deckert J, Falkai P. 45 years German Society of Biological Psychiatry (DGBP). J Neural Transm (Vienna) 2023; 130:1091-1096. [PMID: 37142786 PMCID: PMC10460698 DOI: 10.1007/s00702-023-02645-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/26/2023] [Indexed: 05/06/2023]
Abstract
The foundation of a German Society of Biological Psychiatry (DGBP) was initiated at the Second World Congress of Biological Psychiatry of the WFSBP in Barcelona in 1978. Its mission was and is to promote interdisciplinary research on the biology of mental disorders and to translate results of biological research into clinical practice. During the presidency of Peter Falkai, its tasks were defined to improve the quality and support of biologically oriented research in Germany by the DFG (Deutsche Forschungsgemeinschaft; German Research Foundation), BMBF (Bundesministerium für Bildung und Forschung) and EU (European Union), to promote young researchers doing biologically oriented research, to improve on the diagnosis and therapy of mental disorders and to advise policy makers by taking part in legal processes. The DGBP has been a corporate member of the WFSBP from its beginning, became a cooperative member of the DGPPN (Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde), later of the German Brain Council, and fostered relationships with other scientific societies. Over the past 45 years, more than twenty congresses were held in Germany and neighboring countries. Emerging from the pandemic, the DGBP is ready to continue its mission to promote interdisciplinary research on the biology of mental disorders with a focus on the development of young scientists and to translate results of biological research into clinical practice, with regard to pharmacotherapy in close cooperation with the Arbeitsgemeinschaft Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP). In this sense, this article also aims to stimulate the cooperation of the society with other national and international partners and to foster new relationships with young scientists and professionals interested in the aims and goals of the DGBP.
Collapse
Affiliation(s)
- P Riederer
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany.
- Department of Psychiatry, University of Southern Denmark, Odense, Denmark.
| | - T Kircher
- Department of Psychiatry and Psychotherapy, CMBB, University of Marburg, Marburg, Germany
| | - G Juckel
- LWL-University Hospital of Psychiatry, Psychotherapy and Prevention Medicine at Ruhr University Bochum, Bochum, Germany
| | - K Domschke
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - A Schneider
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
- German Center for Neurodegenerative Diseases, Bonn, Germany
| | - J Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, LMU Munich, Munich, Germany
- Max-Planck-Institute of Psychiatry, Munich, Germany
| |
Collapse
|
2
|
Lukaschek K, Beltz C, Rospleszcz S, Schillok H, Falkai P, Margraf J, Gensichen J. Depressive primary care patients' assessment of received collaborative care. Sci Rep 2023; 13:2329. [PMID: 36759622 PMCID: PMC9911390 DOI: 10.1038/s41598-023-29339-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
The "Patient Assessment of Chronic Illness Care" (PACIC) is a tool for evaluating outpatient health service for patients with chronic diseases. Our aim was to analyze the association between PACIC scores of primary care patients with depression and patients' or patients' general practitioners' (GPs) characteristics. In a data set including depressive primary care patients (N = 280) the association of patient characteristics (sex, age, depressive symptom severity, suicidal ideation) with PACIC scores were assessed by linear regression models. The association between GPs' characteristics (type, location of practice; age, qualification of practitioner) and PACIC scores was assessed by linear mixed models with individual practices as random effects. Patient Health Questionnaire (PHQ-9) scores at 12 months follow up and changes in PHQ-9 scores from baseline to follow up were significantly positive associated with higher PACIC scores (beta = 0.67, 95%-CI [0.02, 1.34]). PACIC scores were not associated with patients' sex (p = 0.473) or age (p = 0.531). GP's age was negatively associated with PACIC scores (p = 0.03). In conclusion, in patients with depression, the PACIC is independent from patients' and GPs' characteristics. The PACIC may be appropriate to assess patient-perspective on depression services in primary care.
Collapse
Affiliation(s)
- K Lukaschek
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Nussbaumstraße 5, St.-Vinzenz-Haus, 80336, Munich, Germany.
| | - C Beltz
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Nussbaumstraße 5, St.-Vinzenz-Haus, 80336, Munich, Germany
| | - S Rospleszcz
- Department of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - H Schillok
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Nussbaumstraße 5, St.-Vinzenz-Haus, 80336, Munich, Germany.,Graduate Programme "POKAL - Predictors and Outcomes in Primary Care Depression Care" (DFG-GrK 2621), Munich, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - J Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - J Gensichen
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Nussbaumstraße 5, St.-Vinzenz-Haus, 80336, Munich, Germany
| |
Collapse
|
3
|
Falkai P, Dombi Z, Acsai K, Barabássy Á, Németh G. The efficacy of cariprazine in chronic schizophrenia – post hoc analyses of phase II/III clinical trials. Eur Psychiatry 2022. [PMCID: PMC9567052 DOI: 10.1192/j.eurpsy.2022.822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Chronic schizophrenia patients are experiencing persistent and severe illness for more than 15-20 years and are usually suffering from long-term negative symptoms. Cariprazine, a novel D3-D2 partial agonist has been proven to be effective in the treatment of acute schizophrenia, however its ability to treat chronic patients has not been assessed yet. Objectives The primary aim of the present post-hoc analysis is to assess the efficacy of cariprazine in treating patients with chronic schizophrenia (late-stage and residual schizophrenia patients). Methods Data from 3 phase II/III 6-week, randomized, double-blind, placebo-controlled trials with similar design in patients with acute exacerbation of schizophrenia were pooled and patients with more than 15 years of schizophrenia were analysed (late-stage patients). Furthermore, schizophrenia patients experiencing predominantly negative symptoms from a 26-week, randomized, double-blind, active-controlled, fixed-flexible-dose trial with an ICD-10 code of F20.5 were analysed post-hoc (residual patients). Results Altogether, 414 late stage (286 cariprazine and 128 placebo) and 35 residual (23 cariprazine and 12 risperidone) patients were identified. The pooled analysis evaluating mean change from baseline to week 6 in the PANSS total score indicated statistically significant difference in favour of cariprazine in the late stage (LSMD -6.7, p<0.01) subpopulation compared to placebo. The mean change from baseline in patients with residual schizophrenia in the cariprazine arm was -9.6 on the PANSS-FSNS scale, while -7.9 in the risperidone arm. Conclusions Based on the results, it seems that cariprazine might be a good treatment option for patients with chronic schizophrenia. Nonetheless, further studies are needed to confirm this. Disclosure I am an employee of Gedeon Richter Plc.
Collapse
|
4
|
Maurus I, Röll L, Keeser D, Schmitt A, Hasan A, Hirjak D, Meyer-Lindenberg A, Falkai P. Effects of Exercise in People with Severe Mental Illness and Recommendations for its Implementation as Add-on Therapy. Eur Psychiatry 2022. [PMCID: PMC9567411 DOI: 10.1192/j.eurpsy.2022.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
There are many reasons for people with (and without) severe mental illness to exercise regularly. In people with schizophrenia, major depression and bipolar disorder, it has already been shown that regular physical activity as an add-on therapy can improve quality of life and symptom severity. This is particularly important in domains that standard therapy is currently not able to treat sufficiently, such as cognitive deficits. Postulated underlying neurobiological effects include increased volume in hippocampal areas as demonstrated by data of a current clinical trial in people with schizophrenia. Furthermore, regular exercise is essential to counteract the increased cardiovascular morbidity and mortality of people with severe mental illness. However, most people with severe mental illness do not achieve the recommended amount of physical activity and the potential of exercise as an add-on therapy is currently not even close to being fully realized. On the one hand, it is important that mental health staff also considers the physical condition of patients with mental illnesses and counsels them on their health behavior. On the other hand, there is a need for individually adapted training programs delivered by qualified exercise professionals that incorporate motivational and adherence strategies. Examples of barriers and facilitators for the implementation of exercise as an add-on therapy are discussed on the basis of current local projects.
Collapse
|
5
|
Falkai P. How to Improve the Physical Health in Patients with Severe Mental Disorders. Eur Psychiatry 2022. [PMCID: PMC9566132 DOI: 10.1192/j.eurpsy.2022.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Schizophrenia is a severe brain disorder characterised by positive, negative, affective and cognitive symptoms and can be regarded as a disorder of impaired neural plasticity. This lecture focusses on the beneficial role of exercise in schizophrenia and its underlying mechanisms.Apart from the established pharmacological treatments in schizophrenia, aerobic exercise has a profound impact on the plasticity of the brain of both rodents and humans such as inducing the proliferation and differentiation of neural progenitor cells of the hippocampus in mice and rats. Aerobic exercise enhances LTP and leads to a better performance in hippocampus related memory tasks, eventually by increasing metabolic and synaptic plasticity related proteins in the hippocampus. In healthy humans, regular aerobic exercise increases hippocampal volume and seems to diminish processes of ageing like brain atrophy and cognitive decline.Several meta-analyses demonstrate the beneficial effect of exercise on function, positive as well as negative symptoms and brain structure in multi-episode schizophrenia.
Disclosure
No significant relationships.
Collapse
|
6
|
Kálmán J, Burkhardt G, Pogarell O, Padberg F, Schulze T, Falkai P. Integration of real-world clinical data into the Munich Mental Health Biobank – clinical and scientific potential and challenges. Eur Psychiatry 2022. [PMCID: PMC9567776 DOI: 10.1192/j.eurpsy.2022.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
New insights into the pathophysiology of mental disorders and innovations in psychiatric care depend on the availability of representative, longitudinal and multidimensional datasets across diverse, transdiagnostic populations. Biobanks usually attempt to collect such data in parallel to clinical routine, which is resource-intensive, puts additional burden on health-care providers, and may reduce the generalizability of the results. Despite containing rich phenotypic and biological information, data generated in routine clinical care is seldomly used for research purposes, because it is usually unstructured and locked in data silos. To truly link clinical practice and research, solutions that optimize the generation and scientific utilization of real-world clinical data are needed. Objectives Evaluation of a new digital infrastructure which warrants the efficient, automatized, and structured collection of real-world data in psychiatric care, and integrates the generated data into existing biobanking efforts. Methods We have developed a new documentation system which augments the existing IT-structures, enables the collection of routine clinical data in a structured format and involves patients in the data generation process. In an implementation science approach, to replicate and extend the findings of Blitz et al. (JMIR Ment Health 2021), we are investigating the acceptance, efficacy, and safety of the system in our outpatient clinic for affective disorders. Results First results describing the technical safety, usage metrics, and acceptance of the system, and the quality of the collected data will be presented. Conclusions Challenges of collecting real-world data for biobanking and research purposes and perspectives on future digital solutions will be discussed. Disclosure No significant relationships.
Collapse
|
7
|
Abstract
Psychiatry is facing major challenges during times of a pandemic as illustrated by the current COVID-19 pandemic. The challenges involve its actual and perceived role within the medical system, in particular how psychiatric hospitals can maintain their core mission of attending to the mentally ill while at the same time providing relief to general medicine. Since psychiatric disorders are the top leading causes of global burden of disease, we need to strengthen mental health care in the wake of the massive onslaught of the pandemic. While nobody can deny the need to act decisively and swiftly and ramp up intensive care readiness, we believe that the immediate availability of psychiatric care is just as important. In order to provide the best possible treatment conditions for people suffering from mental illness but as well for those suffering from the immediate pandemic’s consequences such as isolation, reduced social interaction etc. instant and comprehensive provision is inevitable.
Collapse
|
8
|
Abstract
Abstract BodyPsychiatry is facing major challenges during times of a pandemic as illustrated by the current COVID-19 pandemic. The challenges involve its actual and perceived role within the medical system, in particular how psychiatric hospitals can maintain their core mission of attending to the mentally ill while at the same time providing relief to general medicine. Although psychiatric disorders are the top leading causes of global burden of disease, we can witness mental health care being de-emphasized in the wake of the massive onslaught of the pandemic: psychiatric wards are being downsized, clinics closed, psychiatric support systems discontinued etc. in order to make room for emergency care. While nobody can deny the need to act decisively and swiftly and ramp up intensive care readiness, we believe that there is no need to do this at the expense of psychiatric care. Using the pandemic COVID-19 contingency plan developed at the Department of Psychiatry and Psychotherapy of the University Hospital of LMU Munich as a case in point, we demonstrate how a psychiatric hospital can share in the acute care of a health care system facing an acute and highly infectious pandemic like COVID-19 and at the same time provide for the mentally ill, with or without a COVID-19 infection, and develop mid and long-term plans for coping with the aftermath of the pandemic.DisclosureNo significant relationships.
