[Postpartum depression and migration]

Psychiatric research and care increasingly explore the connection between mental health and migration; however, it is striking that only a small number of analyses exist on the effect of migration on mental ailments specific to women. For example, even though postpartum depression regularly occurs among women with a migration background, in Germany and internationally there is a lack of knowledge on the epidemiology, particularly with respect to factors causing or contributing to postpartum depression among women with a migration background. Prospectively, culturally specific treatment options for women with a migration background are necessary to prevent chronification and subsequent harm to the mother and other family members. With this aim in mind, psychologists, psychiatrists and gynecologists should be aware of the specific factors contributing to the development of postpartum depression among women with a migration background. This overview article focuses on key aspects of postpartum depression, such as epidemiology, symptoms, risk factors and treatment concepts, while contextualizing them with respect to women's experience of migration.

Death anxiety and attitude to death in patients with schizophrenia and depression

Attitude to death and death anxiety in patients with severe psychiatric disorders have been studied rarely so far, although this is an existential perspective for each human being and clinically seems to be changed in patients with depression and schizophrenia. Patients with depression (mean age 46.30 ± 13.39; 12 women, 8 men) and schizophrenia (mean age 38.95 ± 1285; 9 women, 11 men), as well as healthy controls, were included in the study. Death anxiety and attitude to death were assessed using the newly developed and currently validated BOFRETTA scale. Attitude to death was significantly worse in the group of patients with schizophrenia, especially in those with prominent negative symptoms. Concerning death anxiety, patients with schizophrenia and also those with depression exhibited higher mean values compared with healthy controls in the same age range. These results suggest that there are specific similarities and differences concerning attitude to death and death anxiety in patients with psychotic and affective disorders. It can be concluded that existential aspects such as death and meaningful life should also be considered within the treatment of patients with severe mental disorders.

Persönlichkeit, Lebensbedeutungen und Angst vor dem Tod bei affektiven Störungen

Hintergrund

Die Befunde der bislang wenigen durchgeführten Untersuchungen legen nahe, dass die Angst vor dem Tod eine zentrale kausale und aufrechterhaltende Variable bei der Entstehung psychischer Störungen ist. Hierbei ist die Bedeutung von Persönlichkeit oder lebenserfüllenden und krisenbewältigenden Verhaltensweisen nicht abschließend geklärt.

Material und Methoden

An der vorgestellten explorativen Studie nahmen 54 ambulante Psychotherapiepatienten (27 Frauen und 27 Männer, Alter im Mittel 43,7 Jahre [Standardabweichung, SD ± 13,2 Jahre]) teil. Bei mehr als 90 % der Teilnehmenden bestanden psychische Störungen aus den ICD-10-Bereichen F3 (affektive Störungen) und F4 (neurotische, Belastungs- und somatoforme Störungen). Mithilfe von semistrukturierten Interviews und Fragebogen wurden Daten u. a. zu Angst vor dem Tod („Bochumer-Fragebogen zur Erfassung der Angst vor dem Tod und der Einstellung zum Tod“, BOFRETTA), Persönlichkeitsdimensionen (NEO-Fünf-Faktoren-Inventar, NEO-FFI) und Lebensbedeutungen erhoben.

Ergebnisse

Lediglich für die Persönlichkeitsdimension Neurotizismus (nach NEO-FFI) fanden sich signifikante Korrelationen mit den 3 BOFRETTA-Kenngrößen, wobei ein höherer Neurotizismusgrad mit einem höheren BOFRETTA-Gesamtwert (r = 0,496; p ≤ 0,000), einem höheren Wert der Angst vor dem Tod (r = 0,524; p ≤ 0,000) und einer negativen Einstellung zum Tod (r = 0,401; p = 0,003) korrelierte. Zudem zeigte sich ein positiver Zusammenhang zwischen Angst vor dem Tod und Sinnkrise (r = 0,284; p = 0,038). Schließlich fanden sich signifikante Zusammenhänge zwischen der Dimension „Ordnung“ des Fragebogens zu Lebensbedeutungen und Lebenssinn (LeBe) und den BOFRETTA-Werten (Angst: r = 0,458; p ≤ 0,000; Einstellung: r = 0,521; p ≤ 0,000; Gesamt: r = 0,504; p ≤ 0,000). Gerade in Bezug auf diese Zusammenhänge ergaben sich wesentliche Geschlechterunterschiede.

Schlussfolgerung

Neurotizismus und Lebenskrise im Kontext einer psychischen Störung sowie geschlechterspezifisch unterschiedlich gewichtete Lebensbedeutungen wirken sich auf die Angst vor dem Tod aus und gehen mit einer problematischen Einstellung zum Tod einher. Eine stärkere Betrachtung dieser Zusammenhänge im Rahmen der individuell konzipierten psychotherapeutischen Behandlung eines jeden Patienten ist wünschenswert.

[Assessment of Family Based Intervention Needs by a Direct Survey of Patients with a Psychiatric Disorder]

BACKGROUND

The burden on families of the mentally ill, especially on their children, is little explored in the literature. Especially the care situation of minors during a stationary stay of a parent and the related concerns of the parents are little researched.

AIM

Assessment of the care situation of children and the need for family intervention of inpatient parents with mental illness.

METHODS

In a prospective study 100 patients with the main diagnoses affective disorder, mental and behavioral disorder by psychotropic substances and personality disorder were examined using a standardized interviews and questionnaire.

RESULTS

In the majority of cases psychiatrists don't know about the care situation of their patients' children. Most of the patients declare anxiety for the child's care while being in inpatient treatment. They desire an improvement of supporting measures.

CONCLUSIONS

The interaction and communication between patient and psychiatrist should be improved to capture the need of intervention and to instruct individual supporting measures.

Skin Diseases in Patients with Primary Psychiatric Disorders

OBJECTIVE

The few psychodermatological studies of primary psychiatric populations so far suggest that parasitic-infectious skin diseases are the most common dermatological comorbidity in more than 70% of psychiatric patients, which should be studied here in a large data bank outside dermatological treatment facilities.

METHODS

In a descriptive-explorative and retrospective study, more than 17,000 patients with primary psychiatric disorders were examined to investigate dermatological comorbidities.

RESULTS

The proportion of patients with primary mental disorders and additional dermatological disease was 1.24% (n=212). Here, psoriasis (35.4%) and atopic dermatitis (22.6%) were the most frequent dermatological diseases among these 212 patients. Infectious-parasitic skin diseases were present in 13.2% of comorbid patients. The most common mental disorder was a depressive illness, seen in 42.5% (n=90) of patients.

CONCLUSION

Our results confirmed the frequent association of depression with psoriasis and atopic dermatitis, indicating the need for the early detection and treatment of such comorbid patients. In contrast, psychiatric inpatients do not appear to suffer from predominantly infectious-parasitic dermatoses.

Heldentum gegen Todesangst und Psychopathologie: “Selbstwert” als protektiver Faktor in der ambulanten Psychotherapie

<b><i>Hintergrund:</i></b> Die Befunde der bisherigen Untersuchungen legen nahe, dass die Angst vor dem Tod ein wichtiger Faktor bei der Entstehung psychischer Erkrankungen ist. Insbesondere die Terror-Management-Theorie geht davon aus, dass Menschen zwei verschiedene Strategien anwenden, um mit Todesangst umzugehen: (1) Sie versuchen, ihren Selbstwert zu steigern; (2) sie halten die Werte ihrer Kultur hoch. <b><i>Patienten und Methoden:</i></b> Im Rahmen einer prospektiven Studie wurden 56 ambulante Psychotherapie-Patienten (29 Frauen, Alter 42,8 Jahre, SD 13,8) vornehmlich mit depressiven Störungen mittels Interview/Fragebögen u.a. zu Angst vor dem Tod (BOFRETTA) sowie Religiosität untersucht. <b><i>Ergebnisse:</i></b> Die Angst vor dem Tod korrelierte signifikant mit der Schwere der psychischen Symptomatik (BDI), Neurotizismus (NEO-FFI) sowie dem Hochhalten kultureller Werte (LeBe). Erwartungsgemäß zeigte sich ein signifikanter negativer Zusammenhang von Selbstwert und Angst vor dem Tod. Dieser zeigte sich nicht bei Vergleichsvariablen wie Lebenssinn, Religiosität und Spiritualität. <b><i>Diskussion und Schlussfolgerungen:</i></b> Die Angst vor dem Tod spielt bei der Entstehung und Aufrechterhaltung psychischer Probleme eine wesentliche Rolle. Ein wichtiger protektiver Faktor gegen diese scheint das Selbstwertgefühl zu sein. Es lässt sich vermuten, dass das Hochhalten kultureller Werte zwar ein unbewusster Versuch ist, gegen die Angst vor dem Tod (und die psychische Symptomatik) vorzugehen, dieser allerdings nicht wirksam ist.