Collapse
|
9
|
Falkai P. Should schizoaffective disorder be diagnosed cross-sectionally (ICD-11) instead of longitudinally (DSM-5)? Eur Psychiatry 2021. [PMCID: PMC9471941 DOI: 10.1192/j.eurpsy.2021.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Several changes to the classification of schizophrenia and other psychotic disorders have been made to increase the reliability, clinical use and validity of the diagnostic classification which are considered here. A diagnosis of schizoaffective disorder would only be made in ICD-11 when the definitional requirement of schizophrenia is met concurrently with mood symptoms that meet the definitional requirements of a moderate or severe depressive episode, a manic episode, or a mixed episode. This requirement is more restrictive compared to ICD-10, which just required the presence of symptoms of schizophrenia and mood disorder. The total duration requirement would be 4 weeks. A cross-sectional approach was maintained in the ICD-11 for schizoaffective disorders as there is no evidence on how a longitudinal “lifetime” criterion impacts cross-sectional inter-rater reliability, and the reliability of lifetime symptoms’ report by patients and retrospective assessment by clinicians remains unknown.
Collapse
|
10
|
Falkai P. From mid-career professor to chairperson: What remains similar what is different? Eur Psychiatry 2021. [PMCID: PMC9471752 DOI: 10.1192/j.eurpsy.2021.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
For a Mid-career Professor in Germany, there are defined clinical and teaching responsibilities. One can focus either on one’s research or on clinical work and teaching. When tasks are becoming more demanding or significant overarching decisions need to be taken, there is always a chairperson to be asked or to help delegate tasks. As chairperson, one is mostly independent from other persons except for the dean of the medical faculty. One is however, at least in Germany, the chairpersons fully responsible for keeping up teaching, patient care, research as well as running the department. The Chairperson is measured by the achievements of these four tasks. It need special attention to keep up a balanced time schedule to cover clinical care, research, teaching and departmental management. A good chairs means working together with your staff on long-term goals, developing the department fruitfully and trying to fulfil these goals.
Collapse
|
11
|
Galderisi S, Kaiser S, Bitter I, Nordentoft M, Mucci A, Sabé M, Giordano GM, Nielsen MØ, Glenthøj LB, Pezzella P, Falkai P, Dollfus S, Gaebel W. EPA guidance on treatment of negative symptoms in schizophrenia. Eur Psychiatry 2021; 64:e21. [PMID: 33726883 PMCID: PMC8057437 DOI: 10.1192/j.eurpsy.2021.13] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Negative symptoms of schizophrenia remain a major therapeutic challenge. The progress in the conceptualization and assessment is not yet fully reflected by treatment research. Nevertheless, there is a growing evidence base regarding the effects of biological and psychosocial interventions on negative symptoms. The importance of the distinction between primary and secondary negative symptoms for treatment selection might seem evident, but the currently available evidence remains limited. Good clinical practice is recommended for the treatment of secondary negative symptoms. Antipsychotic treatment should be optimized to avoid secondary negative symptoms due to side effects and due to positive symptoms. For most available interventions, further evidence is needed to formulate sound recommendations for primary, persistent, or predominant negative symptoms. However, based on currently available evidence recommendations for the treatment of undifferentiated negative symptoms (including both primary and secondary negative symptoms) are provided. Although it has proven difficult to formulate an evidence-based recommendation for the choice of an antipsychotic, a switch to a second-generation antipsychotic should be considered for patients who are treated with a first-generation antipsychotic. Antidepressant add-on to antipsychotic treatment is an option. Social skills training is recommended as well as cognitive remediation for patients who also show cognitive impairment. Exercise interventions also have shown promise. Finally, access to treatment and to psychosocial rehabilitation should be ensured for patients with negative symptoms. Overall, there is definitive progress in the field, but further research is clearly needed to develop specific treatments for negative symptoms.
Collapse
Affiliation(s)
- S Galderisi
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - S Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - I Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - M Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - A Mucci
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - M Sabé
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - G M Giordano
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - M Ø Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Center for Neuropsychiatric Schizophrenia Research, CNSR, Glostrup, Denmark
| | - L B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - P Pezzella
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - P Falkai
- Department of Psychiatry, University of Munich, Munich, Germany
| | - S Dollfus
- Service de Psychiatrie, CHU de Caen, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| |
Collapse
|
12
|
Galderisi S, Mucci A, Dollfus S, Nordentoft M, Falkai P, Kaiser S, Giordano GM, Vandevelde A, Nielsen MØ, Glenthøj LB, Sabé M, Pezzella P, Bitter I, Gaebel W. EPA guidance on assessment of negative symptoms in schizophrenia. Eur Psychiatry 2021; 64:e23. [PMID: 33597064 PMCID: PMC8080207 DOI: 10.1192/j.eurpsy.2021.11] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background During the last decades, a renewed interest for negative symptoms (NS) was brought about by the increased awareness that they interfere severely with real-life functioning, particularly when they are primary and persistent. Methods In this guidance paper, we provide a systematic review of the evidence and elaborate several recommendations for the conceptualization and assessment of NS in clinical trials and practice. Results Expert consensus and systematic reviews have provided guidance for the optimal assessment of primary and persistent negative symptoms; second-generation rating scales, which provide a better assessment of the experiential domains, are available; however, NS are still poorly assessed both in research and clinical settings. This European Psychiatric Association (EPA) guidance recommends the use of persistent negative symptoms (PNS) construct in the context of clinical trials and highlights the need for further efforts to make the definition of PNS consistent across studies in order to exclude as much as possible secondary negative symptoms. We also encourage clinicians to use second-generation scales, at least to complement first-generation ones. The EPA guidance further recommends the evidence-based exclusion of several items included in first-generation scales from any NS summary or factor score to improve NS measurement in research and clinical settings. Self-rated instruments are suggested to further complement observer-rated scales in NS assessment. Several recommendations are provided for the identification of secondary negative symptoms in clinical settings. Conclusions The dissemination of this guidance paper may promote the development of national guidelines on negative symptom assessment and ultimately improve the care of people with schizophrenia.
Collapse
Affiliation(s)
- S Galderisi
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Mucci
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - S Dollfus
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Nordentoft
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - P Falkai
- Department of Psychiatry, University of Munich, Munich, Germany
| | - S Kaiser
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - G M Giordano
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - A Vandevelde
- CHU de Caen, Service de Psychiatrie, 14000Caen, France.,Normandie Univ, UNICAEN, ISTS EA 7466, GIP Cyceron, 14000Caen, France.,Normandie Univ, UNICAEN, UFR de Médecine, 14000Caen, France
| | - M Ø Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Center for Neuropsychiatric Schizophrenia Research, CNSR, Glostrup, Denmark
| | - L B Glenthøj
- Copenhagen Research Centre for Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark.,Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark
| | - M Sabé
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - P Pezzella
- Department of Psychiatry, Campania University Luigi Vanvitelli, Naples, Italy
| | - I Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| |
Collapse
|
13
|
Adorjan K, Schulze TG, Budde M, Heilbronner U, Tessema F, Mekonnen Z, Falkai P. [Neurogenetics of schizophrenia: findings from studies based on data sharing and global partnerships]. Nervenarzt 2021; 92:199-207. [PMID: 33439287 DOI: 10.1007/s00115-020-01052-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
Schizophrenic psychoses are the result of a multifactorial process in which not only environmental influences but also genetic factors play an important role. These factors are based on a complex mode of inheritance that involves a large number of genetic variants. In the last three decades, biological psychiatric research has focused closely on molecular genetic aspects of the hereditary basis of schizophrenic psychoses. In particular, international consortia are combining cohorts from individual researchers, creating continuously increasing sample sizes and thus increased statistical power. As part of the Psychiatric Genomics Consortium (PGC), genome-wide association studies with tens of thousands of patients and controls have for the first time found robustly replicable markers for schizophrenic psychoses. Through intensive phenotyping, first approaches to a transdiagnostic clinical reclassification of severe mental illnesses have been established in the longitudinal PsyCourse study of the UMG Göttingen and the LMU Munich, allowing new biologically validated disease subgroups with prognostic value to be identified. For the first time environmental factors could even be examined in an African cohort that contribute to the development of the psychosis. In the coming years, the enormous technical progress in the area of genomic high-throughput technologies (next-generation sequencing) is expected to provide new knowledge not only about the influence of frequently occurring single nucleotide polymorphisms but also about rare variants. For the successful use of this technological revolution an exchange of data between research groups is essential.
Collapse
Affiliation(s)
- K Adorjan
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, Nussbaumstr. 7, 80336, München, Deutschland.
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland.
- Center for International Health (CIH), LMU Munich, München, Deutschland.
| | - T G Schulze
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland
| | - M Budde
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland
| | - U Heilbronner
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, München, Deutschland
| | - F Tessema
- Department of Epidemiology, Faculty of Public Health, Gilgel Gibe Filed Research Center, Jimma University, Jimma, Äthiopien
| | - Z Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Äthiopien
| | - P Falkai
- Klinik für Psychiatrie und Psychotherapie, LMU Klinikum, Nussbaumstr. 7, 80336, München, Deutschland
| |
Collapse
|
14
|
Wagner E, McMahon L, Falkai P, Hasan A, Siskind D. Impact of smoking behavior on clozapine blood levels - a systematic review and meta-analysis. Acta Psychiatr Scand 2020; 142:456-466. [PMID: 32869278 DOI: 10.1111/acps.13228] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Tobacco smoking significantly impacts clozapine blood levels and has substantial implications on individual efficacy and safety outcomes. By investigating differences in clozapine blood levels in smoking and non-smoking patients on clozapine, we aim to provide guidance for clinicians how to adjust clozapine levels for patients on clozapine who change their smoking habits. METHODS We conducted a meta-analysis on clozapine blood levels, norclozapine levels, norclozapine/clozapine ratios, and concentration to dose (C/D) ratios in smokers and non-smokers on clozapine. Data were meta-analyzed using a random-effects model with sensitivity analyses on dose, ethnic origin, and study quality. RESULTS Data from 23 studies were included in this meta-analysis with 21 investigating differences between clozapine blood levels of smokers and non-smokers. In total, data from 7125 samples were included for the primary outcome (clozapine blood levels in ng/ml) in this meta-analysis. A meta-analysis of all between-subject studies (N = 16) found that clozapine blood levels were significantly lower in smokers compared with non-smokers (Standard Mean Difference (SMD) -0.39, 95% confidence interval (CI) -0.55 to -0.22, P < 0.001, I2 = 80%). With regard to the secondary outcome, C/D ratios (N = 16 studies) were significantly lower in the smoker group (n = 645) compared with the non-smoker group (n = 813; SMD -0.70, 95%CI -0.84 to -0.56, P < 0.00001, I2 = 17%). CONCLUSION Smoking behavior and any change in smoking behavior is associated with a substantial effect on clozapine blood levels. Reductions of clozapine dose of 30% are recommended when a patient on clozapine stops smoking. Reductions should be informed by clozapine steady-state trough levels and a close clinical risk-benefit evaluation.
Collapse
Affiliation(s)
- E Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - L McMahon
- School of Medicine, University of Queensland, Brisbane, Australia
| | - P Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - D Siskind
- School of Medicine, University of Queensland, Brisbane, Australia.,Metro South Addiction and Mental Health Service, Brisbane, Australia
| |
Collapse
|
15
|
Roeh A, Lembeck M, Papazova I, Pross B, Hansbauer M, Schoenfeld J, Haller B, Halle M, Falkai P, Scherr J, Hasan A. Marathon running improves mood and negative affect. J Psychiatr Res 2020; 130:254-259. [PMID: 32854076 DOI: 10.1016/j.jpsychires.2020.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/13/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Physical activity has beneficial effects on depression, as well as on other mental and somatic diseases. The amount of recommended exercise is still under discussion. We investigated whether marathon runners (MA) exhibit less or more depressive symptoms and negative affects compared to sedentary controls (SC) and how their mood changes in the context of marathon training and marathon running. METHODS We included 100 amateur marathon runners and 46 age- and gender matched sedentary controls in the ReCaP (Running effects on Cognition and Plasticity) study. Questionnaires contained Beck Depression Inventory (BDI), Hamilton Depression Scale (HAMD), Oxford Happiness Questionnaire (OHQ), Visual Analogue Scale (VAS), Positive And Negative Affect Schedule (PANAS), Global Assessment of Functioning (GAF). SC were evaluated one time at baseline, MA six times during the six months study period. RESULTS Compared to SC, marathon runners (281.80 ± 131.44 running min/week) exhibited less depressive symptoms, more positive affects (PANAS-PA) and a higher level of functioning (GAF). Within the marathon group, negative affect (PANAS-NA) decreased and general mood states (VAS) further improved throughout the study period with a maximum 24 h after the marathon. DISCUSSION MA had less depressive symptoms and a higher level of functioning compared to SC. Higher amounts than the recommended duration of 150 min/week aerobic training (WHO/ACSM) and the participation in a marathon seem to even further improve negative affect. These findings give new insight into the relationship between exercise and mood parameters. They can be implemented in future preventive strategies for depressive symptoms.