Kinematic Analysis of Handwriting Movements in Individuals with Intellectual Disabilities with and without Obsessive Compulsive Symptoms

Theory/calculation: Movement disorders such as disturbances of coordination, clumsiness, and hand-related stereotypies are a frequent phenomenon in individuals with intellectual disabilities (ID). Obsessive-compulsive symptoms are also common in persons with ID. Our aim was to investigate hand motor dysfunction in persons with ID with and without OCD, using a digitizing tablet and the kinematic analysis of handwriting and drawing movements.

METHODS

We examinedthe hand motor performance of 23 individuals (12 males, 11 females, 42.6 ± 13.7 years old) with ID of heterogeneous aetiology. All subjects were required to write a sentence and draw circles under various conditions. Kinematic parameters were calculated to quantify hand motion.

RESULTS

Individuals with ID exhibit serious hand motor impairments suggestive of bradykinesia, irregularity, and micrographia. More than half of our ID patients (60.9%) displayed obsessive-compulsive symptoms of moderate severity (Y-BOCS total score: 16.6 ± 8.3). Interestingly, the ID patients with OCD displayed smaller amplitudes of hand motor movements than did patients with no obsessive-compulsive symptoms, while differences observed in the writing and drawing concentric circles trials were significant.

CONCLUSIONS

The results of this pilot study support the use of kinematic analyses of handwriting movements to evaluate motor abnormalities in patients with ID and comorbid mental illnesses.

Psychiatrische Komorbidität beim Ullrich-Turner-Syndrom

Ziel Das Ullrich-Turner Syndrom (UTS) ist eine X-chromosomale Störung, deren klinische Symptomatik vielfältig und heterogen ist. Neuropsychiatrische Erkrankungen zählen jedoch nicht zu den typischen Komorbiditäten des Turner-Syndrom, allerdin gs liegen mittlerweile mehrere Berichte in Form von Einzellfalldarstellungen vor.

Methodik Anhand der Darstellung des Falls einer Patientin mit einem Turner-Syndrom und einer schizoaffektiven Störung werden mögliche Zusammenhänge und die dazu vorhandene Literatur diskutiert.

Schlussfolgerung Die gehäuften Berichte über das zusätzliche Auftreten einer psychotischen Symptomatik beim UTS legen einen Zusammenhang zwischen der X-chromosomalen Aberration und einer Erkrankungen aus dem schizophrenen Formenkreis nahe. Hinsichtlich der Komorbidität bedarf es jedoch einer allgemeingültigen nosologischen Kategorisierung, die auch eine weitere notwendige Forschungsaktivität erleichtern würde.

Relationship Between Neuroanatomical and Serotonergic Hypotheses of Obsessive-Compulsive Disorder: A Combined Functional Magnetic Resonance Imaging-Evoked Potential Study

OBJECTIVE

The so-called neuroanatomical hypothesis (with an increased activity of orbitofrontal cortex [OFC]) and the serotonergic hypothesis (with low activity in this system) have been discussed regarding the pathogenesis of obsessive-compulsive disorder (OCD) for decades. This study aimed to look for a relationship between the 2 pathogenetic concepts.

METHODS

Nineteen OCD patients (8 female, 11 male, mean ± SD age = 33.37 ± 11.73 years, Yale-Brown Obsessive Compulsive Scale: 21.79 ± 6.59; diagnosed by ICD-10/DSM-IV-TR) were compared to 19 matched healthy controls (8 female, 11 male, mean ± SD age = 31.63 ± 10.79 years) and investigated (2012-2014) with the loudness dependence of auditory-evoked potentials (LDAEP) as a marker of the synaptic serotonergic activity and functional magnetic resonance imaging (fMRI) during the delay discounting paradigm, inducing OFC blood-oxygen level-dependent activity in the 2 groups.

RESULTS

There were significant correlation coefficients between LDAEP (eLORETA right side) and fMRI OFC activities (anatomic region of interest) within the delay discounting paradigm (immediate vs control) in patients with OCD (r = -0.554; P = .014). LDAEP differed between the 2 groups with larger LDAEP at Cz in OCD patients indicating low serotonergic activity (0.28 ± 0.14 vs 0.20 ± 0.10 µV/10 dB, F₂,₃₅ = 4.66, P = .016). fMRI activations of dorsolateral and medial prefrontal cortex as well as ventral striatum (functional region of interest) were different between OCD and healthy volunteers.

CONCLUSIONS

The 2 main pathophysiologic hypotheses of OCD seem to be related to each other as measured by LDAEP and fMRI OFC activity during the delay discounting task. This could be interpreted as a further hint that low serotonergic activity induces altered OFC responsivity, which has to be treated in each patient with OCD by a serotonin agonist.

[Death anxiety and its importance for psychiatry]

Inner dealing with the question of death as well as death anxiety accompany human beings from the beginning, which is reflected by the different philosophical and religious positions. It is obvious that work on this issue is sparse in the field of psychiatric disorders. Due to the few literatures it can however be assumed that death anxiety plays a greater role within the changed thoughts and feelings of psychiatric patients, whose intensity we probably determine and assess in non-sufficient manner yet. The terms are defined and the problematic of ego destruction in patients with schizophrenia as expression of death anxiety is specifically discussed. Furthermore, the few studies about death anxiety in psychiatric disorders, its psychodynamics and approaches of the so-called terror management theory are presented besides other aspects. The current state of literature is presented, points out the importance of this issue for our field and wants to initiate more research on this topic.

[Dermatological diseases and their importance for psychiatry]

The relationship between skin and psychiatric disorders is not an uncommon occurrence in the clinical practice; however, there are only a few systematic studies and in addition knowledge about the neurobiological and immunological mechanisms is lacking. Impairments and disorders of the skin are often an (early) sign of a psychiatric disorder. In the sense of true psychosomatics, psychiatrists should also be aware of this relationship as far as possible. This review article focuses on the most important dermatological diagnoses in relation to the respective psychiatric comorbidities and presents the most important aspects of epidemiology, symptomatology, pathophysiology and treatment options.

Serotonergic modulation of orbitofrontal activity and its relevance for decision making and impulsivity

BACKGROUND

The orbitofrontal cortex seems to play a crucial role in reward-guided learning and decision making, especially for impulsive choice procedures including delayed reward discounting. The central serotonergic system is closely involved in the regulation of impulsivity, but how the serotonergic firing rate and release, best investigated by the loudness dependence of auditory evoked potentials (LDAEP), interact with orbitofrontal activity is still unknown.

METHODS

Twenty healthy volunteers (11 males, 9 females, 31.3 ± 10.6 years old) were studied in a 3T MRI scanner (Philips, Hamburg, Germany) during a delay discounting task, after their LDAEP was recorded using a 32 electrodes EEG machine (Brain Products, Munich, Germany).

RESULTS

Significant positive correlations were only found between the LDAEP and the medial orbitofrontal part of the superior frontal gyrus (SFG/MO) [Δ immediate reward - delayed reward] for the right (r = 0.519; P = 0.019) and left side (r = 0.478; P = 0.033). This relationship was stronger for females compared with males. Orbitofrontal activity was also related to the Barratt Impulsivity Scale.

CONCLUSIONS

This study revealed that low serotonergic activity as measured by a strong LDAEP was related to a high fMRI signal intensity of SFG/MO during immediate reward behavior which is related to impulsivity. Since this relationship was only found for the infralimbic medial and not for the middle or lateral part of the orbitofrontal cortex, an exclusive projection tract of the serotonergic system to this cortical region can be assumed to regulate impulsive reward-orientated decision making. Hum Brain Mapp 38:1507-1517, 2017. © 2016 Wiley Periodicals, Inc.

[Skin Diseases in Primary Psychiatric Disorders]

Somatic diseases in psychiatric disorders are frequently seen in clinical practice. Several international studies have shown that patients with a primary psychiatric disorder are at increased risk for developing severe somatic comorbidities in comparison to the normal population. Whereas there has been accumulation of knowledge on cardiovascular comorbidities, the relationship between skin and psychiatric disorders is less understood. There are only a few systematic studies on this subject and, in addition, there is lack of knowledge about underlying neurobiological and immunological mechanisms. Impairments and disorders of the skin are often an (early) sign of a psychiatric disorder. Somatic treatment of skin diseases should be initiated as early as possible in patients with psychiatric disorders. This review article focuses on dermatological diagnoses that are related to primary psychiatric disorders such as psychotic and affective disorders as well as addiction disorders, and presents the most important aspects of epidemiology, symptomatology and possible pathophysiology.