Collapse
Affiliation(s)
- A Roeh
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Nußbaumstraße 7, 80336, Munich, Germany.
| | - M Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - I Papazova
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - B Pross
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - M Hansbauer
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - J Schoenfeld
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Georg-Brauchle-Ring 56, D-80992, Munich, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - B Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Halle
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Georg-Brauchle-Ring 56, D-80992, Munich, Germany; Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Nußbaumstraße 7, 80336, Munich, Germany
| | - J Scherr
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Georg-Brauchle-Ring 56, D-80992, Munich, Germany; University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - A Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians University Munich, Nußbaumstraße 7, 80336, Munich, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| |
Collapse
|
16
|
Kamp F, Hager L, Proebstl L, Schreiber A, Riebschläger M, Neumann S, Straif M, Schacht-Jablonowsky M, Falkai P, Pogarell O, Manz K, Soyka M, Koller G. 12- and 18-month follow-up after residential treatment of methamphetamine dependence: Influence of treatment drop-out and different treatment concepts. J Psychiatr Res 2020; 129:103-110. [PMID: 32652338 DOI: 10.1016/j.jpsychires.2020.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
This study investigates the effects of two different residential treatments and of treatment drop-out in a German methamphetamine (MA) dependent sample. 108 subjects from two addiction treatment concepts were recruited at treatment begin and followed-up at 12 (T2) and 18 (T3) months after treatment. Based on follow-up samples (n = 38 at T2, n = 25 at T3), 77.1% at T2 and 68.0% at T3 were MA abstinent. Classifying everyone, who did not participate at follow-ups as having had a relapse, showed MA-abstinence rates of 25.0% (at T2) and 15.7% (at T3). There was no difference in MA-use between treatment conditions nor between treatment completers and drop-outs. Having injected any substance predicted MA-use at T2 (p = .03). The median time of relapse was 1.5 days after hospital release. Depression scores at T2 predicted MA-use at T3 (p = .02). T2 participants that dropped out of treatment had higher craving scores at T2, than T2 subjects who completed treatment (p = .03). The results show positive effects of current inpatient treatment programs without differences between different concepts. More research is needed to clarify the impact of treatment drop-out. Attention should be paid to a successful transition from residential to outpatient services and to a reduction of study attrition.
Collapse
Affiliation(s)
- F Kamp
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - L Hager
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany.
| | - L Proebstl
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - A Schreiber
- District Hospital Hochstadt, Hauptstraße 13, 96272, Hochstadt Am Main, Germany
| | - M Riebschläger
- MEDIAN Clinic Mecklenburg, Blumenstraße 3, 19217, Rehna OT Parber, Germany
| | - S Neumann
- MEDIAN Clinic Mecklenburg, Blumenstraße 3, 19217, Rehna OT Parber, Germany
| | - M Straif
- District Hospital Hochstadt, Hauptstraße 13, 96272, Hochstadt Am Main, Germany
| | | | - P Falkai
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - O Pogarell
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - K Manz
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Marchioninistraße 15, 81377, Munich, Germany
| | - M Soyka
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| | - G Koller
- Department of Psychiatry and Psychotherapy University Hospital Munich, LMU Munich, Nussbaumstraße 7, 80336, Munich, Germany
| |
Collapse
|
17
|
Wasserman D, Apter G, Baeken C, Bailey S, Balazs J, Bec C, Bienkowski P, Bobes J, Ortiz MFB, Brunn H, Bôke Ö, Camilleri N, Carpiniello B, Chihai J, Chkonia E, Courtet P, Cozman D, David M, Dom G, Esanu A, Falkai P, Flannery W, Gasparyan K, Gerlinger G, Gorwood P, Gudmundsson O, Hanon C, Heinz A, Dos Santos MJH, Hedlund A, Ismayilov F, Ismayilov N, Isometsä ET, Izakova L, Kleinberg A, Kurimay T, Reitan SK, Lecic-Tosevski D, Lehmets A, Lindberg N, Lundblad KA, Lynch G, Maddock C, Malt UF, Martin L, Martynikhin I, Maruta NO, Matthys F, Mazaliauskiene R, Mihajlovic G, Peles AM, Miklavic V, Mohr P, Ferrandis MM, Musalek M, Neznanov N, Ostorharics-Horvath G, Pajević I, Popova A, Pregelj P, Prinsen E, Rados C, Roig A, Kuzman MR, Samochowiec J, Sartorius N, Savenko Y, Skugarevsky O, Slodecki E, Soghoyan A, Stone DS, Taylor-East R, Terauds E, Tsopelas C, Tudose C, Tyano S, Vallon P, Van der Gaag RJ, Varandas P, Vavrusova L, Voloshyn P, Wancata J, Wise J, Zemishlany Z, Öncü F, Vahip S. Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries. Eur Psychiatry 2020; 63:e82. [PMID: 32829740 PMCID: PMC7576531 DOI: 10.1192/j.eurpsy.2020.79] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background. Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. Methods. The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. Results. We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. Conclusions. We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Collapse
Affiliation(s)
- D Wasserman
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,National Centre for Suicide Research and Prevention of Mental-Ill Health, Karolinska Institute, Stockholm, Sweden
| | - G Apter
- French Federation of Psychiatry, Paris, France.,Groupe Hospitalier du Havre, Université de Rouen, Rouen, France
| | - C Baeken
- Flemish Association of Psychiatry, Kortenberg, Belgium.,Department of Psychiatry and Medical Psychiatry, Ghent University, Gent, Belgium
| | - S Bailey
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,University of Central Lancashire, Preston, United Kingdom
| | - J Balazs
- Hungarian Psychiatric Association, Budapest, Hungary.,Department of Developmental and Clinical Child Psychology at the Institute Psychology Eotvos Lorand University, Budapest, Hungary
| | - C Bec
- National Centre for Suicide Research and Prevention of Mental-Ill Health, Karolinska Institute, Stockholm, Sweden
| | - P Bienkowski
- Polish Psychiatric Association, Warsaw, Poland.,Department of Psychiatry, Warsaw Medical University, Warsaw, Poland
| | - J Bobes
- Spanish Society of Psychiatry, Madrid, Spain.,Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
| | - M F Bravo Ortiz
- Association of Psychiatrists of Spanish Association of Neuropsychiatry, Madrid, Spain.,Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - H Brunn
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Danish Psychiatric Association, Copenhagen, Denmark.,Institute of regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ö Bôke
- Psychiatric Association of Turkey, Ankara, Turkey.,Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - N Camilleri
- Maltese Association of Psychiatry, Attard, Malta.,University of Malta, Msida, Malta
| | - B Carpiniello
- European Psychiatric Association Council of National Psychiatric Associations, Strasbourg, France.,Italian Psychiatric Association, Roma, Italy.,Department of Public Health, Clinical and Molecular Medicine, Università degli studi di Cagliari, Sardinia, Italy
| | - J Chihai
- Society of Psychiatrists, Narcologists, Psychotherapists, and Clinical Psychologists from the Republic of Moldova, Chișinău, Moldova.,Department of State Medical and Pharmaceutical University "Nicolae Testemitanu", Chișinău, Republic of Moldova
| | - E Chkonia
- Society of Georgian Psychiatrists, Tbilisi, Georgia.,Department of Psychiatry, Tbilisi State Medical University, Tbilisi, Georgia
| | - P Courtet
- French Congress of Psychiatry, Paris, France.,University of Montpellier, CHRU Montpellier, Montpellier, France.,Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, Montpellier, France
| | - D Cozman
- Romanian Association of Psychiatry and Psychotherapy, Bucharest, Romania.,Medical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-NapocaRomania
| | - M David
- French Federation of Psychiatry, Paris, France.,Fondation Bon Sauveur, Bégard, France
| | - G Dom
- Belgium Professional Association of Medical Specialists in Psychiatry, Brussel, Belgium.,Department of Psychiatry, Antwerp University (UA), Antwerpen, Belgium
| | - A Esanu
- Society of Psychiatrists, Narcologists, Psychotherapists, and Clinical Psychologists from the Republic of Moldova, Chișinău, Moldova.,Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - P Falkai
- German Association for Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany.,Clinic for Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - W Flannery
- College of Psychiatrists of Ireland, Dublin, Ireland.,Department of Adult Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Gasparyan
- Armenian Psychiatric Association, Yerevan, Armenia.,Medical Psychology Department, Yerevan State Mkhitar Herats Medical University, Yerevan, Armenia
| | - G Gerlinger
- German Association for Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany
| | - P Gorwood
- French Congress of Psychiatry, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), University of ParisParis, France
| | - O Gudmundsson
- Icelandic Psychiatric Association, Kopavogur, Iceland.,Psychiatric Department, Landspitali, University Hospital of Iceland, Reykjavík, Iceland
| | - C Hanon
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Regional Resource Center of old age Psychiatry, AP-HP Centre - Université de Paris, Corentin-Celton Hospital, Paris, France
| | - A Heinz
- German Association for Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany.,Clinic for Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Berlin, Germany
| | - M J Heitor Dos Santos
- Portuguese Society of Psychiatry and Mental Health, Lisbon, Portugal.,Institute of Environmental Health (ISAMB) of the Faculty of Medicine of the University of Lisbon (FMUL), Lisbon, Portugal
| | - A Hedlund
- Swedish Psychiatry Association, Sundsvall, Sweden.,North Stockholm Psychiatry, Stockholm County Medical Area (SLSO), Stockholm, Sweden
| | - F Ismayilov
- Azerbaijan Psychiatric Association, Baku, Azerbaijan.,National Mental Health Centre, Baku, Azerbaijan
| | - N Ismayilov
- Azerbaijan Psychiatric Association, Baku, Azerbaijan.,Department of Psychiatry, Azerbaijan Medical University, Baku, Azerbaijan
| | - E T Isometsä
- Finnish Psychiatric Association, Helsinki, Finland.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - L Izakova
- Slovak Psychiatric Association, Bratislava, Slovakia.,Department of Psychiatry, Faculty of Medicine Comenius University and University Hospital, Bratislava, Slovakia
| | - A Kleinberg
- Estonian Psychiatric Association, Tartu, Estonia.,Children Mental Health Centre of Tallinn Children Hospital, Tallinn, Estonia
| | - T Kurimay
- European Psychiatric Association Council of National Psychiatric Associations, Strasbourg, France.,Department of Psychiatry and Psychiatric Rehabilitation, Teaching Department of Semmelweis University, Budapest, Hungary
| | - S Klæbo Reitan
- Department of Psychiatry and Psychiatric Rehabilitation, Teaching Department of Semmelweis University, Budapest, Hungary.,Norwegian Psychiatric Association, Oslo, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norweigan University of Science and Technology, Trondheim, Norway
| | - D Lecic-Tosevski
- Serbian Psychiatric Association, Belgrade, Serbia.,Psychiatric Association of Eastern Europe and the Balkans, Athens, Greece.,Department of Medical Sciences, Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - A Lehmets
- Estonian Psychiatric Association, Tartu, Estonia.,Psychiatric Centre of the Tallinn West Central Hospital, Tallinn, Estonia
| | - N Lindberg
- Finnish Psychiatric Association, Helsinki, Finland.,Forensic Psychiatry, Helsinki University and Helsinki University Hospital, Helsinski, Finland
| | - K A Lundblad
- Swedish Psychiatry Association, Sundsvall, Sweden.,Adult Psychiatry, Stockholm County Medical Area (SLSO), Stockholm, Sweden
| | - G Lynch
- Royal College of Psychiatrists, London, United Kingdom
| | - C Maddock
- Royal College of Psychiatrists, London, United Kingdom
| | - U F Malt
- Norwegian Psychiatric Association, Oslo, Norway.,Faculty of Medicine, Psychiatry and Psychosomatic Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - L Martin
- College of Psychiatrists of Ireland, Dublin, Ireland.,St Loman's Hospital, Mullingar, Ireland
| | - I Martynikhin
- Russian Society of Psychiatrists, Moscow, Russian Federation.,First Pavlov State Medical University of St Petersburg, Saint Petersburg, Russian Federation
| | - N O Maruta
- Association of Neurologists, Psychiatrists and Narcologists of Ukraine, Kharkiv, Ukraine.,Institute of Neurology, Psychiatry and Narcology of the NAMS of Ukraine State Insitution, Kharkiv, Ukraine
| | - F Matthys
- Flemish Association of Psychiatry, Kortenberg, Belgium.,Department of Psychiatry, Universitair Ziekenhuis, Brussel, Belgium
| | - R Mazaliauskiene
- Lithuanian Psychiatric Association, Vilnius, Lithuania.,Lithuanian University of Health Sciences, Psychiatric Clinic, Kaunas, Lithuania
| | - G Mihajlovic
- Serbian Psychiatric Association, Belgrade, Serbia.,Clinic for Psychiatry, University of Kragujevac, Kragujevac, Serbia
| | - A Mihaljevic Peles
- Croatian Psychiatric Association, Zagreb, Croatia.,Zagreb School of Medicine and Zagreb University Hospital Centre, Zagreb, Croatia
| | - V Miklavic
- Slovenian Psychiatric Association, Ljubljana, Slovenia.,Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - P Mohr
- Czech Psychiatric Association, Prague, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - M Munarriz Ferrandis
- Association of Psychiatrists of Spanish Association of Neuropsychiatry, Madrid, Spain
| | - M Musalek
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Institute for Social Aesthetics and Mental Health, Vienna, Austria.,Sigmund Freud University, Vienna, Austria
| | - N Neznanov
- Russian Society of Psychiatrists, Moscow, Russian Federation.,St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, St. Petersburg, Russian Federation
| | | | - I Pajević
- Psychiatric Association of Bosnia-Herzegovina, Tuzla, Bosnia and Herzegovina.,Department of Psychiatry, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - A Popova
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,College Private Psychiatry of Bulgaria, Sofia, Bulgaria.,Nikola Shipkovenski Mental Health Centre, Sofia, Bulgaria
| | - P Pregelj
- Slovenian Psychiatric Association, Ljubljana, Slovenia.,Department of Psychiatry, University of Ljubljana, Ljubljana, Slovenia
| | - E Prinsen
- Netherlands Psychiatric Association, Utrecht, Netherlands
| | - C Rados
- Austrian Society for Psychiatry and Psychotherapy, Vienna, Austria.,Department of Psychiatry and Psychotherapeutic Medicine, Villach State Hospital, Villach, Austria
| | - A Roig
- Association of Psychiatrists of Spanish Association of Neuropsychiatry, Madrid, Spain.,Mental Health Centre, Horta-Guinardó, Barcelona, Spain
| | - M Rojnic Kuzman
- Croatian Psychiatric Association, Zagreb, Croatia.,Zagreb School of Medicine and Zagreb University Hospital Centre, Zagreb, Croatia
| | - J Samochowiec
- Polish Psychiatric Association, Warsaw, Poland.,European Psychiatric Association Council of National Psychiatric Associations, Strasbourg, France.,Department of Psychiatry Pomeranian Medical University, Szczecin, Poland
| | - N Sartorius
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - Y Savenko
- Independent Psychiatric Association of Russia, Moscow, Russian Federation
| | - O Skugarevsky
- Belarusian Psychiatric Association, Minsk, Belarus.,Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus
| | - E Slodecki
- Royal College of Psychiatrists, London, United Kingdom
| | - A Soghoyan
- Armenian Psychiatric Association, Yerevan, Armenia.,Center of Psychosocial Recovery, Yerevan State Medical University, Yerevan, Armenia
| | - D S Stone
- National Centre for Suicide Research and Prevention of Mental-Ill Health, Karolinska Institute, Stockholm, Sweden
| | - R Taylor-East
- Maltese Association of Psychiatry, Attard, Malta.,University of Malta, Msida, Malta
| | - E Terauds
- Latvian Psychiatric Association, Riga, Latvia.,Department of Psychiatry and Narcology, Rīga Stradiņš University, Riga, Latvia
| | - C Tsopelas
- Psychiatric Association of Eastern Europe and the Balkans, Athens, Greece.,Department of Psychiatry, Psychiatric Hospital of Athens, Athens, Greece
| | - C Tudose
- Romanian Association of Psychiatry and Psychotherapy, Bucharest, Romania.,Department of Psychiatry "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - S Tyano
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France
| | - P Vallon
- Swiss Society of Psychiatry and Psychotherapy, Bern, Switzerland
| | - R J Van der Gaag
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Psychosomatics and Psychotherapy Stradina Department, University of Riga, Riga, Latvia
| | - P Varandas
- Portuguese Society of Psychiatry and Mental Health, Lisbon, Portugal.,Casa de Saúde da Idanha and San José Psychiatric Clinic Instituto das Irmãs Hospitaleiras do Sagrado Coração de Jesus, Belas, Portugal
| | - L Vavrusova
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Slovak Psychiatric Association, Bratislava, Slovakia
| | - P Voloshyn
- Association of Neurologists, Psychiatrists and Narcologists of Ukraine, Kharkiv, Ukraine.,Department of Neurology and Neurosurgery of Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
| | - J Wancata
- Austrian Society for Psychiatry and Psychotherapy, Vienna, Austria.,Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - J Wise
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,CNWL NHS Foundation Trust, London, United Kingdom
| | - Z Zemishlany
- Israel Psychiatric Association, Ramat Gan, Israel
| | - F Öncü
- Psychiatric Association of Turkey, Ankara, Turkey.,Forensic Psychiatry Department, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - S Vahip
- European Psychiatric Association Council of National Psychiatric Associations, Strasbourg, France.,Department of Psychiatry, Ege University School of Medicine, Izmir, Turkey
| |
Collapse
|
18
|
Montag C, Brandt L, Lehmann A, De Millas W, Falkai P, Gaebel W, Hasan A, Hellmich M, Janssen B, Juckel G, Karow A, Klosterkötter J, Lambert M, Maier W, Müller H, Pützfeld V, Schneider F, Stützer H, Wobrock T, Vernaleken IB, Wagner M, Heinz A, Bechdolf A, Gallinat J. Cognitive and emotional empathy in individuals at clinical high risk of psychosis. Acta Psychiatr Scand 2020; 142:40-51. [PMID: 32339254 DOI: 10.1111/acps.13178] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Impairments of social cognition are considered core features of schizophrenia and are established predictors of social functioning. However, affective aspects of social cognition including empathy have far less been studied than its cognitive dimensions. The role of empathy in the development of schizophrenia remains largely elusive. METHODS Emotional and cognitive empathy were investigated in large sample of 120 individuals at Clinical High Risk of Psychosis (CHR-P) and compared with 50 patients with schizophrenia and 50 healthy controls. A behavioral empathy assessment, the Multifaceted Empathy Test, was implemented, and associations of empathy with cognition, social functioning, and symptoms were determined. RESULTS Our findings demonstrated significant reductions of emotional empathy in individuals at CHR-P, while cognitive empathy appeared intact. Only individuals with schizophrenia showed significantly reduced scores of cognitive empathy compared to healthy controls and individuals at CHR-P. Individuals at CHR-P were characterized by significantly lower scores of emotional empathy and unspecific arousal for both positive and negative affective valences compared to matched healthy controls and patients with schizophrenia. Results also indicated a correlation of lower scores of emotional empathy and arousal with higher scores of prodromal symptoms. CONCLUSION Findings suggest that the tendency to 'feel with' an interaction partner is reduced in individuals at CHR-P. Altered emotional reactivity may represent an additional, early vulnerability marker, even if cognitive mentalizing is grossly unimpaired in the prodromal stage. Different mechanisms might contribute to reductions of cognitive and emotional empathy in different stages of non-affective psychotic disorders and should be further explored.
Collapse
Affiliation(s)
- C Montag
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - L Brandt
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - A Lehmann
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - W De Millas
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Vivantes Wenckebach-Klinikum, Berlin, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Hellmich
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany.,Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - B Janssen
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,LVR-Klinik Langenfeld, Langenfeld, Germany
| | - G Juckel
- Department of Psychiatry, Psychotherapy, and Preventive Medicine, Ruhr University Bochum, Bochum, Germany
| | - A Karow
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - J Klosterkötter
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - M Lambert
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - W Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany.,DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - H Müller
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - V Pützfeld
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - F Schneider
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.,Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - H Stützer
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - T Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Goettingen, Goettingen, Germany.,Department of Psychiatry and Psychotherapy, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - I B Vernaleken
- Department of Psychiatry, Psychotherapy, and Psychosomatics, RWTH Aachen, Aachen, Germany
| | - M Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,Department of Neurodegenerative Diseases and Geriatric Psychiatry, University of Bonn, Bonn, Germany.,DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
| | - A Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany.,Faculty of Medicine, University Hospital Cologne, Cologne, Germany.,ORYGEN, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - J Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
19
|
Reis-de-Oliveira G, Zuccoli GS, Fioramonte M, Schimitt A, Falkai P, Almeida V, Martins-de-Souza D. Digging deeper in the proteome of different regions from schizophrenia brains. J Proteomics 2020; 223:103814. [PMID: 32389842 DOI: 10.1016/j.jprot.2020.103814] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 02/07/2023]
Abstract
Schizophrenia is a psychiatric disorder that affects 21 million people worldwide. Despite several studies having been shown that some brain regions may play a critical role in the pathophysiology of schizophrenia, the molecular basis to explain this diversity is still lacking. The cerebellum (CER), caudate nucleus (CAU), and posterior cingulate cortex (PCC) are areas associated with negative and cognitive symptoms in schizophrenia. In this study, we performed shotgun proteomics of the aforementioned brain regions, collected postmortem from patients with schizophrenia and compared with the mentally healthy group. In addition, we performed a proteomic analysis of nuclear and mitochondrial fractions of these same regions. Our results presented 106, 727 and 135 differentially regulated proteins in the CAU, PCC, and CER, respectively. Pathway enrichment analysis revealed dysfunctions associated with synaptic processes in the CAU, transport in the CER, and in energy metabolism in the PCC. In all brain areas, we found that proteins related to oligodendrocytes and the metabolic processes were dysregulated in schizophrenia. SIGNIFICANCE: Schizophrenia is a complex and heterogeneous psychiatric disorder. Despite much research having been done to increase the knowledge about the role of each region in the pathophysiology of this disorder, the molecular mechanisms underlying it are still lacking. We performed shotgun proteomics in the postmortem cerebellum (CER), caudate nucleus (CAU) and posterior cingulate cortex (PCC) from patients with schizophrenia and compared with healthy controls. Our findings suggest that each aforementioned region presents dysregulations in specific molecular pathways, such as energy metabolism in the PCC, transport in the CER, and synaptic process in the CAU. Additionally, these areas presented dysfunctions in oligodendrocytes and metabolic processes. Our results may highlight future directions for the development of novel clinical approaches for specific therapeutic targets.