Obsessive-compulsive disorder in dermatology

Patients with obsessive-compulsive (OCD) and related disorders - primarily trichotillomania, body dysmorphic disorder, and skin picking disorder - frequently present to dermatologists due to associated hair and skin symptoms. It is therefore crucial that dermatologists be familiar with these disorders. In this review article, we provide an update on clinical features, neurobiology factors, and treatment options for OCD spectrum disorders. Employing PubMed and Cochrane Library databases, a selective literature search was conducted using keywords related to dermatological disorders within the OCD spectrum. OCD and its related disorders share several phenomenological as well as pathophysiological similarities, thus warranting their classification within a separate nosological category of psychiatric disorders. Another similarity of OCD spectrum disorders is the frequent concurrence of hair and skin diseases. Besides symptomatic dermatological treatment, the combination of psychotherapy (behavioral therapy) and psychopharmacotherapy (SSRIs) may be helpful. Although recent insights into OCD have contributed to a better understanding and treatment thereof, more research is required, especially with respect to OCD spectrum disorders, for which large controlled treatment studies are still lacking.

[Acute agitation conditions]

Acute agitation psychiatric emergencies as frequently occur in psychiatric as well as in non-psychiatric settings, such as general hospitals, specialized clinics, emergency services and private practices. Psychiatric emergencies can be life-threatening and necessitate immediate treatment. This article presents the core symptomatology, differential diagnoses and treatment options of acute agitation emergencies. Case control studies and reliable data regarding prevalence and treatment of acute agitation in psychiatric and general hospitals or private practices are sparse. Existing evidence suggests that optimization of diagnosis and therapy of psychiatric emergencies, such as acute agitation is warranted. Treatment of acute agitation, psychological distress and other psychiatric emergencies are highly demanding regarding psychiatric expertise and concerning the personality and behavior of the therapist. The basis of therapy comprises the ability to form a stable and trustworthy relationship with the patient as well as to patiently calm down agitated patients. Unambiguous and rapid decision-making that takes effective pharmacological treatment options into account usually leads to swift amelioration of the acute symptomatology.

[Help-seeking behavior and pathways to care for patients with obsessive-compulsive disorders]

BACKGROUND

Obsessive-compulsive disorder (OCD) is a chronic and debilitating disorder that is relatively common and is associated with a wide range of functional impairments. This is partly associated with delayed help-seeking behavior of OCD patients, which shows a lag of up to 10 years after onset of the obsessive-compulsive symptoms to the first attempt at seeking professional treatment. The reasons for the delay in initial help-seeking behavior by OCD patients are manifold but still not clear. Early detection and early treatment might, however, have beneficial effects on the treatment-seeking behavior.

AIM

The aim of the study was to examine the help-seeking behavior and the pathways to care of patients with OCD using a modified version of the structured pathways to care questionnaire initially designed for research into schizophrenia.

RESULTS

For the 40 outpatients with OCD who completed the interview retrospectively, the latent period between symptom onset and first seeking professional contact was on average 6.5 years, while the median delay to a third attempt at seeking treatment was nearly 15 years. Although the majority of participants consulted a professional neurological and psychotherapeutic practice even at the first attempt and 90% complained of specific OCD symptoms, only 20% received the standard treatment consisting of cognitive behavioral therapy and medication with a selective serotonin reuptake inhibitor (SSRI). The most common reason for delaying seeking treatment was that the patient was not convinced of having a mental illness such as OCD and of the necessity for treatment. Even so, approximately 40% of the participants reported fear of stigmatization and discrimination as a major reason for the delay in the first attempt at seeking help.

CONCLUSION

Psychoeducation and broad utilization of evidence-based treatment still appears necessary and can contribute to improvement in the help-seeking behavior of OCD patients.