Collapse
Affiliation(s)
- G Reis-de-Oliveira
- Lab of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - G S Zuccoli
- Lab of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - M Fioramonte
- Lab of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - A Schimitt
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University (LMU), Munich, Germany; Laboratory of Neurosciences (LIM-27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University (LMU), Munich, Germany
| | - V Almeida
- Lab of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - D Martins-de-Souza
- Lab of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, Brazil; Experimental Medicine Research Cluster (EMRC), University of Campinas, Campinas, Brazil; D'Or Institute for Research and Education (IDOR), São Paulo, Brazil; Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Científico e Tecnológico, São Paulo, Brazil.
| |
Collapse
|
20
|
McAllister-Williams RH, Arango C, Blier P, Demyttenaere K, Falkai P, Gorwood P, Hopwood M, Javed A, Kasper S, Malhi GS, Soares JC, Vieta E, Young AH, Papadopoulos A, Rush AJ. The identification, assessment and management of difficult-to-treat depression: An international consensus statement. J Affect Disord 2020; 267:264-282. [PMID: 32217227 DOI: 10.1016/j.jad.2020.02.023] [Citation(s) in RCA: 123] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/07/2020] [Accepted: 02/06/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many depressed patients are not able to achieve or sustain symptom remission despite serial treatment trials - often termed "treatment resistant depression". A broader, perhaps more empathic concept of "difficult-to-treat depression" (DTD) was considered. METHODS A consensus group discussed the definition, clinical recognition, assessment and management implications of the DTD heuristic. RESULTS The group proposed that DTD be defined as "depression that continues to cause significant burden despite usual treatment efforts". All depression management should include a thorough initial assessment. When DTD is recognized, a regular reassessment that employs a multi-dimensional framework to identify addressable barriers to successful treatment (including patient-, illness- and treatment-related factors) is advised, along with specific recommendations for addressing these factors. The emphasis of treatment, in the first instance, shifts from a goal of remission to optimal symptom control, daily psychosocial functional and quality of life, based on a patient-centred approach with shared decision-making to enhance the timely consideration of all treatment options (including pharmacotherapy, psychotherapy, neurostimulation, etc.) to optimize outcomes when sustained remission is elusive. LIMITATIONS The recommended definition and management of DTD is based largely on expert consensus. While DTD would seem to have clinical utility, its specificity and objectivity may be insufficient to define clinical populations for regulatory trial purposes, though DTD could define populations for service provision or phase 4 trials. CONCLUSIONS DTD provides a clinically useful conceptualization that implies a search for and remediation of specific patient-, illness- and treatment obstacles to optimizing outcomes of relevance to patients.
Collapse
Affiliation(s)
- R H McAllister-Williams
- Northern Centre for Mood Disorders, Newcastle University, UK; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - C Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - P Blier
- Royal Ottawa Institute of Mental Health Research, University of Ottawa, Canada
| | - K Demyttenaere
- University Psychiatric Center KU Leuven, Faculty of Medicine KU Leuven, Belgium
| | - P Falkai
- Clinic for Psychiatry and Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - P Gorwood
- CMME, Hopital Sainte-Anne (GHU Paris et Neurosciences). Paris-Descartes University, INSERM U1266, Paris, France
| | - M Hopwood
- University of Melbourne, Melbourne, Australia
| | - A Javed
- Faculty of the University of Warwick, UK
| | - S Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - G S Malhi
- The University of Sydney, Faculty of Medicine and Health, Northern Clinical School, Department of Psychiatry, Sydney, New South Wales, Australia; Academic Department of Psychiatry, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065 Australia; CADE Clinic, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065 Australia
| | - J C Soares
- University of Texas Health Science Center, Houston, TX, USA
| | - E Vieta
- Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - A H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London & South London and Maudsley NHS Foundation Trust, UK
| | | | - A J Rush
- Duke University School of Medicine, Durham, NC, USA; Texas Tech University Health Sciences Center, Permian Basin, Midland, TX, USA; Duke-NUS Medical School, Singapore
| |
Collapse
|
21
|
Maurus I, Mantel C, Keller-Varady K, Schmitt A, Lembeck M, Röh A, Papazova I, Falkai P, Schneider-Axmann T, Hasan A, Malchow B. Resistance training in patients with schizophrenia: Concept and proof of principle trial. J Psychiatr Res 2020; 120:72-82. [PMID: 31634752 DOI: 10.1016/j.jpsychires.2019.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/20/2019] [Accepted: 09/25/2019] [Indexed: 12/16/2022]
Abstract
Resistance training has been shown to contribute to the prevention and management of cardiovascular diseases, which is why it can help reducing morbidity and mortality in schizophrenia patients. Moreover, positive effects on different schizophrenia symptom domains have been proposed. However, a specific resistance training tailored to the needs of schizophrenia patients and its evaluation is still lacking. The objective in this proof of principle trial was to evaluate the feasibility and efficacy of a newly developed 12-week resistance program according to current recommendations of the WHO and the American College of Sports Medicine. We employed a single blind, parallel assignment clinical trial design with participants randomized to attend either a resistance training including three 50min units per week or a balance and tone program as control condition. The primary outcome was the impact on health-related difficulties assessed with the World Health Organization Disability Assessment Schedule (WHO-DAS). Secondary outcome parameters included the level of functioning, schizophrenia symptoms, selected cognitive parameters as well as risk factors for cardiovascular diseases. In our proof of principle trial, we could not find significant time or group effects of resistance training on the WHO-DAS. However, we could observe significant positive effects on the level of functioning assessed with the Global Assessment of Functioning Scale (GAF) over the course of time, which were more pronounced in the intervention group. Our findings indicated that patients with schizophrenia could safely participate in resistance training with relevant improvements in their level of functioning. Well-powered replication trials are needed to provide more efficacy data.
Collapse
Affiliation(s)
- I Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - C Mantel
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - K Keller-Varady
- Hannover Medical School, Institute of Sports Medicine, Hannover, Germany
| | - A Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany; Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - M Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - A Röh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - I Papazova
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - T Schneider-Axmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - B Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| |
Collapse
|
22
|
Steiner J, Prüß H, Köhler S, Hasan A, Falkai P. [Autoimmune encephalitis with psychotic symptoms : Diagnostics, warning signs and practical approach]. Nervenarzt 2019. [PMID: 29523913 DOI: 10.1007/s00115-018-0499-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Despite intensive research, a precise cause of schizophrenic and schizoaffective disorders has not yet been identified. Therefore, psychiatric diagnoses are still made based on clinical ICD-10/DSM‑5 criteria and not on any objective markers; however, various causes or pathophysiological processes may ultimately lead to similar symptoms. An important task for the future of psychiatry is to identify disease subtypes with a distinct pathophysiology to develop more specific and causally acting therapies. A new diagnostic entity has become established in clinical neurology and psychiatry in recent years: autoimmune encephalitis with psychotic symptoms caused by specific antineuronal antibodies has been identified as a rare but potentially treatable cause of psychotic disorders; however, these inflammatory brain diseases are not reliably detected by routine psychiatric diagnostics. Therefore, this qualitative review is intended to provide structured support for clinical practice, which, guided by clinical warning signals, enables a rapid and reliable diagnosis as well as the initiation of immunotherapy. In the case of psychiatric symptoms, the additional onset of focal neurological signs, disturbances of consciousness and orientation, autonomic instability or epileptic seizures and electroencephalograph (EEG) abnormalities should always be followed by a more specific cerebrospinal fluid analysis with determination of antineuronal autoantibodies. Although the scientific evidence indicates that only a small subgroup of patients is affected, the swift and correct diagnosis is of high therapeutic and prognostic relevance for the affected individuals.
Collapse
Affiliation(s)
- J Steiner
- Klinik für Psychiatrie und Psychotherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland. .,Center for Behavioral Brain Sciences, Magdeburg, Deutschland.
| | - H Prüß
- Experimentelle Neurologie und Klinik für Neurologie, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Deutschland.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE) Berlin, Berlin, Deutschland
| | - S Köhler
- Klinik für Psychiatrie und Psychotherapie, Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - A Hasan
- Klinik für Psychiatrie und Psychotherapie, Ludwig Maximilians-Universität München, München, Deutschland
| | - P Falkai
- Klinik für Psychiatrie und Psychotherapie, Ludwig Maximilians-Universität München, München, Deutschland
| |
Collapse
|
23
|
Roeh A, Bunse T, Lembeck M, Handrack M, Pross B, Schoenfeld J, Keeser D, Ertl-Wagner B, Pogarell O, Halle M, Falkai P, Hasan A, Scherr J. Running effects on cognition and plasticity (ReCaP): study protocol of a longitudinal examination of multimodal adaptations of marathon running. Res Sports Med 2019; 28:241-255. [PMID: 31345073 DOI: 10.1080/15438627.2019.1647205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Regular moderate physical activity (PA) has been linked to beneficial adaptations in various somatic diseases (e.g. cancer, endocrinological disorders) and a reduction in all-cause mortality from several cardiovascular and neuropsychiatric diseases. This study was designed to investigate acute and prolonged exercise-induced cardio- and neurophysiological responses in endurance runners competing in the Munich Marathon. ReCaP (Running effects on Cognition and Plasticity) is a multimodal and longitudinal experimental study. This study included 100 participants (20-60 years). Six laboratory visits were included during the 3-month period before and the 3-month period after the Munich marathon. The multimodal assessment included laboratory measurements, cardiac and cranial imaging (MRI scans, ultrasound/echocardiography) and neurophysiological methods (EEG and TMS/tDCS), and vessel-analysis (e.g. retinal vessels and wave-reflection analyses) and neurocognitive measurements. The ReCaP study was designed to examine novel exercise-induced cardio- and neurophysiological responses to marathon running at the behavioral, functional and morphological levels. This study will expand our understanding of exercise-induced adaptations and will lead to more individually tailored therapeutic options.
Collapse
Affiliation(s)
- A Roeh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - T Bunse
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Handrack
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - B Pross
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - J Schoenfeld
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| | - D Keeser
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - B Ertl-Wagner
- Department of Clinical Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - O Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Halle
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner site Munich, Munich Heart Alliance, Munich, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - J Scherr
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany
| |
Collapse
|
24
|
Abstract
SummaryFor the development of ICD-11, the World Health Organization (WHO) has inaugurated a Working Group on the Classification of Psychotic Disorders (WGPD). A range of changes of the classification of primary psychotic disorders was developed by this group. While DSM-5 was published in 2013, the ICD-11 proposals are currently undergoing internet-based and clinical field trials and the final version is due in 2017. Among the major changes suggested by the WGPD for ICD-11 are the chapter titles, the replacement of the current schizophrenia subtypes by a number of symptom specifiers, a new set of course specifiers harmonized with DSM-5, transsectional diagnostic criteria for schizoaffective disorder, and a reorganization of the acute and transient psychotic disorders and delusional disorders.
Collapse
|
25
|
Reich-Erkelenz D, Janssen B, Sommerlad K, Gaebel W, Falkai P, Zielasek J, Wobrock T. Qualitätsindikatoren in der Psychiatrie. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1669574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungMit Einführung des neuen Entgeltsystems in Psychiatrie und Psychosomatik sowie der Einführung neuer Versorgungsmodelle stellt sich die Frage, wie sich diese Entgelt- und Versorgungsmodelle auf die Qualität der psychiatrisch-psychotherapeutischen sowie der psychosomatischpsychotherapeutischen Behandlung auswirken. Darum bedarf es begleitend zur gegenwärtigen Einführung eines neuen Entgeltsystems für die Bereiche Psychiatrie und Psychosomatik auch der Einführung von qualitätsorientierten Versorgungsanalysen, wobei als eine der wichtigsten Voraussetzungen für eine sektorenübergreifende Qualitätsmessung konsentierte und valide Qualitätsindikatoren zu entwickeln sind. Dabei spielen neben der Abbildung der Strukturqualität psychiatrischer und psychosomatischer Versorgungseinrichtungen insbesondere Indikatoren der Prozess- und Ergebnisqualität eine zentrale Rolle, die nach Möglichkeit mit den routinemäßig verfügbaren Daten gut messbar sind, eine hohe Aussagekraft besitzen und Aspekte der Qualität der Behandlung über den gesamten Krankheitsverlauf und, wenn möglich, über Grenzen der Versorgungssektoren ambulant vs. stationär hinweg darstellen können. Dabei ist darauf zu achten, dass es nicht zu einem übermäßigen Dokumentationsaufwand zu Lasten der Behandlungsqualität kommt. In dem vorliegenden Beitrag wird ein möglicher Entwicklungsprozess für Qualitätsindikatoren in der Psychiatrie skizziert. Weiterhin werden einige Beispiele für bereits vorgeschlagene Qualitätsindikatoren für die Diagnostik und Behandlung der Schizophrenie und Depression vorgestellt. Abschließend bleibt festzuhalten, dass die aus der Entwicklung der Leitlinien abgeleiteten Qualitätsindikatoren ihre Praxistauglichkeit erst unter Beweis stellen müssen, um sinnvolle Steuerungswirkungen entfalten zu können.
Collapse
|
26
|
Zielasek J, Großimlinghaus I, Janssen B, Wobrock T, Falkai P, Reich-Erkelenz D, Riesbeck M, Gaebel W. Die Rolle von Qualitätsindikatoren in der psychiatrischen Qualitätssicherung und aktueller Stand der Entwicklung von Qualitätsindikatoren. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1671759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDie Entwicklung von sektorenübergreifenden Qualitätsindikatoren für die Versorgung von Menschen mit psychischen Störungen wurde durch den Gemeinsamen Bundesausschuss auf den Weg gebracht. Wir beschreiben diese aktuelle Entwicklung und informieren über den Stand des Projektes zur Entwicklung von Qualitätsindikatoren durch die DGPPN für vier häufige psychische Störungen: Schizophrenie, Demenzen, Alkoholabhängigkeit und unipolare Depressionen.
Collapse
|
27
|
Colling C, Holthoff-Detto V, Falkai P, Musil R. NADA-Auriculoacupuncture as a Symptomatic Treatment for Agitation in People with Dementia: A Randomized, Controlled, Rater-Blind Pilot Study. J Acupunct Meridian Stud 2018. [DOI: 10.1016/j.jams.2018.08.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
28
|
Jobst A, Sabaß L, Hall D, Brücklmeier B, Buchheim A, Hall J, Sarubin N, Zill P, Falkai P, Brakemeier EL, Padberg F. Oxytocin plasma levels predict the outcome of psychotherapy: A pilot study in chronic depression. J Affect Disord 2018; 227:206-213. [PMID: 29100154 DOI: 10.1016/j.jad.2017.10.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Oxytocin is associated with bonding and social deficits in psychiatric disorders and has also been discussed as a potential therapeutic intervention to augment psychotherapy. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a specific form of psychotherapy for chronic depression, an illness in which interpersonal deficits play a major role. In this pilot study, we investigated whether Oxytocin plasma levels predict the clinical outcome of chronic depressive patients after CBASP. METHODS Sixteen patients with chronic depression participated in a 10-week CBASP inpatient program. Oxytocin plasma levels were measured before and after participants played a virtual ball-tossing game (Cyberball) that mimics social exclusion. Clinical outcome after CBASP was evaluated with the Beck Depression Inventory-II (BDI-II) and the 24-item Hamilton Depression Rating Scale (HAMD-24). RESULTS After CBASP, depressive symptoms decreased significantly: the response rates were 44% (BDI-II) and 50% (HAMD-24); and the remission rates, 38% (BDI-II) and 44% (HAMD-24). Lower oxytocin plasma levels at baseline correlated with smaller changes in BDI-II scores, but not with the change in HAMD-24 scores. LIMITATIONS The limitations of our study were the small sample size, concomitant and non-standardized pharmacotherapy, and lack of a controlled design and a follow-up period. CONCLUSIONS Our study provides first evidence that oxytocin plasma levels may predict the outcome of psychotherapy in chronic depression. These findings need to be replicated in larger randomized, controlled trials.
Collapse
Affiliation(s)
- A Jobst
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany.
| | - L Sabaß
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - D Hall
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - B Brücklmeier
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - A Buchheim
- Department of Psychology, Clinical Psychology, University of Innsbruck, Austria
| | - J Hall
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - N Sarubin
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany; Hochschule Fresenius, University of Applied Sciences, Munich, Germany
| | - P Zill
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - P Falkai
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - E-L Brakemeier
- Psychologische Hochschule Berlin (PHB), Berlin, Germany; Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Germany
| | - F Padberg
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| |
Collapse
|
29
|
D´Amelio R, Ruffing-Tabaka S, Falkai P, Delb W, Wobrock T. Repetitive transkranielle Magnetstimulation bei chronischem Tinnitus. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1626762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungChronischer Tinnitus ist nicht selten mit erheblichem Leidensdruck und psychischer Beeinträchtigung verbunden. Funktionell bildgebend konnte neben einer Hyperaktivität des auditorischen Kortex auch eine pathologische Mitaktivierung frontaler und limbischer Hirnstrukturen, welche möglicherweise in eine emotionale und kognitive Bewertung des Tinnitus eingebunden sind, nachgewiesen werden. Es wurde gezeigt, dass niederfrequente repetitive transkranielle Magnetstimulation (rTMS) kortikale Hyperexzitabilität reduzieren kann. In einem randomisierten Plazebo-kontrollierten Cross-over-Design sollte die therapeutische Wirksamkeit einer links temporalen (auditorischer Kortex, entsprechend der Elektrodenposition T3 des 10–20–Systems) versus rechts frontalen (DLFPC, entsprechend der Elektrodenposition F4) rTMS (Intensität 100% der Motorschwelle in Ruhe, Frequenz 1 Hz, 2 000 Stimuli/ Tag, jeweils über 10 Tage) überprüft werden. Bezüglich der Stimulationsbedingung der rTMS-Behandlung waren sowohl Patienten als auch Rater verblindet. Die Plazebostimulation erfolgte mit einer speziellen Shamspule. Behandlungseffekte wurden mit einer visuellen Analogskala (subjektive Tinnituslautheit) sowie insbesondere mit dem Tinnitusfragebogen nach Goebel und Hiller erfasst. Eine erste Auswertung der noch laufenden Pilotstudie zeigte, dass Verum-rTMS sowohl frontal als auch temporal zu einer Verminderung der Tinnitusbelastung im Vergleich zu PlazeborTMS (Shamstimulation) führte. Auf Grund der hohen interindividuellen Ansprechbarkeit und der geringen Fallzahl war dieser Unterschied allerdings statistisch nicht signifikant. Diese Ergebnisse sind als Hinweis aufzufassen, dass rTMS zwar ein vielversprechendes Instrument zur Behandlung des chronischen Tinnitus darstellt, der Effekt aber nicht an die Stimulation des auditorischen Kortex gebunden ist und vermutlich genauso durch eine Beeinflussung der kognitiven und emotionalen Tinnitusbewertung mit Hilfe einer frontalen Stimulation zu erreichen ist.
Collapse
|
30
|
Papiol S, Popovic D, Keeser D, Hasan A, Schneider-Axmann T, Degenhardt F, Rossner MJ, Bickeböller H, Schmitt A, Falkai P, Malchow B. Polygenic risk has an impact on the structural plasticity of hippocampal subfields during aerobic exercise combined with cognitive remediation in multi-episode schizophrenia. Transl Psychiatry 2017; 7:e1159. [PMID: 28654095 PMCID: PMC5537649 DOI: 10.1038/tp.2017.131] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/12/2017] [Accepted: 05/17/2017] [Indexed: 02/06/2023] Open
Abstract
Preliminary studies suggest that, besides improving cognition, aerobic exercise might increase hippocampal volume in schizophrenia patients; however, results are not consistent. Individual mechanisms of volume changes are unknown but might be connected to the load of risk genes. Genome-wide association studies have uncovered the polygenic architecture of schizophrenia. The secondary analysis presented here aimed to determine the modulatory role of schizophrenia polygenic risk scores (PRSs) on volume changes in the total hippocampus and cornu ammonis (CA) 1, CA2/3, CA4/dentate gyrus (DG) and subiculum over time. We studied 20 multi-episode schizophrenia patients and 23 healthy controls who performed aerobic exercise (endurance training) combined with cognitive remediation for 3 months and 21 multi-episode schizophrenia patients allocated to a control intervention (table soccer) combined with cognitive remediation. Magnetic resonance imaging-based assessments were performed at baseline and after 3 months with FreeSurfer. No effects of PRSs were found on total hippocampal volume change. Subfield analyses showed that the volume changes between baseline and 3 months in the left CA4/DG were significantly influenced by PRSs in schizophrenia patients performing aerobic exercise. A larger genetic risk burden was associated with a less pronounced volume increase or a decrease in volume over the course of the exercise intervention. Results of exploratory enrichment analyses reinforced the notion of genetic risk factors modulating biological processes tightly related to synaptic ion channel activity, calcium signaling, glutamate signaling and regulation of cell morphogenesis. We hypothesize that a high polygenic risk may negatively influence neuroplasticity in CA4/DG during aerobic exercise in schizophrenia.
Collapse
Affiliation(s)
- S Papiol
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
- Institute of Psychiatric Phenomics and Genomics (IPPG), Medical Center of the University of Munich, Munich, Germany
| | - D Popovic
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - D Keeser
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
- Institute of Clinical Radiology, Ludwig Maximilian University Munich, Munich, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - T Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - F Degenhardt
- Institute of Human Genetics, University of Bonn, Bonn, Germany
| | - M J Rossner
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - H Bickeböller
- Department of Genetic Epidemiology, University Medical Center, Georg-August-Universität Göttingen, Göttingen, Germany
| | - A Schmitt
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
- Laboratory of Neuroscience, Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| | - B Malchow
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University Munich, Munich, Germany
| |
Collapse
|
31
|
Deister A, Falkai P, Heinz A. [Mental health as a global challenge : Research, care and participation]. Nervenarzt 2017. [PMID: 28642981 DOI: 10.1007/s00115-017-0362-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Deister
- Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Itzehoe, Deutschland
| | - P Falkai
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Nussbaumstraße 7, 80336, München, Deutschland.
| | - A Heinz
- Klinik für Psychiatrie und Psychotherapie, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| |
Collapse
|
32
|
Adorjan K, Kluge U, Heinz A, Stamm T, Odenwald M, Dohrmann K, Mokhtari-Nejad R, Hasan A, Schulze TG, Falkai P, Pogarell O. [Healthcare models for traumatized refugees in Germany]. Nervenarzt 2017. [PMID: 28642982 DOI: 10.1007/s00115-017-0364-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
People with a migration background are a risk group for psychiatric disorders. Innovative, transnational and sustainable projects are necessary to ensure adequate care for refugees and asylum seekers. Selected projects of the University of Munich, the Charité Berlin and the University of Konstanz show promising approaches in addition to other initiatives.
Collapse
Affiliation(s)
- K Adorjan
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstr. 7, 80336, München, Deutschland. .,Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland. .,Center for International Health, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - U Kluge
- Zentrum für Interkulturelle Psychiatrie und Psychotherapie (ZIPP), Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Berliner Institut für empirische Integrations- und Migrationsforschung (BIM), Humboldt Universität zu Berlin, Berlin, Deutschland
| | - A Heinz
- Berliner Institut für empirische Integrations- und Migrationsforschung (BIM), Humboldt Universität zu Berlin, Berlin, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Stamm
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Ruppiner Kliniken, Hochschulklinikum der Medizinischen Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - M Odenwald
- Klinische Psychologie und klinische Neuropsychologie, Universität Konstanz, Konstanz, Deutschland.,vivo international e. V., Konstanz, Deutschland
| | - K Dohrmann
- Klinische Psychologie und klinische Neuropsychologie, Universität Konstanz, Konstanz, Deutschland.,vivo international e. V., Konstanz, Deutschland
| | - R Mokhtari-Nejad
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstr. 7, 80336, München, Deutschland.,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Migrationsambulanz, Klinikum der Universität München, LMU, München, Deutschland
| | - A Hasan
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstr. 7, 80336, München, Deutschland
| | - T G Schulze
- Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland
| | - P Falkai
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstr. 7, 80336, München, Deutschland
| | - O Pogarell
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstr. 7, 80336, München, Deutschland.,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Migrationsambulanz, Klinikum der Universität München, LMU, München, Deutschland
| |
Collapse
|
33
|
Hasan A, Wobrock T, Guse B, Langguth B, Landgrebe M, Eichhammer P, Frank E, Cordes J, Wölwer W, Musso F, Winterer G, Gaebel W, Hajak G, Ohmann C, Verde PE, Rietschel M, Ahmed R, Honer WG, Dechent P, Malchow B, Castro MFU, Dwyer D, Cabral C, Kreuzer PM, Poeppl TB, Schneider-Axmann T, Falkai P, Koutsouleris N. Structural brain changes are associated with response of negative symptoms to prefrontal repetitive transcranial magnetic stimulation in patients with schizophrenia. Mol Psychiatry 2017; 22:857-864. [PMID: 27725655 DOI: 10.1038/mp.2016.161] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/06/2016] [Accepted: 08/04/2016] [Indexed: 12/13/2022]
Abstract
Impaired neural plasticity may be a core pathophysiological process underlying the symptomatology of schizophrenia. Plasticity-enhancing interventions, including repetitive transcranial magnetic stimulation (rTMS), may improve difficult-to-treat symptoms; however, efficacy in large clinical trials appears limited. The high variability of rTMS-related treatment response may be related to a comparably large variation in the ability to generate plastic neural changes. The aim of the present study was to determine whether negative symptom improvement in schizophrenia patients receiving rTMS to the left dorsolateral prefrontal cortex (DLPFC) was related to rTMS-related brain volume changes. A total of 73 schizophrenia patients with predominant negative symptoms were randomized to an active (n=34) or sham (n=39) 10-Hz rTMS intervention applied 5 days per week for 3 weeks to the left DLPFC. Local brain volume changes measured by deformation-based morphometry were correlated with changes in negative symptom severity using a repeated-measures analysis of covariance design. Volume gains in the left hippocampal, parahippocampal and precuneal cortices predicted negative symptom improvement in the active rTMS group (all r⩽-0.441, all P⩽0.009), but not the sham rTMS group (all r⩽0.211, all P⩾0.198). Further analyses comparing negative symptom responders (⩾20% improvement) and non-responders supported the primary analysis, again only in the active rTMS group (F(9, 207)=2.72, P=0.005, partial η 2=0.106). Heterogeneity in clinical response of negative symptoms in schizophrenia to prefrontal high-frequency rTMS may be related to variability in capacity for structural plasticity, particularly in the left hippocampal region and the precuneus.