[Obsessive Compulsive Symptoms in Persons with Intellectual Disabilities]

BACKGROUND

Obsessive-compulsive symptoms are common with a high prevalence of 3.5 % in adults with intellectual disabilities (ID). The present article reviews different aspects (epidemiology, aetiology, clinical features, diagnostic methods and treatment).

METHOD

A computerized search of the relevant literature was done using Pubmed and Cochrane databases.

RESULTS

Difficulties in diagnosing obsessive-compulsive disorder in adults with ID result from difficulties in differentiating true compulsions from stereotypical and repetitive behaviors as also from the fact that patients with ID have cognitive and language impairments. Genetic diseases are most frequently the cause of congenital intellectual disability but only a few with ID are affected by OCD symptoms. Low-dose serotonergic anti-depressants are used in the treatment of OCD symptoms. However, there are only a few controlled treatment studies of obsessive-compulsive symptoms in people with ID.

CONCLUSION

Further research especially regarding treatment of OCD in people with ID is urgently needed.

Relationship of suicide rates to economic variables in Europe: 2000-2011

BACKGROUND

It is unclear whether there is a direct link between economic crises and changes in suicide rates.

AIMS

The Lopez-Ibor Foundation launched an initiative to study the possible impact of the economic crisis on European suicide rates.

METHOD

Data was gathered and analysed from 29 European countries and included the number of deaths by suicide in men and women, the unemployment rate, the gross domestic product (GDP) per capita, the annual economic growth rate and inflation.

RESULTS

There was a strong correlation between suicide rates and all economic indices except GPD per capita in men but only a correlation with unemployment in women. However, the increase in suicide rates occurred several months before the economic crisis emerged.

CONCLUSIONS

Overall, this study confirms a general relationship between the economic environment and suicide rates; however, it does not support there being a clear causal relationship between the current economic crisis and an increase in the suicide rate.

Patient satisfaction with specialized mental health service for obsessive-compulsive disorder

BACKGROUND

Patient satisfaction is an important outcome variable that is increasingly used in mental health service evaluation. There are no results available for patients with obsessive-compulsive disorder (OCD) yet.

METHODS

Using the Verona Service Satisfaction Scale, patient satisfaction with a specialized mental health service was examined in patients with OCD.

RESULTS

OCD patients were overall satisfied with the professional help provided, whereas satisfaction with the professional involvement of relatives within the treatment and health care process was found to be quite low. Patients with more severe OCD, as measured by the Yale-Brown Obsessive-Compulsive Scale, as well as chronically ill and more disabled patients were more likely to be dissatisfied with the overall care they received. Patient satisfaction plays an important role in the long-term course of an illness such OCD. This seems to be decreased so longer illness is not or badly treated. There is a stronger need for involvement of family members in the treatment and health care of patients with OCD.

CONCLUSIONS

More OCD-specific treatment offers have to be established for patients with this long-term illness such as psychotherapy in groups.

P300 in obsessive-compulsive disorder: source localization and the effects of treatment

Converging evidence suggests that frontostriatal abnormalities underlie OCD symptoms. The event-related potential P300 is generated along a widely distributed network involving several of the areas implicated in OCD. P300 abnormalities reported in patients with OCD suggest increased activity in these areas. The aim of the present study was to investigate this assumption in unmedicated patients with OCD, and to assess the effects of OCD treatment on P300 brain activity patterns. Seventy-one unmedicated patients with a DSM-IV diagnosis of OCD and 71 age- and gender-matched healthy control subjects participated in the study. The P300 was obtained through 32-channel EEG during an auditory oddball paradigm. Forty-three patients underwent a second EEG assessment after treatment with sertraline and behavioural therapy. Low-resolution electromagnetic tomography (LORETA) was used to localize the sources of brain electrical activity.

RESULTS

Increased P300-related activity was observed predominantly in the left orbitofrontal cortex, but also in left prefrontal, parietal and temporal areas, in patients compared to controls at baseline. After treatment, reduction of left middle frontal cortex hyperactivity was observed in patients.

CONCLUSIONS

Findings of increased activity in frontoparietal areas in patients are consistent with several previous studies. Importantly, OCD treatment led to reduction of hyperactivity in the left middle frontal cortex, an area associated with context processing and uncertainty that might be important for the emergence of OCD symptoms. Thus, the present study is the first to show an association between P300 abnormalities and activity in brain regions postulated to be involved in the pathophysiology of OCD.