Collapse
Affiliation(s)
- A Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - T Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany.,Department of Psychiatry and Psychotherapy, County Hospitals Darmstadt-Dieburg, Groß-Umstadt, Germany
| | - B Guse
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany
| | - B Langguth
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - M Landgrebe
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.,Department of Psychiatry, Psychosomatics and Psychotherapy, kbo-Lech-Mangfall-Klinik Agatharied, Agatharied, Germany
| | - P Eichhammer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - E Frank
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - J Cordes
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - W Wölwer
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - F Musso
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - G Winterer
- Experimental and Clinical Research Centre, The Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - G Hajak
- Department of Psychiatry, Psychosomatics and Psychotherapy, Sozialstiftung Bamberg, Bamberg, Germany
| | - C Ohmann
- European Clinical Research Network, Düsseldorf, Germany
| | - P E Verde
- Coordination Centre for Clinical Trials, Heinrich-Heine University, Düsseldorf, Germany
| | - M Rietschel
- Department of Genetic Epidemiology in Psychiatry, Institute of Central Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - R Ahmed
- Institut für anwendungsorientierte Forschung und klinische Studien GmbH, Göttingen, Germany
| | - W G Honer
- Department of Genetic Epidemiology in Psychiatry, Institute of Mental Health, The University of British Columbia, Vancouver, BC, Canada
| | - P Dechent
- Department of Cognitive Neurology, Georg-August-University Goettingen, Goettingen, Germany
| | - B Malchow
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - M F U Castro
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - D Dwyer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - C Cabral
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - P M Kreuzer
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - T B Poeppl
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - T Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - N Koutsouleris
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
34
|
Großimlinghaus I, Hauth I, Falkai P, Janssen B, Deister A, Meyer-Lindenberg A, Roth-Sackenheim C, Schneider F, Wobrock T, Zeidler R, Gaebel W. [DGPPN recommendations on quality indicators for schizophrenia]. Nervenarzt 2017; 88:779-786. [PMID: 28484822 DOI: 10.1007/s00115-017-0347-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In Germany, several quality indicators have been proposed for the measurement of quality of mental healthcare. Some of these quality indicators have been tested in feasibility studies. The German Association for Psychiatry and Psychotherapy (DGPPN) established the "Task Force Quality Indicators (QI)" that, based on previous experience in the development and pilot testing of indicators, considered the further development and practical realization of QI for schizophrenia. AIM The aim was to select a set of QI for schizophrenia that can also be applied to other diagnoses or used in generic measurements. Another goal was to focus on high feasibility of indicators. METHODS In a multistage selection process, the DGPPN Task Force selected QI that focus on essential quality aspects from an inventory of 161 existing QI developed by national and international research groups. Indicators were adapted in consultation with the "trialogic forum" of the DGPPN. RESULTS The DGPPN proposes the following ten indicators for quality measurement in mental healthcare for schizophrenia: QI1 Long-term treatment/Monitoring of side effects, QI2 Seclusion and restraint, QI3 Number of suicides, QI4 Psychoeducational-oriented intervention for significant others, QI5 Timely beginning of outpatient treatment after discharge from inpatient treatment, QI6 Aggression management - inpatient treatment, QI7 Diagnostic procedures/Physical examination, QI8 Antipsychotic polypharmacy, QI9 Rehabilitation/Vocational rehabilitation, QI10 Diagnostic procedures/Psychosocial functioning. DISCUSSION Most of our proposed QI have to be measured by means of additional data documentation. Based on prior experience in the pilot testing of QI, the DGPPN estimates that the additional efforts in data documentation would be manageable, but have to be refinanced. The indicators will be tested in feasibility studies in different mental healthcare hospitals in Germany.
Collapse
Affiliation(s)
- I Großimlinghaus
- LVR-Institut für Versorgungsforschung, WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Medizinische Fakultät, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität, Bergische Landstraße 2, 40629, Düsseldorf, Deutschland
| | - I Hauth
- Zentrum für Neurologie, Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Joseph Krankenhaus Berlin-Weißensee, Berlin, Deutschland
| | - P Falkai
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - B Janssen
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, LVR-Klinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
| | - A Deister
- Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Itzehoe, Deutschland
| | - A Meyer-Lindenberg
- Klinik für Psychiatrie und Psychotherapie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Mannheim, Deutschland
| | - C Roth-Sackenheim
- Fachärztin für Psychiatrie und Psychotherapie in eigener Praxis, Berufsverband Deutscher Psychiater, Andernach, Deutschland
| | - F Schneider
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, RWTH Aachen University, Aachen, Deutschland.,JARA-BRAIN Institute Brain Structure-Function Relationships: Decoding the Human Brain at systemic levels, Forschungszentrum Jülich GmbH and RWTH Aachen University, Jülich, Deutschland
| | - T Wobrock
- Zentrum für Seelische Gesundheit, Kreiskliniken Darmstadt-Dieburg, Groß-Umstadt, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - R Zeidler
- Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN-Geschäftsstelle), Berlin, Deutschland
| | - W Gaebel
- LVR-Institut für Versorgungsforschung, WHO Collaborating Center for Quality Assurance and Empowerment in Mental Health, Medizinische Fakultät, LVR-Klinikum Düsseldorf, Heinrich-Heine-Universität, Bergische Landstraße 2, 40629, Düsseldorf, Deutschland.
| |
Collapse
|
35
|
Keeser D, Weidinger E, Linhardt A, Palm U, Hasan A, Kirsch B, Pogarell O, Karali T, Paolini M, Ertl-Wagner B, Müller N, Falkai P, Padberg F. P276 Transcranial Direct Current Stimulation (tDCS) replaces Electroconvulsive Therapy (ECT) in a patient with corpus callosum agenesis and catatonic schizophrenia. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
36
|
Kumpf U, Palm U, Nolden J, Pfeiffer A, Egert S, Görlitz T, Bajbouj M, Plewnia C, Langguth B, Zwanzger P, Kirsch B, Worsching J, Mansmann U, Falkai P, Keeser D, Hasan A, Padberg F. P278 Transcranial direct current stimulation (tDCS) as treatment for major depression (DepressionDC) – Objectives and design of a prospective multicenter double blind randomized placebo controlled trial. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2016.10.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
37
|
Café-Mendes C, Ferro E, Torrão A, Crunfli F, Rioli V, Schmitt A, Falkai P, Britto L, Turck C, Martins-de-Souza D. Peptidomic analysis of the anterior temporal lobe and corpus callosum from schizophrenia patients. J Proteomics 2017; 151:97-105. [DOI: 10.1016/j.jprot.2016.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/17/2016] [Accepted: 05/23/2016] [Indexed: 12/22/2022]
|
38
|
Adorjan K, Steinert T, Flammer E, Deister A, Koller M, Zinkler M, Herpertz SC, Häfner S, Hohl-Radke F, Beine KH, Falkai P, Gerlinger G, Pogarell O, Pollmächer T. Zwangsmaßnahmen in deutschen Kliniken für Psychiatrie und Psychotherapie. Nervenarzt 2016; 88:802-810. [DOI: 10.1007/s00115-016-0261-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
39
|
Falkai P. [Not Available]. Fortschr Neurol Psychiatr 2016; 84:668. [PMID: 27846650 DOI: 10.1055/s-0042-117294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
|
40
|
Hasan A, Wobrock T, Palm U, Strube W, Padberg F, Falkai P, Fallgatter A, Plewnia C. [Non-invasive brain stimulation for treatment of schizophrenic psychoses]. Nervenarzt 2016; 86:1481-91. [PMID: 26341690 DOI: 10.1007/s00115-015-4323-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite many different available pharmacological and psychosocial treatment options, an optimal control of symptoms is only partly possible for most schizophrenia patients. Especially, persistent auditory hallucinations, negative symptoms and cognitive impairment are difficult to treat symptoms. Several non-invasive brain stimulation techniques are increasingly being considered as new therapeutic add on options for the management of schizophrenia, targeting these symptom domains. The technique which has been available for the longest time and that is best established in clinical care is electroconvulsive therapy (ECT). New stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) allow a more pathophysiological-based approach. This review article introduces various non-invasive brain stimulation techniques and discusses recent treatment studies on schizophrenia. In total, the novel brain stimulation techniques discussed here can be considered relevant add on therapeutic approaches for schizophrenia. In this context, the best evidence is available for the application of rTMS for the treatment of negative symptoms and persistent auditory hallucinations; however, negative studies have also been published for both indications. Studies using other non-invasive brain stimulation techniques showed promising results but further research is needed to establish the clinical efficacy. Based on a growing pathophysiological knowledge, non-invasive brain stimulation techniques provide new treatment perspectives for patients with schizophrenia.
Collapse
Affiliation(s)
- A Hasan
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland.
| | - T Wobrock
- Zentrum für seelische Gesundheit, Kreiskliniken Darmstadt-Dieburg, Darmstadt-Dieburg, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Georg-August-Universität Göttingen, Göttingen, Deutschland
| | - U Palm
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - W Strube
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - F Padberg
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - P Falkai
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München Ludwig-Maximilians Universität, Nußbaumstr. 7, 80336, München, Deutschland
| | - A Fallgatter
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Tübingen, Tübingen, Deutschland
| | - C Plewnia
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinik Tübingen, Tübingen, Deutschland
| |
Collapse
|
41
|
Abstract
BACKGROUND Many patients with psychiatric and organic disorders may present primary or secondary psychotic symptoms. Based on the ICD 10 classification, this article describes the possible underlying diseases and their subdivision. The main focus will be differential-diagnostic evaluations of psychotic syndromes. RESULTS In the clinical setting, the differential diagnosis of the paranoid schizophrenia and other psychotic disorders into three main disease groups is important: 1. other psychiatric diseases, 2. primary and secondary organic diseases and 3. autoimmune diseases. The first group contains, for example, drug-induced psychoses, affective disorders, personality disorders. The second group includes forms of dementia, forms of deliria or metabolic diseases. Recently, another focus is set on autoimmune diseases, especially encephalitides. SUMMARY A detailed medical history, a physical examination and organic diagnostic can lead to the correct diagnosis and therapy. The differential-diagnostic classification and the detection of organic causes is an important part of psychiatric care, but often a good cooperation with organic specialties is needed.
Collapse
|
42
|
Abstract
BACKGROUND In mental healthcare the concept of pathways addresses diverse issues and problem areas, such as heterogeneous health service offers, the regional variability of treatment concepts and clear-cut guidelines on how and where to obtain treatment for a particular mental disorder. The ambiguous aspects of the concept require international and national definitions and consensus which must also cover quality criteria. METHODS This article gives an overview of currently available evidence for the analysis of clinical pathways and pathways to care in international mental healthcare, covering studies on schizophrenia and depression from 2010 to 2014. RESULTS AND DISCUSSION The ambiguity of the concept impedes the overview and does not provide unequivocal results. The development, implementation and analyses of guidelines or clear-cut clinical and pathways to care must consider individual, clinical and care system aspects as well as the interplay of these factors. Results suggest that system aspects tend to dominate over clinical factors of schizophrenia and depression. As a consequence, the definition, implementation and evaluation of clinical pathways or pathways to mental healthcare is first and foremost a responsibility of the respective national mental healthcare system and must be understood on that level, before findings are summarized internationally and models of best practice are debated.
Collapse
Affiliation(s)
- H J Salize
- Zentralinstitut für Seelische Gesundheit, Klinische Fakultät Mannheim/Universität Heidelberg, Medizinische Fakultät Mannheim, J5, 68159 , Mannheim, Deutschland.
| | - E Voß
- Zentralinstitut für Seelische Gesundheit, Klinische Fakultät Mannheim/Universität Heidelberg, Medizinische Fakultät Mannheim, J5, 68159 , Mannheim, Deutschland
| | - A Werner
- Zentralinstitut für Seelische Gesundheit, Klinische Fakultät Mannheim/Universität Heidelberg, Medizinische Fakultät Mannheim, J5, 68159 , Mannheim, Deutschland
| | - P Falkai
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - I Hauth
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer St. Joseph-Krankenhaus Berlin-Weißensee, Berlin, Deutschland
| |
Collapse
|
43
|
Langgartner S, Strube W, Oviedo T, Hansbauer M, Karch S, Wirth S, Falkai P, Hasan A. Treatment-resistant Schizophrenia and Global Cortical Atrophy in a Patient with Turner Syndrome. Pharmacopsychiatry 2016; 49:262-263. [PMID: 27458742 DOI: 10.1055/s-0042-111207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- S Langgartner
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - W Strube
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - T Oviedo
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - M Hansbauer
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - S Karch
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - S Wirth
- Department of Clinical Radiology, Ludwig-Maximilians University, Munich
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| | - A Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich
| |
Collapse
|
44
|
Heinz A, Voss M, Lawrie SM, Mishara A, Bauer M, Gallinat J, Juckel G, Lang U, Rapp M, Falkai P, Strik W, Krystal J, Abi-Dargham A, Galderisi S. Shall we really say goodbye to first rank symptoms? Eur Psychiatry 2016; 37:8-13. [PMID: 27429167 DOI: 10.1016/j.eurpsy.2016.04.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND First rank symptoms (FRS) of schizophrenia have been used for decades for diagnostic purposes. In the new version of the DSM-5, the American Psychiatric Association (APA) has abolished any further reference to FRS of schizophrenia and treats them like any other "criterion A" symptom (e.g. any kind of hallucination or delusion) with regard to their diagnostic implication. The ICD-10 is currently under revision and may follow suit. In this review, we discuss central points of criticism that are directed against the continuous use of first rank symptoms (FRS) to diagnose schizophrenia. METHODS We describe the specific circumstances in which Schneider articulated his approach to schizophrenia diagnosis and discuss the relevance of his approach today. Further, we discuss anthropological and phenomenological aspects of FRS and highlight the importance of self-disorder (as part of FRS) for the diagnosis of schizophrenia. Finally, we will conclude by suggesting that the theory and rationale behind the definition of FRS is still important for psychopathological as well as neurobiological approaches today. RESULTS Results of a pivotal meta-analysis and other studies show relatively poor sensitivity, yet relatively high specificity for FRS as diagnostic marker for schizophrenia. Several methodological issues impede a systematic assessment of the usefulness of FRS in the diagnosis of schizophrenia. However, there is good evidence that FRS may still be useful to differentiate schizophrenia from somatic causes of psychotic states. This may be particularly important in countries or situations with little access to other diagnostic tests. FRS may thus still represent a useful aid for clinicians in the diagnostic process. CONCLUSION In conclusion, we suggest to continue a tradition of careful clinical observation and fine-grained psychopathological assessment, including a focus on symptoms regarding self-disorders, which reflects a key aspect of psychosis. We suggest that the importance of FRS may indeed be scaled down to a degree that the occurrence of a single FRS alone should not suffice to diagnose schizophrenia, but, on the other hand, absence of FRS should be regarded as a warning sign that the diagnosis of schizophrenia or schizoaffective disorder is not warranted and requires specific care to rule out other causes, particularly neurological and other somatic disorders. With respect to the current stage of the development of ICD-11, we appreciate the fact that self-disorders are explicitly mentioned (and distinguished from delusions) in the list of mandatory symptoms but still feel that delusional perceptions and complex hallucinations as defined by Schneider should be distinguished from delusions or hallucinations of "any kind". Finally, we encourage future research to explore the psychopathological context and the neurobiological correlates of self-disorders as a potential phenotypic trait marker of schizophrenia.
Collapse
Affiliation(s)
- A Heinz
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Saint-Hedwig Hospital, Humboldt University, Berlin, Germany
| | - M Voss
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Saint-Hedwig Hospital, Humboldt University, Berlin, Germany.
| | - S M Lawrie
- Division of Psychiatry, University of Edinburgh, Kennedy Tower, Royal Edinburgh Hospital, Edinburgh EH10 5HF, UK
| | - A Mishara
- Department of Clinical Psychology, Chicago School of Professional Psychology, Los Angeles, USA
| | - M Bauer
- University Hospital Carl Gustav Carus, Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - J Gallinat
- University Clinic Hamburg-Eppendorf, Clinic and Policlinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - G Juckel
- Department of Psychiatry, Psychotherapy, and Psychosomatic Medicine, Ruhr-University, Bochum, Germany
| | - U Lang
- Psychiatric University Clinics (UPK), Basel, Switzerland
| | - M Rapp
- Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany
| | - W Strik
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland
| | - J Krystal
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - A Abi-Dargham
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - S Galderisi
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| |
Collapse
|
45
|
Falkai P. [Not Available]. Fortschr Neurol Psychiatr 2016; 84:195. [PMID: 27100843 DOI: 10.1055/s-0042-106013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|
46
|
Möller-Leimkühler AM, Möller HJ, Maier W, Gaebel W, Falkai P. EPA guidance on improving the image of psychiatry. Eur Arch Psychiatry Clin Neurosci 2016; 266:139-54. [PMID: 26874959 DOI: 10.1007/s00406-016-0678-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/28/2016] [Indexed: 10/22/2022]
Abstract
This paper explores causes, explanations and consequences of the negative image of psychiatry and develops recommendations for improvement. It is primarily based on a WPA guidance paper on how to combat the stigmatization of psychiatry and psychiatrists and a Medline search on related publications since 2010. Furthermore, focussing on potential causes and explanations, the authors performed a selective literature search regarding additional image-related issues such as mental health literacy and diagnostic and treatment issues. Underestimation of psychiatry results from both unjustified prejudices of the general public, mass media and healthcare professionals and psychiatry's own unfavourable coping with external and internal concerns. Issues related to unjustified devaluation of psychiatry include overestimation of coercion, associative stigma, lack of public knowledge, need to simplify complex mental issues, problem of the continuum between normality and psychopathology, competition with medical and non-medical disciplines and psychopharmacological treatment. Issues related to psychiatry's own contribution to being underestimated include lack of a clear professional identity, lack of biomarkers supporting clinical diagnoses, limited consensus about best treatment options, lack of collaboration with other medical disciplines and low recruitment rates among medical students. Recommendations are proposed for creating and representing a positive self-concept with different components. The negative image of psychiatry is not only due to unfavourable communication with the media, but is basically a problem of self-conceptualization. Much can be improved. However, psychiatry will remain a profession with an exceptional position among the medical disciplines, which should be seen as its specific strength.
Collapse
Affiliation(s)
- A M Möller-Leimkühler
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - H-J Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336, Munich, Germany.
| | - W Maier
- Department of Psychiatry and Psychotherapy, University of Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-University Düsseldorf, Bergische Landstraße 2, 40629, Düsseldorf, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Nussbaumstr. 7, 80336, Munich, Germany
| |
Collapse
|
47
|
Falkai P. Clinical and neurobiological effects of aerobic endurance training in multi-episode schizophrenia patients. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Schizophrenia is a severe brain disorder characterised by positive, negative, affective and cognitive symptoms and can be viewed as a disorder of impaired neural plasticity. Aerobic exercise has a profound impact on the plasticity of the brain of both rodents and humans such as inducing the proliferation and differentiation of neural progenitor cells of the hippocampus in mice and rats. Aerobic exercise enhances LTP and leads to a better performance in hippocampus related memory tasks, eventually by increasing metabolic and synaptic plasticity related proteins in the hippocampus. In healthy humans, regular aerobic exercise increases hippocampal volume and seems to diminish processes of ageing like brain atrophy and cognitive decline.Disclosure of interestThe author has not supplied his declaration of competing interest.
Collapse
|
48
|
Jobst A, Brakemeier EL, Buchheim A, Caspar F, Cuijpers P, Ebmeier KP, Falkai P, Jan van der Gaag R, Gaebel W, Herpertz S, Kurimay T, Sabaß L, Schnell K, Schramm E, Torrent C, Wasserman D, Wiersma J, Padberg F. European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe. Eur Psychiatry 2016; 33:18-36. [PMID: 26854984 DOI: 10.1016/j.eurpsy.2015.12.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. METHODS We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. RESULTS We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. DISCUSSION The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. CONCLUSION Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
Collapse
Affiliation(s)
- A Jobst
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - E-L Brakemeier
- Department of Clinical Psychology and Psychotherapy, Berlin University of Psychology, Berlin, Germany
| | - A Buchheim
- Department of Psychology, Clinical Psychology, University of Innsbruck, Innsbruck, Austria
| | - F Caspar
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - P Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - K P Ebmeier
- Department of Psychiatry, Division of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - P Falkai
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | | | - W Gaebel
- Department of Psychiatry und Psychotherapy, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - S Herpertz
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - T Kurimay
- Institute of Behaviour Sciences, Semmelweis University, Budapest, Hungary
| | - L Sabaß
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - K Schnell
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - E Schramm
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - C Torrent
- Clinical Institute of Neuroscience, Hospital Clinic Barcelona, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - D Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - J Wiersma
- Department of Psychiatry, GGZinGeest, Amsterdam, The Netherlands
| | - F Padberg
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany.
| |
Collapse
|
49
|
Normann C, Wolff J, Hochlehnert A, Klein JP, Hohagen F, Lieb K, Deckert J, Falkai P, Berger M, Herpertz SC. [Resource use and financing of guideline-adherent psychotherapeutic inpatient care]. Nervenarzt 2016; 86:534-41. [PMID: 25877042 DOI: 10.1007/s00115-015-4309-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The financing of psychiatric psychotherapeutic care in Germany is determined by the German psychiatric staffing regulations which are unchanged since 1991. Psychotherapy was established after 1991 as an effective and indispensable treatment of mental and behavioral disorders. AIMS AND OBJECTIVES The aim of this study was to empirically investigate the use of psychiatrists' and psychologists' working time for psychotherapy in guideline-adherent hospital care. A further aim was to compare these results to the resources defined by the German psychiatric staffing regulations and in the new prospective payment system for psychiatry and psychosomatics in Germany. MATERIAL AND METHODS University hospitals for psychiatry and psychotherapy were asked to retrospectively provide data of patients for which guideline-adherent care was possible. Participating institutions provided both data describing the staff time utilization of psychotherapeutic services provided by psychiatrists and psychologists and patient classifications according to the German psychiatric staffing regulations and the new prospective payment system for psychiatry and psychosomatics. RESULTS Resources defined by the German psychiatric staffing regulations covered a mean of only 71 min of psychotherapy per patient and week while the actual mean intensity of psychotherapeutic care provided by the participating hospitals was 194 min per patient and week. The associated use of staff time was 102 min per patient and week. Both figures increased during an inpatient episode. The resources defined by the German psychiatric staffing regulations covered only 70 % of medical and psychological personnel. The current configuration of the new prospective payment system for psychiatry and psychosomatics covered only 59 % of staff time. CONCLUSION The results of this study provide another unambiguous recommendation to adjust the out-dated German psychiatric staffing regulations to the current evidence and S3 guidelines for psychiatric psychotherapeutic hospital care. In particular, more resources are required for the provision of psychotherapeutic care.
Collapse
Affiliation(s)
- C Normann
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 5, 79104, Freiburg, Deutschland,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Falkai P. [Not Available]. Fortschr Neurol Psychiatr 2015; 83:592. [PMID: 26588722 DOI: 10.1055/s-0041-106650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
|